What is Disc Degeneration?
Disc degeneration is a normal age-related process. As we age, there is a general loss of hydration in our tissues that occurs due to a complex interaction of proteins and their breakdown products. This happens in hair, skin, muscle, and our spinal discs. As we age and the degenerative process breaks down our tissues, we start to see structural problems.
As the discs collapse, the outer portion of the disc, the annulus, becomes more brittle. The inner portion, the nucleus pulposus, loses height and volume. If we think of the disc as one leg of a tripod, the back two legs are the facet joints. When the disc collapses in the front, the back two legs, facet joints, see more force and become arthritic. This can lead to pain, stiffness, and decreased range of motion.
Patients with disc degeneration will often see changes in their x-rays including decreased disc height space, larger arthritic facet joints, and osteophyte or spur formation. Bone spurs are commonly misunderstood as patients think the “spurs are poking me in the back!” In reality, the bones form spurs as they try to spread the increased force over a greater surface area. Think of it like this – would you rather have someone step on your hand with a stiletto heel or a barefoot? Obviously barefoot because the weight is distributed over a greater area and not concentrated in one spot. Ouch!
How Does Disc Degeneration Cause Spinal Stenosis?
Disc degeneration will often show changes on patient MRIs as well, showing loss of hydration (water content), loss of disc height, reaction at the bony endplates (Modic Changes), and ligament hypertrophy. What does this mean?
As the discs lose height and bulge out like a tire without enough air, and the facet joints get bigger like arthritic knuckles, the space for the nerves become compromised. This narrowing of the space for the nerves is called stenosis. The stenosis is responsible for nerve related leg pain.
We now have a two pronged problem. Back pain caused by disc degeneration and facet arthrosis, and leg pain caused by stenosis. These complaints can present by themselves or together. Traditionally, back pain has been less predictable to treat than nerve related leg pain, also called radiculopathy.
Why is back pain more complicated to treat? In large part because of the distribution of pain sensing fibers for back pain in these areas. Additionally, the back is a complicated piece of the body and there are other pain generators in the back that will not be covered in this post.
What Are the Treatment Options?
Conservative or Non-Operative Treatments
Non-operative conservative treatment has been and still remains the number one treatment option for these age-related processes. The vast majority of patients get better with a combination of physical therapy, massage, chiropractic, anti-inflammatory medications, heat, stretching etc. All anyone needs to do is search the internet for back pain treatments and there will be more than a million results. No matter what treatment is applied, most people get better with time. Unfortunately, there are many websites out there who claim that their treatment is responsible for the “cure”. In reality, this is just playing on the natural self-limiting nature of episodic back pain. Be wary of anyone who promises a cure! For patients that have chronic symptoms of greater than six months and are significantly limited in their quality of life, there are more advanced treatment options.
Advanced Treatment Options
Unfortunately, many of us are genetically predetermined to wear out faster than others. At this point, we can not alter our genetics. However, the option of altering the disc at the chemical level has always been a great alternative to surgery, but the mechanism and how to achieve this has been poorly understood. We are now gaining more knowledge about the chemical architecture of the disc and the breakdown products, including some breakdown products that have been associated pain generation.
One option, now available through advances in MRI technology, is to identify chemical markers for breakdown products in order to manipulate the environment inside the disc. This can be accomplished through treatments that attempt to eliminate the pain sensing nerves. Two examples of such treatments are Chymopapain and intradiscal heating. Both of these were initially thought of as the “Holy Grail” of back pain treatment. Unfortunately, both of these treatments have not been very effective and in many cases resulted in an increase in long term back pain complaints. What other options does that leave you?
Stem Cell Treatments – The Truth
Stem cell treatments that utilize bone marrow aspirate concentrate (BMAC) and Platelet Rich Plasma (PRP) have been used by many physicians to treat patients for years. There is increasing medical literature to support their use in treating spine related issues.
While most physicians that use these treatment options have seen promising results, there are no guarantees. The claims that “Stem Cells are going to regrow your spine” sound fantastic. THIS IS NOT TRUE. A statement that is closer to reality is that regenerative techniques are working to change the architecture of the disc at a chemical level. This change in the chemical make-up, either by direct injection or by harnessing the signaling capacity of Mesenchymal Stem Cells to influence the body’s own healing capacity, is the goal of treatment. The use of before and after MRI technology also gives more horsepower to the science of this approach.
Will Stem Cells Help With Stenosis?
Stenosis is the narrowing or compression on the nerves. Most people know they have stenosis because it’s on their MRI report, not because they really know what it is. Most patients with stenosis also have degenerative disc disease and low back pain. They think the stenosis is the reason they have back pain, but it’s actually the degeneration.
Stem cell injections will not get rid of nerve compression but regenerative techniques may have the ability to change the make-up of the disc at the cellular level, helping the body to influence its own ability to heal.
It’s important to discuss options and the needs of each patient individually. We customize every treatment plan to ensure you get the optimal results. We are in this for the long-term with you! This is a rapidly changing field and you deserve treatment from fellowship trained orthopedic surgeons who understand the nuances of the musculoskeletal system, surgical treatment options and surgical alternatives. For more information, or to set up a consultation, contact our office today.