Degenerative Disc Disease

A diagnosis of degenerative disc disease (DDD) doesn't mean that the patient's back is disintegrating. Adults in their thirties and forties often feel lower back pain and get concerned that they will be crippled when they get older. However, this isn't necessarily true. The lower back is often, given time, quite resilient. Chronic lower back pain may not signal a continued deterioration. In fact, the severity of the pain doesn't necessarily correlate with the damage. The individual experiencing increased pains shouldn't jump to the conclusion that his back is getting worse. Much older adults, those of retirement age, experience DDD symptoms because of aging. Not surprisingly, many adults have some level of DDD simply from working, playing, and living. This is a common occurrence because the spinal discs can lose the gel-like fluid that acts as a buffer between the bones of the vertebrae. Over time, tiny cracks may also appear. People who smoke or are obese are especially susceptible to degenerative disc disease. Those individuals who work in occupations that require physical labor, such as a lot of lifting, are also prone to DDD.

Disc damage not only occurs in the lower back, but also in the neck. People who sit at computers for long periods of time often complain of neck aches. Discs in the vertebrae are like shock absorbers. The gel-like center allows the discs to compress as the body moves. Without the elasticity of these discs, it would be impossible for the spine to twist and bend. People's movements would be stiff and stilted if the spine had a long solid bone similar to those in the arms and legs. If the discs are damaged or lose fluid, naturally the individual is going to hurt. Though good posture won't necessarily prevent degenerative disc disease, paying attention to one's neck and back positions may alleviate the symptoms. Computer users should take periodic breaks away from the desk. Chairs and desk tops should be at the right height for the individual user. Ergonomic furniture can help a person maintain good posture while working at the computer. An ergonomic chair offers support to the lower back and the individual should adjust the monitor so that the screen can be seen without bending the neck unnaturally forward for long periods of time.

Sometimes degenerative disc disease is the result of a fall. But whatever the cause, someone who experiences chronic pains in the lower back or neck should seek medical attention. Often the pain comes from an inflammation, but the individual may have an infection that needs treated. Long ago, the scribes and Pharisees criticized Jesus by asking, "How is it that he eateth and drinketh with publicans and sinners? When Jesus heard it, he saith unto them, They that are whole have no need of the physician, but they that are sick: I came not to call the righteous, but sinners to repentance" (Mark 2:16b-17). A properly-trained physician can diagnose the condition and provide a treatment plan. In addition to taking a medical history and asking about past injuries, the physician may check the patient's reflexes. Additional tests may be ordered. For example, the patient may need x-rays or other imaging tests, such as an MRI or CAT scan. Bone spurs often develop around the area of an injury and these can be seen on the imaging scans. Additionally, when discs are damaged the space between them often narrows. This narrowing may also show up on the x-rays. However, x-rays and imaging tests may not help with the diagnosis at all. This is why the patient will want to seek the medical advice of a degenerative disc disease specialist who is up-to-date on all the latest research and diagnostic tools.

The treatment for DDD often depends on the severity of the pain. A simple change of position can often bring comfort. For example, many individuals with chronic pains feel more comfortable walking than sitting. Ice packs or heat therapy may also bring relief. Over the counter medications can also help. These include such common medications as acetaminophen and nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen. For more severe pains, the physician may prescribe a stronger medication. It's best when treating degenerative disc disease, even with over the counter medications, to follow a physician's advice. Physical therapy and exercises can also help provide relief and will probably even strengthen other muscles and ligaments that support the spine. Many people will seek the services of a chiropractor and begin a regular routine of spinal manipulations. This type of treatment can help return the spine to its proper alignment.

Surgery for degenerative disc disease should be considered only as a last resort. The surgery may be needed to remove a damaged disc. When this happens, the surgeon might replace the damaged disc with an artificial one or he may fuse the bone. Either way, the patient should research all other options before undergoing this drastic step. It's not unusual for DDD to cause pains to radiate down the individual's hips and legs, Numbing and tingling are not unusual symptoms because the nerves are often affected or damaged. This can lead to other conditions, such as an abnormal bulge known as a herniated disc, spinal steriosis, or osteoarthritis. Though degenerative disc disease isn't necessarily progressive, everyone should do whatever they can to take care of their bodies. This means good nutrition and proper exercise. Be careful when lifting heavy objects and maintain good posture, especially when working at a computer or spending a great deal of time at a desk. The back needs to be taken care of to maintain flexibility and movement.

