A.Griguolo Degenerative Discopathy

Generality

Degenerative discopathy is the expression that, in the medical field, identifies the natural wear, fruit of the aging of the human body, of the intervertebral discs.

A condition favoring pathologies such as disc protrusion or herniated disc, degenerative discopathy can be associated with a painful symptomatology at the level of the back, whose precise site varies in relation to the location of disc wear (eg: if the intervertebral discs subjected to wear are the lumbar ones, the patient could feel pain in the lumbar portion of the back).

For the diagnosis of degenerative discopathy, the following are fundamental: the patient's account of symptoms, physical examination, anamnesis and spinal MRI.

Only for symptomatic cases, the treatment of degenerative discopathy can be conservative (first-line therapeutic choice) or surgical (therapeutic choice adopted only in case of failure of conservative treatments).

Short revision of the spine

Carrier axis of the body, the spine or spine is a bone structure of about 70 centimeters (in the adult human being), which includes 33-34 irregular bones ; stacked on each other and joined together by means of so - called intervertebral discs, these irregular bones are the known vertebrae .

VERTEBRAE

In a generic vertebra three characteristic elements can be recognized, which are:

The vertebral body, in anterior position;
The vertebral arch, in posterior position;
The vertebral hole . It is the opening resulting from the particular arrangement of the vertebral arch with respect to the vertebral body.
The set of vertebral holes of all the vertebrae constitutes the so-called spinal canal ; in the spinal canal houses the spinal cord .

INTERVERTEBRAL DISCS

An intervertebral disc is a circular fibrocartilaginous structure, which contains within it a gelatinous substance, called the pulpy nucleus, and the cartilaginous tissue that surrounds the aforementioned nucleus pulposus, ie the so-called fibrous ring .

In addition to providing for the conjunction of the adjacent vertebrae, the intervertebral discs have the task of absorbing, by means of the pulpy nucleus, the shocks and loads that weigh on the spine. In other words, with their particular content, the intervertebral discs act as shock-absorbing bearings.

What is Degenerative Discopathy?

Degenerative discopathy is the medical term that indicates the natural wear of the intervertebral discs of the spine, accompanied by a more or less accentuated deformation .

Degenerative discopathy is not exactly a pathology of the intervertebral discs, but rather it is the physiological decay of these fundamental structures of the spine.

Degenerative discopathy is a risk factor for numerous spinal diseases, including the known disc herniation and the phenomenon of disc protrusion (or bulging discal ).

Causes

The intervertebral discs of a young adult or middle-aged individual are 90% water; this water ensures their elasticity, resistance to deformation and cushioning capacity.

With advancing age and the consequent aging of the human body, however, the intervertebral discs are subject to progressive degeneration, which induces the irreversible loss of a large part of the aforementioned aqueous component .

Following the loss of water, the intervertebral discs become more fragile and less elastic, and tend to develop deformations or to break up.

The term degenerative discopathy summarizes in just two words what has just been described, that is the progressive degeneration of the intervertebral discs consequent to the natural aging process and responsible for changes in the composition and structure (water loss, deformation, etc.).

Did you know that ...

The water present in the intervertebral discs is fundamental to guarantee the latter their cushioning function.

The loss of water from the intervertebral discs, therefore, makes these structures less able to absorb shocks to the vertebral column.

Causes and factors of favors

The causes and risk factors of degenerative discopathy include:

The aging process of the human body . As previously stated, with age, intervertebral discs are inevitably subject to a degenerative phenomenon, which removes part of the water contained in them.
Daily activities and constant practice of sports that are a source of stress or minor injuries to the intervertebral discs.
A history of spinal injuries .

Symptoms and Complications

Degenerative discopathy can be asymptomatic or symptomatic .

It is asymptomatic, when the wear on the intervertebral discs is slight and affects sections of the spine that are not particularly critical as regards the supporting action of the human body; it is instead symptomatic, when the wear of the intervertebral discs is important or concerns portions of the spine with a supporting role, towards the human body, more relevant than others.

Back pain is characterized by the symptomatic forms of degenerative discopathy; this pain has a different location, depending on where the intervertebral discs affected by the condition in question are located; in practical terms, this means that a degenerative discopathy with cervical site will produce a pain in the neck ; a degenerative dislocation with thoracic site will induce pain in the middle section of the back ; finally, a degenerative discopathy with lumbar site will cause pain in the lumbar area of the back ( low back pain ).

Did you know that ...

Degenerative discopathy is more often an asymptomatic condition than a symptomatic condition.

Characteristics of Pain Associated with Degenerative Discopathy

The pain produced by degenerative discopathy is a feeling that:

Worsens when the patient takes a sitting position for a long period of time.
Experts have observed that the sitting position involves an increase in the load on the vertebral column and this represents a cause of suffering for the intervertebral discs that are no longer perfectly healthy;
Worsens when the patient bends or twists his back;
Worsens when the patient lifts a weight, especially if he does not flex the lower limbs);
Improves when the patient is on the move (ex: during a walk or a brisk walk). It may seem strange, but it is so;
Improves when the patient is lying down;
It alternates moments in which it is very intense at times when it seems to have almost disappeared;
If it affects the lower part of the spine, it can be combined with:

Pain in the buttocks;
Pain in one or both thighs;
Numbness, tingling and / or muscle weakness along one or both lower limbs.

If it affects the upper area of the spine, it can be associated with:

Pain in one or both shoulders;
Pain in one or both arms;
Pain in one or both hands;
Numbness, tingling and / or muscle weakness along one or both upper limbs.

FACTORS FAVORING THE PRESENCE OF SYMPTOMS

To promote the appearance of symptoms in a context of degenerative discopathy are factors such as: obesity (entails an extra load on the spine), incorrect postural behaviors, the lifting of heavy objects by loading the back instead of flexing the legs and the excessive sedentary lifestyle .

