Degenerative Spine Disease Treatment
What is Degenerative Spine Disease?
Degenerative spine disease is typically the result of gradual, aging-related wear and tear on the spine. This can cause pressure on the spinal cord and/or spinal nerves, and lead to back pain that is sometimes quite severe. A number of different medical conditions can involve degeneration of the spine. They include:
- Herniated disks — In this potentially painful problem, the hard outer coating of the disks, which are the circular pieces of connective tissue that cushion the bones of the spine, are damaged, allowing the disks’ jelly-like center to leak, irritating nearby nerves. This causes severe sciatica and nerve pain down the leg. A herniated disk may be called a ruptured disk.
- Spinal stenosis — Spinal stenosis is the narrowing of the spinal canal, through which the spinal cord and spinal nerves run. It is often caused by the overgrowth of bone caused by osteoarthritis of the spine. Compression of the nerves caused by spinal stenosis can lead not only to pain, but also to numbness in the legs and the loss of bladder or bowel control. Patients may have difficulty walking any distance and may have severe pain in their legs along with numbness and tingling.
- Spondylolisthesis — In this condition, a vertebra of the lumbar spine slips out of place. As the spine tries to stabilize itself, the joints between the slipped vertebra and adjacent vertebrae can become enlarged, pinching nerves as they exit the spinal column. Spondylolisthesis may cause not only low back pain but also severe sciatica leg pain.
- Vertebral fractures — These fractures are caused by trauma to the vertebrae of the spine or by crumbling of the vertebrae resulting from osteoporosis. This causes mostly mechanical back pain, but it may also put pressure on the nerves, creating leg pain.
- Diskogenic low back pain (degenerative disk disease) — Most people’s disks degenerate over a lifetime, but in some, this aging process can become chronically painful, severely interfering with their quality of life.
How are these conditions diagnosed?
Diagnosis of the different conditions can vary, but it may include a physician examination by a doctor, X-ray tests, computed tomography (CT) scan and magnetic resonance imaging (MRI).
What is the treatment?
Treatment is also dependent on the particular condition as well as its severity. Physical therapy, pain medication, a back brace and/or complementary therapies (such as acupuncture and massage) may helps some patients. Others, particularly those with severe, chronic back pain may benefit from surgery. Commonly performed back surgeries include laminectomy/diskectomy, laser surgery and spinal fusion.
What kind of research is being done?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supports research to better understand and treat back pain. One major focus of research in recent years has been on the relative efficacy and cost effectiveness of surgical versus nonsurgical treatment of conditions associated with low back and leg pain.
A 5-year multicenter study called the Spine Patient Outcomes Research Trial (SPORT) compared the most commonly used standard surgical and nonsurgical treatments for patients with the three most common diagnoses for which spine surgery is performed: intervertebral disk herniation, spinal stenosis, and degenerative spondylisthesis.
Key findings included the following:
- Decompressive laminectomy — A surgical procedure called decompressive laminectomy, which involves removing bone and soft tissue to relieve pressure on the nerves, is more effective than nonsurgical treatments for degenerative spondylolisthesis, which can result in spinal stenosis. Two years after enrollment in the SPORT trial, patients with degenerative spondylolisthesis and spinal stenosis who received nonsurgical treatments such as physical therapy, steroid injections, and analgesic medications, reported modest improvement in their condition. However, patients who had the surgery reported significantly reduced pain and improved function. Furthermore, for the surgery group, relief from symptoms came quickly; some reported significant relief as early as 6 weeks after the procedure.
- Lumbar diskectomy — The most common surgical procedure for back or leg pain, lumbar diskectomy, offers significant benefits over nonsurgical treatment for herniated disks—at least short term. In one arm of the SPORT trial, 743 patients received surgery and 191 received the usual nonoperative care. The benefits of surgery were seen as early as 6 weeks and were maintained at least 2 years. Consistent with the earlier findings, however, the patients who received nonoperative treatments also improved.
Other research from the SPORT study looked at the factors that go into patients’ decisions whether to pursue surgery for herniated disks. It found that compared with patients who chose nonsurgical treatments, patients who preferred surgery:
- Were more definite about their preference than those preferring nonoperative treatment
- Experienced longer periods away from work, either because of disability or because of unemployment
- Reported higher levels of pain, worse physical and mental functioning, and more disability related to back pain. They were also more likely to be taking narcotic pain medications.
- Expected more benefit from having surgery and had a low anticipation of risk from the operation.
Because a patient’s expectations for a therapy are closely linked to his or her response to and ultimate satisfaction with care, this research has important implications for tools to assist people in making informed choices about herniated disk surgery.
NIAMS-supported research is ongoing. Goals of current research are to:
- Understand the mechanisms of back pain
- Identify ways to prevent back pain
- Improve surgical and nonsurgical treatments for back pain
- Prevent disability in people who suffer from back pain.