Degenerative Disc Disease is the blanket term that describes the conditions arising due to the general wear and tear of inter-vertebral discs. It usually presents as pain in the lower back, buttocks or thighs which lasts from several days to a few months. Patients find that no particular position relieves the pain and it worsens when they sit down. Our day to day activities, posture, diet and genetic makeup dictate the onset and worsening of the disease.
Our spine is made of a string of 33 bones called vertebrae which are connected to each other through ligaments and intervertebral discs. In between two vertebra there are fluid filled discs which act as shock absorbent and provide the spine, its flexibility. With progressing age, the discs undergo wear & tear, lose its fluid content and sponge like quality and thus flexibility. These discs have a very limited blood supply which is just enough to sustain them and help withstand occasional minor disturbances. However, repeated trauma can lead to hardening of these discs and development of cracks in them which becomes a source of constant neck or lower back pain. On MRI scans, degenerated discs appear darker relative to normal discs.
Discogenic pain “disc related pain” in degenerative disease is usually localized around the offending disc(s) and doesn’t radiate far from its location. This pain is thought to arise due to new nerve endings growing inside the disc after developments of cracks (fissures) through normal daily wear and tear or through trauma. Discogenic pain presents as a deep-seated pain around the spine and typically no particular position appears to relieve pain.
Interventional pain management procedures for discogenic pain
Interventional pain procedures like like Discography or Provocative discogram can help pinpoint the offending disc(s). Discography is a interventional procedure during which we create pressure inside individual disc(s) under X-ray guidance to duplicate patient’s everyday pain. Discography is mainly used to diagnose the particular disc as offending agent for pain.
Pain due to Disc Herniation arises when a disc develops cracks or in medical terminology ‘fissures, bulge, protrusion, extrusion’ and the leaking disc contents put pressure on the surrounding nerves. Patient might experience shooting pain or sciatica like symptoms with pain radiating down from the neck to the arm or down their leg from the lower back as the herniated disc causes nerve irritation. As the discs have very little blood supply of their own, over the counter pain relievers or other oral medications provide very limited pain relief in these cases.
Epidural Steroid Injections, a type of interventional pain management procedure is an effective way to relieve pain caused by herniated discs. Steroids, which are powerful anti-inflammatory medications when injected around the herniated disc provide relief by reducing the sensitivity of the nerve ending and reducing inflammation around the disc herniation and protrusion allowing the body’s natural healing process to work. Although Epidural injections are helpful for relieving Sciatica symptoms caused by disc herniation, they provide limited help for localized low back pain originating from deep seated disc issues ie degenerative disc disease presenting as Discogenic pain.
Traditionally, treatment options for Discogenic Pain have mostly been surgical in nature and aim to provide pain relief without actually addressing the root cause of the condition. Some options available are:
- Micro Discectomy, where the intrusive inter-vertebral disc fragments are removed via surgery
- Spinal Fusion Surgery, where vertebrae surrounding the offending disc(s) are fused. This provides pain relief by limiting movement of the affected disc(s). However, the fused vertebrae divert pressure to other areas of the spine and over the years, patients develop problems above or below the fusion level adding to herniation, stenosis or spondylosis.
- Total Disc Replacement, as the name implies, involves replacement of the natural disc with an artificial one. Studies show that the outcomes for this surgery are similar to that observed with Spinal Fusion Surgery.
Regenerative therapy is another treatment modality that has been gaining popularity for treatment of Degenerative Disc disease. Platelet Rich Plasma (PRP) therapy is a kind of Regenerative therapy that has been successfully used in many studies to reduce Discogenic low back pain. It involves injecting a small amount of growth factor rich fraction of your blood inside the offending disc(s).
The growth factors activate and expedite the natural healing processes of the body, healing the discs from within and relieving pain. Stem Cell Therapy, another regenerative therapy uses Mesenchymal Stem Cells derived from a patient’s bone marrow to repair Degenerated Discs. Several cases have been reported where the discs have been repaired to normal disc heights alleviating the patient’s disc related pain in as little as 6 months.
For more information on the treatments that we offer, contact Miami Stem Cell www.stemcellmia.com