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Degenerative Disc Disease: Cause and Treatment Options in Malaysia

What is the Degenerative Disc Disease and How is it Treated?

Degenerative Disc Disease (also known as disc degeneration or DDD) is not an actual disease, but a term used to describe physical alterations within a disc. The most spine issue in the elderly is degenerative disc disease. However, it is becoming all too common in young otherwise healthy individuals. Disc degeneration (degenerated disc) is the most common spinal condition we have seen in our centers in Malaysia.

Our journey through life leads to degenerative (deterioration) changes in our bodies. The intervertebral discs (spinal discs) are part of these changes: Degenerative Disc Disease. Some of these changes are the result of genetic predispositions, excessive load bearing, poor posture or injury. The degenerative changes resulting from advancing age may be considered normal. These changes can range in severity. Hence, these may include shifts in a disc’s appearance, fluid levels, nutrient levels, and behavior. The medical term used for spinal disc deteriorations is “Degenerative Disc Disease.”

Degenerative Disc Disease is the leading factor spinal disc tears, disc bulges, disc herniations and even sciatica. In this section of our website, we will familiarize you with disc damage as well as the non-surgical treatment options you need for live a healthy active life. Chiropractic Specialty Center is one of the few centers that address the cause of disc degenerations through patient education and target specific treatments. Our clinical teams of expert chiropractors are the best experienced non-operative clinicians. Visit one of our centers to experience clinical chiropractic. Our knowledge, abilities, and technology are second to none. We have succeeded when others have failed.

Implications of Disc Degeneration in Adolescents

Disc degeneration, poor posture, muscle weakness and increased weathering activities are the leading causes of back pain in adolescents. Nowadays, more teenagers are diagnosed with degenerative disc disease than there were a decade ago. Our modern lifestyle is the primary reason thin the increased numbers of teenagers diagnosed with disc degeneration. There are several well-published research articles that alert of impending back pain at an almost epidemic levels in young adults.

Although dis degeneration in itself may not cause pain, it can lead to spinal disc tears that will. The primary culprit in bulging, herniated or protruded disc is disc degeneration. Early onset degenerative changes with a disc will lead to pain in near future. A published research found spinal disc degeneration in teenagers to be the primary factor in recurrent pain. According to the researchers, frequent flare-up and recurrent back pain were common in those with disc degeneration. More importantly, teenagers with recurrent back pain must have their spine assessed for disc degeneration. Therefore, a thorough assessment of the spine is needed for teenagers with recurrent back pain. MRI (Magnetic Resonance Imagining) is the recommended diagnostic test for proper assessments of disc determinations.

Degenerated Spinal Discs and MRI

The Magnetic Resonance Imaging or MRI is the “Gold Standard” in the assessment of spine and spinal discs. Unlike x-rays or Ct scans, MRI does not have radiation. As the name applies, MRI uses strong magnets. To date, there are no side-effects associated with having an MRI exam. Therefore, it is a safe modality for the young and elderly alike.

The healthy spinal disc has relatively high fluid levels. Prolonged sitting, poor posture and traumatic events can deplete these fluid levels. When the fluid levels are low, the spinal disc is classified as a degenerated disc. MRI exams are the best diagnostic test for the disc as it reveals disc hydration or fluid levels. “Degenerative Disc Disease” or DDD is often reported as “Disc Desiccations” on an MRI report. The term disc desiccation signifies a degenerative change in a disc. Degenerative Disc  Disease (also known as disc degeneration) is not an actual disease, but a term used to describe physical alterations within a disc. Although often seen in the elderly. However, nowadays it is becoming all too common in young otherwise healthy individuals.

Side view of the lumbar spine showing Degenerative Disc Disease.

Spinal Disc Degeneration Can Occur at Any Age

Spinal disc degenerations can vary, and individual differences are always present. Hence, a young adult can have what would appear to be a spinal disc of a senior citizen. And by the same token, the elderly may present with the spinal discs of those in their twenties. In other words, there are times when a young adult have degenerative changes that are advanced for their age. So, it is not always an age issue. In fact, medical research has confirmed that 20% of adolescents have early signs of disc daamge: this is alarming! So, our recommendation for all of you is to get periodic checkups to ensure a normal healthy progression as you age.

