The intervertebral discs act as a kind of cushion between the vertebrae of the spine. Among other things, they absorb the impact that puts daily strain on the spine.
Inside, the intervertebral discs contain a gel-like nucleus that loses moisture and elasticity over the decades. This process of wear and tear is known as intervertebral disc degeneration. The intervertebral discs in the cervical spine (C-spine) and lumbar spine (L-spine) are particularly prone to wear and tear. In most cases, the only option is symptomatic pain management; however, surgery may be necessary in some instances.
Disc Degeneration—What Degenerated Discs Mean, How Back Pain Develops, and When Conservative or Surgical Treatments Are Appropriate for the Cervical and Lumbar Spines
Natural aging is the main cause of disc degeneration. As we age, the intervertebral discs lose their ability to retain water. As a result, they lose elasticity and flatten out. This can also lead to tears in the disc.
However, various risk factors can further contribute to the process of intervertebral disc degeneration, such as
Equally harmful is prolonged pressure on the spine, for example, when lifting heavy loads or carrying heavy objects incorrectly.
In most cases, degenerative disc disease progresses gradually, so that no symptoms are present at first. Depending on the location and extent of disc degeneration, a wide variety of symptoms may develop as the condition progresses.
In most cases, degenerative disc disease causes pain that can radiate into the abdomen or chest. In addition, pain often occurs when coughing, sneezing, or straining. A very common progression of disc degeneration is a herniated disc. In this condition, part of the gel-like nucleus of an intervertebral disc protrudes from the intervertebral space and presses on the nerve roots. Doctors refer to this as a “protrusion,” or a bulging of the affected disc.
As a result, in addition to pain, mood swings may also occur. The patient often adopts a protective posture due to the pain. This can lead to restricted movement and improper weight-bearing, which in turn can damage other joints.
Depending on the extent of the disc degeneration, nerves and blood vessels may sometimes be affected. This can result in
.
A lumbar herniated disc is a possible consequence of disc degeneration © Henrie | AdobeStock
A review of the patient’s pain history is usually followed by a physical examination by an orthopedic surgeon. In cases of sensory disturbances, it may be necessary to consult a neurologist.
If a herniated disc is suspected, for example, imaging is necessary. An X-ray shows the structure of the vertebral bodies. The physician can indirectly detect changes in the intervertebral discs based on the spacing between the vertebrae.
Magnetic resonance imaging (MRI) visualizes the soft tissue components involved in disc degeneration. These include, for example, the intervertebral disc itself, adjacent nerves and blood vessels, as well as a detailed view of the spinal canal.
Damage to the intervertebral discs cannot be repaired using conventional methods. Therefore, treatment for intervertebral disc degeneration is limited to pain management.
However, this is by no means limited to simply taking pain medication. Pain management aims to prevent the progression of the disease through behavioral changes, physical therapy, and rehabilitation exercises. However, this conventional treatment cannot always alleviate the symptoms. In such cases, as well as when pain becomes chronic, spinal disc surgery may be considered. Surgery is always the last resort, though, when nothing else helps.
Spinal surgery is also necessary for a lumbar herniated disc (prolapse), which occurs primarily at a younger age—between the ages of 30 and 50.
The surgery then offers two different ways to treat the symptoms:
- Replacing the intervertebral disc with a disc prosthesis, and
- fusion of the adjacent vertebrae, in which the intervertebral disc is removed (spondylodesis).
Disc Replacement
A disc prosthesis is primarily used to prevent spinal fusion. This allows the patient to retain a certain degree of mobility.
Today, disc replacement surgery can be performed using minimally invasive techniques, so no large incisions are necessary.
During the procedure, an artificial intervertebral disc is implanted in place of the body’s natural disc. Its material properties mimic the function of the natural disc. However, this does not restore 100% of the natural range of motion.
Furthermore, without a change in lifestyle, there remains a residual risk that
- the artificial disc will shift or
- further disc degeneration occurs elsewhere in the spine.
Advantages of microsurgery for intervertebral disc replacement include, for example:
- Small incisions for access (1.5–2 cm),
- good surgical outcomes,
- only a low risk of infection,
- low complication rates,
- faster mobilization of patients after surgery.
