FAQs on Degenerative Disc Disease (DDD) Treatment in Nashville TN

Intervetebral discs are the quarter-sized cushions that sit between each individual vertebrae of the spine. According to experts, around 90% of people age 60 years and older have degenerative disc disease (DDD). This condition involves three stages: temporary dysfunction, instability, and stabilization.

What is the cause of degenerative disc disease?

Degenerative disc disease begins with progressive fraying and tearing of the outer disc layer (annulus fibrosis) and dehydration of the inner jelly-like material (nucleus pulposus). These disc changes result in a loss of disc height. As the degeneration of discs progresses, load transmission shifts to the posterior spine elements, which causes spinal arthritis, facet joint syndrome, and osteophyte formation. With wear and tear of the spine, the disc dry out and shrink, which can contribute to disc herniation, bulging discs, and/or spinal stenosis.

What are the risk factors for DDD?

  • Advancing age
  • Smoking
  • Family history
  • Chronic vibration (operating a jackhammer or truck driving)
  • Heavy repetitive lifting

What are the symptoms of degenerative disc disease?

The symptoms of DDD vary from person to person. Some people with deteriorated discs have no pain, while others experience intense pain that interferes with activities of daily living. Pain usually begins after a major injury followed by sudden intense pain or it occurs from a trivial injury. The pain will gradually progress and worsen. In addition, you may experience pain in one or both legs and buttocks (sciatica). Many patients with DDD have numbness and/or tingling of the leg and foot.

What are the treatment options for DDD?

The pain associated with DDD is treated based on the patient’s unique pain problem.

  • Medications – The pain specialist can prescribe pain relievers, nonsteroidal anti-inflammatory medications, muscle relaxers, and steroids. Treatment options include:
  • Physical therapy – The goal of physical therapy is to assist patients in returning to full activity as soon as possible. The physical therapist will instruct you on exercises that alleviate pain, as well as proper lifting and walking techniques. Common therapy modalities used are heat/ice therapy, massage, ultrasound, and electrical stimulation.
  • Epidural steroid injection (ESI) – With this minimally invasive procedure, the doctor uses x-ray guidance to insert a needle into the epidural space, which lies between the spinal cord and the epidural tissue. A long-acting steroid is injected into the space. According to researchers, the efficacy rate for ESI is 80-90%.
  • Trigger point injection (TPI) – Trigger points are painful regions of the back and shoulders that twitch in response to pressure. With TPI, the doctor injects an anesthetic into the trigger point, which alleviates pain. TPI success rate is 90%, according to recent clinical studies.
  • Medial branch block (MMB) – The doctor will insert small needles into the facet joints of the spine (near the spinal cord) under x-ray guidance. Once the needles are in place, an anesthetic agent is instilled onto the nerves. In a recent clinical trial, MBB had an 84% success rate, with study participants reporting pain relief at two years follow-up.
  • Spinal decompression therapy – This is a noninvasive approach where a therapist applies gentle decompression to one or more discs using a special table. Distraction force is applied via the table, and a computer controls the force, as it is applied with alternating periods of relaxation.
  • Acupuncture – With this traditional Chinese treatment, the practitioner inserts many tiny needles into the skin and soft tissues of the back. According to a review by the Agency for Healthcare Research and Quality, acupuncture is more effective than placebo for relieving low back pain.

 

Resources

Dhadwal, N, Hangan, MF, Dyo, FM, Zeman, R, & Li, J (2013). Tolerability and efficacy of long-term lidocaine trigger point injections in patients with chronic myofascial pain. International Journal of Physical Medicine and Rehabilitation.

Kuczynski JJ, Schwieterman B, Columber K, et al. (2012). Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Int J Sports Phys Ther, 7(6): 647–662.

Madigan L, Vaccaro AR, Spector LR, & Milam RA (2009). Management of symptomatic lumbar degenerative disk disease. J Am Acad Ortho Surg, 17(2), 102-111.

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and legpain: mechanism of action and efficacy. Spine Journal, 5:191-201

Shim JK, Moon JC, Yoon KB, Kim WO, & Yoon DM (2006). Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med, 31:451-454.

Veizi E & Hayek S (2014). Interventional therapies for chronic low back pain. Neuromodulation, 17(2), 31-45.