Lumbar Degenerative Discopathy: Definition, Causes, Symptoms, Diagnosis, Treatment, Prevention and Prognosis

It is the result of the discs in the spine “wearing out.”

When a disc is injured, the tough outer ring loses its stiffness and the inner material can squeeze toward the nerves and cause pain.

Loss of disc stiffness can lead to spinal instability or abnormal movement between two bones in the spine during normal activities, such as bending forward, leaning back, or twisting.

Lumbar degenerative disc disease is a disease that can cause severe pain in the lower back, with pain shooting through the buttocks or occasionally down the leg.

As we age, the intervertebral discs in the spine can lose water and dry out.

When this happens, the disc is compressed and this can lead to deterioration of the strong outer ring, allowing the nucleus, or the interior of the ring, to protrude, which is considered a bulging disc.

Lumbar degenerative disc disease is one of the most common causes of low back pain.

As the disease continues to worsen, or with continued stress on the spine, the internal nucleus pulposus can rupture from the annulus, which is called a herniated disc.

This can cause pain, weakness, numbness, or changes in sensation.

Most herniated discs occur in the lower lumbar spine, especially at the L4-5 and L5-S1 levels.

Lumbar degenerative disc disease can also occur in the thoracic area of ​​the spine, most often at the thoracolumbar junction (where the thoracic and lumbar areas of the spine meet).

Although similar to cervical and lumbar degenerative disc disease disorders, thoracic lumbar disc disease is much less likely to cause symptomatic lesions.

Spinal column

The vertebrae are the bony building blocks of the spine.

Between each of the largest parts of the vertebrae are the discs.

Ligaments are located around the spine and the discs.

The spine has seven vertebrae in the neck (cervical vertebrae of the cervical spine), 12 vertebrae in the middle of the back (thoracic vertebrae of the thoracic spine), and five vertebrae in the lower back (lumbar vertebrae of the lumbar spine) .

Also, in the lower part of the buttocks below the fifth lumbar vertebra there are five sacral vertebrae, usually fused as the sacrum bone followed by the coccyx

Function of the  spine

The spinal column is designed so that the vertebrae “stacked” together can provide a mobile support structure and protection of the spinal cord against injury.

Each vertebra has a bony arch behind the spinal cord that protects the nerve tissue in the spinal cord.

The vertebrae also have a strong bony “body” in front of the spinal cord to provide a suitable platform for weight bearing.

Spinal discs are pads that serve as pads between each vertebral body that serve to minimize the impact of movement on the spine.

Because the discs are located between the vertebrae, they are sometimes called intervertebral discs.

Each disc is designed like a gelatin donut with a softer central component (nucleus pulposus) surrounded by a firmer ring of tissue (annulus fibrosus).

When injury or degeneration occurs, the soft component can sometimes herniate through the surrounding fibrous outer ring and cause irritation of the adjacent nerve tissue.

Ligaments are strong fibrous tissues that firmly support bones.

Ligaments fix each of the vertebrae and surround each of the discs.

If these ligaments are injured, localized pain can occur in the affected area as the disc degenerates.

Causes of lumbar degenerative disc disease

Lumbar degenerative disc disease is due to a change in the structure of the normal disc.

Most of the time, lumbar degenerative disc disease occurs as a result of aging and the degeneration that occurs within the disc.

Occasionally, severe trauma can cause a normal disc to herniate. Trauma can also cause a herniated disc to get worse.

As we age, the water and protein content of the body’s cartilage changes.

This change results in weaker, more fragile, and thinner cartilage.

Because both the discs and the joints that stack the vertebrae (facet joints) are partially made up of cartilage, these areas are subject to wear and tear over time (degenerative changes), and this disease is known as Lumbar Degenerative Disc Disease.

Wear of the facet cartilage and bone changes in the adjacent joint are known as degenerative disease of the facet joint or osteoarthritis of the spine.

Traumatic spinal injury can also lead to lumbar degenerative disc disease.

