Intervertebral disc degeneration or wear and tear is characterized by wear and tear of intervertebral discs. A main therapeutic focus is to combat any symptoms that occur.
What is disc degeneration?
Schematic anatomical representation of the vertebrae and the intervertebral disc, as well as the pinched nerve. Intervertebral disc degeneration is wear and tear of the intervertebral discs (the intervertebral discs of the spine that are made of cartilage). In the course of intervertebral disc degeneration, the discs become thinner and more cracked, so that they are less able to buffer the vertebral bodies against each other. As a result, the vertebral bodies are subjected to increased stress. In most cases, the intervertebral discs of the lumbar and/or cervical spine are affected by disc degeneration. Typical complaints that often accompany disc degeneration are localized back pain, which can be additionally aggravated by muscle tension. The risk of suffering a herniated disc (in this case, parts of an intervertebral disc protrude between the vertebrae) also increases when disc degeneration is present.
Causes
Not only can various pathological processes lead to intervertebral disc degeneration – with increasing age, the intervertebral discs increasingly lose the ability to absorb water, so that the cartilage tissue becomes less elastic. Due to the increasing porosity of the intervertebral discs, cracks also frequently occur in the disc; disc degeneration sets in. Age-related degeneration of the intervertebral discs can also be promoted by factors such as a lack of physical exercise and prolonged heavy pressure loads on the spine. Such an increase in pressure is caused in the lumbar region, for example, by heavy carrying or lifting with the trunk bent forward. Diseases and injuries that can cause or promote disc degeneration include fractures of the vertebral bodies. Deformities of the spine, such as those present in scoliosis (a spinal curvature), also promote disc degeneration.
Symptoms, complaints, and signs
Disc degeneration manifests itself through various symptoms and complaints, depending on the extent and location of the wear. Acute disc bulging manifests as localized back pain, sometimes radiating to the abdomen or sternum. A herniated disc causes dysfunction of the bladder and rectum as a result of compression. In addition, there may be pain that increases with coughing, sneezing or pressing. In most cases, the affected section of the spine is also put in a protective posture, which can be manifested, for example, by a stooped posture or a hollow back. In the case of chronic disc degeneration, the vertebral joints are subjected to severe stress, which can lead to the development of local pain symptoms. The pain is usually accompanied by psychological and psychosomatic complaints. Many affected persons suffer from mood swings, depressive moods and a general feeling of malaise. The restrictions in mobility can cause further complaints. This can lead to further wear and tear of the surrounding joints. Circulatory disorders, sensory disturbances and paralysis cannot be ruled out either. Furthermore, muscle tension and muscle hardening can occur. If the disc degeneration is based on an acute injury, such as a fracture, further symptoms and complaints may develop in some cases.
Diagnosis and progression
To diagnose disc degeneration, an attending specialist (such as an orthopedist) usually first asks facts such as the nature and approximate onset of existing symptoms. After a physical examination, possible diagnostic procedures to be used then include X-rays or MRI (magnetic resonance imaging). While the X-ray procedure is well suited for diagnosing disc degeneration in order to depict the bony structure of the vertebral bodies, magnetic resonance imaging is suitable, among other things, for depicting nervous structures that run in the spinal canal and may be affected by disc degeneration.Intervertebral disc degeneration can be recognized characteristically on the basis of X-ray images, for example, by a reduction in affected intervertebral spaces. The course of intervertebral disc degeneration varies from person to person and depends, among other things, on factors such as the corresponding causes and measures taken against the degenerative phenomena. As a rule, disc degeneration progresses insidiously and often does not lead to immediate symptoms. When the first symptoms appear varies from individual to individual.
Complications
In the case of disc degeneration, there is qualitative wear and tear of the disc tissue. Important fluid needed by the fine supporting cartilage tissue can no longer be stored. The vertebral bodies become more porous and lose their buffering function. The symptom can occur in the lumbar as well as in the cervical spine. A distinction is made between age-related or accident-related degeneration due to vertebral fractures, congenital spinal curvature and athletes and people with one-sided occupational stress. Disc degeneration can cause several life-limiting complications. These include extensive pain conditions that are evident even during everyday executions such as bending over, sneezing, coughing, pressing, or resting. If left untreated, the symptom can take on chronic proportions in the form of a bulging disc. The space between the vertebrae shrinks and there is a risk of prolapse with loss of autonomic functions in the lower or upper body. In the medical clarification, diagnostic imaging procedures help to determine the extent to which the damage to the intervertebral discs and nervous structures has progressed. This is followed by treatment of the cause. However, damage to cartilage tissue that has already occurred cannot be regenerated. Medical measures serve to alleviate pain with physiotherapeutic strengthening of the muscle tissue supporting the spinal column. Surgical measures are taken only when important bodily functions are acutely blocked. Stiffening or disc prosthesis can reduce pain, but as a complication consequence, further disc degeneration can form near the operated site with increasing patient age.
When should you see a doctor?
