"Disc Disease"

March 27, 2019

I came across an article on “Disc Issues” and it is fascinating that some of these old ideas are still being shared.


“Disc Disease” is the loss of fluid/flattening of a disc as it sits between two vertebrae in the spine. This is usually a normal part of the aging process.  We are moving through space as gravity is pushing down on us leading to these changes.  Many studies have show in the neck this starts to happen around the 20th decade of life and then in our lumbar spines by the 50-60th. These findings are on MRIs all the time and have been found in studies of patients that have no pain at all!  Disc Bulging usually accompanies Disc Disease. Imagine the disc as a balloon and as it gets smaller from top to bottom it will spread out laterally.  This is more common in the lower back due to a narrowing of the ligament (posterior longitudinal ligament) that is supposed to hold them in place.  The disc bulges again have been shown on many MRI studies of people without pain as well.  “Disc Herniations” are where the inside of a disc (nucleus pulposus) extrudes outside of the disc. This is described as if the jelly inside of a jelly donut were to squirt out. There is some concern that this can cause an immune reaction due to a foreign substance and result in inflammation and pain. This process can be quiet painful and should resolve over 4-6 weeks.  Pain can also happen when a disc is pressing on nerves, resulting in “Nerve Impingement”.  Over a decade ago tears on the outside of the disc called “Annular Tears” were considered a cause of pain, but that has fallen out of favor recently.  I believe it was due to a study that showed injecting the discs was not of any benefit. Personally, I feel these are still a cause of pain and can be very difficult to manage.  

 

This all being said, the vast majority of back pain issues are mechanical in nature and not related to these normal aging processes

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