DEGENERATIVE DISC DISEASE IN INDIA
How is the spine designed?
The vertebrae are the bony building blocks of the spine. Between each of the largest part of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock, beneath the fifth lumbar vertebra, is sacrum followed by the tailbone (coccyx).
Degenerative disc disease (DDD) is typically associated with aging. As you age, your discs, like other joints in the body, can degenerate (break down) and become problematic: that’s a natural part of growing older as your body deals with years of strain, overuse, and maybe even misuse. However, DDD can occur in people as young as 20, so sadly, youth doesn’t always protect you from this disc-related condition. In fact, some patients may inherit a prematurely aging spine.
A healthy intervertebral disc has a great deal of water in the nucleus pulposus (the center portion of the disc). The water content gives the nucleus a spongy quality and allows it to absorb spinal stress. Excessive pressure or injuries to the disc can cause the injury to the annulus (the outer ring of tough ligament material) that holds the vertebrae together. The annulus is generally the first portion of the disc to be injured. Small tears show up in the ligament material of the annulus. These tears heal by scar tissue, which is not as strong as normal ligament tissue. The annulus becomes weaker over time as more scar tissue forms. This can lead to damage of the nucleus pulposus. It begins to lose its water content and dry up. View animation of degeneration.
Loss of water content causes the discs to lose some of their ability to act as cushions. This can lead to even more stress on the annulus and still more tears as the cycle repeats itself. As the nucleus loses its water content, it collapses. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses or provide the movement needed to bend and twist.
collapses, allowing the two vertebrae above and below to move closer to one another. This results in a narrowing of the disc space between the two vertebrae. As this shift occurs, the facet joints (located at the back of the spine) are forced to shift. Shifting changes the way the facet joints work together and can cause problems as well.
Bone spurs, sometimes called osteophytes, may begin to form around the disc space. These can also form around the facet joints. This is thought to be due to the body’s response to try to stop the excess motion at the spinal segment. The bone spurs can become a problem if they start to grow into the spinal canal and press into the spinal cord and spinal nerves. This condition is called spinal stenosis.
Diagnosis in India
The diagnosis of degenerative disc disease begins with a complete physical examination of the body, with special attention paid to the back and lower extremities. Your doctor will examine your back for flexibility, range of motion, and the presence of certain signs that suggest that your nerve roots are being affected by degenerative changes in your back. This often involves testing the strength of your muscles and your reflexes to make sure that they are still working normally. You will often be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.
A routine set of X-rays is also usually ordered when a patient with back pain goes to see a doctor. If degenerative disc disease is present, the X-rays will often show a narrowing of the spaces between the vertebral bodies, which indicates that the disc has become very thin or has collapsed. Bone spurs begin to form around the edges of the vertebral bodies and also around the edges of the facet joints in the spine. These bone spurs can be seen on an X-ray, where they are called osteophytes. As the disc collapses and bone spurs form, the space available for the nerve roots starts to shrink. The nerve roots exit the spinal canal through a bony tunnel called the neuroforamen, and it is at this point that the nerve roots are especially vulnerable to compression.
In many situations, doctors will order a MRI or a CT scan (CAT scan) in order to evaluate the degenerative changes in the lumbar spine more completely. A MRI scan is very useful for determining where disc herniations have occurred and where the nerve roots are being compressed. A CT scan is often used to evaluate the bony anatomy in the spine, which can show how much space is available for the nerve roots and within the neuroforamen and spinal canal.
Treatment in India
Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people who do not have evidence of nerve root compression with muscle weakness, the first line of therapy includes non-steroidal anti-inflammatory drugs and physical therapy. A soft lumbar corset is often prescribed in order to allow the back to have a chance to rest. Surgery is offered only after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period of time.
Treatment Options in India
Conservative Treatment in India
Treatment will depend on the seriousness of your condition. Some problems need immediate attention-possibly even surgery. The vast majority of back problems do not require surgery. Treatment for your back may be as simple as reassuring you that it is not a serious problem and doing nothing but watching and waiting. In most cases, simple therapies, such as mild pain medications and rest are effective in relieving the immediate pain.
The overall goal of treatment is to
- make you comfortable as quickly as possible
- design a spine-care program to reduce further degeneration
- get you back to normal activity in a timely manner
The more you know about how your back works and what you can do to prevent further injury, the more effective your program will be.
Immediately after a back injury, rest is often all your back needs to feel better. Rest is used to take the pressure off your spine and the muscles around it. You should rest in a comfortable position on a firm mattress. Placing a pillow under your knees can also help relieve pain. Do not stay in bed for several days. Bed rest for more than two or three days can weaken the back muscles, making the problem worse instead of better. Even though you may still feel some pain, a gradual return to normal activities is good for your muscles. In most cases of sudden back pain, the sooner you start moving again, the sooner your back pain will improve. If you are sent to see a physical therapist, the first few days may be spent educating you on ways to take stress off the back, while remaining as active as possible. Short periods of rest combined with brief exercises designed to reduce your pain may be suggested.
Physical Therapy and Exercise in India
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Therapy visits are designed to help control symptoms, enabling you to begin moving and exercising safely and easily. Regular exercise is the most basic way to combat back problems. Consider it part of long-term health management and risk reduction program. Exercises focus on improving strength and coordination of the low back and abdominal muscles. The emphasis of therapy is to help you learn to take care of your back through safe exercise and self care when symptoms flare up. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- learn ways to manage your condition and control symptoms
- maintain appropriate activity levels
- learn correct posture and body movements to reduce back strain
- maximize your flexibility and strength
Degenerative Disc Disease Surgery in India
Degenerative Disc Disease Surgery is one of the worst uses of spinal surgery. DDD is a completely normal part of the aging process and is rarely symptomatic. It is also one of the most commonly diagnosed causes of back pain today. It is a travesty of good medicine to blame pain on this scapegoat condition. The misdiagnosis of degenerative disc disease is one of the main causes and perpetuators of the back pain epidemic and the most common reason why many patients never find lasting relief from their torturous pain.