Template:Condition

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Clinically Relevant Anatomy

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. .

Mechanism of Injury / Pathological Process

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.

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.

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

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   

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
   
   

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;  

Diagnostic Procedures

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.

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.

Management / Interventions

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Key Evidence

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Case Studies

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Recent Related Research (from Pubmed)

References

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