John Reagan • Aug 01, 2022
Low back pain (LBP) presents a significant burden to patients, healthcare systems, and society at large– did you know it is the biggest contributor to the number of years people live with a disability?! The prevalence rate of LBP is between 12% and 35% at any given time, with lifetime prevalence rates between 49% and 80%! This means that between 5 and 8 in 10 people will suffer from this condition in their lifetime! Lumbar disc degeneration (LDD) or degenerative disc disease (DDD) is the most common cause of LBP (Berg, et. Al., 2020)
A study by the Centers for Medicare and Medicaid Services (CMS) show around 1.8 million people are currently diagnosed with LDD, many over 50 years old. Most patients are not aware they may be suffering from DDD.
Disc degeneration is considered a normal aging process. As individuals age, the intervertebral discs, shock absorbers for the spine, begin to lose form and strength. With lumbar DDD, more significant problems can arise as a result of the disc’s degeneration: discs may lose height causing a narrowing of nerve pathways, bones in the spine might press against each other causing mechanical pain, impingement, severe inflammation, and chronic pain, and the disc may protrude back as it degenerates causing pain, numbness, and/or weakness as it pushes against the nerve(s).
Most intervertebral disc degeneration is asymptomatic, which makes it hard to know who suffers from this disease. This is partly due to a lack of uniformity in defining disc herniations and degenerations. When blood vessels surrounding the spine, responsible for delivery of nutrition, are compressed, their ability to provide nutrients may be compromised (they may experience an ischemic effect). Inflammation from the compression may result in severe pain along the path of this nerve root. It may also result in an increase in cytokines, TNF-alpha, and macrophages.
Your doctor will take into account various episodes of pain you have experienced. While evaluating this history, they will also pay close attention to your pain timeline and any related incidents. They will also assess for any episodes of trauma that you may have experienced.
Those suffering from lumbar disc degeneration may experience pain down the buttocks and lower extremities. Your doctor may attempt to determine if the pain is localized to the lower back or if it radiates to your legs.
The lumbar spinal canal is the area inside the lower portion of the spine which carries nerves to both the legs. Over time, the bone and tissue surrounding the canal might grow. This growth could result in a narrowing of the canal over time (a condition is known as stenosis). When the lumbar spinal canal narrows, nerves that pass through it are squeezed. As a result, the patient might experience weakness, numbness, and/or pain in the back and legs.
Problems with the intervertebral disc are also directly related to the body mass index. Thus, those suffering from being overweight and obesity are generally at a higher risk of degeneration.
All physical examinations may include evaluating the neurologic function of the arms, legs, bladder, and bowel. The patient may be asked to walk on their toes, arise from a chair to test their strength, and undergo reflex testing. They may be asked to undergo a straight leg raise (SLR) test. If radiating back pain is reported in either leg, it may indicate that they are suffering from a stenotic canal. Your doctor will document the findings, any progress made over time, and order tests, which may be used for future evaluations.
Patients with low back pain may be evaluated with imaging such as anterior-posterior (AP) and lateral x-rays. They may also be advised to undergo an MRI at the initial presentation if the patient is suspected of suffering from an acute disc herniation. The patient may also need to undergo nerve testing such as electromyography (EMG) or nerve conduction studies.
Most patients’ with LDD have symptoms that improve without undergoing surgical treatment. Many patients may be asked to undergo physical therapy that focuses on core strengthening and stretching for 6 and 8 weeks. In addition, many patients are recommended to undergo lifestyle modification, including minimizing activities that induce pain and undergoing mild exercise such as walking. As part of the treatment, non-steroidal anti-inflammatory medications (NSAIDs) and epidural injections are often also prescribed. For patients who fail to respond to non-surgical treatment, surgical treatment options for disc herniations and degenerative spinal stenosis are a logical next step.
Patients with red flag symptoms often will not respond to conservative measures, typically need an expedited workup, and may have a disease process more significant than DDD. Red flag symptoms include:
● Issues in controlling their bowel movements.
● Difficulty with urination.
● Trauma caused by a fall, physical assault, or a collision.
● Suspected tumor or known history of cancer.
● Infection, history of fever and chills, especially during the night.
● Sudden weight loss
If symptoms of lumbar degenerative disc disease show no signs of improving with conservative measures, your doctor may recommend surgery as part of the treatment plan. If this occurs, they may ask you to undergo a few tests, including MRI, CT, myelogram, and discography to evaluate the severity of the condition. If one or more vertebral discs are damaged and are causing pain or other symptoms, your doctor may recommend surgery.
Depending on the specifics of the case, your doctor may remove a portion or all of the disc of concern, then bind together the vertebrae located above and below the removed disc with surgery. The surgeon may use minimally invasive surgical techniques including robotics to perform the surgery, as this results in faster recovery. Minimally invasive decompression and fusion surgery is often used to treat spinal conditions that are structurally destabilizing. Surgery may be recommended to treat conditions such as:
● Spinal fracture
● Degenerative disc disease (DDD)
● Herniated discs
● Scoliosis
● Spinal stenosis
● Spondylolisthesis
Lumbar decompression is performed under anesthesia. Depending on the severity of the condition and the treatment, patients may be asked to stay in the hospital for one to three days.
Like most surgical procedures, lumbar decompression surgery has risks that include those commonly associated with anesthesia, which can cause other problems, including heart issues, lung issues, urinary tract infection (UTI), Deep Venous Thrombosis (DVT), stroke, eye or vision problems, or pressure wounds. Before the lumbar decompression surgery, patients undergoing the procedure must inform the doctor about their past medical issues, if any, as they can impact anesthesia. Remember, these complications are pretty rare, and the surgery is overall a safe and effective procedure.
Once the patient is stable and back on their feet, post-surgery, the doctor may encourage the individual to walk. A section of patients may need rehabilitation. The elderly and those who have undergone more than one level of treatment may require rehabilitation. While patients could be advised not to lift heavy objects, they may be permitted to drive one or two weeks after surgery.
Patients may also be prescribed oral pain medication to manage pain in the postoperative period. The scar may take about two weeks to heal, after which hydrotherapy may begin, and after 3 or 4 weeks, physiotherapy may be started. Furthermore, those who have undergone lumbar decompression surgery may be asked to modify their diet and lifestyle.
If you are experiencing signs or symptoms of degenerative disc disease (DDD) of the lumbar or other regions of the spine, you should reach out to a specialist at IGEA Brain, Spine & Orthopedics for an evaluation. You can book an appointment online or call us at (800) 467-1770 for a consultation with one of the specialists at IGEA Brain, Spine & Orthopedics.