Degenerative Disc Disease: Causes, Symptoms and Treatments

Why do the intervertebral discs wear out?

The spine consists of the stack of 24 vertebrae: 7 cervical vertebrae, 12 dorsal, and 5 lumbar vertebrae. All these vertebrae are articulated between them. Between each of them is a "pad", the intervertebral disc, which participates in this articulation.

Degenerative pathologies happen because of the excessive demands of the spine. These discs can wear out as a result of repetitive movements, heavy loads, bad postures. But the essential factor causing the degeneration of the intervertebral discs is aging.

The disc loses its flexibility and becomes rigid. It gets stuck and decreases in height. In the most severe cases, the disc may disappear completely.

How do degenerative discopathies manifest?

The most frequent location of this injury is at the lumbar level (lower back). It then causes pain at the very bottom of the spine, called low back pain. When the movements cause a sudden contracture of the muscles of the lower back, we speak of lumbago.

Damaged discs can compress nerve roots as they emerge. In this case, the pain reaches the legs and causes cruralgia if the injury corresponds to the disc located between the 4th and 5th lumbar vertebrae or sciatica if the affected disc is located between the 5th lumbar vertebra and the sacrum. Cruralgia causes pain especially on the anterior aspect of the thigh, sciatica on the posterior aspect of the leg.

Degenerative discopathies can also occur at the dorsal level and cause pain called back pain, rather throbbing, and exacerbated by deep breathing movements and coughing.

When they touch the cervical vertebrae, they lead to cervicalgia (pain of the neck) and possibly neuralgia cervico-brachiales, compression of the nerve roots innervating the arms.

Whatever the level of attack, spinal stiffness is constantly observed, with difficulty in rotating movements to stoop and a decrease in size due to the crushing of the discs.

How to take charge of degenerative disc disease?

At first, we focus on relieving pain. Pain-relieving drugs (analgesics) may be used, possibly combined with anti-inflammatory drugs, either in tablet form or in injectable form, intramuscularly. It is also possible to prescribe muscle relaxants (muscle relaxants) that will lift the reflex contracture of the paravertebral muscles.

In a second step, physiotherapy is recommended, when the pain has decreased, in order to soften the intervertebral joints and strengthen the paravertebral muscles. The physiotherapist also teaches the patient the movements to avoid and others to prefer to preserve his back.

These treatments have their limitations because they improve the symptoms related to degenerative disc disease, but do not treat the cause.

It may happen that surgery becomes necessary when the disc is sufficiently worn out of its envelope and cause disc herniation, which compresses the nerve roots.

In this care, it is especially important to insist on the prevention of painful crises. For this, it is recommended to practice regular physical exercise. The recommended sport activity is swimming, because it allows effective strengthening of the back muscles.

Degenerative disc disease: what is the operation?

There are several surgical techniques of treatment in case of degenerative disc disease:

• Lumbar arthrodesis posteriorly. This technique is preferred in patients with osteoarthritis or herniated discs in addition to degenerative disc disease. The surgeon will then remove the diseased intervertebral disc and replace it with a plastic prosthesis: a few months after the operation, the vertebrae concerned are welded and (if the movement is a little limited) the pain disappears almost completely. Scars are concentrated in the lumbar region.
• Lumbar arthrodesis anteriorly. Similar to the previous technique, anterior arthrodesis is for patients who suffer "only" from degenerative disc disease. It also involves replacing the diseased disc with a plastic prosthesis and "blocking" the area in order to calm the pain almost completely.
• The disc prosthesis. This technique involves replacing the diseased intervertebral disk with a plastic prosthesis - which helps to maintain the mobility of the area. This technique is however only available to young patients without osteoarthritis.

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