1. Back Pain: Sufferers and cost to community
2. Degenerative disc disease ( DDD)
3. DDD; compression causes,predisposing factors
4. DDD; compression symptoms
5. DDD; conservative management vs.. surgery
1/ Back Pain
An astounding 214,000 thousand people reported Back pain with or without leg pain in 2015/16 in the UK according to figures released by the Health and Safety Executive (2). This does not account for the possibility of many unreported cases of Degenerative Disc Disease (DDD).
Degenerative Disc Disease is a commonly cited predisposing factor for mechanical back pain. It is widely agreed however that multiple factors contribute to back pain and that many structures in the body, in addition to intervertebral discs may be responsible; facet joints, muscles and ligaments can give rise to back pain.
Back pain can lead to physical disability, immobility and a severely restricted lifestyle. Back pain resulted in an astounding 3,000,000 working days lost in the UK alone (2).
Medication and surgery are often life-saving when treating spinal pathology and trauma however current medical practice (medication and surgery alone) is sometimes incomplete when trying to relieve the symptoms of sufferers who have mechanical low back pain and who contribute to the figures of working days lost in the UK with this debilitating condition.
2/ Degenerative Disc Disease; Associated terms include:
Spinal compression, Nerve compression, pinched nerves, Herniated Discs, Slipped Disc, Ruptured Disc, spinal stenosis, Sciatica, lumbago, back pain, neuralgia, apophysitis, myalgia, osteochondrosis, osteophytosis, spinal arthritis, facet joint syndrome, failed back syndrome. Intervertebral disc disease; Disc degeneration, ‘slipped disc’, Disc Bulge, Discogenic pain.
3/ How & Why Do Herniated Discs Develop?
Discs are soft, ‘rubbery pads’ located between the bony vertebrae that make up the spinal column. Composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus)
The discs act as central shock absorbers and in association with the spinal (zygo-apophyseal or facet) joints allow the back to move in many directions. Spinal muscles provide the pulling forces for joint movement and the ligaments act like guy ropes keeping in check the range of movement to protect the joints from mechanical strain.
When we are young, our discs have a high-water content, approximately 80 percent. As we age, the water content decreases, causing the discs to become compressed, less pliable and more susceptible to wear and tear.
The spinal column surrounds and protects the spinal cord and nerves. When the annular cartilage (outer tougher part of the disc) develops a defect or tear, the nucleus (central ‘gel like’ part ) can break through the tear. The Nucleus is like ‘gel toothpaste’ and may bulge out or herniates, resulting in a compression on the nerves (pinching). Even slight amounts of compression/ pinching can cause pain and pins and needles. More marked nerve compression can cause numbness, or weakness in the muscles of the arms or legs.
Associated terms: Slipped disc, degenerative disc disease, disc bulge, herniated disk, disc protrusion, disc degeneration, spinal stenosis, spinal osteochondrosis, Sciatica, lumbago, radicular pain referred pain.
Conditions that can further weaken or influence the damage to your discs (2):
· Heavy or incorrect lifting
· Repetitive twisting movements
· High impact athletic activities
· Excessive body weight
· Traumatic injury
· Poor workplace ergonomics
4/ Degenerative Disc Disease (DDD) Compressive Symptoms
Degenerative Disc disease (DDD) is characterised by increased spinal compression squashing discs and spinal nerves, contributing to biomechanical problems in muscle and ligaments.
DDD can occur anywhere in the spine.
Most often, it occurs in the cervical spine (neck) or lumbar spine (lower back), typically causing “a compressed or pinched nerve.”
If you are experiencing pain or numbness in the neck, arm, lower back, or leg, you could be suffering from DDD with a herniated disc.
Degenerative Disc Disease ( DDD ) with a herniated disc in the lower spinal segments can exert compression on the sciatic nerve (sciatica). The sciatic nerve is comprised of several spinal nerve branches as they travel from the spine down the length of the leg. When compressed or pinched, sciatic pain may be experienced anywhere along these branches, radiating from the buttocks down the back of the leg and sometimes through the calf, shin and foot. Leg pain may occur without any back pain.
Many patients with compression from degenerative disc disease (DDD) can be successfully managed with conservative treatment without surgery.
·5/ Herniated Disc Symptoms
Symptoms of DDD can be different depending on where the injured disc is located. Low back pain and/or leg pain (sciatica) are the most common symptoms of DDD with a herniated disc in the lumbar (lower) spine. Pain may vary from mild to severe.
Symptoms may be experienced suddenly or gradually and may also include:
· Pain in one or both buttocks / legs
· Burning, tingling (a “pins–and–needles” sensation), or numbness in the buttock, leg, or foot
· Pain with specific movements, usually bending or twisting
· Intensified pain with prolonged sitting, bending, sneezing, or coughing
· Weakness in one or both legs
· Loss of bladder or bowel control (note that this is rare)
6/ Conservative Management VRS Surgery for Disc Herniation
• Approximately 2% of patients with low back pain undergo surgery for disc herniation (2)
• Over 90% of patients with low back pain will be managed with conservative therapy.