Degenerative Spine

There’s nothing inevitable in this world but death, taxes, and…degenerative disc disease? There’s plenty you can do at any age to keep your back strong and healthy, but time marches on and good luck trying to stop that. Sooner or later, your spinal discs – the shock absorbing pads between each vertebra – start to wear out. That can lead to degenerative disc disease (DDD).
DDD is a condition in which a damaged spinal disc causes pain. (While everyone has some wear and tear of their spinal discs; not everyone will have pain.) And although it may take decades before you feel pain (if you ever do), the degeneration process can start as early as your 20s.

What is Degenerative Disc Disease?

DDD is a common cause of back pain, especially as you get older. The discs that cushion the vertebrae – the long stack of bones in your spine – begin to dry out. Discs can also get damaged from normal wear and tear or an injury.
Both the extent of the breakdown and how it affects people varies. One person may have severe disc breakdown but only mild pain, while another may have minor disc damage and excruciating pain.
“It’s really about the individual,” says Neel Anand, MD, a professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. “Some spines can bear a lot of load. Others cannot.”

To better understand DDD, it’s helpful to know a bit about the spine’s basic structures and how they work:

• Vertebrae. Your vertebrae are the interlocking bones in your spine that support your entire body. They’re divided into three different regions: cervical spine (neck), thoracic spine (upper- and mid-back), and lumbar spine (lower back). DDD tends to occur in your neck or lower back, but it can happen anywhere along your spine.
• Discs. In between each vertebra are shock-absorbing discs, known as spinal discs or intervertebral discs. They cushion your vertebrae and allow your back to bend, flex, and twist. The outer part of a disc is firm and contains nerves, so a bulge or tear can be very painful. If the jellylike interior leaks out, you could hurt even more. That stuff contain proteins that cause any tissue it touches to become swollen or tender.
• Cartilage. Each spinal joint is surrounded by cartilage, which protects and cushions the spine. Wear and tear can cause cartilage to break down, exacerbating DDD.

Your spine is divided into regions:

• Neck (cervical spine)
• Mid-back (thoracic spine)
• Low back (lumbar spine)
• At the lower end of your spine, you also have the sacrum and the coccyx, which is commonly called your tailbone.

Causes

Age

The spine starts degenerating somewhere between the ages of 20 and 25, explains Dr. Anand. But there’s a reason you don’t see most 20-somethings wincing from back pain: it takes a long time for spinal discs to wear down on their own.

Your activity levels

Were you ever a runner, wrestler, dancer, or tennis player? Did you carry around kids or lift moving boxes? Whether that’s all in the past or part of your present, activities of daily living cause wear and tear on your spinal discs.

Injuries

Any back injury that causes swelling or soreness – from a car accident to that one wayward swing on the golf course – can increase your risk of DDD.

Spinal diseases

Certain back conditions, such as ankylosing spondylitis (an inflammatory spine condition that causes vertebrae to fuse together), can increase your risk for DDD.

Obesity or excess weight

Being overweight and obese increases the load your spine has to bear. That excess weight compresses the spinal discs. Compared with normal-weight people, those who are overweight and obese are more likely to have significant disc degeneration.