Lumbar Degenerative Disc Disease

Fig 1: Degenerative Disc Disease
(larger view)

Fig 2: X-ray of Degenerative Disc Disease
(larger view)

Degenerative disc disease in the lumbar spine, or lower back, refers to a syndrome in which a compromised disc causes low back pain.

Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine.

Despite its rather dramatic label, degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding on an MRI scan rather than the exception.

Lumbar Degenerative Disc Disease Symptoms

Most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Symptoms can vary, but the general characteristics usually include:

• Pain that is centered on the lower back, although it can radiate to the hips and legs
• Pain that is frequently worse when sitting, when the discs experience a heavier load than when patients are standing, walking or even laying down
• Pain that is exacerbated by certain movements, particularly bending, twisting or lifting

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources:

• Inflammation, as the proteins in the disc space irritate the surrounding nerves, and/or
• Abnormal micro-motion instability, when the outer rings of the disc, called the annulus fibrous, are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment (See Figure 1).

Excessive micro-motion, combined with the inflammatory proteins, can produce ongoing low back pain.

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Fortunately, over a long period of time the pain from lumbar degenerative disc disease eventually decreases, rather than becoming progressively worse. This is because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position (see Figure 2), eliminating the micro-motion that generates the pain. Because of this process, even patients who experience severe pain and frequent flare-ups in their 40’s may find that their back pain is almost gone when they are in their 60’s.

• See The "Degenerative Cascade" of a Degenerating Disc.

• Article written by:
• Peter F. Ullrich, Jr., MD

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