Degenerative disc disease is a pathology involving the spinal column. Associated, due to some common features, with low back pain, this disease specifically affects the discs of the spinal column, the degeneration of which can lead to considerable physical discomfort

The symptoms of degenerative disc disease are due to a loss of thickness or discs in the spine

The most common symptom of this pathology is an unpleasant sensation of pain, which, however, may also not be felt.

In the case of symptomatic individuals, the reason why so much pain is felt is simple: the vertebral discs function as shock absorbers and help absorb microtraumas in the spinal column.

The lack or thinning of these anatomical structures means that there is less cushioning and thus, in the long run, painful injuries.

This pathology affects many people and can be caused by many factors, which is why it is not easy to give precise numbers.

Certainly older people are more likely to suffer from degenerative disc disease

With increasing age, in fact, the vertebral discs may lose elasticity and may decrease in thickness, causing the severe pain and other symptoms typical of the condition.

A factor on which, unfortunately, no action can be taken.

Today, there are various treatments for degenerative disc disease, and it is also easier to diagnose thanks to various tests available to doctors.

The main symptom of degenerative disc disease is severe pain.

However, several people who suffer from this condition, in a mild form, do not have any symptoms.

This occurs when areas of the spinal column that do not have to respond to particular strain are affected.

The symptoms of degenerative disc disease occur when the thinning of the vertebral discs is significant or when it is not so significant but affects areas of the spine that are essential for supporting the body.

Among the most common symptoms that can accompany pain are:

• tingling in the legs and arms
• radiating pain in the thighs, buttocks, neck and boxes;
• twinges or pain when performing certain movements, such as getting up and down, bending or turning;
• difficulty walking.

Causes

To understand the causes of degenerative disc disease, it is good to briefly present the anatomy of the intervertebral discs.

These are composed of 90 per cent water, particularly in young and middle-aged individuals.

When the water component decreases, this can cause degeneration of the disc and the resulting thinning makes its work as a shock absorber much more complex.

If the function of this component is diminished, pain can occur.

The ageing process is the main cause of degenerative disc disease, because advancing age leads to a loss of water and various changes in the spinal column.

Other risk factors include:

• trauma or sports injuries
• genetic or cardiovascular diseases;
• overweight;
• sedentary lifestyle with little physical activity;
• infectious diseases;

Complications

The clinical situation may worsen due to the appearance of various complications related to the pathology.

The pain may become suddenly acute following various movements affecting the spinal column such as bending, turning or lifting weights.

The main complications of degenerative disc disease are two:

• Disc bulging: crushing of the disc, the elements of which compress the spinal cord. This can lead to the inability to perform even the simplest daily activities, such as taking the stairs.
• Herniated disc: complete discharge of the nucleus pulposus of the intervertebral disc compressing the spinal cord present at the level of the spinal canal. This can lead to neurological symptoms with sensory-motor deficits in the limbs.

Diagnosis

The first step in diagnosing degenerative discopathy involves the collection of a thorough anamnesis by the general practitioner or orthopaedist.

During the interview, the different aspects of the symptoms are investigated.

Perceived pain characteristics are crucial in directing the doctor’s suspicion towards discopathy.

Any previous illnesses or family history of discopathy are also the subject of the interview.

Lifestyle is thoroughly investigated, as there may be several factors contributing to the onset of the condition.

Secondly, an MRI is likely to be prescribed, which is the most sensitive method of investigating pathologies involving the soft tissues of the spine.

Thanks to this diagnostic test, it is possible to obtain very specific information on the health of the spinal column and intervertebral discs.

Thanks to this test, it is possible to confirm the diagnostic suspicion and exclude the presence of other pathologies that could cause a similar symptomatology.

In more complex cases, it may be necessary to call in a neurologist to perform electromyography, a test that evaluates the ability of nerve structures to conduct electrical impulses.

Prevention

It is not easy to prevent degenerative disc disease as the main risk factor is old age.

The reduction of the hydric component of the disc and the resulting reduced elasticity predispose to the disease.

It is possible, however, to intervene in the patient’s behaviour, encouraging him/her to avoid certain attitudes that could worsen the condition.

These preventive elements include

• avoiding an unhealthy diet
• proper exercise and sporting activity;
• avoiding stress;
• avoiding obesity;
• taking great care when lifting weights.

Therapy

Treatments for degenerative disc disease are primarily aimed at pain control and management.

For example, specific physical exercises can lead to an increase in muscle mass, which can help support body weight, without it affecting the vertebrae.

Conservative therapies include:

• administration of medication, such as anti-inflammatory drugs to immediately reduce pain, e.g. NSAIDs;
• if the pain is not controlled, corticosteroid drugs can be used. These are only prescribed in the most severe cases, as they have several contraindications and possible side effects, first and foremost immunodeficiency. Despite this, they are able to perform an important analgesic action;
• specific motor activity, i.e. postural education and physiotherapy, is essential. This strengthens the muscles around the spine, making the trunk stronger and more flexible. In this way, the spinal column is supported correctly;
• a change in lifestyle, especially for those who live a sedentary lifestyle, do not exercise and follow incorrect diets.

Surgery

In addition to conservative remedies, there are treatment options involving surgery.

These interventions are reserved for serious cases that cannot be effectively treated with conservative intervention or that have complications that could permanently compromise the patient’s clinical condition in the long run.

These include:

• dynamic stabilisation, a low-invasive operation that consists of the insertion of a spacer that can also be removed later;
• discoplasty, which is the reconstruction of the vertebral disc through the application of specific prostheses that ensure the maintenance of quality of movement and flexibility;
• spinal fusion surgery, which is a type of surgery involving the fusion of two or more adjacent vertebrae. This treatment, which is effective in controlling pain, reduces the patient’s ability to move.

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