Osteoarthritis in lumbar discs
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The vertebrae are bony building blocks that make up the spine.
Between each of the vertebrae are rubbery discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), twelve vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae).
Vertebrae are "stacked" together to provide a movable support structure while also protecting the spinal cord (nerve tissue that extends down the spinal column from the brain) from injury. Each vertebrae has a spinous process, which is a bony prominence behind the spinal cord that also shields the cord. In addition to protection for the spinal cord, the vertebrae provide a weight-bearing function.
The discs are pads that serve as "cushions" between each vertebral body which minimize the impact of movement on the spine. Each disc is like a jelly donut with a central soft component (nucleus pulposus). The nucleus pulposus can rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that attach bones to bones. Ligaments attach to each of the vertebrae and surround each disc. When ligaments are injured as the disc degenerates, pain can result.
Degenerative disc disease refers to a situation in which a painful disc causes chronic low back pain. The condition generally starts with a twisting injury to the disc space. The injury weakens the disc and creates excessive motion at the vertebral level because the disc ligaments and other structures cannot hold the vertebral segment together properly. Local inflammation promoted by cytokine production causes pain.
The disc does not have a blood supply and cannot heal itself. Thus, the painful symptoms of degenerative disc disease become chronic.
Not all disc degeneration causes pain. Disc degeneration is considered part of the natural process of aging and does not necessarily lead to low back pain. MRI scans have documented that roughly 30% of 30 year olds have signs of disc degeneration on MRI scans even though they have no back pain symptoms. It must be stressed that not all degenerated discs that are seen on MRI scans generate pain.
As the population ages, it is even more common for individuals to have signs of disc degeneration without accompanying pain. By the time an individual reaches 60 years of age, disc degeneration is an expected finding on an MRI scan.
For most people, degenerative disc disease can be successfully treated with conservative care. Most patients will experience low-grade continuous but tolerable pain that will occasionally flare (intensify). The frequency and intensity of the flares can be managed with an exercise program that consists of:
• hamstring stretching
• dynamic lumbar stabilization exercises
• low-impact aerobic conditioning
Non-prescription medications, such as NSAID's and acetaminophen, may be helpful in alleviating low back pain, and stronger therapies, such as oral steroids or epidurals, may be prescribed to treat flares.
For patients who are unable to function because of the pain, or who have progressive neurologic deficit, lumbar spinal fusion surgery is an option. Fusion surgery works because it stops the motion at a painful motion segment.
A one-level fusion does not significantly change the mechanics in the back, and a two-level fusion may also be considered for patients with severe, disabling pain. The problem is that fusion surgery places increased stress on the lumbar segments above and below the fusion leading to eventual instability in those areas.
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