please ↑Like, ↓Comment and Share↑ now. http://www.medilaw.tv Subscribe for latest movies. medical 3D animations. Shows a lateral view of a normal and a degenerate L4-5 segment during flexion-extension. Also shows a superior view of the L4-5 disc and L5 vertebra during the natural progress of degenerative disc disease - nucleus degeneration, vertebral body lipping, ligamentum flava hypertrophy/kinking, facet joint cartilage degeneration and osteophytes, spinal canal stenosis and nerve root radiculopathy.
When you sit, stand up, bend or twist, large compressive forces are applied to your spine. There are several factors that determine the ability of your inter-vertebral discs to handle these forces:
your inherited make-up
disc health -- worsened by smoking, poor nutrition, sedentary lifestyle, weak muscles, and obesity
ageing
poor posture -- while sitting, standing and lifting
heavy loads during home, work or sporting activities.
DISC INJURY
When the forces applied to your neck exceed the strength of your discs, minor injuries to the disc can occur. It is important to note these injuries may or may not hurt at the time they occur.
DISC DEGENERATION
As the continuous stresses and repeated injuries accumulate, they cause wear and tear on the spine's discs and joints. Some people are more susceptible to this degeneration, for reasons that are unclear.
Often the annulus of the inter-vertebral disc is the first area injured. Small tears occur that heal with weaker scar tissue. As more scar tissue accumulates, the annulus becomes weaker overall.
This damages the inner nucleus, which loses it cushioning water content, and begins to dry up and stiffen. It changes from a jelly-like consistency, to more like crab meat. As it dries up, the height of the disc collapses. The decreased cushioning ability of the drier, weaker nucleus leads to even more stress on the annulus, and further annulus damage and nucleus collapse.
The attachment of the disc to the vertebra is placed under a lot of stress by this disc collapse, and the vertebra reacts by growing more bone in an attempt to get stronger. This can be seen as vertebral lipping at the edges of the vertebral body. This lipping can encroach on the spinal canal and adjacent nerves.
The alignment of the facet joints at the back of the spine alters to accommodate the disc collapse. This changes the way in which the facets slide over each other, causing increased wear of the cartilage on the joint surface. The cartilage frays, and is ground down to the underlying bone. When this facet joint arthritis occurs, the bone around the facet joint is irritated, and grows in an attempt to stop the excess motion.
These facet joint bone spurs, or osteophytes enlarge, and can grow into the intervertebral foramen or spinal canal, where they can compress the spinal nerve and the adjacent spinal cord.
The ligamentum flavum runs along the back of the spinal canal from one vertebra to the next. As the disc height collapses, and the adjacent vertebra move closer together, the ligamentum flavum thickens and buckles into the spinal canal, placing additional pressure on the spinal cord.
The collapsed intervertebral disc and the deformed facet joints can lead to instability of the adjacent vertebra. The top vertebra can slide forward on the bottom one under the weight of the body, a process called spondylolisthesis.
SUMMARY
So degenerative disc disease involves disc collapse and bulging, vertebral body lipping, facet joint osteophytes, thickening of the ligamentum flavum, and the slipping of the adjacent vertebra. This disease puts pressure on the spinal cord and adjacent nerves, and can cause pain.
TREATMENT
Although this process can not be reversed, there are things that you can do to slow it down and control any pain.
The safest and most effective treatments for degenerative disc disease include
Stop smoking
Physical therapies - correct posture, activity modification (avoiding bending, lifting, twisting and prolonged sitting), low impact and flexibility, strength and endurance exercises, hydrotherapy, physical therapy modalities such as heat, ice, massage, and manipulation or mobilization
Medications - early aggressive use of medication to reduce pain, inflammation, muscle spasm and sleep disturbance
Other treatments -- ie acupuncture, ultrasound, laser, short-wave diathermy.
The use of lumbar bracing and acupuncture is controversial.
The amount of pain experienced from degenerative disc disease varies widely. This may be due to differing degrees of instability, scarring of the disc and facet joint arthritis. Once the degeneration is advanced, and the instability produces uncontrollable pain, or the pressure on the nerves affects their functioning, then your clinician will consider fusing the two vertebrae together, or inserting an artificial intervertebral disc.
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