degenerative disc disease ( DDD ) describes the natural damage of the spinal intervertebral disc. Despite its name, DDD is not considered a disease, nor is it increasingly degenerative. Conversely, disc degeneration is often the effect of natural daily stresses and minor injuries that cause the spinal discs to gradually lose water such as the annulus fibrosus, or the rigid outer skin of a disc, weakens. When discs are weakened and water loses, they begin to collapse. This can cause pressure on the nerves in the spine, causing pain and weakness.
Although not always symptomatic, DDD may cause acute or chronic back pain or back neck and nerve pain depending on the location of the affected disk and the amount of pressure it occupies on the surrounding neural roots.
The typical radiographic findings in DDD are black discs, narrowing disc space, vacuum disks, end plate sclerosis, and osteophyte formation.
DDD can greatly affect the quality of life. Disk degeneration is a disease of micro/macro trauma and aging, and although for most people it is not a problem, in certain individuals, degenerating discs may cause severe chronic pain if left untreated.
Video Degenerative disc disease
Cause
The term, degenerative disc disease is wrong because it is technically not a disease, nor is it degenerative. It is not considered a disease because degenerative changes in the spine are natural and common in the general population.
There are discs between each vertebra in the spine. A healthy, well-absorbed disk will contain a lot of water at its center, known as the nucleus pulposus, which provides cushioning and flexibility for the spine. Most of the mechanical stresses caused by daily movement are transferred to the disc inside the spine and the water content inside them enables them to effectively absorb the shock. At birth, a typical human nucleus pulposus will contain about 80% water. However, natural daily stresses and minor injuries can cause the disc to gradually lose water because the annulus fibrosus, or the rigid outer shell of a disc, weakens.
This water loss makes the disc less flexible and leads to gradual collapse and narrowing of the spine in the spine. As the space between the vertebrae is getting smaller, extra pressure can be placed on the disc that causes a small crack or tear to appear on the annulus. If sufficient pressure is given, it is possible for the nucleus pulposus material to seep out through the tear in the annulus and can cause what is known as a herniated disk.
When two vertebrae above and below the affected disc begin to collapse with each other, the facet joints behind the spine are forced to shift which may affect their function.
In addition, the body can react to the closure gap between the vertebrae by creating bone spurs around the disk space in an attempt to stop excessive motion. This can cause problems if the bone spurs begin to grow into the spinal canal and put pressure on the spinal cord and surrounding neural roots as they can cause pain and affect nerve function. This condition is called spinal stenosis.
For women, there is good evidence that menopause and associated estrogen loss are associated with lumbar disc degeneration, usually occurring during the first 15 years of climacteria. The potential role of sex hormones in the aetiology of degenerative skeletal disorders is being discussed for both sexes.
Degenerative disc disease may also occur in mammals other than humans. This is a common problem in some variants of dogs and attempts to eliminate this disease from the dog population have caused some crosses, such as Chiweenie.
Maps Degenerative disc disease
Signs and symptoms
Degenerative disc disease may cause lower back or upper neck pain, but this is not always true across the board. In fact, the amount of degeneration does not correlate well with the amount of experience of sick patients. Many people do not experience pain while others, with the same amount of damage have severe chronic pain. Whether a patient experiences pain or not, depends largely on the location of the affected disk and the amount of pressure placed on the spinal column and surrounding neural roots.
However, degenerative disc disease is one of the most common sources of back pain and affects around 30 million people each year. With symptomatic degenerative disc disease, pain may vary depending on the location of the affected disc. Discs that slump in the lower back can cause lower back pain, sometimes radiating to the hips, as well as pain in the buttocks, thighs or legs. If pressure is placed on the nerve by a nucleus that is exposed to the pulposus, tingling or sporadic weakness through the knee and leg may also occur.
The degeneration discs in the upper neck will often cause pain in the neck, arms, shoulders and hands; Tingling in the fingers may also become apparent in the event of a nerve collision.
Pain is most often felt or aggravated by movements such as sitting, bending, lifting and twisting.
After an injury, some discs become painful because inflammation and pain come and go. Some people have nerve endings that penetrate deeper into the annulus fibrosus (the outer layer of the disc) than others, making the disc more likely to produce pain. Alternatively, trauma healing in the outer annulus fibrosus can cause scarring and pain impulses from the disc, as these nerves are inflamed by the nucleus material of the pulposus. Degenerative disc disease can lead to chronic debilitating conditions and can have a serious negative impact on a person's quality of life. When pain from severe degenerative disc disease, traditional nonoperative treatment may be ineffective.
Mechanism
Degenerative discs usually show degenerative fibrocartilage and chondrocytes clusters, suggestive of improvement. Inflammation may or may not be present. Histologic examination of resected disk fragments for suspected DDD is routine to exclude malignancy.
Fibrocartilage replaces the gelatinous mucus from the nucleus pulposus as discs change with age. There may be a split in the annulus fibrosus, allowing the herniation of the nucleus element of the pulposus. There may also be a shrinking of the nucleus pulposus resulting in prolapse or folding of the annulus fibrosus with the formation of secondary osteophyte at adjacent vertebral body edges. Pathological findings in DDD include protrusion, spondylolysis, and/or subluxation of the vertebrae (spondylolisthesis) and spinal stenosis. It has been hypothesized that Propionibacterium acnes may play a role.
Diagnosis
The diagnosis of degenerative disc disease will typically consist of an analysis of the patient's individual medical history, a physical exam designed to reveal muscle weakness, tenderness or poor range of motion, and an MRI scan to confirm the diagnosis and exclude other causes.
Treatment
Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs, traction, or epidural steroid injections often provide sufficient relief from disturbing symptoms.
Surgery may be advised if conservative treatment options do not provide help in two to three months. If leg or back pain restricts normal activity, if there is weakness or numbness in the legs, if walking or standing is difficult, or if medication or physical therapy is ineffective, surgery may be necessary, most often spinal fusion. There are many surgical options for the treatment of degenerative disc disease, including anterior and posterior approaches. The most common surgical treatments include:
The traditional approach in treating patients with DDD-generated discs-often including discectomy-is, in effect, a spine-related surgical procedure involving the removal of damaged intervertebral discs (either whole-removal, or partially based). The first of two discectomy techniques involved in open discectomy is known as Subtotal Discectomy (SD, or, aggressive discectomy) and finally, Limited Discectomy (LD; or, conservative discectomy). However, with good technique, the possibility of postoperative rehneation exists and at a fairly high maximum of 21%, prompting the patient to potentially undergo repeated disk surgery.
New treatments appear that are still in the early clinical trial stage. Glucosamine injections can offer pain relief for some people without blocking the use of more aggressive treatment options. In the US, artificial disk replacements are viewed with caution as possible alternatives to fusion in carefully selected patients, but are widely used in more widespread cases in Europe, where replacement of multi-level discs of the cervical spine and Waist is common. Adult stem cell therapy for disk regeneration is still in its early stages. Investigation into mesenchymal stem cell therapy without fusion-knife from the spine in the United States began in 2006.
Researchers and surgeons alike have conducted clinical and basic science studies to uncover the regenerative capacity possessed by the large animal species involved (humans and quadrupeds) for potential therapies to treat the disease. Several therapies, conducted by a research laboratory in New York, include introduction of a biosynthetic riboslavin cross-linked high-density collagen (HDC-laden) into the spinal segment of the disease to induce regeneration, ultimately restoring function and structure to 2 main. the inner and outer components of the vertebral disc - annulus fibrosis and nucleus pulposus.
See also
- Failed back syndrome
References
Source of the article : Wikipedia
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