A drawback is that the patient must continue to take measures to prevent infection and thrombosis for some time after surgery. This is done to prevent complications caused by pathogens or circulatory disorders.
Surgery in advanced cases cannot restore the spine’s natural mobility, even with disc replacement. However, for patients with chronic back pain resulting from degenerative disc disease, it can improve their quality of life. In 75–90% of cases, surgery results in a reduction of symptoms or even complete relief.
Be sure to maintain a healthy weight. This helps prevent disc damage and can slow the progression of existing disc degeneration. Being overweight and a lack of physical activity, on the other hand, promote disc degeneration.
In addition, low-impact sports such as
- swimming,
- cycling, or
- Nordic walking
are ideal for becoming a bit more active again and relieving some of the everyday strain on your back.
An orthopedic surgeon is the right person to consult for the treatment of degenerative disc disease.
In cases of severe disc degeneration, a herniated disc, or compromised nerves and blood vessels, a neurologist may also be consulted.
Disc degeneration encompasses various forms of disc degeneration in which degenerative and wear-and-tear-related changes in the disc tissue occur as part of the normal aging process; genetic factors, mechanical stress, excessive or improper loading, poor posture, and wear-and-tear processes are considered possible causes of intervertebral disc degeneration.
As a result, the annulus—or annulus fibrosus—loses its elasticity, small tears develop, the intervertebral disc tissue becomes cracked, the water content decreases, intervertebral disc cells undergo changes, the nucleus pulposus shifts, and a disc protrusion, prolapse, or herniation may develop, which increases the likelihood of a subsequent disc herniation.
If a herniated disc occurs, it can acutely lead to a herniated disc with narrowing of the vertebral canal or spinal canal, causing nerve roots to become irritated due to compression, which can result in leg pain, sensory disturbances, or, in severe cases, even paralysis—particularly in patients with a herniated disc.
The cervical spine, the lumbar spine, and the thoracic spine are frequently affected, as the vertebrae, vertebral bodies, facet joints, the ligamentum flavum, and bony structures are subjected to additional stress due to osteoarthritis, spondyloarthrosis, scoliosis, or other degenerative changes.
Diagnosis relies primarily on imaging techniques to reliably identify degenerated intervertebral discs, reduced elasticity, damaged structures, narrowing, or wear-and-tear-related changes, and to determine whether conservative or surgical treatment is appropriate.
Conservative treatment—including pain management, injections, strengthening of the back muscles, reduction of muscle tension, and maintenance of mobility—can alleviate symptoms and relieve pain as long as there is no advanced degenerative process or a herniated disc.
If surgery is necessary, depending on the findings, minimally invasive surgical procedures, a disc prosthesis or artificial disc, artificial discs, or—as a last resort—spinal fusion (spondylodesis) may be used to stabilize the spine, particularly in cases of herniated discs, herniated discs, or severe changes to the intervertebral discs and surrounding tissue are present.
What is disc degeneration?
Intervertebral disc degeneration refers to a degenerative wear-and-tear process of the intervertebral disc in which the disc’s water content, elasticity, and load-bearing capacity decrease. It is part of the normal aging process but can be accelerated by mechanical stress or poor posture.
What symptoms does disc degeneration cause?
Typical symptoms include back pain, muscle tension, and limited mobility of the spine. In advanced cases of degeneration, sensory disturbances or leg pain may occur, especially when nerve roots are affected by compression within the spinal canal.
How does intervertebral disc degeneration differ from a herniated disc?
Disc degeneration is the structural basis from which a herniated disc can later develop. While degeneration initially weakens the annulus fibrosus, a herniation results in the protrusion of disc tissue.
How is degenerative disc disease diagnosed?
Diagnosis is typically made using MRI, as this imaging modality clearly shows degenerated intervertebral discs, small tears in the annulus, and changes in the nucleus pulposus. A clinical examination and medical history are also conducted.
How is intervertebral disc degeneration treated?
In most cases, treatment is conservative, such as physical therapy, pain management, injections, and targeted strengthening of the back muscles. Surgical procedures, such as intervertebral disc replacement or spondylodesis, are used only for severe, treatment-resistant symptoms.
