Disc Degeneration

Background

EarlyStages keyDegenerative disc disease (DDD) typically arises as a result of the normal aging process and may lead to acute or chronic low back or neck pain. The degenerative process may begin as early as the third decade of life, with aging, obesity, smoking, and excessive axial loads perpetuating the deterioration of the discs. For most people, DDD does not cause significant problems; however, in patients with chronic low back pain, studies have shown that disc degeneration was one of the main factors contributing to their pain. In addition to low back pain, symptomatic DDD may also result in pain radiating to the hips, pain in the buttocks or thighs while walking, and tingling/weakness in the knees and legs. Chronic neck pain may also be evident, with pain radiating to the head, shoulders, arms, and hands.

Disc pain is thought to arise in those people who have nerve endings that penetrate more deeply into the annulus fibrosus (outer disc layer) than others. Degenerative discs typically show replacement of the normal gelatinous material of the disc with fibrocartilage, which is suggestive of an underlying repair process occurring. This change is disc histology can result in protrusion, spondylolysis, subluxation of the vertebrae (spondylolisthesis), and/or spinal stenosis. MRI is the test of choice in evaluating intervertebral disc pathology. Typical radiographic findings include disc space narrowing, end plate sclerosis, and osteophyte formation.

Current Treatment

Degenerative disc disease can often be managed conservatively through physical therapy, chiropractic manipulative therapy, osteopathic manipulation, anti-inflammatory medications such as non-steroidal anti-inflammatory drugs, and/or spinal injections that provide pain relief.

If these more moderate approaches fail to alleviate symptoms, surgery may be necessary. There are several surgical options for the treatment of DDD, with spinal fusion being the most common. Fusion of the vertebrae of the spine, using supplementary bone tissue either from the patient or a donor, can eliminate pain caused by abnormal motion of the vertebrae. Newer regenerative treatment strategies to reverse or inhibit degeneration are currently in clinical trials and include growth factor administration, stem cell therapy, gene therapy, and the introduction of biomaterials.

Focused Ultrasound Research

Focused ultrasound (FUS) is currently being evaluated in clinical trials for the treatment of lumbar back pain of facet joint origin. A phase 1 observational pilot study of 18 patients has already been performed at St. Mary’s Hospital in London, where FUS reduced pain and improved quality of life in patients with facet arthritis. While the use of FUS for degenerative disc disease is still in the pre-clinical stages, it may offer a non-invasive method of destroying the nerves that supply the annulus fibrosus through precise thermal ablation  Using magnetic resonance imaging or ultrasound as a guide, FUS may target a beam of acoustic energy to the involved nerves, ultimately deactivating the nerve and inhibiting its ability to transmit pain signals to the brain.

Notable Papers

Weeks EM, Platt MW, Gedroyc W. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain-case series of an innovative new technique. Eur Radiol. 2012 Dec;22(12):2822-35. Epub 2012 Aug 31.

     

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