Best Practice Health TV
Discs are shock absorbers. They sit between bones that are connected by facet joints, but they don’t provide much strength. Walking, running, and bouncing create stress and strain on the spine. The discs absorb those forces, protecting the nerve roots and spinal cord. Over time millions of small stresses and strains begin to add up. Eventually, the discs develop tears, become dry, get shorter, and just plain wear out. As the body tries to heal the tears in the discs, nerve fibers that send pain signals sometimes grow into the disc. This can result in a disc that feels like a knife in the back every time you stand. Normal changes in the disc that occur due to the forces of everyday life are called degenerative changes. If these changes occur across several discs, or prematurely, they’re referred to as degenerative disc disease. For most of us, though, it’s not a disease like diabetes; it’s really just part of aging.
Degenerative disc disease causes low back pain in two different ways. First, the nerve roots can be pinched as a direct result of degenerative disc disease. A nerve root exits the spinal canal through a small hole called the foramen. The height of the foramen is determined, to a great degree, by the height of the disc. When discs degenerate, they lose height. As a result, when discs degenerate, the foramen loses height. If the space for the nerve root in the foramen gets tight enough the nerve root and become pinched and painful. When this occurs you feel leg pain more than back pain.
Degenerative disc disease can also cause back pain itself. The reason is a little bit complicated. The disc is composed of two parts: a very tough outer part, and an inner gel. Because the inner part of the disc is made out of a gel, it does not have its own blood supply. (Fun fact, the disc is the largest structure in the human body that does not have its own blood supply.) The way your body knows what is part of you, and when his not part of you, is through the blood supply. As a result, if you have a tear in the disc, the inner part is exposed to the rest of the body.
It sounds strange, but your body really doesn’t realize the disc is part of you. If you’ve ever had a sliver stuck in your skin you know what happens next. The result is a strong inflammatory response. The tear in a disk can feel like a knife in your back because to your body, there is a knife finger back. Left alone, all of this inflammation ultimately reabsorbs the disc, and her body would cause a fusion across the disc space made out of bone.
In the meantime, pain fibers accompany the healing reaction actually grow into the disc. Activation of these pain fibers just by standing up every day creates severe back pain. In addition, the inflammation spills into the epidural space causing epidural irritation. If you put numbing medicine in the epidural space you can temporarily relieve pain; if you put inflammation in the epidural space it causes pain.
Life. Degeneration is normal. No one was designed to live to be over 40. If you were hit by a bus at age 20 you would have very little degenerative disc disease. Some people are clearly more prone to it than others. Doctors don’t know the exact gene, but bad discs run in the family.
The best way to handle degenerative disease is to build core strength. You may have inherited your discs, but you can sure build lots of strong muscle around them to help absorb the stress and strain. Losing weight helps, too. A brace may be useful once in a while to support the spine in high stress activities. Tylenol, Aleve, and ibuprofen help too. In really severe cases the whole disc needs to be removed surgically. That usually involves a fusion to replace the missing disc.
If the degenerative disc is the source of your low back pain, then the only way to eliminate the pain is to eliminate the disc. In an outpatient surgery center, they remove painful discs using a minimal access approach. Looking down a microscope through a 1 inch incision they incise the disc, and remove it entirely. Something has to replace the disc, otherwise the vertebral bones with collapse.
They will often use an implant from Titan Spine to maintain the disc height. The implant is made out of plastic but has a nano-technology coating made out of titanium which allows your bones to connect directly with the implant. Surgery takes around 60 min, and you can go home afterward.
As a result of the minimal access techniques, most patients are 50% recovered from the surgery in one week, and completely recovered by three weeks. The implant heals to the bone over 6-12 weeks. Ultimately your body grows bone through the former disc space entirely, causing a solid fusion in 6-12 months.
Read about Titan Spine’s Interbody Devices and their unique surface technology
See more about disc pain in our Your Pain section
Learn more about Spinal Fusions performed at Phoenix Spine & Joint Surgery Center
A great question came in this week on Phoenix Spine & Joint - YouTube: If you have new onset back pain, the first thing you should consider is whether or not you need to act. You need to see a doctor immediately if you have any red flags: Unable to walk, severe numbness, weakness Fever, [...]
read more
If you watch my show Best Practice Live you know that the cause of back pain determines how it feels. Back pain that starts to one side, radiates to your butt, feels like it’s coming from the hip, and burns on the outer thigh is due to arthritis. An electrical zinger down one leg with [...]
read more
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
Enter below and we will email or text you more information about how to get rid of your radiculopathy due to herniated disc.
Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
Enter below and we will email or text you more information about how to get rid of your low back pain due to arthritis.
Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
Enter below and we will email or text you more information about how to get rid of your discogenic low back pain.
Subscribe!