As we get older, the discs that separate the individual bones, or vertebrae, in our spine can lose their shape and ability to “cushion” the spine. This process is called degenerative disc disease, and it’s very common.
“Some of this degeneration is considered normal, just like getting gray hair is normal with age,” says Kevin Kelly, MD, a neurosurgeon at Rush. “Over age 60 or 70, almost everybody will have some degenerative disc disease at almost every level in their lower back.”
Risk factors for degenerative disc disease
Genetics may play a role, so if you have a family history, you may be more likely to have disc issues. While you cannot change your age or genes, you can control some of the other risk factors for degenerative disc disease. These include:
- Obesity
- Smoking
- Diabetes
- Coronary artery disease
- Peripheral vascular disease
Healthy habits — like good nutrition, regular exercise and not smoking — can help keep your spine healthy, Kelly says. Controlling blood sugar and managing cardiovascular disease may also protect the spine.
Signs of degenerative disc disease
Degenerative disc disease doesn’t cause symptoms in many people, Kelly says. But when it does, the most common signs include:
- Pain that starts in the lower back and travels down the back or side of the leg, known as sciatica, caused by compression of the sciatic nerve
- Pain in the front of the leg, which can also be caused by a pinched nerve in the spine
- Weakness, tingling or numbness in the arms or legs
An episode or two of back pain shouldn’t cause too much concern, Kelly says. “The symptoms of degenerative disc disease are quite common, and they often will improve on their own with rest, ice, heat and over-the-counter pain medicine,” he says.
When to see a doctor for degenerative disc disease
If you have severe back pain that lasts more than a week or two, Kelly recommends getting checked. “If you start to have pain that shoots down the leg or weakness in your leg or difficulty lifting your foot, then you should either see a spine specialist or have your primary care doctor order advanced imaging, such as an MRI,” he says.
While magnetic resonance imaging can reveal changes in the discs and other soft tissue of the spine, these changes don’t always trigger back pain. “This is counterintuitive for patients, but just because we see something on a scan does not mean it’s causing their symptoms,” Kelly says. “We need to take what is seen on the images and then marry that with what the symptoms are in that individual.”
Surgery for degenerative disc disease
While nonsurgical treatments like anti-inflammatory medications and physical therapy help many people with degenerative disc disease, others may benefit from surgery. This includes people with severe pain and certain patients who have arm or leg weakness, including difficulty lifting the foot, from a pinched nerve in their back.
Although rare, some of these individuals may permanently lose muscle function or develop chronic pain from nerve damage. When this happens, “the pain is no longer being generated from the compression of the nerve. The pain is being generated because the nerve is — for lack of a better word — damaged,” he says.
For such patients, Kelly often recommends surgery over conservative treatments. Surgery falls into two broad categories: decompressive and reconstructive options.
Spinal decompression
Decompressive surgeries involve “decompressing individual nerves or multiple nerves to help shooting pain down the leg or muscle weakness,” he says.
These surgeries, which can often be performed using minimally invasive techniques, may also help treat spinal stenosis, a condition associated with degenerative disc disease. In spinal stenosis, “the ligaments around the structure of the spine — what’s called the ligamentum flavum and synovium — can get so thick that the nerves can actually be squeezed around the entire canal where the nerves are traveling through.”
Decompression surgeries may also help relieve the pain from herniated discs that can develop when discs “slip” and press on a spinal nerve.
Spinal reconstruction
Reconstructive surgery, such as spinal fusion, is often recommended for people with pain that’s worse with motion, which is usually caused by a structural problem in the spine. Reconstruction uses implants like screws and rods to help fuse one or more “levels” in the spine (a level includes two vertebrae and the disc space between them). Using computer-guided 3D mapping, surgeons at Rush can place many implants in the spine with greater safety and accuracy.
Spinal fusions can also help straighten degenerative scoliosis, or spinal curvatures, that cause pain when discs between vertebrae collapse.
Often, spinal decompression and spinal construction can be combined in one surgery to address each patient’s particular concerns. “We might do a decompression at one level and a fusion at another,” Kelly says.
Getting evaluated for spine surgery
Advanced technology and techniques have made spine surgery safer and more effective than ever before. Even people in their 90s may be candidates for spine surgery if they do not have other serious health conditions, Kelly says. But because only some people with degenerative disc disease benefit from surgery, it’s important to see a specialist for a thorough evaluation.
Kelly suggests finding a spine specialist who will carefully consider your specific symptoms and imaging results before recommending surgery. “Everyone’s an individual, and things are so different between individuals, we have to take each person one at a time,” he says.
If you’re interested in learning more about neurosurgery for degenerative disc disease, call (888) 352-7874.
