Degenerative Spinal Disk

[JOEYZ]

I am posting about this since I was recently told that I have a degenerative disk.

DEGENERATIVE DISK DISEASE

A Quick Overview of the Spine:
Your spine, or backbone, consists of the column of 33 bones and tissue that extends from your skull down to your pelvis. Providing the support of your head and body, your backbone encloses and protects a cylinder of nerve tissues, called the spinal chord. The 33 bones in your spine are called vertebrae (one is called a vertebra). The upper 24 vertebrae join together like links in a chain. In between each vertebra is an intervertebral disk, a band of cartilage that acts as a shock absorber between the vertebrae. When someone has a “slipped disk,” he or she has an intervertebral disc that has slipped out of position, thus causing friction between two vertebrae and extreme pain from nerves being exposed. The lowest nine vertebrae are fused (joined) together in two groups, forming the sacrum and coccyx.

The cervical vertebrae are the seven vertebrae that form the upper part of your spine, between the skull and the chest.

The thoracic vertebrae are the 12 bones between your neck and your lower back. Thoracic vertebrae have cup-shaped surfaces called facets, in which the ribs rest and connect to the spine. These ‘joints’ help the ribs to move up and down during breathing.

The lumbar vertebrae are the five largest and strongest of all vertebrae. They are found in your lower back between the chest and hips. The strong muscles of the back are attached to the lumbar vertebrae.

Your sacrum and coccyx are the bones found at the base of your spine. The triangular sacrum—made up of five vertebrae fused together—supports the spine and connects it to the pelvis. Your coccyx, or tailbone, is formed from four fused vertebrae and has little function.

The vertebral foramen is the hollow part of the vertebrae where the spinal chord (nerve tissues) attaches to your brain and sends signals all over your body.

What is “Lumbar Degenerative Disk Disease?”
For most people with low back pain, an injury doesn't just happen. Instead, over the years, the stress your back has been subjected to begins to take its toll. The repeated sprains and strains and overuse add up and cause a slow degeneration of the disks of the spine.

Most episodes of low back pain are at least partially the result of these degenerative changes. In some cases, an acute injury is the cause for the pain, but even then the overall condition of the lumbar spine is very important since it usually determines how fast you will recover from the injuries and whether you risk the condition becoming chronic.

Degenerative disk disease means wear and tear changes in the disk. Nearly everyone has signs of degeneration of lumbar disks after age 40, although some people show evidence of changes much earlier. Some experience no symptoms of this degenerative process, but others will experience backaches, particularly in their lower backs. And in a few people, the pain can be severe and if nerves are compressed between the disks, there can even be a loss of muscle function.

‘Lumbar Degenerative Disk Disease’ itself is a general term applied to lower back pain that has lasted for more than three months. It's caused by degenerative changes in the intervertebral disks in the lumbar region.

When we're young, these disks are normally soft, and they act as cushions for the vertebrae. The disks have two parts: a thick ring of fibrous tissue around the outside, called the annulus fibrosus, and an inner gelatinous center, called the nucleus pulposus.

As we grow older, the material in these lumbar disks becomes less supple and the disks begin to erode, losing some of their height. As their thickness changes, their ability to act as a cushion lessens. The less dense cushion now alters the position of the vertebrae and the ligaments that connect them. In some cases, the loss of density can even cause the vertebra to shift their positions. This is called segmental instability.

And, as the vertebrae shift and affect the other bones, the nerves can get caught or pinched and muscle spasms can occur.

Causes of Lumbar Degenerative Disk Disease?
Degeneration is common as the disks lose their blood supply after age 30. Their water content also diminishes, predisposing the disks to tears. Degenerative disk disease is a result of the normal aging process. But, it may also occur as a result of trauma, infection, or direct injury to the disk. Heredity and physical fitness may also play a part in the process.

The degeneration process is gradual and the wear and tear on the vertebrae are what causes the deterioration. The disk is subjected to different types of stress as we use our backs each day. The disk generally acts like a shock absorber. Bending over compresses the disk, and may cause it to bulge backwards towards the spinal canal and nerves. Twisting and bending together is perhaps the greatest stress on the parts of the spine - especially the disk.

As the degeneration of the disk progresses the nucleus pulposus loses some of its water content. It becomes stiff and loses the ability to act as a shock absorber. The process may continue until the disk is collapsed. Bone spurs may form as the body's response to this degeneration. It isn't really clear why the body develops bone spurs, but some think it has to do with excess movement at the spinal segment. Eventually, bone spurs form around the nerves of the spine as well.

Symptoms of Lumbar Degenerative Disk Disease?
In lumbar degenerative disk disease, lifting or twisting can aggravate pain. And while most of the pain is felt in the low back, there are cases where it can radiate down the back of one leg. That happens when the sciatic nerve gets involved.

