Back pain is increasingly common with age, and it can come in many forms. The spine is composed of 26 vertebrae, and each one, along with the surrounding ligaments, tendons, and muscles, can be damaged and cause discomfort. One of the most common areas of the spine for injury is the discs that sit between each of the vertebrae. They act as cushions to absorb compression and allow for movement of the spine, and they can degenerate with overuse or age.
This is known as degenerative disc disease, and it can cause movements to become painful and may result in the spinal nerves becoming compressed. If the sciatic nerve in the lower back is compressed, it can result in pain and numbness that runs down the hip and leg known as sciatica. Degenerative disc disease (DDD) is a common source of back pain, and it may lead to sciatic nerve irritation in certain situations.
What is Degenerative Disc Disease?
The spine is a complex part of the human body. It is required to perform several different movements and must withstand forces in many directions. The spine can bend, twist, compress, and extend because of the discs that are located between each set of vertebrae. These discs are composed of a hard, fibrous outer layer and a soft, gel-like inner layer. The outer layer provides support for the spine while the inner layer allows for compression and flexibility.
When the spine is forced to undergo lots of stress and as the body ages, these discs can begin to break down. This is known as degenerative disc disease or DDD. This condition causes the outer layer of the disc, called the annulus fibrosis, to break down and crack. The inner layer, known as the nucleus pulposus, may begin to dry out, limiting the disc’s ability to withstand compression. This condition is also known as osteoarthritis of the spine.
When a disc degenerates, it can cause the affected portion of the spine to become stiffer and may result in pain with certain movements. The affected disc also becomes more susceptible to injury. In some cases, the outer layer of the disc can rupture. When this occurs, the inner layer can leak out of the disc, which is known as a disc herniation.
Surrounding the spine are many nerves that stem from the spinal cord and travel to all areas of the body. Because of their location, when a disc herniates, the nucleus pulposus may place pressure on one of the nerves and pinch it. This commonly results in numbness or tingling in the arms if the pinched nerve is in the neck and down the legs if the herniation is in the lower back.
What is Sciatica?
This is a condition that is also known as lumbar radiculopathy. Radiculopathy refers to nerve irritation caused by damage to intervertebral discs, and lumbar radiculopathy means that the irritation is occurring in the lower back. The sciatic nerve is large in size and runs from the lower back and down each leg to the foot. If this nerve becomes pinched due to DDD, it can cause a variety of symptoms.
Oftentimes, lumbar radiculopathy causes pain on only one side of the body. This pain can be mild and may simply be felt as an ache in the lower back or down into the hip. In more severe cases, a “popping” sensation may occur and be followed by numbness or tingling down the leg.
The negative side effects of this condition are often made worse with certain movements, especially those that involve bending or extending from the waist. In addition, violent movements, such as sneezing, coughing, or sudden twists can make the pain worse.
How are DDD and Sciatica Treated?
Physicians can recognize these conditions based on their associated symptoms, and they are able to confirm their suspicions using x-rays and MRIs. These allow them to visualize the spine and note any discs that are compressed, dried out, or herniated. Once they note the exact issue and its location, they can determine the most effective treatment option.
In many cases, medications are used to manage DDD and sciatic nerve pain. These medications work to alleviate the pain itself or relax the muscles and reduce inflammation surrounding the damaged disc. Physical therapy is another commonly used intervention that can help to promote flexibility and strength to take the pressure off the affected disc and nerves.
For severe cases, surgical procedures may be used. These procedures often remove the damaged portion of a herniated disc or remove damaged pieces of bone in the spine. In some cases, these procedures can be successful, but their recovery often requires periods of physical therapy to restore strength and functionality and they may require follow-up procedures or cause secondary injuries.
Other, less-invasive procedures can also be used, such as the Discseel® Procedure. This procedure involves injecting Fibrin, an FDA-approved substance that is used off-label, into the damaged disc. Stem cells are able to transform into a variety of cell types to help repair and regrow damaged tissues. When injected into the spinal discs, they can help to repair any cracks due to degeneration and reduce associated pain.