Degenerative Back Condition Fundamentals
Degenerative changes in the spine are those that cause the loss of normal structure and/or function. They are not typically due to a specific injury but rather to age. Repeated strains, sprains, and overuse of the back cause a gradual degeneration of the disks of the spine. Nearly everyone experiences some disk degeneration after age 40.
Since most patients do improve with time and non-operative treatment, surgery is only recommended when degeneration or disk herniation produces persistent back pain or leg pain from nerve compression. A comprehensive back program, combining physical therapy, activity modification, pain management, and appropriate surgery when indicated provides each individual with his or her best chance of recovery.
What causes the pain?
Degenerative back conditions erode the disk’s ability to handle mechanical stress, leading to back pain. Many patients with persistent pain are found to suffer from symptomatic disk degeneration, a condition in which the disk loses its normal water content and its ability to absorb weight and shock during motion. These changes are part of the normal aging process, in that everyone experiences disk degeneration as they age, but only some of the disks with these changes ever produce symptoms of pain.
When young, our disks are soft and serve as a cushion for the vertebrae. As we age, the material in these disks becomes less supple and the disks erode, losing some height. As they narrow, their ability to cushion the vertebrae decreases, resulting in changing the position of the vertebrae and the ligaments that connect them. As the vertebrae shift and affect other bones, the nerves can get caught or pinched and muscle spasms can occur. As disk degeneration progresses, disks may become inflamed and collapse.
In the late stages of spinal degeneration, bony spurs form and may lead to spinal stenosis. In this condition, the spinal canal becomes too small and presses on the nerve roots, leading to pain and nerve dysfunction in the legs.
The following symptoms may indicate you have a degenerative back condition:
- Pain caused by lifting objects or twisting
- Pain that travels down one leg (sciatica)
What are my treatment options?
When back pain is acute, your doctor will likely prescribe bed rest for a short period of time. After that, you should engage in regular stretching and low-impact exercise. Stretching can improve muscle flexibility. Low-impact exercise promotes muscular endurance, coordination, strength, strong abdominal muscles and weight loss. Strong abdominal muscles work like a brace to reduce the loads to the lumbar spine. Other types of treatment include:
- Drug therapy, such as anti-inflammatory agents, muscle relaxants and acetaminophen
- Manipulation to improve spinal mobility
If pain persists despite medical treatment, your doctor may recommend surgery. Listed below are surgical treatment options for degenerative back conditions:
- Laminectomies are recommended when you have spinal stenosis. In a laminectomy, the lamina, or back portion of the spine, is removed to give the nerves more room and reduce inflammation. Although the lamina will not grow back, scar tissue will develop and will protect the spinal nerves.
- Spinal fusion is recommended in the most severe degenerative back conditions and involves joining the bones together with screws or bone grafts to provide stability. It may be combined with laminectomy surgery. The surgery lasts several hours and can be done using one of two methods:
- Bone is removed from elsewhere in the body or obtained from a bone bank. This bone is used to create a bridge between vertebrae and stimulate the growth of new bone.
- Metal implants, such as rods, hooks, wires, or screws, are secured to the vertebrae to hold them together until new bone grows between them.
Surgical removal of an inferior disk may involve the removal of disk fragments and compression of the nerve. Micro-discectomy is often a preferred procedure requiring smaller incisions resulting in reduced scarring and a more rapid recovery.
What are the risks of surgery? Is the surgery safe?
Several common risks include nerve injury, infection, bleeding, and stiffness.
Risks of surgery are dependent on the individual, please discuss your risk level with your surgeon, prior to surgery.
How do I prepare for surgery?
To prepare for surgery quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.
What are the Cleveland Clinic physician credentials?
- All doctors at the Cleveland Clinic Center for Spine Health are fellowship-trained and board-certified or board-eligible in orthopaedic surgery, medical spine or neurosurgery. In addition, our surgeons have subspecialty training and years of experience in spine surgery.
- All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
- All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
How do I make an appointment?
Call 216.636.5860 or toll free 1.866.588.2264, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time)
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
- American Academy of Orthopaedic Surgeons
- www.spine.org North American Spine Society
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is eCleveland Clinic, a contemporary adaptation of Cleveland Clinic’s 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, eCleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With eCleveland Clinic’s personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life. To learn more about eCleveland Clinic, click here.