As the vertebrae shift, pinching and irritation of the nerve root can happen and muscles, wanting to stop the painful spinal segment from moving, begin to tighten and spasm. Eventually, the disk can get inflamed and that starts to hurt too.

In the late stages of spinal degeneration, bony spurs from the degenerative process can cause a condition known as spinal stenosis. In this condition, the spinal canal becomes too small and presses on the nerve roots causing pain and nerve dysfunction in the legs. This usually occurs after years of wear and tear on the spine and is much more common in elderly people. Spinal stenosis is usually a term that is used to describe narrowing of the whole spinal canal in the lumbar spine.

Several tests can be used to help diagnose degenerative disk disease. X-rays are the most common.

Usually x-rays are ordered to rule out any fracture or broken bone or infection. But x-rays only show bones, and sometimes it's the tissue around the bones that can give us better clues.

An MRI stands for Magnetic Resonance Imaging. It uses magnetic waves to look at the spine layer by layer. It takes a picture of all the layers - bones and tissues - and lets us see the disks and nerves as well.

A couple of other tests that are sometimes used include the Computer Assisted Tomography or CAT scan and the myelogram.

The CAT scan is similar to the MRI, but pays more attention to the spinal bones themselves.

Then there are also some tests that involve putting either dye or electrodes into the effected area to get a better look at the problem.

In the discogram, dye is injected directly into the disk in the area of the nucleus pulposus. If the injection causes the same back pain you've been experiencing, it is likely that the disk being tested is the one causing the problem .

An electromyogram (EMG) might be used if there seems to be a lot of nerve involvement. Here, small electrodes are inserted into the muscles and the electrical signals given off by the muscles can be analyzed.. Abnormal signals can show if a nerve is irritated or pinched.

A bone scan uses a radioactive chemical injected into your bloodstream. The chemical bonds to places in bones that are undergoing rapid changes and these spots appear as dark areas on the film, helping us determine which area in the spine is causing the problem..

Treatment of Lumbar Degenerative Disk Disease?
Treatment should focus on management of chronic pain. Non-steroidal anti-inflammatory medications (NSAIDs) or other non-narcotics may be used to manage pain. Narcotics should be avoided, however, as the risk of dependency with a chronic pain problem is high. Muscle relaxants may be used, but are generally not prescribed for long-term, chronic back pain.

Physical therapy modalities such as ultrasound, heat, and massage may also help in controlling pain. Some patients have found acupuncture to be of some relief, though no consensus exists in the medical community about the effectiveness of such a treatment.

Initial treatment may require a short portion of bed rest, but a return to activity should be encouraged as soon as possible. The temptation may be to limit physical activity with relation to the back. On the contrary, physical activity should actually be increased, as overall physical fitness will improve the condition of the back. An exercise program should be implemented in order to build up the muscle strength in the back and abdominal muscles. Weight should also be adequately managed, as increased weight on the back causes stress on the vertebrae and only exacerbates the condition.

More severe cases that do not respond to conservative treatment may require more aggressive courses. Chemonucleolysis, a procedure in which an enzyme is injected into the affected area to dissolve the extruded disk material, has been found helpful in some cases. Similarly, surgical treatment, in which either the lamina (a portion of the vertebra) is removed, or the affected disk is removed, may be helpful in some cases.

If spinal stenosis is the culprit, you may need a surgical procedure called a laminectomy. The lamina is the back part of your spine and the part that acts as a roof over the spinal column. In a laminectomy, the lamina is removed to give the nerves more room and reduce the inflammation along the nerves. And while the lamina will not grow back, scar tissue will develop in its place and act to protects the spinal nerves.

In the most severe cases of lumbar degenerative disk disease, surgical fusion may be required in order to maintain adequate distance between the vertebrae and to increase the stability of the spine. If your back problem is caused by segmental instability, a spinal fusion may be needed. But, this should never be your first course of action.

During a spinal fusion, a bone graft - most often from your pelvic bones - is put between two or more vertebrae, which causes the vertebrae to fuse or grow together. The goal of a spinal fusion is to stop the motion between two vertebra that comes from the segmental instability.

There are two general types of spinal fusions. The first is called posterior fusion and the other is interbody fusion. Each type is of the sort of surgery called open - where an incision is made to expose the affected area. Each type also has very low complication rates and about 90% of the patients experience pain relief. Some though complain of back pain and fatigue, which is a result of muscle loss from the operation.

