Template:Condition: Difference between revisions

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Early dysfunction is the classifed as the beginning of degenerative changes which can occur as early as 20 years. Intermediate instability is classified by a loosening of the annulus fibrosis, which can cause back pain. Fibrosis to the posterior structure and formation of osteophytes denotes the final stabilization classification. Pain decreases, but there is less motion. .<ref> Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, NY: McGraw-Hll; 2008.</ref> <br>
Early dysfunction is the classifed as the beginning of degenerative changes which can occur as early as 20 years. Intermediate instability is classified by a loosening of the annulus fibrosis, which can cause back pain. Fibrosis to the posterior structure and formation of osteophytes denotes the final stabilization classification. Pain decreases, but there is less motion. .<ref> Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, NY: McGraw-Hll; 2008.</ref> <br>
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== Mechanism of Injury / Pathological Process<br> ==
== Mechanism of Injury / Pathological Process<br> ==
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== Management / Interventions<br> ==
== Management / Interventions<br> ==


Medications such as non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen, COX-2 inhibitors) and pain relievers like acetaminophen (such as Tylenol) help many patients feel good enough to engage in regular activities. Stronger prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used to manage intense pain episodes on a short-term basis, and some patients may benefit from an epidural steroid injection. Not all medications are right for all patients, and patients will need to discuss side effects and possible factors that would preclude taking them with their physician. <ref>Ulrich, P. F. (2005, 11 6). Lumbar Degenerative Disc Disease Treatment Options. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease-treatment-options</ref>
add text here relating to management approaches to the condition<br>
 
An exercise program is essential to relieving the pain of lumbar degenerative disc disease and should have several components, including <ref>Ulrich, P. F. (2005, 11 6). Lumbar Degenerative Disc Disease Treatment Options. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease-treatment-options</ref>:
 
*Hamstring stretching, since tightness in these muscles can increase the stress on the back and the pain caused by a degenerative disc.
*A strengthening exercise program, such as Dynamic Lumbar Stabilization exercises, where patients are taught to find their ‘natural spine’, the position in which they feel most comfortable, and to maintain that position.
*Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate flow of nutrients and blood to spine structures, and relieve pressure on the discs.
 
Lumbar manipulation can relieve low back pain by taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and, like more active exercise, promoting the release of endorphins within the body to act as natural painkillers. <br>Epidural steroid injections can provide low back pain relief by delivering medication directly to the painful area to decrease inflammation.<br>


== Differential Diagnosis<br> ==
== Differential Diagnosis<br> ==

Revision as of 21:39, 2 June 2009

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This is a picture of the spinal nerves exiting the verterbal column. The nerves are color coded by section
This is a close up picture of the cauda equina.
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Clinically Relevant Anatomy
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Dengenerative Disc Disease (DDD) is thought to begin with changes to the annulus fibrosis, intervertebral disc, and subchondral bone. The process of degeneration is divided into three classifications including: early dysfunction, intermediate instability, and final stabilization.

Early dysfunction is the classifed as the beginning of degenerative changes which can occur as early as 20 years. Intermediate instability is classified by a loosening of the annulus fibrosis, which can cause back pain. Fibrosis to the posterior structure and formation of osteophytes denotes the final stabilization classification. Pain decreases, but there is less motion. .[1]

Mechanism of Injury / Pathological Process
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Degenerative disc disease refers to a condition in which the involved disc causes LBP. Lumbar degenerative disc disease is usually the result of a twisting injury to the lower back, such as when a person swings a golf club or rotates to put an object on a surface to the side of or behind them. [2]

The pain is also frequently caused by simple wear and tear on the spine and comes with the general aging process.

Degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. [3]


The process that leads to DDD begins with structural changes. The annulus fibrosis (outer portion of the disc) loses water content over time which will make it increasingly unyielding toward everyday stress and strain on the spine. The loss of compliance in the discs contributes to forces being redirected from the anterior and middle portions of the facets to the posterior aspect, thus causing facet arthritis. Another result is hypertrophy of the vertebral bodies adjacent to the degenerating disc. The overgrowths are known as bony spurs (or osteophytes.)

Clinical Presentation[edit source]

People with DDD will have low back pain; however there are varying levels of severity. Pain is often chronic, but one with DDD can experience varying episodes of exacerbation where pain levels are elevated [4]  

DDD commonly occurs with other diagnoses such as:

  1. idiopathic low-back pain
  2. lumbar radiculopathy
  3. myelopathy
  4. lumbar stenosis
  5. spondylosis
  6. osteoarthritis
  7. zygapophydeal joint degeneration
    [5]

Activities that typically increase pain include: 

  • Sitting for extended periods of time
  • Rotating, bending, or lifting

Activities that typically decrease pain include:

  • Changing positions often
  • Lying down
  • Staying active;[6]  

Diagnostic Procedures[edit source]

Patients may present with a history of Chronic LBP, and can experience symptoms into the buttock. They may also state a history of spine stiffness that gets worse with activity and tenderness with palpation over involved area. [7]

Xray findings are used to diagnose DDD. Anterior-Posterior and lateral views are taken; presence of osteophytes, narrowing of the disc joint space, or a “vacuum sign” is noted. [8]



Management / Interventions
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Differential Diagnosis
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Key Evidence[edit source]

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Resources
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Case Studies[edit source]

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Recent Related Research (from Pubmed)[edit source]

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References[edit source]

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  1. ↑ Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, NY: McGraw-Hll; 2008.
  2. ↑ Ullrich, P. F. (2006 11 6). Lumbar Degenerative Disc Disease. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease
  3. ↑ Ullrich, P. F. (2006 11 6). Lumbar Degenerative Disc Disease. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease
  4. ↑ Ulrich, P. F. (2005, 11 29). Common Symptoms of Degenerative Disc Disease. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/common-symptoms-degenerative-disc-disease
  5. ↑ Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, NY: McGraw-Hll; 2008.
  6. ↑ Ulrich, P. F. (2005, 11 29). Common Symptoms of Degenerative Disc Disease. Retrieved 06 02, 2009, from Degenerative Disc Disease: http://www.spine-health.com/conditions/degenerative-disc-disease/common-symptoms-degenerative-disc-disease
  7. ↑ Thompson, J.C. MD. Netter's Concise Atlas of Orthopaedic Anatomy. (2002) Saunders Elsevier. p.36-7
  8. ↑ Thompson, J.C. MD. Netter's Concise Atlas of Orthopaedic Anatomy. (2002) Saunders Elsevier. p.36-7
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