Degenerative disc disease is a process that, in a global sense, explains what causes 98% of neck and back pain. Here is how. And this is the natural history of the human spine, so this is relevant to all humans.
The spinal disc is a soft tissue, made up of two components, that exists between the vertebral bones. Imagine a jelly donut with jelly on the inside, and very tough fibrous connective tissue rings that encircle and contain the jelly. The discs are subjected to lots of physical/mechanical stress from bending, twisting, loading, lifting, carrying, sitting, standing, and all the other physical activities and postures we impose upon them from our activities.
These outer fibers for the disc have physical limitations and, over a lifetime, micro-tears occur, weakening the outer fibers and permitting the inner component to push out, bulge, or herniate from their proper confines. The inner fibers do not have a nerve supply so injuries to the inner fibers are not painful. But the outer fibers do a sensory nerves so they will cause pain when they are injured. Usually, injuries to the disc will be short-lived, heal to a partial degree, and become painless again. Sometimes, however, the pain will persist for weeks, months, or years, and require medical treatment.
As the spinal disc ages, it accumulates these tears, heals imperfectly, even if you feel fine, and slowly becomes more vulnerable to future injuries. As the micro-tears accumulate, the inner part, called the nucleus pulposus, loses water content and degenerates on a microscopic basis, with the accumulation of degenerative molecules that evince the process. In addition to the microscopic changes, eventually macroscopic or gross changes occur to the disc which we can see on MRI scans and x-rays.
Spine specialists, such as myself, have seen hundreds of thousands of spine images that demonstrate this process. Usually, when we read the images we are asking ourselves several questions. Is there anything dangerous such as cancer? Are there any congenital or development anomalies that contribute to, or cause the pain? Is the amount of degenerative changes that we see, average for the person’s age, or more, or less, than average? Do we see a probably explanation for the pain? Can we treat this problem conservatively, or does it require surgery?
The next step in disc degeneration, after the microscopic tears and loss of water/hydration of the inner part of the disc, is a slowly, progressive, collapse of the disc. This is analogous to a tire losing air, but it is a disc losing water. As the disc collapses, it doesn’t cushion the bones as well. That results in more pressure on the bones, which results in the bones and ligaments becoming enlarged, which makes the space for the spinal cord and nerves smaller. This can result in acute or chronic, persisting pinching of the cord and nerves.
The human spine is remarkably resilient in terms of enduring degeneration, and not being in as much pain as you might expect, based upon the, sometimes, severely abnormal appearance of the bones and ligaments. But it is common for people to need some treatment interventions for spinal pain during the course of their lives.
The various treatments for this degenerative process are other topics to be addressed on this website. If you are looking for the best treatment for this problem, from the most qualified, non-surgical provider, but who is knowledgeable about surgery and when that is appropriate, call me at 404-558-4015. I would love to be able to help you.
