I would like to feature an article from a fellow orthopaedic surgeon and friend, Dr. Tom Haverbush.
Pain From Degenerative Disc. Maybe Not......
By Thomas J. Haverbush, M.D. - Orthopaedic Surgeon
Transforming patient information into patient understanding.
Degenerative Disc Disease
Doctors use this term a lot talking to patients. They write it on a requisition for an x-ray study that the patient reads after he or she has seen their doctor for back or neck pain.
What they read (degenerative disc disease) sounds ominous, gloomy and scary. "I'm falling apart" is the usual patient thought!
This is especially true if the person is having a lot of pain in the neck or lower back.
Well, it's no more a "disease" than gray hair.
Did you know that 90% of people over sixty show some evidence on x-ray of what are called "wear and tear changes" in their disc?
Yes, it's true. MRI scans of the neck and/or back in people over sixty show degenerative change (wear and tear) 90% of the time even though the patient may have no symptoms.
The change process is almost universal in people over sixty. It is a natural process (like gray hair or eyesight changes). The changes in the spine begin much earlier than sixty, however, often appearing on plain x-rays in a patient's forties.
A disc (some spell it disk; same thing) can be thought of as a little shock absorber or water balloon between the vertebrae (back bones). A disc is 70% water surrounded by a tissue which is very complex.
Over a period of time the disc loses some of its water.
Why does that happen?
- Genetic inheritance (blame your grandparents)
- Smoking (nicotine causes constriction of tiny blood vessels cutting off circulation)
- Mysterious other factors not clear yet
An MRI study of the spine shows a healthy disc as bright, white and shiny. It turns black appearing in older patients.
Disease implies illness. It is not. It is a natural process. Degenerative spinal disease is a progressive loss of the structure and function of the intervertebral disc and other soft tissue components of the spine.
Origin of Pain
There is debate whether these changes especially in only one disc are the origin of the pain. They could be, but they don't have to be.
Ligaments and muscles are also affected by time and wear and tear changes. Also affected are the little facet joints located at every spinal level in the neck and spine behind the disc. Patients have often not even heard of these little joints which can be the source of intense pain.
In reality, the back is an impossibly complicated structure that has baffled physicians since the earliest days of medicine. Lots of doctors won't see patients with neck and back pain because the problems are so hard to diagnose and difficult to treat effectively. If you can't pinpoint the origin of the pain (pain generator) the chance of helping the patient is low.
If you think we have the answer because of all the back surgery being done now, think again. I do back surgery if I feel it is needed.
I see numerous patients who have had three or four (or more) back operations and they are not sure if they are much better than before surgery. Hmm. What does this tell you?
I can see this has to be more than a one part article so try real hard to come back next week to hopefully learn more. See you then.
My patients put their trust in me and what I do improves the quality of their lives.
Office Website and Gratiot County Herald Archive
What if there was a whole world of musculoskeletal information at one place? There is!
www.orthopodsurgeon.com opens up for you the office website, Your Orthopaedic Connection and the Archive of all previous GCH articles I have written for you, your family and friends.
Please check it out. Do yourself a favor.