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Degenerative Disc Disease
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What is degenerative disc disease?
Degenerative disc disease is a disorder caused due to age related problems. For decades, the constant daily pressure on the spine and occasional minor as well as major injuries, begin to do more damage. In most cases, the gradual degeneration of discs is not a problem. But, in some cases, the wearing out eventually causes severe, chronic and unbearable pain. The spine specialists refer to this pain caused by a damaged intervertebral disc as discogenic pain. Some people suffer from degenerative disc disease and never experience any related symptoms.
Signs and symptoms
A symptom is what the patient feels and describes, and a sign is what others too can detect. Many people may have degenerated disc but have no symptoms. While some others experience pain so intense that they are unable to undertake their daily activities. Most common early symptom is pain in the back that spreads to the buttocks and upper thighs. Apart from pain, patients also feel tingling or numbness in the leg or foot. For a majority of patients, the pain is worse when they are sitting. This is because the discs have more weight on them when the body is in sitting position. Degenerative disc disease pain frequently starts in one of following three ways:
A major injury - followed by sudden and unexpected pain.
A minor injury - followed by sudden and unexpected back pain.
Progressive pain - where the patient feels slight back pain, which worsens over the time.
What causes degenerative disc disease?
As a human body ages, the intervertebral discs start wearing out, that to degenerative disc disease in some people. The changes include,
Loss of fluid - the intervertebral discs consist mainly of fluid. With increasing age, the fluid content decreases, making it thinner, which means the distance between each vertebra becomes smaller, and the cushion or shock-absorber between each vertebra becomes less effective.
Disc structure is affected - tiny tears or cracks develop in the outer layer of the disc. The soft and gelatinous material in the inner part of the disc make its way through the cracks or tears, resulting in a bulging or rupturing disc, sometimes breaking into fragments.
The degeneration of disc occurs faster in obese individuals, people who do strenuous physical work, and regular tobacco smokers. A sudden injury as after a fall may accelerate the process of degeneration. With less padding between vertebrae, the whole spine becomes less stable. To cope with the loss, the body builds osteophytes, called bone spurs. They are small bony projections that develop along the edge of bones. They press against the spinal cord or spinal nerve roots, which hamper nerve function and cause pain.
Tests and diagnosis
The doctor will seek complete information about symptoms, where pain, tingling is felt and when, and which situations cause acute pain. Physical examinations may also be carried out which include:
Checking nerve function - different areas are tapped with a reflex hammer. If there is poor or no reaction, it is a sign of a compressed nerve root.
Checking muscle strength - the patient may be asked to undress so the doctor can view the muscles and check for wasting or abnormal movements.
Checking for pain with motion or palpation - it means examining by touching. The patient is made to move in specific ways. If pressure applied to the lower back causes pain, it could mean there is a degenerated disc.
CT scan - a medical imaging method generates a 2-dimensional image of a section/slice through a 3-dimensional object.
MRI scan - the machine uses a magnetic field and radio waves to create detailed images of the inside of the body on a monitor.
Treatment options for DDD
Treatment for degenerative disc disease includes any of occupational therapy, special exercises, medications, losing weight, stem cell therapy, and surgery.
- Kneeling is less painful than sitting. Patients can be taught how to position themselves so that their symptoms are less severe.
- Lifting weights must be done without bending the body.
- Medications may benefit from non-steroidal anti-inflammatory drugs, steroids and sometimes muscle relaxers.
- Wearing a corset or brace can also bring down pain.
- Doing special exercises to build the back and stomach muscles like yoga, pilates, and swimming are effective.
- Facet rhizotomy - is a radiofrequency current that deadens the nerves around the facet joint, preventing pain signals from reaching the brain. It may be recommended if the patient responded to facet joint injections. Facet rhizotomy may provide pain relief that lasts for more than a year.
- Intradiscal electrothermal annuloplasty (IDET) - here, painful discs are heated using discography CT with a copper coil. When the right temperature is reached the disc hardens, making it better at resisting weight-bearing movements. The procedure is effective in 70% of cases.
Specialized health care professionals at Spine and Neuro Surgery Hospital in India, including physiatrists, neuro radiologists and pain management specialists help with more aggressive treatments that do not require surgery. The joints next to the bad disc may be injected with steroids and a local anesthetic to provide effective pain relief.
Surgery is recommended if the patient does not respond positively to conservative therapies within about three months. Surgery is considered if:
- Back or leg pain disables the patient from doing normal activity
- Numbness/weakness in the legs
- Standing or walking is troublesome
- Physical therapy did not yield desired results
- Medication was ineffective.
The following surgeries are available for possible cure:
Spinal fusion - two vertebrae are joined together, providing stability to the spine. The procedure can be performed at any level of the spine, but is common in the lower back and the neck area, the most movable parts of the spine. Spinal fusion can be done from the back with rods and screws. If done from the front, the disc is replaced with graph materials.
Decompression surgery - in methods like facectomy, foraminotomy, laminectomy, laminotomy the surgery is performed from the back of the spine. Decompression surgery may needed to be done from the front, if the patient has a bulging disc that pushes into the spinal canal.
Why India for DDD treatment?
Our spine is the supporting pillar of the body and any minor problem can gradually become huge, hindering the smooth functioning of the spine and nerves. Hosptial in India has some of the best healthcare professionals providing excellent healthcare facilities, specifically of the spine. Cities like Delhi, Mumbai, Nagpur, have etched their name in the list of best orthopedic treatment providers across the world.
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