WHAT DOES DEFENSE, FORMICOLIO AND MUSCULAR WEAKEN DEPEND ON?

In a context of degenerative discopathy, the presence of numbness, tingling and / or muscle weakness in the limbs is due to the compression that a particularly worn and deformed intervertebral disc can exert against the nearby spinal nerves.

Complications

As anticipated, degenerative discopathy is a predisposing factor for disc bulging and herniated disc, two pathologies of the spine correlated with each other, since the former may represent the prelude to the latter.

Bulging discal : it is the crushing of an intervertebral disc, which involves the slippage outside the hypothetical axis resulting from the normal overlapping of the other intervertebral discs.
In disc bulging, the fibrocartilaginous structure of the intervertebral disc is intact and this is essential to maintain the nucleus pulposus and the fibrous ring within the intervertebral disc itself.
Herniated disc : with this expression, doctors identify the leakage, from its natural site, of the nucleus pulposus contained within the intervertebral disc.
Unlike what happens in disc bulging, in the herniated disc, the fibrocartilaginous structure of the intervertebral disc is damaged and for this reason that the pulpy nucleus can escape.

CONSEQUENCES OF DISCAL BULGING AND DISC HERNIA

Discal bulging and, in particular, the herniated disc worsen the symptomatology (above all the pain) to the point of making it an obstacle to the execution of the most banal daily activities (ex: making the stairs, getting on or off the car, engage in household chores, etc.).

The obstacle that these diseases of the spine determine for everyday life represents, for the subjects involved, a reason for low mood, if not even real depression .

Possible symptoms of when degenerative discopathy faces complications:

Absence of sensitivity in the limbs
Severe muscle weakness in the limbs
Lameness
Loss of control of the bladder or anal sphincter

When should I go to the doctor?

Symptoms such as those found in the presence of degenerative discopathy merit immediate medical evaluation when:

Despite the rest, the symptoms worsen rather than improve;
There was a sudden and unreasonable worsening of the symptoms;
The symptoms worsened after a violent neck or back injury;
In addition to the classic pain disorders, the patient also complains: loss of control of the anal sphincter or visceral sphincter, complete lack of sensitivity, etc.

Diagnosis

As a rule, the information coming from: is essential to formulate the diagnosis of degenerative discopathy.

The patient's account of symptoms . It is the starting investigation; it allows the doctor to know the symptoms that afflict the patient.
Physical examination and medical history . They consist of a critical study of the present symptomatology, whose purpose is to trace the causes / risk factors.
Spine MRI . By providing detailed images of each component of the spine, it allows to establish the state of health of the intervertebral discs and to ascertain any anomalies.
Spine MRI is not the diagnostic confirmation exam, but also the investigation by which the doctor can identify complications such as disc bulging or herniated disc.

If the symptomatology is particularly debilitating for the patient, it is highly probable that the doctor intends to deepen the situation through a neurological evaluation and electromyography .

Neurological assessment: helps clarify aspects such as: spinal nerve health, site of nerve compression, gravity of deformation, etc .;
Electromyography: consists in the study of the conduction of nerve signals along the anatomical area manifesting tingling, numbness and / or muscle weakness.

Therapy

Degenerative discopathy is a condition to be treated when it is symptomatic; therefore, if it lacks symptoms, it does not require any treatment.

Going specifically to symptomatic cases, treatment for these circumstances is usually conservative and rarely surgical .

Conservative therapy: when does it apply and what does it consist of?

In a context of symptomatic degenerative discopathy, conservative therapy is the first line treatment, that is the first therapeutic solution adopted after the diagnosis of the condition in question.

The conservative therapy of degenerative discopathy includes:

The administration of anti-inflammatory drugs, such as NSAIDs or paracetamol . The purpose of these medicines is to reduce the painful sensation.
Physiotherapy sessions and the so-called postural education . Strengthening the musculature of the back, increasing the flexibility of the trunk and the spine, and correcting any errors in posture, physiotherapy and postural education alleviate the suffering of the spine due to the presence of intervertebral discs that are no longer efficient and healthy.

Administration of corticosteroids . Corticosteroids are powerful anti-inflammatories, with an important analgesic action. Due to their serious side effects, however, they are used only when NSAIDs or paracetamol are not very effective.
Massage therapy . It is a practice recommended to reduce pain.
Control / abolition of behaviors that favor the suffering of the spine . For example, a patient suffering from obesity must follow a weight loss treatment, while an excessively sedentary patient must practice regular physical activity.

Statistics show that, if the patient is careful in following it, a good conservative treatment for disc bulging has clear benefits, from the point of view of symptoms, after about 6 weeks from the beginning of treatment.

Surgical therapy

In a context of degenerative discopathy, surgical therapy is a treatment reserved for the circumstances for which conservative therapy is completely ineffective after 2-3 months of its application.

In practice, the surgical treatment of degenerative discopathy consists of a procedure called discectomy, which involves the removal of a damaged or no longer functional intervertebral disc, followed by its replacement with a sort of prosthesis.

From the operational point of view, discectomy is a complex procedure, because it requires the incision of an extremely delicate area of the body, given the dense network of nerves, ligaments and blood vessels present.

The complexity of discectomy is the reason why doctors only practice it in severe cases or when conservative remedies are completely ineffective.

Prognosis

Degenerative discopathy is a progressive and irreversible condition, which, however, if subjected to adequate treatments early, is controllable with good results. In general, therefore, the cases of degenerative discopathy that have a better prognosis are those for which the diagnosis was early and timely therapy (ie planned before the onset of complications).