Degenerative Disc Disease (DDD) Treatment

Degenerative disc disease (DDD) is not so much a disease as it is a progressive condition resulting from normal changes in spinal discs which are the cushion-like pads between the vertebrae in the spine. These discs act as shock absorbers, providing flexibility and support to the spine. As one ages, the discs can lose their hydration, elasticity, and height, leading them to no longer cushioning or providing mobility between the vertebrae.

DDD is one of the most common causes of low back and neck pain and may develop at any level of the spine but is most common in the cervical and lower lumbar regions.

Cuba offers advanced treatment options for DDD, leveraging its renowned healthcare system and medical expertise. The goal of treatment is to ease pain and stop more damage typically beginning with conservative treatments include personalized physical therapy programs designed to strengthen spinal muscles, improve flexibility, and reduce pain. These programs may feature stretching, strengthening exercises, and hydrotherapy. For patients requiring more intensive care, or who have not responded to conservative treatment, interventional treatments like steroid injections and surgical options such as discectomy and spinal fusion ensuring a holistic approach to managing and alleviating the symptoms of DDD.

It is important to note that disc degeneration cannot be reversed, the symptoms of DDD can sometimes improve over time with appropriate management however it can lead to additional spinal conditions, such as:

• Spinal stenosis, the narrowing of the spinal canal, which can compress the spinal cord and nerves.
• Osteoarthritis in the spine, the cartilage that cushions the joints in the spine wears down.
• Spondylolisthesis, one vertebra slips forward over the vertebra below it, due to facet joint degeneration.
• Scoliosis, abnormal lateral curvature of the spine, often resulting in a C- or S-shaped curve.
• Osteophytes, development of bony projections (bone spurs) along the edges of the bones in the spine

Types of Degenerative Disc Disease

Degenerative Disc Disease (DDD) can manifest in several forms, depending on the location and nature of the disc degeneration.

• Cervical Degenerative Disc Disease affects the discs in the neck region (cervical spine).
• Thoracic Degenerative Disc Disease affects the discs in the mid-back region (thoracic spine).
• Lumbar Degenerative Disc Disease affects the discs in the lower back region (lumbar spine).
• Multilevel Degenerative Disc Disease affects multiple discs in various regions of the spine.
• Radiculopathy is when disc degeneration leads to compression of the nerve roots.
• Myelopathy is when the spinal cord itself is compressed.

Causes of Degenerative Disc Disease

• Aging: The primary cause of DDD is the natural aging process. Over time, discs can dehydrate and lose their flexibility, elasticity, and shock-absorbing characteristics.
• Wear and Tear: Repeated stress and minor injuries can cause tears in the outer disc.
• Genetics: A family history of DDD can increase the risk.
• Injury: Trauma or injury to the spine can accelerate disc degeneration.

Symptoms of Degenerative Disc Disease

• Chronic pain.
• Pain radiating to extremities.
• Numbness and tingling.
• Muscle weakness.
• Increased pain with activities.
• Periodic episodes of severe pain.
• Reduced Range of Motion.
• Muscle spasms.

Diagnosis of Degenerative Disc Disease

Degenerative Disc Disease is diagnosed through tests to determine its severity and to develop an effective treatment plan tailored to the patient’s specific needs. In addition to consultation with specialist, physical examination and medical history review, the following teat may be conducted:

• Diagnostic Imaging:
  • X-rays: X-rays are often the first imaging test performed. They can show changes in the bone structure of the spine, such as disc space narrowing, bone spurs, or other signs of degeneration.

• MRI (Magnetic Resonance Imaging): MRI scans provide detailed images of the soft tissues, including the intervertebral discs, spinal cord, and nerves. MRI is particularly useful for identifying disc herniation, disc dehydration, and nerve compression.
• CT (Computed Tomography) Scans: CT scans offer more detailed images of the spinal structures than X-rays and can be helpful in evaluating the extent of bone changes and narrowing of the spinal canal.
• Additional Tests:
  • Nerve Conduction Studies/Electromyography (NCS/EMG): These tests measure the electrical activity of nerves and muscles to determine if there is nerve damage or compression caused by disc degeneration.

• Bone Scans: A bone scan may be used to detect areas of increased bone activity, which can indicate inflammation or other abnormalities.
• Blood tests: Blood tests may be carried out to rule out other conditions that can cause similar symptoms or to check for underlying issues that could be contributing to the patient’s pain. They may also be carried out to assess the patient’s general health.

Treatment Options for Degenerative Disc Disease

Degenerative disc disease treatment is primarily to reduce pain and prevent pain flare-ups for as much as possible mostly through a combination of pain management methods, exercise/physical therapy, and lifestyle modifications. Should conservative treatment not provide relief of symptoms or for severe DDD, surgical options may be recommended.

Non-Surgical Options

Conservative methods include pain, medications muscle relaxants, narcotics, corticosteroids injections and physical therapy.

Physical Therapy: 

• Heat and Cold Therapy: Applying heat can relax muscles and improve blood flow, while cold therapy can reduce inflammation and numb sore tissues.
• Electrical Stimulation: Techniques like Transcutaneous Electrical Nerve Stimulation (TENS) can help reduce pain and improve muscle function.
• Ultrasound Therapy: Uses sound waves to generate deep heat in tissues, promoting healing and reducing pain.
• Mobilization and Manipulation: Gentle, hands-on techniques to improve joint mobility, reduce pain, and increase flexibility.
• Strengthening Exercises: Focus on core muscles to support the spine and reduce the risk of further injury.
• Flexibility and Stretching Exercises: Enhance flexibility of the spine and surrounding muscles, alleviating pressure on the degenerated discs and improving range of motion.
• Stabilization Exercises: Focus on improving spinal stability and posture, such as pelvic tilts, bridging, and leg raises.
• Aerobic Exercises: Low-impact activities like walking, swimming, or cycling to improve cardiovascular fitness without putting excessive strain on the spine.

• Posture Correction: Education on proper posture to minimize strain on the spine during daily activities.
• Education and Self-Management: Teaching strategies to manage pain at home and guidance on modifying activities to avoid exacerbating symptoms and incorporating regular exercise into daily routines.
• Task-Specific Exercises: Exercises tailored to the patient’s daily activities and occupational needs to improve overall function and reduce the risk of further injury.
• Balance and Coordination Training: To improve overall stability and reduce the risk of falls or further injury.

Surgical Options

Surgery is typically considered when conservative treatments fail to provide relief or when symptoms become severe and significantly impact the patient’s quality of life. Consideration for surgery include:

• Persistent pain.
• Neurological symptoms.
• Spinal instability.
• Loss of function.
• Bladder or bowel dysfunction.
• Patient’s overall health.

Surgical options include:

• Discectomy: This procedure involves removing the damaged portion of an intervertebral disc that is pressing on a nerve root or the spinal cord.
• Spinal Fusion: This procedure involves permanently joining two or more vertebrae to stabilize the spine and reduce pain caused by disc degeneration. During the procedure, bone grafts, along with metal rods or screws, are used to fuse the affected vertebrae together, preventing any movement between them and thus alleviating the pain associated with spinal instability.
• Foraminotomy: This procedure enlarging the foramen, the passageway through which spinal nerve roots exit the spinal canal by removing bone or tissue that is obstructing the foramen.
• Laminotomy and Laminectomy: These are a minimally invasive procedure to remove a portion of the lamina, the bony arch of a vertebra, to make more space within the spinal canal so as to relieve pressure on the spinal cord or nerves. This minimally invasive procedure creates more space within the spinal canal.