Living with Degenerative Disc Disease – An Update

As many of you know, I was diagnosed with degenerative disc disease (DDD) in 2017. (See that post here.)  The disc that is degenerating (drying up and shrinking) is one of the most common to degenerate – between lumbar spine #5 (L5) and sacral spine #1 (S1). This shrinking of the disc is causing me lower back pain that’s aggravated by bending, lifting, and most general movements I make.

For me, every day brings a different level of pain. Some days are better than others, but even on a great day, there is always some discomfort in my lower back.

Since it had been three years since my first diagnosis, I figured it was time to go back to an orthopedic doctor (who specializes in the spine) and see how my DDD is fairing. This time, I tried a new doctor since the first one, who diagnosed me with DDD, basically left me, without addressing any questions and concerns. 

After a few x-rays, this new doctor compared my old images with the new and stated that my DDD has remained the same. I was actually worried that it was worse, as my pain is more frequent now.

However, this orthopedic doctor actually explained to me what exactly is causing all of the pain in my back. This is the new information I wanted to share with you.

How Degenerative Discs Cause Pain

The last few bones of the lumbar spine (L4-L5) have the extraordinary task of keeping our upper half mobile, as well as supporting everything above it. This is why it’s very common to have an injury or degenerative disc in this area. L5 is the largest vertebra in the spine and has great range of motion. Add to this the extreme weight-bearing on this bone, and it’s obvious why the discs in-between the vertebrae may shrink and facet (spinal) joints wear down over time. Here’s how that happens:

For all people, every night during sleep, fluid fills the middle of the spinal discs and the during the day, body movements push the fluid out. It’s natural for these cushioning discs to lose fluid over time, causing shrinkage as we age. This is why most older people (60 years +) have some form of degeneration in their spine, although it may not cause any pain.

As these discs degenerate and shrink, the vertebrae get shoved closer together and get irritated. In addition, the facet joints of the vertebral bones are affected. This is where we feel the pain. The pain is coming from the worn and damaged cartilage of the joint, poor joint alignment, and the inflammation of these facet joints in the spine. Bone spurs commonly occur on the vertebrae with shrinking discs; these bony growths can irritate nerves and possibly cause inflammation of the facet joints, muscles, and ligaments of the spine. This is our source of pain. See the photos below.

As you can see in the photos above, the back of each vertebrae contains facet joints. These facet joints are on the top and bottom of each vertebrae and only allow gliding movements of flexion and extension and limit the spine’s rotation. (wikipedia.org) When a disc shrinks, it isn’t able to provide the cushioning and stability to the spine that it’s supposed to. The shrinkage also pushes the facet joints closer together which can limit movement and increase stress on the spinal column.

Just as your knee joint works in only one direction and limits side to side movement, the facet joints of the spine work in the same way. As you age, the cushioning cartilage discs of the spine get thinner and degenerate, which leads to the joints to be pushed closer together. This can eventually result in inflammation, irritation, and can lead to bone-on-bone grinding within the joint. Ouch!

So the pain that we experience with degenerative disc disease is not from the disc itself, but rather the joints behind it. As with most things in the body, there is often a domino effect with injury. Because the entire spine is working together in so many different ways, if one part isn’t working right, it’s going to affect another. In fact, it’s common to see facet joint arthritis along with other back problems or conditions like DDD.

Why Do We Experience So Much Pain?

So what is exactly happening within the joint for this pain to occur?

Usually, there is one of three reasons why we have pain. First, there is damage to the protective cartilage that covers the facet joints of the spine. This is similar to an overworked knee joint that has worn down much of its cartilage and is grinding bone-on-bone. Second, there could be less synovial fluid (a lubricant) in the joint. And lastly, there could be bone spurs forming on the joint, our body’s way of fixing the damage of the facet joint. When bone spurs rub up against a nerve, you could get shooting pains in your buttocks and legs. 

Whether it’s from trauma or a natural degeneration of the disc, these damaged facet joints can become unstable, affecting the nerves, connective tissues, and muscles around it. This can result in an incredibly sore lower back. 

Forms of Treatment

When it comes to living with facet joint arthritis and degenerative disc disease, my doctor explained that there are a few steps to take to keep my spine healthy and minimize pain.

He recommended:

• Using NSAIDs for pain and inflammation (ex. ibuprofen (Advil), naproxen (Aleve))
• Supplementing with tumeric, fish oil, glucosamine, and chondroitin
• Implementing proper lifting techniques and body mechanics, as well as minimizing overuse of the back
• Core strengthening exercises and back stretches

If there is no pain relief, start with:

• Steroid (cortisone) injections at the site of pain
• If there is still no relief from pain, the next step could be getting a facet nerve ablation. This is a minimally invasive procedure where the nerve around the joint is blocked or burned (destroyed).  This is “similar to a root canal when the nerve serving the tooth is destroyed but the tooth remains fully functional.” (www.coastalspineandpaincenter.com/treatment/facet-joint-nerve-ablations/) 

The last hope for treatment is spinal fusion. My doctor explained that spinal fusion (the joining of two vertebrae) is not guaranteed to take away back pain and it may cause more pressure and inflammation on the bones and discs around the site of fusion. This is more of a ‘last resort’ treatment.

Do Inversion Tables Help with Degenerative Disc Disease?

In terms of using an inversion table, my doctor expressed that it’s not going to do much for my pain. He told me that inversion tables work better for patients with sciatica, opening up the joints and stretching enough to relieve pressure off a pinched nerve. Because I have a drying, thin disc, the inversion table may relieve some pain in the facet joints while I’m upside down, but it’ll return as soon as I’m upright. He stated it’s not going to bring about lasting change. 

And Time Goes On…

So again, with no medication, no recommended physical therapy, no MRI, and no future appointment, I was sent home. 

Needless to say, all of this has been a struggle for me. There are times I find myself sobbing because I will be dealing with this pain for the rest of my life, upset my daily activities are often limited, and afraid of what’s to come in the future. 

I still work out regularly, try to garden once a week (with much soreness afterwards), and keep my core strong. I’m going to try to focus more on proper body mechanics, continue core strengthening, add more back stretches, and supplement with tumeric for now. 

It’s so isolating when you don’t hear about many middle aged people dealing with DDD, but I’ve been comforted by the comments many of you have made. I hope this update has been as helpful to you as it was to me. Take care of your spines!

Here’s to your health,

Julie

sources: spine-health.com, spineuniverse.com, midwestbonejoint.com, wikipedia.org

Medical Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Information provided on this web site is for general information purposes only.