Degenerative Disc Disease

The outer annulus of the disc is richly supplied with nerve fibers to help protect the spine and spinal cord from injury. Disease, injury, or aging weakens and may tear the annulus allowing bulging and stretch on sensitive nerve endings to occur, even in the absence of herniation. This is called discogenic pain, and may be very difficult to treat. Discogenic pain is usually made worse by prolonged sitting, standing, or bending which has been shown to increase the pressure inside the disc. The pain specialist may use a special test called a discogram to confirm the diagnosis of discogenic pain and to indicate specifically which disc or discs is/are causing the pain

Cross section of normal lumbar disc showing intact annulus and rich nerve supply

Degenerated lumbar disc with degenerative tears in the annulus and early herniation of nucleus

Once the offending disc is found, treatment options include medications, nerve blocks, intraspinal drug therapy, and newer techniques such as laser disc decompression and endoscopic microdiscectomy and foraminotomy: Artificial disc replacement is a promising new surgical technique that is being evaluated in clinical trials and may be available soon.

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