Disc degeneration

Degeneration of the intervertebral disc


Degeneration of the cartilage affects not only the diarthrodial joints, but the intervertebral disc as well. This disease, often referred to as spondylosis, spondylarthrosis, may affect any level of the spine, however, most commonly the lower lumbar segments are involved.


Two main parts of the intervertebral discs are the outer ring (annulus fibrosus) and the inner gelatinous material. (nucleus pulposus). The outer ring consists of fibrocartilage, while the inner material shows many similarities to the articular hyaline cartilage both in its biochemical and histological appearance. The function of the outer ring would be to keep the inner substance within the disc and resist the rotational and loading forces. The inner material functions as shock absorber for axial loads. Intervertebral discs loose their water content with time and become narrower (the explanation behind the loss of height in elderly) as a normal aging process.






The middle aged and elderly people are affected, however, degenerative changes appear in young patients in their twenties as well. Degenerative changes in the cervical (neck) part of the spine would provoke dull or shooting pain in the neck, shoulder, arm or even to the fingers. Similar changes in the lower lumbar segments cause low back pain and some shooting pain to the buttock and the lower limb (though less frequently than in disc herniation). Very common in the population of heavy labor, drivers, and people work in an ergonomically inappropriate sitting work environment.




  Variable complaints may be present, dull pain, pins and needles, and sudden shooting pain may develop after strenuous exercises making straightening of the spine almost impossible. Movements like bending torsion are very painful if possible at all.      

Usual protocol of examination


·        Assessment of the gait and spinal curvatures, range of motion


·        Stiffness of the paravertebral muscles.


·        Neurological assessment


·        Muscle strength measurement, assessing sensorium


X-ray is usually not necessary, however, in prolonged complaints it may be taken, and in the presence of neurological deficit computer tomography (CT scan) and magnetic resonance imaging (MRI) may be required


Treatment options


Acutely developed complaints are assessed and treated mostly with resting with specially elevated legs. Drug regime includes muscle relaxants, painkillers. After a short immobilization period of 2-3 days physiotherapist supervised mobilization is started, and usually in 2-4 weeks full recovery is expected.



Chronically reoccurrence of these periods, however, may caution and regular physical exercises, physiotherapy may be needed. Rehabilitation in specially prepared facilities are often very effective (wellness hospitals). Any pathological changes behind the complaints must be referred to a specialist orthopedic surgeon.



Prevention is priceless in these conditions, including ergonomical changes, education in the weight lifting, psychosocial balance and loosing weight if appropriate.


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