Many of the problems in the spine are caused because of the process of degeneration of the intervertebral disc.
Everything you do during the day - once you stand upright - begins to test the spine's ability to support your body weight. Over time, these repeated daily stresses and minor injuries can add up and begin to affect the discs in your spine. Minor injuries to the disc may occur and not cause pain at the time of the injury. However, as they add up, the disc eventually begins to suffer from the wear and tear - it begins to degenerate.
With degenerative disc disease, the main problem lies within one or more of the intervertebral discs. There is a disc between each of the vertebra in your spine. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement. The discs are similar to shock absorbers. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses, or provide the movement needed to bend and twist. Bones cannot sustain high stress repeatedly without being damaged. Much of the mechanical stress of everyday movements is transferred to the discs.
A healthy intervertebral disc has a great deal of water in the nucleus pulposus - the center portion of the disc. The water content gives the nucleus a spongy quality and allows it to absorb spinal stress. Excessive pressure or injuries to the disc can cause the injury to the annulus - the outer ring of tough ligament material that holds the vertebrae together. Generally, the annulus is the first portion of the disc that seems to be injured. Small tears show up as in the ligament material of the annulus. These tears heal by scar tissue. The scar tissue is not as strong as normal ligament tissue. Over time, as more scar tissue forms, the annulus becomes weaker. Eventually this can lead to damage of the nucleus pulposus. The nucleus begins to lose its water content due to the damage - it begins to dry up.
Because of water loss, the discs lose some of their ability to act as a cushion. This can lead to even more stress on the annulus and still more tears as the cycle repeats itself. As the nucleus loses its water content it collapses, allowing the two vertebrae above and below to move closer to one another. This results in a narrowing of the disc space between the two vertebrae. As this shift occurs, the facet joints located at the back of the spine are forced to shift. This shift changes the way the facet joints work together and can cause problems in the facet joints as well.
Bone spurs, sometimes called osteophytes, may begin to form around the disc space. These bones spurs can also form around the facet joints. This is thought to be due to the body's response to try to stop the excess motion at the spinal segment. The bone spurs can become a problem if they start to grow into the spinal canal and press into your spinal cord and nerves. This condition is called spinal stenosis.
The most common early symptom of degenerative disc disease is usually pain in the back that spreads to the buttocks and upper thighs. When back specialists refer to degenerative disc disease, they are usually referring to a combination of problems in the spine that "start" with damage to the disc, but eventually begin to affect all parts of the spine.
Discogenic pain is a term back specialists use when referring to pain caused by a damaged intervertebral disc. A degenerating disc may cause pain of the mechanical type. As the disc begins to degenerate, there is some evidence that the disc itself becomes painful. Movements that place stress on the disc can result in back pain that appears to come from the disc. This is similar to any other body part that is injured, such as a broken bone, or even a cut in the skin. When these types of injuries are held still there is no pain. However, if you move a broken bone, or the skin around a cut, it causes pain.
Discogenic pain usually causes pain felt in the lower back. It may also feel like the pain is coming from your buttock areas and even down into the upper thighs. The experience of feeling pain in an area away from the real spot causing the pain is common in many areas of the body, not just the spine. Examples include: a person who has gallstones may feel the pain in their shoulder; or a person experiencing a heart attack may feel pain in the left arm. This is referred to as radiation of the pain. It is very common for pain produced by spine problems, such as disc problems, to be felt in different areas of the body, including the back itself.
Bulging discs are fairly common in both young adults and older people. They are not cause for panic. In fact, abnormalities that show up on MRIs, such as bulging or protruding discs, are seen at high rates in patients both with and without back pain. Most likely, some discs begin to bulge as a part of both the aging process, and the degeneration process of the intervertebral disc. A bulging disc is not necessarily a sign that anything serious is happening to your spine.
A bulging disc becomes important when it bulges enough to cause narrowing of the spinal canal. If there are bone spurs present on the facet joints behind the bulging disc, the combination may cause narrowing of the spinal canal in that area. This is sometimes referred to as segmental spinal stenosis.
Before a health care professional can diagnose your condition and design a treatment plan, a complete history and physical examination are necessary. There are so many possible internal causes of pain; it is important to determine what is and is not the root of the problem. After the physician has a better idea of what is causing your discomfort, diagnostic tests of some sort may be recommended.
First, you will be asked for a complete physical history of your condition. This may begin by filling out a written form that asks you a number of questions relating to your pain. The more information you share with your provider, the easier your problem will be to diagnose. Your physical history is important because it helps your doctor understand: when the pain began, anything that could have caused an injury, your lifestyle, physical factors that might be causing the pain, and any family history of similar problems. After reading through your written history, your physician will ask more questions that relate to the information you have given.
Some typical questions include:
After taking your history, the doctor will give you a physical examination. This allows the doctor to rule out possible causes of pain and try to determine the source of your problem. The areas of your body that will be examined depend upon where you are experiencing pain - neck, lower back, arms, legs, etc. The following are some of the things that are checked in a typical exam:
Weakness - Your muscles will be tested for strength. You might be asked to try to push or lift your arm, hand, or leg when light resistance is put against them.
Pain - The doctor may try to determine if you have tenderness of certain areas.
Sensory Changes - Can you feel certain sensations in specific areas of the feet or hands?
Reflex Changes - Your tendon reflexes might be tested, such as under the kneecap and under the Achilles tendon on your ankle.
Motor Skills - You might be asked to do a toe or heel walk.
Special Signs - The physician will also check for any "red flags" that could indicate something other than spinal/vertebrae problems. Some signs of other problems include: tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss.
On your first visit to a back specialist, the initial decision that must be made is exactly how serious the problem is. Some problems need immediate attention - possibly even surgery. However, the vast majority of back problems do not require surgery. Once the most likely cause of your problem has been determined (your diagnosis has been made), you and your health care provider can decide on a treatment plan.
A variety of treatment options exist for different types of back pain. In most cases, simple therapies such as mild pain medications and rest are effective in relieving the immediate pain. The overall goal of treatment is: to make you comfortable as quickly as possible, to design a program to reduce further degeneration, and to get you back to normal activity in a timely manner. The more you know about how your back works and what you can do to prevent further injury, the more effective your program will be.