The disc provides cushioning between the vertebral bodies and bears much of the load with the facet joints. The disc is made up of a jelly material in the middle called the nucleus pulposus and tough annular fibers surrounding the nucleus. The process of lumbar disc degeneration occurs with age. DDD initially begins with small tears in the annulus which coalesce. Over time discs lose their hydration and proteoglycan content leading to structural changes and their ability to handle mechanical stress. Degeneration most commonly happens in the lowest portion of the lumbar spine L4/5, L5/S1 levels and less often at the L3/4 levels. Degenerative disc disease can start as early as in the teenage years.
SYMPTOMS
Low back pain worse with bending forward. May include pain or sensory symptoms in the legs suggestive of sciatica. Just because lumbar DDD is found on MRI, it may not cause any pain.
DIAGNOSTIC TESTING
Lumbar spine X-rays can identify disc space narrowing, endplate changes and structural deformities such as scoliosis.
Best seen on MRI. MRI images may show disc desiccation, diminished disc height, bulging, annular defects, changes in the endplates of the vertebral body, Ligament changes, and stenosis or narrowing of the spinal canal or the spinal nerve root. Certain features seen on MRI point to more than just age-related changes such as radial tears in the disc, endplate changes and erosion, and bone marrow changes closes to the disc space.
TREATMENTS
Mostly treated non-surgically with anti-inflammatories, muscle relaxers, and Physical therapy. If symptoms are flared up and not responding to conservative measures, an epidural steroid injection (fluoroscopically guided injection of steroid into the lumbar spine) may be helpful.
PROGNOSIS
Most DDD is part of the natural history of aging. It is important to maintain activity and stop smoking.