Symptoms of lumbar degenerative disc disease

The symptoms of lumbar degenerative disc disease vary depending on the herniated disc and the nerve root it is pushing on. Symptoms can include:

  • Intermittent or continuous back pain (this can be made worse by moving, coughing, sneezing, or standing for long periods of time).
  • Spasm of the back muscles.
  • Pain that begins near the back or buttocks and travels up the leg to the calf or to the foot (sciatica).
  • Weakness in the muscles of the legs.
  • Numbness in the lower extremities (leg or foot).
  • Decreased reflexes in the knee or ankle.
  • Changes in bladder or bowel function.

The symptoms of lumbar degenerative disc disease may resemble other conditions or medical problems.

Diagnosis of lumbar degenerative disc disease

Lumbar degenerative disc disease is suspected when the symptoms described above are observed.

A complete medical history and physical examination is performed, procedures used to diagnose lumbar disc disease may include the following:

X-rays

Doctors can visualize degenerative spondylosis using plain film X-ray images of the spine, CT scan, or MRI.

Magnetic resonance imaging and computed tomography

Herniated disc can be detected with radiology tests, such as scanning through a CT scan or MRI.

Myelogram

It is a procedure that uses a dye injected into the spinal canal to make the structure clearly visible on X-rays.

Electromyography

Lower extremity nerve tests (electromyogram and nerve conduction velocity) can be used to detect nerve irritation.

Treatment

Treatment for degenerative lumbar disc disease will be determined based on the following aspects:

  • Age.
  • The general condition of the patient and his medical history.
  • Extension of the condition.
  • Condition type.
  • Tolerance of medications, procedures, or therapies.
  • Expectations for the course of the condition.

Conservative therapy is generally the first line of treatment to control lumbar degenerative disc disease. This can include a combination of the following:

  • Bed rest.
  • Patient education on proper body mechanics (to help decrease the chance of worsening disc pain or damage).
  • Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs.
  • Weight control.
  • Use of a lumbosacral support.
  • Medicines (to control pain and / or to relax muscles).
  • Epidural steroid injections.

When these conservative measures fail, surgery may be recommended to repair lumbar degenerative disc disease.

The type of surgery needed will be based on your surgeon’s evaluation, but the most common include:

  • Discectomia.
  • Laminectomy.
  • Lumbar fusion.

Most patients who experience degenerative lumbar disc disease will improve with nonsurgical treatment and will never need surgery. The most common non-surgical treatments include:

  • Patient education.
  • Rest.
  • Weightloss.
  • Medication.
  • Corset treatment.
  • Physical therapy.
  • Acupuncture.
  • Chiropractic care.
  • Massage.
  • Injections

Prevention of lumbar degenerative disc disease

There are some simple lifestyle changes that you can start right away that reduce the risk of premature onset of lumbar degenerative disc disease, or even stop its progression:

  • Quit Smoking:  Nicotine and other toxins found in cigarettes are bad for bone health.
  • Reduce Alcohol: Alcohol slows down your metabolism, thus accelerating the decline in bone health.
  • Good posture should be maintained: but maintaining good posture is not limited to the way a person stands.
  • The use of high heels should be avoided: sleeping on a good mattress that supports the spine and not doing heavy lifting that is exhausting for the spine.
  • The diet helps to have healthy bones: eat healthy by consuming vitamins from fruits and vegetables, consume whole grains, obtain protein from dairy products, fish and lean meats, avoid saturated fats and excess sugar.
  • Exercise: Provides two benefits for the spine, pumps blood throughout the body helping healthy bone growth and stimulates a neurochemical reaction in the brain that reduces pain.
  • Vitamins and other supplements: reduce the risk of lumbar degenerative disc disease. Calcium, iron, and zinc help maintain healthy bone structure.

With these preventive measures, you can avoid debilitating symptoms, avoid chronic pain, and even avoid surgery.

However, if the condition worsens, minimally invasive spinal surgical procedures could be the best solution to improve quality of life.

Prognosis of lumbar degenerative disease

The prognosis of degenerative lumbar disc disease depends on the severity of the disease, its precise cause and the interventions used to treat the patient.

When patients respond to conservative treatments, the result can be a complete cure.

Surgical repairs may require post-operative rehabilitation, including physical therapy.