Lumbar Degenerative Disc Disease - DDD

At the San Diego Center for Spinal Disorders (SDCSD) we see patients with all types of spinal problems. One of the most common disorders we encounter among our adult patients is lumbar degenerative disc disease (DDD). It is a condition that our team of spine experts is experienced with diagnosing and successfully treating.

Symptoms of Lumbar DDD
Intervertebral discs serve as shock absorbers for the spine. As we age the discs begin to dry out, losing strength and resiliency. These changes are gradual in most people. In fact, many of our patients don't know they have degenerative disc disease. They only become aware of the condition when being examined for another health problem.

Disc degeneration in itself is not usually a problem; it is a normal aging process. However, DDD can cause the discs to lose height, resulting in nerve pathways narrowing and causing nerve impingement, inflammation, and pain. In severe cases, this neurogenic pain (i.e. pain that originates from the nervous system) may be constant. DDD may also cause mechanical pain, which results from the degeneration of the disc (the "shock absorber") leading to bones in the spine pressing against each other.

Diagnosing Lumbar DDD
The physicians here SDCSD care about your health, and thus put immense emphasis on getting the correct diagnosis. It is important to distinguish between DDD that is part of the aging spine, and DDD requiring treatment. To make an accurate diagnosis, we will use a combination of tools and sophisticated technology:

• Medical history. We will talk to you about your symptoms, their severity, and the treatments you have already tried.
• Physical examination. You will be carefully examined by one of our spine specialists for limitation of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
• Diagnostic tests. Generally, we start with x-rays, which allow us to rule out other problems such as tumors and infections. An MRI may be taken to enable the physicians to assess the degree of disc degeneration, especially any loss of disc height. A diagnostic nerve root block may be done as well. In some cases we also use a test called a discography to confirm the diagnosis. This test involves injecting contrast dye into the affected disc (or discs) to create a clearer image. All of these diagnostic tests can be done in our practice, or at affiliated centers within the same building complex pending your insurance authorization.

Lumbar spine MRI showing degenerated disc

Non-Operative Treatment of Lumbar DDD
There are several non-operative treatments that we consider when treating lumbar DDD. None of them is a "silver bullet" that will suddenly heal your condition. However, our team will carefully select a combination of treatments that will provide the best opportunity for alleviating your symptoms and improving the overall health of your back.

For acute or sudden low back pain, we prescribe pain relief medications such as acetaminophen, anti-inflammatory agents, and muscle relaxants. For some patients we may prescribe pain management injections, such as nerve root blocks, to further manage your pain.

Temporary bed rest may also be suggested. But such rest is only temporary, and patients are encouraged to get up and gradually resume their activities. In fact, we prescribe physical therapy and spinal conditioning exercises for many patients. Carefully supervised strengthening and stretching exercises can improve flexibility and strength and can help maintain the spine's natural curve. Hot/cold therapy and gentle massage can also be beneficial for acute low back pain.

In rare cases, soft lumbar braces are used to provide short-term support to the effected area.

After acute symptoms subside (usually within two to three weeks), patients are encouraged to begin a daily exercise regimen. At SDCSD we are well equipped to help develop healthy exercise routines for our spine patients, and we even have a superb gym in our building that is staffed by physical therapy and rehabilitation experts. Visit Spine and Sport

Surgical Treatments
If symptoms of lumbar DDD persist despite these non-operative treatments, further diagnostic tests may be necessary. These tests may include an MRI, CT Scan, myelogram, and possibly discography. If the surgeon discovers that one or more of the vertebral discs are damaged and are causing pain or other symptoms (e.g. weakness in muscles), surgery may be necessary.

The surgical procedure is likely to include a discectomy (removal of the degenerated disc) and interbody fusion (fusing together of the vertebrae above and below the removed disc).

At SDCSD we are experienced with minimally invasive discectomies and have been pleased with the results. A minimally invasive discectomy offers the advantages of successfully removing the disc while reducing the amount of damage to the surrounding muscles, reducing blood loss during the surgery, and reducing the operating and recovery times. At SDCSD, this type of technique will most likely be performed as an out patient procedure in the state-of-the-art surgery center that is located in the same building as our practice.

In addition to the discectomy, your surgeon is likely to fuse together the vertebrae above and below the area from which the disc was removed. He will approach the spine from the back of the spine using either a TLIF or PLIF technique, or from the front of the spine using an ALIF technique.

Whether a PLIF, TLIF or ALIF technique is used, different types of spinal implants, such as specially designed cages, screws, hooks and rods, will also be utilized to secure the spine and maximize the likelihood of an effective fusion. The surgical team at SDCSD will obviously explain these procedures to you in detail before your surgery.

Recovery
While lumber DDD is a natural part of aging, it does not mean you have to live with low back pain. We can help you return to a healthy, pain-free and active life. For most patients this can be accomplished with non-surgical treatments. But even if surgery is needed, be assured that we will discuss with you all risks and benefits of the procedure and provide you with the best care possible.