Methods of treatment of degenerative spinal cord

Dr. Moradi, a neurologist

The spine is a complex structure comprised of muscles, vertebrae, cartilage, discs and ligaments, all of which naturally deteriorate as we age. In fact, the joints of the spine are more susceptible to deterioration than any other region of the body. Degenerative spinal conditions, particularly those involving the shock-absorbing discs, shouldn’t be taken lightly. Our discs act as protective cushions and prevent our vertebrae from grinding together. Any disruption can compress and aggravate nerves, cause pain and discomfort and even limit mobility.

Although certain spinal conditions do not become apparent until they begin to cause secondary complications, waiting too long to obtain an accurate diagnosis and proper treatment can oftentimes mean increasing the severity of symptoms.

Degenerative changes in the spine are those that cause the loss of normal structure and/or function. They are not typically due to a specific injury but rather to age. Repeated strains, sprains, and overuse of the back cause a gradual degeneration of the discs of the spine. Nearly everyone experiences some disc degeneration after age 40.

Degenerative Spine Causes

Aging and the general wear and tear associated with the body’s natural processes are the primary causes of degenerative spine conditions. Every time we twist, move and bend, strain is placed upon our spine. Many factors besides time can encourage or accelerate degenerative spine disorders, including:

  • Osteoarthritis
  • Osteoporosis
  • Rheumatoid arthritis
  • Sudden acute injuries, traumas or accidents, such as those that may occur during a car accident, high-impact sport or hard fall
  • Infections
  • Spinal stenosis, or the narrowing of the spinal canal
  • Slipped or herniated discs
  • Benign tumors
  • Cancer
  • Smoking and alcohol abuse
  • Lack of exercise
  • Malnutrition
  • Degenerative disc disease
  • Improper footwear
  • Making strenuous, repetitive movements frequently, which often occurs when individuals have a job that requires manual or highly physical labor

If you believe you may be at risk for rapid or premature spine degeneration, schedule a consultation with one of our spine experts. By making minor adjustments and living mindfully, it is often possible to slow or reduce the effects of degenerative spine conditions.

Degenerative Spine Symptoms

Generally speaking, symptoms of a degenerating spine typically include:

  • Spinal deformity
  • Limited mobility, stiffness and frequent aches
  • Sharp or chronic pain that can occur either when moving or at rest
  • Nerve damage
  • Weakness in the limbs associated with the aggravated nerve area(s)
  • Numbness and loss of sensation in the limbs associated with the affected region(s)
  • Difficulty participating in everyday activities
  • Discomfort that returns with certain movements
  • Neck pain
  • Clumsiness
  • The sensation that your foot is slapping against the ground when you walk, known as “foot drop”
  • Feelings of “pins-and-needles” in the back or limbs
  • Because degenerative spine complications can harm various areas of the body, they are easily confused with other conditions.

Who’s at risk for this disease?

Sometimes, developing a degenerative spinal disease is part of the normal aging process, and there’s not much you can do to prevent it. Other risk factors for degenerative spinal disease include:

  • Having a previous back or neck injury
  • Being overweight
  • Having bad posture
  • Working in a job that requires a lot of bending or lifting
  • Participating in high-impact sports

The best ways to prevent degenerative spinal disease are to maintain a healthy weight, eat a balanced diet and stay physically active. If your job or your activities put you at risk, be sure to wear proper safety equipment and use correct form when lifting objects.

Tests and Diagnosis

If a patient presents with symptoms associated with degenerative spine disorders, the doctor may order the following tests:

  • X-ray (also known as plain films) –test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones. Soft tissue structures such as the spinal cord, spinal nerves, the disc and ligaments are usually not seen on X-rays, nor are most tumors, vascular malformations, or cysts. X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, as well as local and overall spine balance can be assessed with X-rays. Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays. Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
  • Magnetic resonance (MR) imaging – provides a detailed image of soft tissue like discs, nerves and the spinal cord. This scan allows the doctor to see how the nerves and spinal canal space are affected by degenerative spine conditions.
  • Computed tomography (CT) scan – provides a detailed image of bone structures in the spine. A CT scan uses computers and X-rays, and provides much more detail than a plain X-ray.
  • Myelography / post myelogram CT – provides images that can help determine whether bulging or herniated discs are compressing the spinal cord or nerve roots. Performed by injecting a contrast dye into the spinal column and taking several X-rays and, usually, a CT scan.
  • Electromyography (EMG) – tests the electrical activity of a nerve root to help determine the cause of pain.
  • Discogram – helps determine whether pain is due to a damaged intervertebral disc. Performed by injecting a contrast dye into the disc and taking several X-rays while also asking the patient about symptoms.

 

Treatments of Degenerative Spine diseases

To treat degenerative diseases of the spine, various methods can be introduced, which are:

Home treatment

Using heating pads and ice packs in alternation, purchasing proper footwear, undergoing professional therapeutic massage and making other adjustments may help reduce the severity of degenerative spine-related conditions. The specific treatments used will depend upon the location and extent of your spinal deterioration.

Medications

Your doctor may prescribe prescription medications including the following:

  • Pain relievers
  • Anti-inflammatory agents to reduce swelling
  • Muscle relaxants
  • Spinal injections that introduce steroid medication directly to the painful area
  • Antidepressants
  • Sleep aids

Your doctor may recommend non-prescription (over the counter) medications including non-steroidal anti-inflammatory agents (NSAIDs) like ibuprofen and naproxen) and pain relieves like acetaminophen (Tylenol). Follow your doctor’s recommendation for these, as there is a risk of side effects.

Exercise and Physical Therapy

Contrary to popular belief, bed rest is not typically beneficial for patients suffering from a degenerative spine condition. By strengthening the joints and muscles around the spine, losing excess weight and increasing flexibility, it is possible to reduce the amount of strain placed upon what is referred to as the “backbone.” Physical therapy that targets the abdomen and affected regions of the spine can also be extremely effective and will likely play a central role in any recuperation program.

Surgery

If you have been unsuccessful with non-surgical treatments for six months or more it may be time to discuss surgery with neurosurgeons. The presence of certain symptoms, like loss of bladder or bowel control due to nerve root compression, may indicate that surgery is required immediately. The type of surgery—and what you can expect—depend on your precise diagnosis, symptoms, location of the degenerated discs and your overall health. Generally, patients who do not smoke and who are not obese have better spinal surgical outcomes.

Traditional surgery has focused on removing the discs or parts of discs pressing on nerves, known as decompression surgery and fusing the spine to control movement, known as stabilization surgery. Often these processes are done at the same time.

Neurosurgeon will discuss the various options for decompression and stabilization. These include procedures that remove facet joints, bone spurs and all or part of the lamina, the bony plate that protects the spinal cord. When the lamina presses on the spinal cord it can cause significant pain. These techniques are performed from the back of the spine (posterior).

Other decompression surgeries are performed from the front of the spine (anterior) because the spinal cord is in the way. One option is a discectomy, using a minimally invasive approach with tiny tools and a shorter recovery period. Another option is corpectomy or vertebrectomy, which involves removing more of the vertebral material.