Degenerative Disc Disease (DDD)

Treatment

Treatment for degenerative disc disease ranges from conservative therapies to surgical interventions. The goals of treatment are to relieve pain, prevent or reduce stress on the discs, and maintain normal function.

Conservative Treatment
Most treatment plans involve a combination of self-administered treatments, medications, and therapeutic measures. Self-administered treatments include the following:

• Learn/practice proper posture and body mechanics
• Rest and restrict activities
• Limited bed rest to take pressure off the spine
• Mild activity (exercise) such as walking, biking, and swimming
• Apply cold and/or hot packs
• Wear a brace for support (may not be helpful in all cases)

Therapeutic treatments for DDD include the following:

• Chiropractic treatment to manipulate the spine
• Acupuncture to relieve pain
• Massage therapy to relieve muscle spasms and tension
• Physical therapy to improve function and increase flexibility and strength

Medications
In some cases, medications are used to supplement conservative therapy. Medications that may be used include the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen)
• Pain relievers (e.g., acetaminophen)
• Muscle relaxants
• Spinal injections (anesthetics or corticosteroids)
• Antidepressants
• Sleep aids

Other non-surgical treatments include ultrasound therapy and transcutaneous electrical nerve stimulation (TENS) pain control units. Ultrasound uses sound waves to warm the area, increase blood flow, and relieve discomfort. TENS units use electrical stimulation of the nerve to interrupt pain signals. In some cases, a spinal cord stimulator is implanted permanently to supply a low intensity impulse to a certain location in the spinal cord.

Surgery
Symptoms of degenerative disc disease usually can be managed without surgical intervention; however, patients who experience debilitating pain and disability that does not respond to other treatments may benefit from surgery. Primary reasons for surgery are to:

• relieve pressure on a nerve root or the spinal cord;
• stabilize an unstable or painful vertebral segment;
• prevent or limit radiculopathy (nerve damage); and
• reduce deformity or curvature of the spine (e.g., scoliosis).

Discectomy and fusion involves removing the damaged intervertebral disc and replacing it with a piece of bone or another material. Over time, this replacement fuses with the adjacent vertebrae. A newer procedure, called microdiscectomy, accomplishes the same solution, but involves using smaller instruments and requires a smaller incision.

In corpectomy, a section of the vertebrae and discs is removed to create more space for the remainder of the spine. A bone graft and/or metal plate with screws is then attached to stabilize the spine.

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Facetectomy, laminotomy, and spinal laminectomy are other procedures that involve removing a portion of the bony structure of the spine to relieve pressure on the nerve roots. Foraminotomy and laminoplasty can also be used to enlarge areas of the spinal column to make more room for the nerves and spinal cord.

Prognosis

Generally, the prognosis (expected outcome) for people who have degenerative disc disease is good. Over time, and with certain lifestyle changes, most people can manage pain, reduce flare-ups, and even eliminate symptoms. By the age of 65, inflammatory proteins in the discs no longer cause pain; however, the discs are stiffer and flexibility often is reduced.

Prevention

Because degenerative disc disease is primarily associated with the aging process, it cannot be prevented in all cases. Moderate exercise, lifestyle modifications, and good nutrition can help prevent painful and disabling symptoms.

Exercise increases blood flow to the muscles, which supplies healing nutrients and oxygen; preserves function of the spine and surrounding muscles; and promotes the release of endorphins (substances produced in the brain that reduce pain). People who have degenerative disc disease should be sure to get moderate exercise, including low impact and strength training activities, for at least 30 minutes daily.

Lifestyle modifications include improving posture; changing positions frequently, especially if work involves a lot of sitting; learning and using correct lifting techniques; and sleeping on a supportive mattress. Avoiding smoking, maintaining a healthy weight through good nutrition and exercise, staying well hydrated, and reducing alcohol consumption all can contribute to a healthier back and faster healing.

Degenerative Disc Disease (DDD), Treatment, Prognosis, Prevention reprinted with permission from pain.healthcommunities.com
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