By Mariam Ghobriel-Sawiris, MD – Liberty Pain Center, Freehold
The vertebral column (backbone) is made up of 33 vertebrae. These vertebrae are then grouped into divisions called the cervical (neck), thoracic (upper back), and lumbar (lower back). A fibrous disc (intervertebral disc) connects each pair of the vertebrae. Healthy spines have discs that cushion the vertebrae allowing for normal flexibility and movement of the spine.
Degenerative Disc Disease (DDD) is the weakening of one or more of these intervertebral discs. Unfortunately, the condition develops as a natural part of the aging process. These discs between the bones of the spine are made up of cartilage, fibrous tissue, and water. With age, the discs weaken, flatten, bulge, or break down. Sometimes there may be a genetic component in some individuals who suffer from DDD, but the true cause can be a combination of things, but usually it’s simple “wear and tear” or the result of an injury.
Degenerative Disc Disease in the lower back, or lumbar spine, occurs when a disc is compromised and causes pain. The disc itself does not have a blood supply, so if an injury occurs it is unable to repair itself the way other tissues in the body can. DDD is so common that an estimated 30% of individuals ages 30-50 years old have some degree of disc space degeneration. Many may not ever even experience pain or have it diagnosed. After a person reaches the age of 60, some level of disc degeneration is considered normal and nothing to be alarmed about.
Symptoms
Symptoms vary with each individual depending on the location and the type of disc degeneration. However, a primary symptom of the disease includes sharp and/or chronic pain in the back and neck.
Other signs are weakness or numbness. As a disc undergoes change, the body may react and develop bone spurs as well. These bony growths may take up space, therefore compressing the nerves, and causing weakness in the arms and/or legs.
Tests
If a patient presents any of the above symptoms, their doctor may order X-rays, an MRI (Magnetic Resonance Imaging), or a CT (Computed Tomography) scan.
Treatment
The severity of the condition will determine the best approach for treatment before considering surgery. Nonoperative measures may include: heat and/or ice therapy, activity modification, medications, physical therapy to strengthen the muscles. These measures are often effective in providing pain relief in mild to moderate cases.
Minimally invasive Epidural injections are used for the treatment of pain that does not respond to the above measures. Injections are performed using an x-ray machine called fluoroscope to visualize the site of injection precisely and insure accurate placement. A steroid is injected to relieve the inflammation and help the body heal. It usually takes under 15 minutes to perform and patients can go about their day uninterrupted once the procedure is done. There is no down time and it is not always necessary to take days off from work to undergo the injections. All injections are same day procedures.
Surgery such as a discectomy, may be required for those patients not responding to any of the nonoperative measures, whose disc changes have resulted in spinal cord compression, who have a structural abnormality, or those who have such severe chronic pain. Surgery is reserved for cases which fail injection therapy.
Mariam Ghobriel-Sawiris, MD has received extensive training in Pain Management. She is board certified in Pain Management and Anesthesiology. She is the chair of the Pain Management Division at Centrastate Medical Center. She has been practicing Pain Management in the Monmouth county area for over 10 years. Liberty Pain Center is located 800 West Main St., Suite 111, Freehold, NJ 07728. To schedule an appointment, please call (732) 303-0102.
