Lumbar degenerative problems and stenosis

Lumbar Degenerative Disc Disease

Lumbar degenerative disc disease is characterized by the breakdown of intervertebral discs in the region of the lumbar spine (lower back) compressing nerve structures such as spinal nerves and spinal cord.

Low back pain is most common in patients with lumbar degenerative disc disease.

Introduction

The human spine (back) is made up of 24 vertebrae (bones) that are connected to each other by intervertebral discs. The lower 5 vertebrae together make up the lower back and is known as the lumbar spine.

The intervertebral disc contains a tough, flexible outer ring (annulus fibrosus) surrounding a soft, jelly like nucleus (nucleus pulposus) at the center. Discs provide cushion to the vertebral bones and protects them during strenuous activities like jumping, running, and lifting.

Causes

As we grow older, the intervertebral discs lose their water content causing disc shrinkage making the space between the vertebrae narrower. As a result, the discs lose their ability to act as shock absorbers and the spine becomes less flexible. In addition to aging induced natural wear and tear, smoking also contributes to the degeneration of discs. Gradually, the discs between the vertebral bodies degenerate resulting in disc degeneration.

Initially the nucleus at the center of the disc loses its ability to absorb water, and becomes thick and dehydrated., The disc loses the ability to absorb shock or to sustain routine stress and strain, resulting in the rupture of the annulus (outer layer). The disc then weakens and starts to collapse making the bone space narrow, and compressing the nerve structures.

Symptoms

In patients with degenerated lumbar disc disease, lower back pain is the common symptom. The other symptoms include:

  • Pain in the lower back extending to the hip and legs
  • Numbness, weakness or tingling sensation in the legs
  • Worsening of pain while sitting, standing, walking or even laying down
  • Increased pain by certain physical movements such as bending, twisting or lifting

Diagnosis

Your physician diagnoses lumbar degenerative disc disease based on your symptoms, medical history, and by performing a physical examination of your lower back (lumbar spine). Your physician checks your spine for flexibility, range of motion and other signs that suggest the presence of degenerated discs. Your physician may also request an X-ray, CT (contrast tomography) or MRI (magnetic resonance imaging) scan to locate the degenerated discs in the lumbar spine (lower back).

Treatment

Treatment of lumbar degenerative disc disease involves non-surgical therapy and surgical therapy.

Non-surgical therapy includes physical therapy, using braces and medications. In patients with degenerated lumbar discs, physical therapy, exercise and continuation of daily activities are recommended over bed rest. Braces are advised to keep the back bone in proper position. Drugs can be used to reduce pain (pain killers) and inflammation (anti-inflammatory drugs). In some patients, steroid injections are required to reduce severe pain and swelling.

Surgical approaches to treat lumbar degenerative disc disease include lumbar laminectomy, discectomy and fusion. Surgery is recommended only after non-surgical treatment fails to improve the symptoms.

  • Lumbar laminectomy involves removal of the lamina, a roof like structure over the back of the spinal column, to relieve pressure/compression on the spinal nerves.
  • Discectomy involves removal of the total or a part of the damaged disc that is compressing the nerve structures.
  • Fusion involves fusing the vertebral bones around the herniated disc to prevent it from collapsing. Fusion allows the bones and disc to grow together as a single bone avoiding movement between the fused bones.

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