Introduction
Degenerative disc disease is one of the most common diagnoses in spine care today. According to Columbia University, “most people’s spinal discs degenerate over time. By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels. By the age of 60, more than 90% of people will show evidence of some disc degeneration.” There are many questions surrounding this chronic and progressive disease of the spine. We first have to understand the disease progression. Currently, there are four understood stages of degenerative disc disease.
Stage 1: The Dysfunction Stage
It’s unclear what causes the degenerative process to start. In some cases, it could be due to age, while others are related to excessive stress placed on the spine, which can be from sports or occupational demands. Whatever the cause, it is understood that degenerative disc disease is a chronic and progressive condition.
The first stage of dysfunction does not always cause pain. Intervertebral discs have two unique factors compared to other tissues in the body. They have a poor blood supply and aren’t well innervated either. Innervation refers to the nervous system. There are billions of nerves within our body; each does something unique. Some nerves sense pressure, others sense temperature, and some control motor function. Most patients are only concerned with nociceptors, which is your body’s ability to feel pain. The inner two-thirds of the disc does not have a nerve supply that interprets pain. This means that you could be in the dysfunction stage of degenerative disc disease and not have any perception of it. Why? Because you can’t feel it.
This stage marks the onset of structural changes to the spine, which may include disc compression, disc dehydration, bone spurs, facet joints, and/or ligament hypertrophy. These sequelae are often associated with the dysfunction that begins the degenerative disc disease process. These structural changes are often caused by a compensation pattern to take pressure off of diseased discs, which can lead to many postural issues.
The longer the body remains locked in a compensation pattern, the more damage is caused to dysfunctioning discs. This often leads to other issues highlighted by doctors specializing in spinal balance and posture. Dr. Michael Lea is one of the leading experts in Indiana who has additional training in postural alignment of the spine. Through his postgraduate training, he is able to diagnose degenerative disc disease in the early stages. Through the treatment options at Crossroads Brain & Spine, degenerative discs can begin to heal naturally without addictive opioids, risky epidural injections, and invasive spine surgeries.
Even though pain is not characteristic of this stage, dysfunction can often lead to more serious issues, such as bulging or herniated discs. These, on the other hand, are more acutely painful than degenerative discs. By diagnosing degenerative discs early in the disease process, it often takes less time to treat them than if you were to wait until they become symptomatic.
Stage 2: The Dehydration Stage
Dehydration is the driving factor behind degenerative disc disease. Intervertebral discs have water-attracting molecules within them that have the propensity to retain hydration. What happens is that as the disc begins to degenerate, it starts to slowly lose water content. This will accentuate the aforementioned postural changes of the spine. Spinal imbalance, left untreated, can lead to a host of other factors that complicate degenerative disc disease. It’s during the dehydration stage that pain can be felt. As discs degenerate, they become thinner and thinner over time.
This is because the pressure inside the disc starts to increase as the disc degenerates. As the pressure rises, it can push water out of the disc. This occurs because the disc is losing its ability to retain water. Unless this mechanism is corrected, the dehydration process can become quite rapid. As discs lose water, become compressed, and degenerate, they force the weight of the body on other structures that weren’t meant to carry the load. In a normal, healthy spine, the disc will bear approximately 80% of the weight of the spine and body, whereas the facet joint will bear only 20%. As this disease progresses, facet joints that carry more load can start to hypertrophy. This can cause them to change their structure as a side effect of degenerating discs. Additionally, the degenerative discs will cause undue stress on the vertebral bodies, which leads to traction osteophytes, also known as bone spurs. These bony irregularities often accompany degenerating discs and can begin during the dehydration stage.
Patients in this stage of degenerative disc disease can start feeling increasingly intense pain. This often leads them to seek medical treatment for back and/or neck pain. The current medical approach for spine pain is a trial of conservative care which often means 6-8 weeks of physical therapy. If physical therapy is deemed unsuccessful, the patient is often given painkillers. Doctors are prescribing less and less addictive opioids now than before. However, the medical management of spine pain is difficult. This has led to other medical treatments such as cortisone injections, epidural injections, nerve blocks, nerve ablations, and spinal cord stimulators, to name a few. While some patients experience less pain after these treatments, we have to ask ourselves, how is this putting water back into the degenerated disc? The short answer: it isn’t.
Of course, spine surgery is the last resort. Every year, new surgical procedures and techniques are developed in the hope that they will help patients experience less pain. Unfortunately, as the statistics show, the outcomes of these invasive spine surgeries are marginal at best. Again, we have to ask how this surgical procedure rehydrates the disc. The short answer: it doesn’t.
Stage 3: The Stabilization Stage
As discussed previously, degenerative disc disease is progressive. If left untreated, it will continually deteriorate until there is nothing left of the disc itself. One of the sequelae of degenerative disc disease is the change to the surrounding skeletal structures, most notably the vertebrae located above and below the disc. Remember, the disc is largely comprised of water content. Through the degenerative process, the disc loses water and becomes compressed. As a disc compresses, the pressure within the disc significantly increases. This often leads to bulging and/or herniated discs. The most common symptom of a bulging/herniated disc is sciatica. The reason is that the disc pinches on nerve roots as they exit the spine, which can cause numbness, burning, or tingling down your leg.
