Degenerative disc disease (DDD) is arthritis in the spine. It is often part of the natural process of aging. This being said, the condition can be hastened by lifestyle/working/activity choices with increased wear and tear, smoking and certain types of vibration along with major injury or fracture and genetics. Unfortunately, as we mature, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc called the annulus fibrosis, become brittle and therefore are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, is unable to absorb fluid and starts to dry out and shrink. Over time, routine activities can cause tears in the outer covering and the disc weakens and collapses. The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the spine.
Facet joint arthritis involves bony overgrowth and hardening of the structures in the posterior (back) aspect of the spine. The facet joints connect the vertebrae together and inflammation of the ligaments and joint space results in frictional pain. Typically, facet arthritis is a degenerative condition that develops over time, but may be frequently encountered in patients with a history of fractures to the spine, ligament tears and disc problems. The most common symptoms in facet arthritis involve pain that is typically worse following sleep or rest and is exacerbated by bending or twisting.
Over time, arthritis can result in the development of bone spurs, or osteophytes, an irregular growth of bone. This is the body’s natural way to limit spine mobility and decrease pain. While bone spurs may not result in pain, the location and size may act to trap or compress a nerve that normally passes through a vertebral body. The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the spine. This can result in spinal stenosis and pain at the site and in the affected extremity.
Arthritis is diagnosed through careful insight into the patient’s history and symptoms along with X-rays that help to evaluate the extent of joint damage. Blood tests are also useful to determine if other forms of arthritis are present, especially gout and rheumatoid arthritis. Symptoms on physical exam include tenderness to touch at the joint spaces, limited range of motion, swelling and a grating feeling or sound with movement of joints.
Treatments include over the counter anti-inflammatory medications along with prescription strength alternatives, injections into the affected joint spaces, physical therapy, exercise and weight reduction, along with specific medications directed toward other forms of arthritis (ie rheumatoid arthritis and gout). Surgical intervention is also a consideration, with procedures used to limit the further motion of the spine. Surgical intervention should also be considered as a last resort after all other non-operative treatments have failed.
References:
www.spineuniverse.com
Spine arthritis: Symptoms Arthritis-Osteoarthritis-Rheumatoid Arthritis-Spinal Stenosis,
Dr. Stewart Eidelson
Osteoarthritis:
Degenerative Spinal Joint Disease
www.laserspineinstitute.com: Arthritis of the Spine
www.spine-health.com: Causes of Osteoarthritis and Spinal Arthritis by Dr. Charles Ray Understanding Osteoarthritis of the Spine by Dr. Charles Ray.
This educational tool was created by J. Fortenberry, PA-C 12/7/09