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Lumbar Degenerative Disc Disease: What Patients Should Know

Joliet-Pain-ClinicLumbar degenerative disc disease is a common cause of chronic lower back pain. This occurs when a disc weakens, often due to either general wear and tear or a torsional (twisting) injury to the disc space. The result is excessive micro-motion at the corresponding vertebral level because the disc cannot hold the vertebral segment together adequately. This micro- motion, combined with the inflammatory proteins inside the disc that become exposed and irritate the local area, can create lower back pain. There is some confusion over the term “degenerative”, which implies that the symptoms will worsen with age. Although the disc degeneration will likely progress, the symptoms (pain) that result from it typically do not worsen, but in fact usually get better over time. A fully degenerated disc no longer has any inflammatory proteins and usually collapses into a stable

position. While many people over the age of 60 have degenerated discs, it is uncommon for them to suffer from pain caused by this condition. The end stage of the disc degeneration is re-stabilization as the disc stiffens, and this can lead to less pain. It is, however, a process that typically takes many years (as much as 20 to 30 years).

Symptoms
The typical individual with degenerative disc disease is an active and otherwise healthy person who is in his or her thirties or forties.
Common symptoms of lumbar degenerative disc disease:

  • The pain is generally made worse with sitting, since in the seated position the lumbosacral discs are loaded three times more than when standing
  • Certain types of activity will usually worsen the pain, especially bending, lifting and twisting
  • Walking, and even running, may actually feel better than prolonged sitting or standing
  • Patients will generally feel better if they can change positions frequently, and lying down is usually the best position since this relieves stress on the disc space
  • The degree of pain will usually fluctuate and may be quite painful at times (e.g. for a few days, or weeks) and then subside to a more tolerable level

In addition to low back pain, there may be leg pain, numbness and tingling. Even without pressure on the nerve root (a “pinched nerve”), other structures in the back can refer pain down the buttocks and into the legs. The nerves can become sensitized with inflammation from the proteins within the disc space and produce the sensation of numbness/tingling. Generally, the pain does not go below the knee. These sensations, although worrisome and annoying, rarely indicate that there is any ongoing nerve root damage. However, any weakness in the leg muscles is an indicator of some nerve root damage.

Diagnosis
A Magnetic Resonance Imaging (MRI) scan is the best test to determine whether or not there is disc degeneration. However, not all degenerated discs cause pain, so simply seeing the condition on the scan does not necessarily indicate the presence of this condition. Experiencing the above symptoms, in conjunction with findings from a clinical exam and MRI scan, is a good indication that this condition is causing the pain. On occasion a discogram may be required.