Degenerative disc disease (DDD) can be debilitating, as it is a common cause of low back pain and can significantly affect an individual’s quality of life. Research has shown that DDD is widely acknowledged as a significant contributor to low back pain, which is a prevalent and debilitating health condition affecting millions of individuals worldwide.
Degenerative disc disease (DDD) is indeed recognized as a debilitating condition. It is a significant contributing factor to low back pain and forms the pathological basis for various debilitating spinal diseases (Zhang et al., 2016). Specifically, degenerative cervical spine disorders, a form of DDD, can result in severe pain and potentially lead to neurologic sequelae, indicating its debilitating nature (Todd, 2011).
Furthermore, DDD is associated with chronic and debilitating pain due to tissue impingement on nerve roots, often presenting as herniated or ruptured discs. This condition accounts for approximately 75% of low-back pain cases (Marcolongo et al., 2005). Additionally, cervical disc degeneration is a common and potentially debilitating disease, with over 100,000 surgical procedures performed annually in the U.S. to treat it (Anderst et al., 2011).
A study also found a statistically significant relationship between body mass index (BMI) and the clinical severity of DDD, with worsened symptoms among individuals with elevated BMI compared to those with a normal range of BMI.
The severity of symptoms and the impact on daily life can vary from person to person. Some individuals may experience significant pain and limitations in their activities, while others may have milder symptoms that do not greatly affect their functionality.
How common is degenerative disc disease?
Degenerative disc disease is a common condition, often attributed to both physiological aging and pathological factors. It is a prevalent manifestation in routine imaging of the spine, with its distinction from normal aging sometimes being unclear.
Epidemiological studies suggest that low back pain, often associated with Degenerative disc disease, is widespread, frequently debilitating, and costly, with approximately 25% of American adults reporting low back pain in the past 3 months.
Degenerative Disc Disease can result in morphological and cell changes in the intervertebral disc, leading to reduced structural integrity, disc height, and overall flexibility of the spine
How can DDD affect the spine?
- Structural Changes in the Spine:
- Discal Herniation: DDD can cause the soft center of a spinal disc to bulge out past the tough outer layer.
- Facet Joint Changes: Degeneration can lead to changes in the facet joints, which help stabilize the spine and facilitate movement.
- Spinal Canal Narrowing: The degeneration of discs and formation of bone spurs can narrow the spinal canal, a condition known as spinal stenosis.
- Degenerative Instabilities: Conditions like spondylolisthesis (slipping of one vertebra over another) and scoliosis (spinal curvature) can arise from weakened structures in the spine due to DDD (Benoist, 2003).
- Disc Height, Signal Intensity, and Contour Changes:
- Disc Height: As discs degenerate, they lose height, affecting the overall alignment and movement of the spine.
- Signal Intensity: Changes in the water content of the disc can alter its appearance on MRI, a sign of degeneration.
- Disc Contour: Degeneration may lead to irregularities in the shape of discs, such as bulging or herniation, impinging on surrounding nerves or the spinal canal (Parizel et al., 2016).
- Impact on Intervertebral Discs and Vertebral Bodies:
- Intervertebral Discs: Degeneration leads to biochemical and structural changes in the discs, affecting their ability to absorb shock and facilitate movement.
- Vertebral Bodies: Changes in the discs can lead to increased stress on vertebral bodies, causing bone spurs and other degenerative changes in the vertebrae themselves (Goel et al., 2019).
- Reduced Spinal and Root Canal Dimensions:
- Spinal Canal: DDD can lead to a reduction in the space within the spinal canal, increasing the risk of spinal cord compression.
- Root Canal: Narrowing of the spaces where nerve roots exit the spine (neural foramina) can compress nerve roots, causing radiculopathy (Goel, 2010).
- Alteration in Spinal Kinematics:
- Whole Spine Impact: Even moderate degeneration at a single level can affect the movement and stability of the entire lumbar spine, altering its overall biomechanics (Ruberté et al., 2007).
- Degenerative Arthritis in Intervertebral Joints:
- Osteophytes: Bone spurs may develop as a response to increased stress on the spine.
- Intervertebral Foramen Narrowing: The spaces through which nerves pass can narrow, leading to nerve compression and pain (Jandrić & Antić, 2006).
- Pain Mechanisms:
- Irritation of Pain Receptors: Degeneration can irritate nerve endings in and around the spine.
- Nerve Compression: Compressed nerves can lead to pain, numbness, or weakness.
- Edema and Inflammation: Swelling and inflammatory factors can contribute to pain and discomfort (Kvasnytskyi, 2020).
- Influence on Nucleus Pulposus:
- The nucleus pulposus is the gel-like center of a disc. DDD often starts here, leading to reduced water content and decreased ability to absorb shocks, affecting spinal biomechanics (Velnar et al., 2017).
- Lumbar Spine Degeneration:
- Modic Changes: These are changes seen in vertebral bone marrow near degenerated discs, associated with low back pain (Walwante et al., 2017).
- Genetic and Lifestyle Influences:
- Genetics: Certain genetic factors can predispose individuals to DDD.