In the posterior fusion, the bone graft is placed on the backside of the vertebrae. This fuses the vertebrae by creating a solid chink of bone. The interbody fusion places the bone graft between the vertebrae, where the disk has been removed. It too acts to fuse the vertebrae. Each method eases pain and reduces the likelihood of pinching any nerves.

While various techniques are used to do a spinal fusion, one that has gained much recent attention is the laparoscopic approach because it invades the body less. Only a small incision is made and the hospital stay is often only two days compared to the 4 or more for the traditional techniques. A return to work can even occur in as little as 3 weeks depending on physically demanding your job is. On the other hand, if open surgery is used, the return to work can be anywhere from 3 to 6 months.

If open surgery is used, the patient will be remain in the hospital for several days and learn how to move properly, how to change positions, sit, stand, and walk. Pain medication will be given the first few days to minimize discomfort and a urinary catheter may be used. In some cases, the patient will wear a back brace for a while after surgery.

Possible Complications of Spinal Fusion?
There are always risks involved in any surgery. They can be minimized, but they are always present. They include:

Complications with the anesthesia, including respiratory or cardiac malfunction.
Infection.
Neurovascular damage.
If surgery is needed for your lumbar degenerative disk disease, you should carefully consider these risks along with the possible advantages of the surgery, and weigh them carefully.

[powerlifter]

Nice post Bro - sorry to hear about your disk though

[Naughty Nurse]

Yeah, sorry to hear about that.

Hmmm what about mega dose of Glucosamine Chondroitin & MSM & some jintropin? It's worth a shot.

[Naughty Nurse]

Hey Joeyz....what about those inversion tables?

[JOEYZ]

Originally Posted by Naughty Nurse

Hey Joeyz....what about those inversion tables?

What ??????

[Nemo9]

Joeyz,

I've got a similar problem: cervical disk herniation. An inversion table turns you upside down and allows the spine to decompress. The theory is that it allows more fluid to flow into the disks, helping recovery and reducing pain. Some people swear by them, and others don't.

Basically, you've got to avoid things that inflame the nerve (if you are getting nerve compression). Otherwise you'll be in pain and you'll lose muscle strength. Any lifting that puts pressure through the part of the back that is troubling you needs to be watched so you don't overdo it. I find that you can choose lifts that are less stressful on that spot, you just need to experiment.

Apart from painkillers, I don't know if there are any medicines that will help. I take glucosamine for other stuff but I don't think it helps that much. You can take prednisone but only for a short period as it is quite toxic. It reduces inflammation. You could also get an epidural if the pain is not tolerable. Everyone says to avoid back surgery at all costs and I've seen studies that question whether it is a superior treatment to just letting nature take its course.

You may need to figure out whether heavy lifting is compatible with this condition. I'm not a bodybuilder so, while I lift reasonable amounts, I can always stop when it hurts.

[JOEYZ]

I was thinking Tables, as in tables that you read or look at in a book. The problem with mine is that I dont think it is compressed. Although conventional X-ray's dont show disks as well as CT scans do, you could see well enough to judge that the disk wasnt bulging on either side like it does when it is compressed. I have taken prednisone off and on my whole life, so this might contribute to it. As far as working out, he pretty much told me that my heavy back days are over as well as heavy squats. The disk thing kinda sucks because it wont heal like the broken vertabrae will. He told me that I will probably have pain from the disk and the vertabrae for the rest of my life.

Originally Posted by Nemo9

Joeyz,

I've got a similar problem: cervical disk herniation. An inversion table turns you upside down and allows the spine to decompress. The theory is that it allows more fluid to flow into the disks, helping recovery and reducing pain. Some people swear by them, and others don't.

Basically, you've got to avoid things that inflame the nerve (if you are getting nerve compression). Otherwise you'll be in pain and you'll lose muscle strength. Any lifting that puts pressure through the part of the back that is troubling you needs to be watched so you don't overdo it. I find that you can choose lifts that are less stressful on that spot, you just need to experiment.

Apart from painkillers, I don't know if there are any medicines that will help. I take glucosamine for other stuff but I don't think it helps that much. You can take prednisone but only for a short period as it is quite toxic. It reduces inflammation. You could also get an epidural if the pain is not tolerable. Everyone says to avoid back surgery at all costs and I've seen studies that question whether it is a superior treatment to just letting nature take its course.

You may need to figure out whether heavy lifting is compatible with this condition. I'm not a bodybuilder so, while I lift reasonable amounts, I can always stop when it hurts.

[Naughty Nurse]

Joeyz, apparently even ppl who don't have compression can benefit...I've heard wonderful things, and in fact my husband badly wants one....he does have back problems...so I think I'm getting one for xmas. It's also supposed to help with circulation in general....and be beneficial for all your organs. I hear you get real "regular" with them too! lol