Degenerative disc disease refers to the symptoms of pain and sometimes radiating numbness or weakness caused by a degenerating disc or discs in the spine. The term degenerative does not, in this instance, mean that the disease will get worse, necessarily, but that the degenerative disc disease symptoms are caused by the degeneration of the spine that is a natural part of aging. It generally occurs in the lumbar or cervical spine.

• Lumbar degenerative disc disease: symptoms range in severity and include lower back pain, pain that worsens when sitting and is exacerbated by twisting, bending, or lifting, tingling and numbness in the legs, difficulty walking, and leg pain caused by nerve pinching
• Cervical degenerative disc disease: symptoms include neck pain, sharp pain radiating down the shoulder into the arm on one side of the body, tingling and numbness or weakness in an arm, hand, or fingers, and pain that worsens with movement
• Thoracic degenerative disc disease: pain in the back and sides, front or upper abdomen, muscle weakness, tingling, or numbness, limited mobility, and pain that worsens with certain movements

Treatment Goals for Degenerative Disc Disease

Degenerative disc disease treatment options range from conservative, allopathic treatments to alternative treatments such as chiropractic care and acupuncture, to surgical options. The goal of these treatments is to relieve lower back pain and restore normal function.

Exercise Treatments for Degenerative Disc Disease

A regular routine of back exercises can help prevent lower back pain and reduce the severity of flare-ups. These exercises not only maintain flexibility and strength in the back, they also promote the delivery of nutrients that keep muscles, discs, joints, and ligaments healthy. The muscles, tendons, and ligaments in your spine are designed for motion, and limitations to motion can cause lower back pain.

It may take several weeks or even months of exercise and stretching to reduce chronic sciatica and lower back pain caused by degenerative disc disease. However, patients often find that strengthening their backs and improving their range of motion gives them relief from their lower back pain. Exercises that can relieve sciatica and lower back pain include:

Stretches

• Hamstring stretches
• Psoas Major muscle stretches
• Pelvic tilt
• Arm/leg raises
• Bridges

Low-Impact Aerobic Exercises

• Walking (including on a treadmill)
• Riding a stationary bike
• Step machine
• Elliptical trainer
• Water aerobics

Physical Therapy

If you have an episode of lower back pain that lasts 2-6 weeks (chronic pain), or if you have frequent flare-ups (acute pain), your physician may recommend physical therapy as part of your rehabilitation. Some will recommend physical therapy sooner if the pain is severe. There are several physical therapy modalities that may be recommended, such as:

• TENS units (electrical simulation)
• Hot/cold therapy
• Ultrasound
• Iontophoresis

Alternative Treatments

There are also alternative degenerative disc disease treatment options such as:

Chiropractic Care

Chiropractic care is a degenerative disc disease treatment your doctor might recommend. Manipulation by a chiropractor may help relieve lower back pain by decompressing sensitive neurological tissue, restoring blood flow, increasing your range of motion, reducing muscle tension, and creating chemical reactions in your body that act as natural painkillers.

Your chiropractor will first determine if you have a true disc-related problem. If you have degenerative disc disease and lower back pain are main symptoms, the chiropractor will consider if:

• Degeneration of the spinal joints could be affecting the mechanics of the spine
• Deteriorating discs are bulging and putting pressure on the spinal nerves
• Spinal stenosis is causing leg pain and back pain

The goal of chiropractic care is to improve joint mechanics by reducing inflammation and improving spinal motion. Your chiropractor will use spinal manipulation to relieve your pain. Some of these include:

• Specific spinal manipulation
• Flexion-distraction technique
• Instrument-assisted technique

Additional techniques your chiropractor may use include:

• Deep tissue massage
• Trigger point therapy
• Manual joint stretching

Acupuncture

Acupuncturists believe that you have an energy force – Chi – that when blocked causes the development of physical illness, such as lower back pain. Based on your symptoms and diagnosis, an acupuncturist will insert thin needles into precise points in the body to restore a healthy flow of Chi. It has been theorized that acupuncture needles cause the release of neurochemicals, such as serotonin or endorphins, that act as natural painkillers.

Pain Medications

Chronic and acute pain are treated by different painkillers. Pain medication for chronic or acute back pain include:

• Acetaminophen (Tylenol): dampens the brain’s perception of pain but does not treat inflammation
• NSAIDs (non-steroidal anti-inflammatory drugs): reduce inflammation and are available either over-the-counter or by prescription. Ibuprofen, Naxopren, and COX-2 inhibitors are common NSAIDS used to treat chronic pain from degenerative disc disease
• Oral Steroids: powerful anti-inflammatory prescription medication that can effectively provide relief from lower back pain. Their use is limited to a short period of time and they are generally prescribed for acute pain flare-ups
• Muscle Relaxants: have a sedative effect on the entire body and usually prescribed early in the course of degenerative disc disease treatment to alleviate pain caused by muscle spasms
• Narcotic Pain Medications: opioid pain relievers that contain codeine, propoxyphene, hydrocodone, or oxycodone can help patients manage pain. Due to their highly addictive nature, an opioid pain reliever is generally prescribed for a short period of time to relieve acute sciatica and back pain

Pain Management Techniques

Pain management techniques are often used on pain that is difficult to treat, such as the pain caused by degenerative disc disease. Many patients find that they have to experiment with which treatment, or combination of treatments, works best for them. Below are some treatments often used on patients suffering from chronic back pain:

• Cognitive therapy
• Relaxation techniques
• Visual imagery and distraction
• Hypnosis

Epidural Steroid Injections

Lumbar epidural steroid injections (LESI) place corticosteroids directly into the epidural area of the spine in order to reduce inflammation and relieve pain. They usually consist of cortisone an anti-inflammatory and local anesthetics to offer short-term pain relief for degenerative disc disease.

Lifestyle Changes

Self-care such as lifestyle changes can help alleviate and manage lower back pain and sciatica symptoms. These changes include:

• Staying active: exercise can keep the spine strong and flexible
• Quitting smoking: nicotine can cause cell damage and increase sensitivity to pain
• Losing weight: being overweight can put stress on the spine
• Standing up straight: good posture and keeping your spine aligned will help keep your back pain-free
• Ergonomics: you may need to make adjustments to how you sit, sleep, lift, and bend

Surgery Options

The Bonati Spine Procedures offer an array of techniques for degenerative disc disease surgery when conservative treatments, such as exercise and physical therapy, do not offer pain relief. These procedures may include:

Discectomy

A discectomy is a surgical procedure in which the diseased portion of the disc that is causing nerve compression is removed using specially adapted patented endoscopic instruments. A laser is used to shrink and remodel the remaining disc.

Laminectomy/laminotomy

A laminectomy/laminotomy is a surgical procedure performed to treat spinal stenosis. The surgery is designed to relieve pressure (decompress) on the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation in the patient.

Facet Thermal Ablation

A Facet Thermal Ablation is a laser eradication of sensory nerves causing pain.

Learn more about degenerative disc disease surgical options offered at The Bonati Spine Institute.