In any case, a doctor should be consulted if back pain or muscle tension increases. Anyone who has already suffered a herniated disc or similar should speak directly to the relevant specialist. If the pain increases rapidly and is associated with acute symptoms such as lumbago, it is advisable to go to the nearest hospital. The same applies if the above-mentioned symptoms occur more frequently during everyday activities such as bending over, sneezing or coughing. If the pain results in deformities, a physician must be consulted. The doctor can clarify beyond doubt whether it is a case of disc degeneration and then refer the affected person to an appropriate specialist. Depending on the diagnosis, further examinations must be performed. In the case of disc degeneration, further examinations and surgical treatment should be carried out promptly. Otherwise, chronic pain, malpositions and other sequelae may result, sometimes burdening the affected person for the rest of his or her life.
Treatment and therapy
If disc degeneration was caused or favored by existing diseases/injuries of the spine, an important therapeutic goal is usually a treatment of the cause. Through a correspondingly consistent treatment of the causes, the favored disc degeneration can often also be positively influenced. Since damage to the cartilage tissue that has occurred in the course of disc degeneration cannot be reversed, symptomatic treatment (such as pain relief) plays an important role. Such pain can be counteracted by individually tailored physiotherapeutic (physiotherapy) measures. Avoiding carrying heavy loads and reducing any excess weight can also help to relieve pain. In the case of severe pain in the context of disc degeneration, pain-relieving medication can also be used after consultation with the attending physician.Surgical measures can be useful, for example, if the back pain is chronic, i.e. if it has persisted for at least several months without subsiding in the meantime. Depending on the patient, surgical treatment of a disc generation may include the option of disc prosthesis or so-called spondylodesis (stiffening) – in which the affected vertebral segment is stiffened to achieve freedom from pain.
Outlook and prognosis
Disc degeneration normally has an unfavorable prognosis. Nevertheless, the expression of the disease is individual and may lead to very minor limitations in everyday life in some patients. The course of the disease is insidiously increasing. Wear and tear is basically part of a natural process over the lifespan. Nevertheless, the symptoms depend on the physical stress, the genetic conditions and the lifestyle of the patient. With good conditions, a healthy lifestyle and adherence to various medical tips, the progress of the disease can be delayed for a long time. Targeted training and exercises help to load the body properly and to coordinate optimally during movements. The signs of wear and tear are often hardly noticed by these patients or can be well compensated by a correct as well as healthy posture. In people with a high dead weight and a professional or sporting activity that leads to a heavy load on the skeleton, the complaints often increase rapidly. They need a restructuring of their daily life and are asked to significantly relieve their body as soon as possible. Surgical intervention can provide significant relief from the discomfort. However, a natural range of motion or a habitual load limit is not achieved with it. Nevertheless, with treatment of the intervertebral disc, the quality of life as well as the general well-being increase significantly.
Prevention
Age-related disc degeneration can only be prevented to a limited extent. However, the degeneration process can be slowed by measures such as physical exercise, low pressure on the spine, and avoiding/controlling obesity. Early treatment of diseases/injuries that can lead to disc degeneration can often counteract corresponding degenerative processes.
Follow-up
Disc degeneration can be treated conservatively and surgically. Both treatment options need good aftercare to optimize regeneration and ensure therapeutic success. Once surgery has been performed, aftercare begins with wound care and mobilization, which also requires active cooperation from the patient in collaboration with physicians and specialists such as physiotherapists. Initially, the patient is only allowed to lift certain weights, which must be consistently adhered to in order not to overload the affected region of the spine. Getting out of bed in a way that is appropriate for the back is also very important and can also be incorporated into everyday life. The back school shows patients exactly what back-friendly behavior looks like in everyday life. Correct lifting and carrying are also addressed, as is sleep, which requires a back-friendly mattress. Back school is therefore a very important factor in aftercare, regardless of the previous form of treatment. Muscular imbalance and overweight are often factors in the development of disc degeneration. Conversely, this means that aftercare also means correcting muscular imbalance and reducing weight. Muscles that are weakened should be strengthened. This often concerns the abdominal muscles and the upper back. Muscles that are shortened, on the other hand, are to be stretched. Weight reduction is particularly well achieved through endurance sports. Back-friendly variants such as walking or backstroke are recommended here. Rehab sport shows the patient which sport can be used specifically.
What you can do yourself
In everyday life, the degeneration of the intervertebral discs is often a hindrance in the usual movements. Even if sufferers are in pain, they should take a painkiller for relief and remain active. Only in very acute phases is short-term rest recommended to prevent possible inflammatory processes or further nerve irritation. Activity should consist primarily of endurance sports that strengthen the back muscles.Swimming is particularly suitable because it trains the back optimally, pain is relieved in the water and those affected also sometimes find the cooling effect of the water pleasant and relieving. In addition, the weight of the body does not rest on the intervertebral discs. Less recommendable are sports in which the entire loading pressure is cushioned by the intervertebral discs and the spine. This is especially the case with jogging. Better suited then is cycling. Wearing support belts should only be used for a very short time. Wearing them quickly weakens the muscles, as is the case with sparing when pain interferes with movement. As a supportive measure, those affected can also make use of the medical services on offer. These consist in particular of physiotherapy and functional training. In each individual case, of course, the cause of the disc degeneration must always be included and the assistance must be optimally tailored to the individual patient.