In the stabilization phase, the intelligence in your body makes an effort to stabilize the spine. This stabilization is needed because as discs degenerate, they can no longer do their job effectively, which means that other structures have to support the structure of the spine. In the stabilization phase, we see advanced stages of bone spurring of the adjacent vertebrae. As the discs degenerate, they can no longer support the spine; thus, the responsibility falls on the vertebrae. Bone spurs are a sign that the degenerative process is well underway. These can cause severe pain if they encroach on nerves in and around the spine.
The stabilization phase is not a positive one. Unfortunately, it changes the structure of the spine to the extent that it can severely limit the spine’s mobility. These patients often complain of decreased range of motion and poor posture. In some cases, the posture can become so poor that a person is unable to stand up straight and thus is left in a hunched or stooped position.
The severity of pain in the stabilization phase varies between patients. However, most commonly, the pain is constant. In previous stages, it could be intermittent or occasional. If the discs are in the third stage of the degenerative disc disease process, the pain can become uncontrollable, leaving the patient desperate for some kind of relief. This starts to greatly reduce your capacity to perform simple and basic activities of daily living.
Though treatable, the stabilization stage of degenerative disc disease becomes increasingly difficult to treat.
Stage 4: The Collapsing Stage
At this point in the degenerative disc disease process, there may be irreversible damage to the spine. Some physicians are of the opinion that invasive spine surgery is the only option. This may include procedures such as a discectomy or disc replacement. However, oftentimes, the surgery of choice is a laminectomy and spinal fusion. This may be necessary in some cases because the disc becomes so collapsed that the vertebrae can fuse together under the gravitational force, causing spinal stenosis. If it gets that bad, there is severe loss of mobility as well as constant and debilitating pain.
As things continue to degenerate, the inflammatory process spirals out of control, causing worsening symptoms. Unfortunately, some of these patients need assistance walking through canes or walkers. Depending on the severity, a wheelchair might be necessary due to the intensity of the pain. While every patient is different and unique, one thing is for certain: pain.
Pain is a consistent theme throughout the degenerative disc disease process. Patients don’t seek treatment because of dysfunction of their spine. They seek treatment because they feel pain. While it makes sense to be proactive about your health, our culture is primarily focused on feeling, not function.
As an example, how often have we heard somebody say, “I’ll go to the dentist when I have a toothache.” By the time the tooth has started to hurt, the process of tooth decay is well underway. The patient could have potentially avoided the toothache if they maintained their dental hygiene and went for a cleaning/checkup every six months.
Frequently Asked Question: What are my treatment options?
In each stage of the degenerative disc disease process, there are different treatment options ranging from physical therapy to spinal fusion. Each varies in severity and cost. While these treatments may reduce the pain you may be feeling with degenerative disc disease, how is it putting rehydrating the disc? The answer is that it isn’t.
Remember, the intervertebral discs are primarily made up of water. If the disc loses water content, the degenerative process is expedited. Non-surgical spinal decompression is a non-invasive, outpatient treatment that has been cleared by the FDA for over two decades. Currently, only two non-surgical spinal decompression tables have an FDA 510K code. The DRX-9000 is the first table to achieve this status. In fact, many competitors have attempted to use the same mechanism to achieve decompression over the years. However, they don’t have the patents to do so.
The DRX-9000 is the only true non-surgical spinal decompression table available on the market. Many major universities in the United States have researched using this technology, including Stanford, Johns Hopkins, Harvard, Cleveland Clinic, and the Mayo Clinic.
This technology works based on the mechanical principle of imbibition. A natural pump mechanism within the spine works to keep discs healthy and hydrated. Conditions like degenerative disc disease disrupt this process. Through imbibition, the DRX-9000 is able to rehydrate the discs. Non-surgical spinal decompression is the process of gently pulling the vertebrae apart and bringing them back together. This pumping mechanism creates a negative pressure and vacuum effect within the disc to bring water from the extracellular matrix (around, yet outside, the disc area) to inside the disc itself.
The disc has molecules within it that are polar and attract water. If the pressure inside the disc gets too high, water is pushed out of the disc, which leads to stage two, the dehydration stage. By using the DRX-9000, true non-surgical spinal decompression occurs, and the pressure gradient is reversed, bringing water back into the disc.
The process of decompressing the disc is not an overnight event. In many patients, this is a process that can take several months. On average, most decompression patients will undergo a series of 20-30 treatments in the initial phase of care prior to transitioning to maintenance.
While degenerative disc disease is a difficult and painful condition that leads to decreased function, there is another treatment available that does not include addictive opioids, risky injections, and invasive surgeries. The DRX-9000 is the preferred method of conservative treatment among many disc specialists. This technology has been available for over two decades and boasts FDA clearance. The McClure Study, a hallmark decompression study, was conducted by Dennis McClure, MD, who was an orthopedic surgeon who found an 88-92% success rate using non-surgical spinal decompression.
Conclusion
If you or someone you know is suffering from spine pain as a result of degenerative disc disease, there is hope that you can live a healthier, normal life without the need for addictive opioids, risky injections, and invasive surgeries. The DRX-9000 is a non-surgical spinal decompression treatment that is FDA-cleared for the treatment of many disc injuries. It has clinical studies proving the effectiveness of the technology.
Crossroads Brain & Spine is Indiana’s premier non-surgical spine care center. Located conveniently in Indianapolis, it uses the latest and greatest technology to treat spine conditions like bulging discs, herniated discs, degenerative discs, and sciatica.
Dr. Michael Lea is a leading expert in the field of conservative spine care. He is one of two disc specialists in Indiana holding a national spinal decompression certification. To date, he has performed over 3,700 treatments with a success rate of 90%.