Degenerative Disk Disease - What Is It? What Can We Do to Treat It?

78619467.jpg

            The great majority of adults, approximately 70-85%, will experience low back pain at some point in their life. A subset of those with back pain will have a form of osteoarthritis in their back referred to as degenerative disk disease (DDD) responsible for their pain. DDD involves damage to intervertebral disks from long wear and tear. The diagnosis of DDD is very difficult to make. Many individuals will have disks that look damaged on an MRI but will experience no symptoms.

Some studies show that up to one third of adults with absolutely no back pain will have disks that look damaged on MRIs. For this reason, if a patient has back pain and a damaged disk on MRI, that disk is not necessarily the cause of the patient’s pain.

            DDD often presents with low back pain that does not shoot down your, unless other conditions are present in addition to DDD. The pain is often worse with flexion the back forward, which places more stress/pressure on the disk. Assuming that your back specialist has made the diagnosis of DDD, lets talk about what treatments have been shown to help. The good news here is that over 90% of backpain will go away on its own without any surgery. For this reasons non-operative treatment must be tried first. Physical therapy with strengthening of abdominal muscles and the muscles in your back has been shown to work well. Being active and exercising as well as participating in physical therapy is better for pain from DDD then being sedentary.

Do not stay in bed! This may only decondition the supporting muscles if your back further, and cause the condition to be worse. 

            The use of chiropractors and spinal manipulation has not been shown to have any benefit in long standing low back pain, and has controversial role in acute or recent onset low back pain.

Medications may have some role in management of low back pain from DDD however most experts agree that opiates must be minimized. It is all too easy to become addicted to opiate/narcotic medications. For this reason NSAIDs or Tylenol have been suggested. Some psychiatric drugs have been used to manage pain associated with longstanding DDD. A recent review of 22 studies on the use of tricyclic antidepressants noted there may these drugs may be effective in relieving pain. However it should be noted that tricyclic antidepressants can have severe side effects.

            A number of more invasive measures have been used for treatment of low back pain from DDD that has not responded to the conservative treatment above. Intradiscal Electrothermal Therapy (IDET) is a relatively new minimally invasive treatment that aims to burn the pain fibers in the disk. Unfortunately there have been absolutely no studies suggesting that IDET has any long term benefit. Epidural steroid injections have also been tried in the setting of DDD.

Injections can provide short term relief but unfortunately there have not been any studies that demonstrate long term benefit of epidural steroid injections.

            The last option to be discussed in this article is spinal fusion for DDD. This is a controversial application of this surgery, and unfortunately the outcomes of spinal fusion for low back pain are significantly worse then in other settings such as radiculopathy (pain shooting down the legs). Studies have shown a broad range of satisfactory outcomes ranging from 16% to 96% with an average of 68% patients showing satisfactory outcomes from spinal fusion for low back pain. A number of factors have been linked to worse surgical outcomes; it seems that patients on workman’s compensation, patients with depression, and older patients tend to have worse outcomes.

            I hope this has been a useful review of the outcomes of various treatments of low back pain. The most important points to take aware are 1. 90% of back pain goes away on its own; 2. 30% of asymptomatic people have degenerated discs on MRI, which means that if you have low back pain and a degenerated discs it doesn’t mean that the disc is the cause of your back pain; 3. Surgical outcomes for low back pain are not great, with about 70% of patients reporting a “satisfactory” outcome.

Continue Reading