- Lifestyle Factors: Physical activity, occupation, and smoking can influence the development and progression of DDD (Wilson, 2013).
Physical disability due to spine issues, Impact of disc degeneration on daily life
Physical disability due to spine issues, particularly stemming from intervertebral disc degeneration, significantly impacts daily life. This condition causes neck and back pain and limits mobility due to the complex interactions of various stressors (Rider et al., 2018). Age-related degenerative changes in the intervertebral discs contribute to spine stiffness, neck pain, and back pain, which are common causes of impairment and disability (Buckwalter, 1995). Even in younger populations, juvenile disc degeneration is associated with increased low back pain intensity, diminished physical and social functioning, and is strongly linked with overweight and obesity (Samartzis et al., 2011).
Degenerative spinal disease, including conditions like herniation of intervertebral discs and spinal canal stenosis, can lead to severe pain and disability (Shrestha et al., 2017). The aging of discs, facets, ligaments, and muscles may result in rotatory scoliosis and destabilization, thus affecting daily life (Benoist, 2003). Lumbar degenerative disk disease is recognized as a leading cause of functional incapacity and chronic disability in both men and women, with a high prevalence even in asymptomatic individuals (Modic & Ross, 2007).
Intervertebral disc degeneration (IDD) is the primary contributor to low back pain and is a leading cause of disability worldwide (Oichi et al., 2020). This condition leads to years lived in disability, profoundly affecting the quality of life and imposing significant healthcare costs (Cazzanelli & Wuertz-Kozak, 2020). Disc degeneration is a major health-care concern, causing disability and affecting millions, with an estimated direct cost burden of $86 billion per year in the U.S. alone (Gruber & Hanley, 2014).
Physical Therapy and Rehabilitation
Physical therapy plays a crucial role in managing spine health, particularly for conditions like lumbar spinal stenosis. A comprehensive physical therapy approach often includes manual therapy, active exercise, and patient education, and is effective in reducing symptoms and improving functional outcomes (Rademeyer, 2003). Additionally, endurance exercise as part of physical therapy has been consistently associated with better health outcomes in patients with spinal impairments, highlighting the importance of physical activity in managing spine health (Jette & Jette, 1996).
Pilates, for example, has been shown to effectively improve vital functions in middle-aged women with degenerative-dystrophic lumbar spine lesions, confirming its role in physical therapy for spinal health (Odynets & Kolomyichenko, 2021). Similarly, non-operative management of degenerative lumbar scoliosis, including physical conditioning, medication, and orthotics, can help manage symptoms and improve quality of life, albeit with limitations compared to surgical options (Kotwal et al., 2011).
In addition to physical therapy, lifestyle changes are critical in managing spinal degeneration. Regular lifestyle physical activity programs are feasible and can promote greater physical activity among people with spinal cord injury, which is essential for maintaining spine health (Warms et al., 2004). Furthermore, a bio-psycho-social approach that includes rehabilitative and cognitive behavioral therapy can enhance long-term benefits for pain, disability, and quality of life in spine-operated patients (Monticone & Giovanazzi, 2008).
For those with degenerative disc disease, conservative therapies like physical therapy, NSAIDs, and epidural steroid injections are often the first line of treatment. These approaches can manage symptoms and improve functionality, allowing patients to engage more actively in daily life and potentially delaying or avoiding the need for surgical intervention (Goel et al., 2019). Physical therapy can significantly improve quality of life and reduce pain in patients with conditions like lumbar spinal stenosis, further underscoring its importance in managing spinal health (Hotić-Hadžiefendić et al., 2016).
References
- Rademeyer, I. (2003). Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach. Physical medicine and rehabilitation clinics of North America.
- Jette, D., & Jette, A. (1996). Physical therapy and health outcomes in patients with spinal impairments. Physical therapy.
- Odynets, T., & Kolomyichenko, O. (2021). Application of pilates means in physical therapy of middle age women with degenerative-dystrophic lesions of the lumbar department. Scientific Journal of National Pedagogical Dragomanov University. Series 15. Scientific and pedagogical problems of physical culture (physical culture and sports).
- Kotwal, S. Y., Pumberger, M., Hughes, A., & Girardi, F. (2011). Degenerative Scoliosis: A Review. HSS Journal ®.
- Warms, C., Belza, B., Whitney, J., Mitchell, P., & Stiens, S. (2004). Lifestyle Physical Activity for Individuals with Spinal Cord Injury: A Pilot Study. American Journal of Health Promotion.
- Monticone, M., & Giovanazzi, E. (2008). Usefulness of a cognitive behavioural and rehabilitative approach to enhance long lasting benefit after lumbar spinal stenosis and degenerative spondylolisthesis surgery. A case report. European journal of physical and rehabilitation medicine.
- Goel, A., Wang, E., & Bicket, M. (2019). Degenerative Disc Disease. Spine Pain Care.
- Hotić-Hadžiefendić, A., Kapidžić-Bašić, N., Kikanović, Š., & Hodžić, R. (2016). Influence of physical therapy on lumbar spinal stenosis.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.