Degenerative Disc Disease

Degeneration of the disc occurs when the vertebral endplate tears from its connection to the intervertebral disc. The disc itself has no blood supply and relies upon osmosis of nutrients and Oxygen from the vertebral endplates above and below. When there is an interruption from one of the endplates the disc begins to show damage due to lack of nutrients and Oxygen. Gradually this process spreads to other parts of the disc. In fact this may be a normal part of the way that the spine degenerates with age, but often the more rapid degeneration caused by abrupt injury results in a painful reaction. This may occur because of loss of mechanical advantage causing pain in the outer third of the disc anulus or it may occur because of an inflammatory response. Furthermore, weakening of the inner disc wall may cause internal disc disruption or herniation. Additionally pain may be provoked by loss of disc height causing compression of the nerve root in the neuroforamen. Another consequence of loss of the normal architecture of the disc and its relationship to the vertebrae is zygapophyseal joint pain due to compression, hypertrophy or inflammation of these joints. Discs can degenerate in the Cervical, Thoracic or Lumbar spine. Clinically the most significant problems are Lumbar Disc Degeneration and Cervical Disc Degeneration.

Painful degenerative disc disease can be treated in a number of ways. Conservative approaches may involve the use of physical therapy and/or pain medications, including antiinflammatories, opioids and membrane stabilizers. Additionally blocks to nerve roots and facet joints may be both therapeutic and diagnostic. Discograms can help determine if internal disc disruption is present. If it is a part of the clinical picture an IDET (Intradiscal Electrothermal Therapy) approach can be taken. Some surgeons even recommend using the epidurascope to visualize the torn anulus and repair this, employing microsurgical techniques. Still the mainstay of surgical treatment for the painful degenerative disc is that of spinal fusion surgery, which may be done from the anterior approach, posterior approach or both, with and without hardware placement.

Spondylolisthesis can also occur with disc degeneration. Spondylolisthesis is the actual slipping of a disc forward, backwards or to the side, due to weakening of the restraining connective tissue. It can occur as a congenital abnormality or it can be the result of degenerative disc disease. Spondylolisthesis is graded by degree of severity. When this becomes severe enough, the patient suffers with a high degree of spinal stenosis from the nerve being trapped by the slipping disc. The condition must be halted and the nerve path cleared if it is not to become worse. The only appropriate surgical approach is that of fusion, which can be done as an anterior and posterior fusion with instrumentation or sometimes by use of fixation with a transverse titanium cage.

Degenerative Scoliosis can also be quite problematic. When degenerative in pathogenesis, this occurs secondary to sideway slippage of a degenerative spine and can be very extensive causing severe pain, loss of nerve function and collapse of the spinal column. Patients can become severely disabled and pain is extremely high. Surgical interventions are often necessary over several levels. Bracing can help with some palliation and protection, but when this becomes severe, extensive multilevel fusions with instrumentation may be the only solution to stemming the tide of runaway spinal collapse.