Remember, just because the patient may have degenerative disc disease does not mean they are going to have symptoms of lower back pain. These people had no symptoms. I am always reminded of this when I see older NFL players with horrible looking spines and minimal to no pain.
This leads into the theory of wiring. There are 2 groups of patients with the same problems found on x-rays and MRI. One group has no symptoms and the other may be incapacitated with the same type of degenerative spine. This effect has to do with the sensitivity of the central nervous system and the number of pain receptors present and active in the area of injury. For example, I personally have a degenerative disc at L5-S1 and have virtually no low back pain. Others with the same type of disc on MRI are incapacitated.
I have lousy wiring and am so grateful that my spine is so uneducated. Click to Enlarge Image Diagram of the side view of the disc. Note the high signal white within the disc space arrows indicating good hydration of the nucleus. Disc space is also tall. The white arrow points to the tear in the annulus and there is a small disc herniation at the end of the tear.
Click to Enlarge Image Annular tear with good disc height and hydration. Arrow points to tear of back of annulus.
Note small bulge in back wall. Click to Enlarge Image This is the same patient as in image 4 but one year later. Click to Enlarge Image X-ray lateral of isolated disc resorption. The black arrow points to the significant narrowing of the disc space. Click to Enlarge Image This is a laboratory specimen of a lumbar disc.
The disc was loaded in torsion twisting. Note the tear in the annulus arrows that was induced from the torsion. The tear goes through and through. Click to Enlarge Image This illustration is a top down view of a degenerative bulge in the back of the disc.
You can see some of the fibers are torn and others are stretched out to create the bulge. Click to Enlarge Image This illustration demonstrates the stresses on the back wall of the disc with standing relaxed and with flexion bending forward. With forward bending, the back wall of the disc is stretched. With any significant load lifting , the fibers are tensioned and can tear. Click to Enlarge Image The first picture is looking down at an intact normal disc.
These pictures are of a lumbar spine disc but the cervical spine discs are almost exactly the same. The pink center is the nucleus jelly in the donut and the outer beige area is the annulus donut of jelly donut fame.
You can see the rings of collagen if you look carefully. Behind the disc lie the nerve roots seen in yellow. The facets in the back of the spine are seen in blue.
Click to Enlarge Image The second picture is of an annular tear in the back of the disc arrow. The tear partially goes through the annulus. Note that the jelly pushes into the fibers of the annulus. The back wall of the annulus is full of pain receptors. This jelly is also neurotoxic so exposure of the pain nerves to this substance has an additional inflammation penalty. Click to Enlarge Image The third pictures demonstrates a full through and through tear through the annulus and a disc herniation.
The pressure of the jelly has pushed through the tear and has extruded out the back of the disc. The nerve root is compressed arrow.
Are you suffering from symptoms of lumbar degenerative disc disease DDD? There are two ways to consult with Dr. You can schedule an office consultation that should be covered by your insurance. Please keep reading below for more information on this condition. They all relate to the same area with significantly different presentations.
Of course, lumbar degenerative disc disease can cause or be associated with many other problems such as degenerative spondylolysthesis , herniated disc, degenerative scoliosis and many others. The symptoms discussed here are strictly related to simple DDD of the lower back. Results A total of 95, individuals were included in the analysis. Average age at the time of initial diagnosis was The ratio of focal interventions transforaminal and facet interventions to less selective interlaminar procedures was greater for the specialty of Physical Medicine and Rehabilitation compared to the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery.
The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort.
The concept of minimum clinically important difference MCID is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment.
The exact cause of spondylolysis is unknown, although certain risk factors have been identified. For example, spondylolysis is much more common in individuals participating in sports that require frequent or persistent hyperextension of the lumbar spine.
These sports include gymnastics, diving, wrestling, weight lifting, and football linemen Figure 3 A-C. It is believed that the repetitive trauma can weaken the pars interarticularis and lead to a spondylolysis. Another theory is that genetics plays a role in the development of the pars defects and spondylolisthesis. The diagnosis of spondylolysis is made based on your child's symptoms, physical examination, as well as radiographs x-rays of the spine.
The bone scan can also be useful in differentiating an acute stress reaction spondylolysis from a chronic defect. The most common finding on physical examination is low back pain and pain with extension of the lumbar spine Figure 4. Hamstring tightness is another very common finding in patients with spondylolysis.For acute spondylolysis, the antilordotic brace and physical therapy are usually initiated for weeks. The next most common levels affected by degenerative spondylolisthesis are L3-L4 and L5-S1. The muscles along the neck and back present with severe rigidity upon palpation. Behind the disc lie the nerve roots seen in yellow. Similarly, a fusion is necessary to adequately deal with the mechanical issues of instability in spondylolisthesis.
Degenerative spondylolisthesis usually occurs in people over 60 years of age. The first problem is that the blood supply, for all intensive purposes, disappears from the disc by about the age of eight.
Others with the same type of disc on MRI are incapacitated. We will discuss those demands and offer causes of low back pain and reasons to why lower back problems exist. His doctor has advised surgery, but he is hopeful that acupuncture might reduce his pain enough to avoid surgery. The most common area for spondylolisthesis to occur is within the bottom level of the lumbar spine between L5-S1. Click to Enlarge Image Diagram of the side view of the disc. The bone scan can also be useful in differentiating an acute stress reaction spondylolysis from a chronic defect.
Patient relates his pain to a history of heavy labor, working as a field digger and brick carrier. To say it another way, any injury to the disc is essentially, a permanent injury. The cells lining the outside wall of the annulus attempt to repair the outer defect but are unsuccessful and actually get in the way. The tear goes through and through. When a tear occurs in the annulus of the disc, these pain receptors come in contact with the nucleus of the disc.
Arrow points to tear of back of annulus.
He is unable to walk without support from his wife, and exhibits severe pain when standing up or beginning to walk. Objective To determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.
Most patients will not have neurological symptoms or referred pain to the lower extremity. Nourish Kidney yin, tonify qi and blood, move qi and blood. Treatment options. Treatment for any of the three conditions noted above is pain control, strengthening, endurance and education.
Spondylolysis and spondylolisthesis are the most common causes of structural back pain in children and adolescents. Normally, a spinal fusion surgery of the painful segment is in order. This structure absorbs impact and still allows for motion of the spine.