Degenerative Disc Disease

Degenerative Disc Disease

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Why Do Spines Degenerate? Hi, I am Dr. John Shim, and this is a common question asked by many of my patients. I hope you had a chance to already view my basic spine anatomy video, as that foundation will make it much easier to understand this Spine Degeneration discussion. To simplify how the spine degenerates, we must make some basic assumptions. The degeneration is a result of aging, not a traumatic event, or known medical condition. As you know, the spine is composed of the functional spine unit. The so called vertebral body sandwich with the intervertebral disc being the center of the sandwich. For this discussion, we will focus on the intervertebral disc. The disc is composed of two main components. The center is the nucleus pulposus. The outer section is the annulus fibrosus. Current-day research indicates the water-filled nucleus changes as we age. There are specific proteins called proteoglycans that have a water capturing property. When we are young, the proteoglycan strongly pulls in water, keeping a nucleus full of water, and maintaining its height and strength. If you MRI most healthy teenagers, the MRIs will show the discs are full of water, and as a result of this water pressure the disc walls, or the annulus are straight. The disc height is full, and tall. There is plenty of space in the foramen, and the nerve has lots of room to safely exit the spine, without any concerns for pinching. As we age, the body starts to produce a different form of proteoglycan. To simplify the discussion, each time the small cells in our body divide to produce another, it loses a bit of a marker called the teleomere. As we lose more and more of the teleomere, our resultant cells start to change. The resultant cells, in the spine, and in the cartilage will produce different proteogylcans. The proteoglycan for aging spines will not have the same water retention properties as younger cells. As a result, the disc is less full of water. The disc height reduces. The water pressure on the annulus lessens, and the annular walls start to sag, or bulge. Yes, this is the disc bulge process. As the disc height reduces, the forces on the facet joints of the spine also change. There is more excursion of the facet joint, and the facet joints may start to slide further against each other. This leads to wear of the cartilage of the facet joints. Because of the wear on the facet joints can be a painful process, the body reacts to decrease the joint forces experience on the individual facet joints surfaces by an enlarging the facet joint surface area. The facet joint enlarge or hypertrophies. This process is how bone spurs form that pinch the nerves as they exit out the foramen. Not only is the height of the formen hole decreased by the shorter disc height, but the facet joints, that are located in the back of the foramen enlarges, and also contributes to the narrowing of the space for the nerves before exiting out the spinal canal. As the discs lose its water content, the disc bulge also contributes to the narrowing of the central canal space of the thecal sac or nerve tube, causing another area of pinching of the nerves. The narrowing of the space of the nerve is the spinal stenosis process. In addition to the narrowing of the space caused by bulging of the disc, and hypertrophy the facet joints, the narrowing of the foramen by the shrinking of the disc space, there is also an enlargement of the ligaments between the vertebral bodies. The ligament that most enlarges is the ligamentum flavum. To understand how this happens, imagine stretching a rubber band. When it's stretched, it thins. When the rubber band is no longer stretched, it thickens. The ligamentum flavum is a ligament that is stretched by a tall, well hydrated disc. When the disc shrinks because it is loosing water content (proteoglycan no longer holds water), it no longer stretches the ligamentum flavum. As a result, it thickens. That thickening can contribute to the narrowing or spinal stenosis condition. While I am oversimplifying the process, I hope you can now understand how the aging process of the spine begins with disc dehydration by change of the proteoglycans. It causes disc height shrinkage, leading to facet hypertrophy, disc bulging and ligament thickening. That all leads to spinal stenosis, and facet arthritis and hypertrophy. This process is called a degenerative cascade. Thank you for staying with this video, as this degenerative cascade process will help explain many of the pains experienced by many of my patients. Thank You!

Degenerative disc disease is not really a disease but a term used to describe the normal changes in the spine due to age. It happens throughout the whole spine but mostly in the lumbar discs as they have the most pressure on them throughout life.

This is caused by the loss of fluid in the disc over time, which makes it less useful as a shock absorber and narrows the distance between the vertebrae. This also lessens the space nerves have to exit the spinal column. Time, and wear and tear on the disc can also cause cracks or breaks in the annulus (the outer covering of the disc). Often the disc material inside leaks out causing a disc herniation and increases acceleration in degeneration.

As the space between the vertebrae get smaller, the discs get worn, and the stabilizing ligaments become less elastic, the spine becomes less stable. The facets move against each other and can cause pain or the body reacts to this by constructing bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the nerve root and cause pain numbness and tingling in the extremities.

People who smoke and those who do heavy physical labor, such as repeated heavy lifting, are more likely to have accelerated disc degeneration. People who are obese are also more likely to be symptomatic.  Approximately 20% of younger people due to genetics, injuries to the spine or who have done years of weightlifting or extremes sports can be diagnosed with degenerative disc disease.

Exercise, weight loss, and quitting smoking are ways to slow down disc degeneration. Surgical intervention would only be considered after extensive conservative care.

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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