Disc Replacement Surgery

Disc replacement surgery is one of the options for some patients who are facing the prospect of continued pain from a compressed nerve injury. A vertebrae disc or cushion is a gel like cushion with a fibrous outer shell that allows the bones of the spine to float as movements occur. An injury or aging can either create a cushion that bulges and may compress a nerve in the spine, or the cushion may deteriorate and turn into an oatmeal like consistency that also can compress a nerve. In some cases, the cushion may actually have to be removed. Bulging discs can often respond to physical therapy and the pain may subside to a livable degree. In some cases the surgeon may remove the oatmeal like cushion altogether and leave the space open, but much of this depends on where on the spine the anomaly has developed and how the surgeon views the long term implications for the patient. Often the surgeon may choose to do a fusion of vertebrae bones so that the area without a cushion moves with a bone that has cushion protection.

A physician treating someone who has a degenerative disc condition will always attempt first to treat the pain and the condition with anti-inflammatory medicines, physical therapy and epidural steroid injections. But often those conservative procedures don't bring the kind of relief that the patient needs for a normal lifestyle. In that case, the options facing the patient and his surgeon may be limited to bone fusion or if possible, disc replacement surgery. The fusing of vertebrae bones has long been the standard operating procedure (no pun intended) for surgeons following the removal of a damaged cushion. If the surgeon recommends fusion, a bone will be grafted to the empty space on either side of the vertebrae and the bones will eventually grow together. The goal is to stop any abnormal movement that the empty space might be subject to without the disc in place. The bone will either come from the patient or from a graft from a bone bank.

The problem with fusion is the issue of range of motion that may be quite limited by the fusion operation. This may be particularly true if the disc is in the cervical area of the spine. That is the area near the shoulder and neck area. There are a number of risks that are associated with fusion surgery such as the two segments not fusing together. Additionally, there is the possibility that the vertebrae nearest the fusion location will develop problems, usually years later. The surgeon performing the disc replacement surgery will no doubt talk about the possibility of blood loss and infection with the fusion surgery as well as the risk of damage to the spinal cord in rare cases. Because of all these risks there has been an intense push by major medical prosthetic companies to develop artificial discs to replace those that have failed in one way or another and these artificial substitutes for the real thing have made disc replacement surgery a viable option.

Disc replacement surgery is possible because of state of the art prosthetics that have been approved by the FDA. One design of these discs is made of plastic and cobalt and has a middle core which slides back and forth giving the disc the opportunity to move when the patient's spine moves. The ends have teeth that secure them to the bones above and below the disc space. Since these same materials that make up a modern prosthetic replacement are used in other places in the body such as a replacement knee prosthetic, there is less chance that the body will reject the piece. Because there are risks inherent in replacement surgery, there will always be some fear and some anxiety about the decision to have the operation. Christians facing this operation can pray like David: "Be merciful to me O God, be merciful unto me: for my soul trusteth in thee: yea in the shadow of thy wings will I make my refuge, until these calamities be overpast." (Psalm 57:1)

Depending on the type of replacement that is used, entry to the spine is either through the front or the back. If entrance is gained through the front, the organs of the patient are gently moved aside so the surgeon gets a good look directly at the area in which the disc replacement surgery will take place. This kind of surgery may mean that there will be the possibility of a number of possible side effects from this operation. Some of these include spinal cord damage, bleeding, bladder problems and infection. Disc replacement surgery patients are usually in the hospital for between one and four days and rehabilitation will begin during that time.

Because there are more patients who have disc replacement surgery for lower back issues than cervical issues, there is less information on its benefits for cervical spine issues. In many ways, the information on replacement surgery for cervical anomalies is still somewhat sketchy, although there are smaller prosthetics designed for the neck spinal area. The decision to have such surgery, either for lumbar or cervical cushion replacement should not be taken lightly. The patient should do as much reading as possible and not rely solely on the physician's recommendations. If need be, seek a second or third opinion on the recommendation until one is comfortable with the final decision, whatever that might be. Be it fusion surgery or replacement surgery, there is help on the way for that chronic spinal pain.







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