 

Human pine in prone position showing degenerative disc disease.

Good healthy habits are key to spinal wellbeing. In short, if you have a familial history of back pain or partake in activities that put undue stresses on your spine. Remember: prevention is better than a pound of cure!

It is important to know how good your spinal discs are, in particular for those at risk. So, if you are at risk; you will need to be aware of the early degenerative changes in your spine. Early awareness is like having an early warning system. Hence, it can help you avoid potential life-changing issues. Degenerative disc disease leads to other more serious health issues. For example, a degenerated disc can lead to a bulging or herniated disc (referred to as the “slip disc” or “slipped disc”).

Why Spinal Discs Degenerate?

For some, spinal discs degenerate at an alarming rate, far earlier than do other musculoskeletal tissue. A Volvo Award-winning research in basic sciences revealed that the first unequivocal finding of degeneration in the lumbar discs to be at age group 11-16 years. About 20% of people in their teens have discs with mild signs of degeneration; degeneration increases with age, particularly in males, so that around 10% of 50-year-old discs and 60% of 70-year-old discs degenerate! This award-winning research highlights the reasons why so many teenagers today have slipped disc (sciatica).

So, parents with kids that complain of back discomfort or pain should keep a close eye on the child’s development. If symptoms persist, visit us and let us find the cause. If caught early, we can help prevent degenerative changes. Therefore early detection is critical. We are here to help if you need us.

Scoisosi, Prolonged Sitting, Poor Posture and Disc Degeneration

On a separate note, spinal disc degenerations are common in kids with scoliosis. So, if your child has a scoliotic curve, bring them to one of our centers. Our methods of scoliosis treatments are geared to assist in inducing spinal disc rehydration through specialized care and lifestyle changes. We can help and have had significant success treating adults and kids with scoliosis.

Spinal disc degenerate due to excessive stresses placed on them. Prolonged sitting, sitting in a bad posture, familial history of disc degeneration, congenital malformations of the spine as well as neglecting mild or moderate spinal conditions are all reasons for disc degeneration. Two key points worth mentioning as the primary cause of disc degeneration are interruptions in “Imbibition” and “Diurnal Change” both of which we shall cover in the coming paragraphs. But first, let us help your understanding of a spinal disc’s architecture and function.

Top view of a spinal disc without degenerative disc disease.
A spinal disc without degenerative disc disease.

Degenerated Spinal Disc and Back Pain

Published MRI of Olympic athletes published in the British Journal of Sports Medicine reported Degenerative Disc Disease as the primary cause of pain. Yes, even Olympians have back pain. So, having strong muscles does not make you bulletproof. This published research is an excellent point, especially for the self-proclaim indestructible gym goers. There is no immunity when it comes to back pain!

The results of this study revealed spinal disc related conditions (slipped disc AKA slip disc) in 58% of the athletes examined. Degenerative disc disease was the most significant finding.

Also, two other articles published in the Spine Journal suggested that disc degeneration might be an inherited disorder.

In fact, they suggested heritability exceeding 60%.

 

Research Proved Spinal Discs Degerantes Faster than other Tissues of the Spine

According to orthopedic surgeons Jill Urban and Sally Roberts: Spinal discs show signs of aging earlier than do muscles, ligaments or tendons. They reiterated its clinical importance and association with back pain. Another article published in the Spine Journal on February 15, 2000, reported that disc degeneration of the lumbar spine is due to underlying factors of low back pain. In other words, back problems occur first and once ignored it leads to degenerative disc disease. What is worse is the most are unaware of initial issues with their back.

Mild conditions such as muscles tightness, ligamentous laxity, weakness in core muscles are part of initial back problems that lead to disc degeneration changes. In short, tight or weak muscles put undue stresses on joints and discs. With increased stress, spinal discs and even spinal joints start to wear out or degenerate. Hence, the need to get proper care as early as possible to avoid years of agony or complications.

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Top view of spinal disc, cord and nerves
Cross-section of spinal disc without degenerative disc disease.

Understanding the Spine and Spinal Disc Degeneration

For a better understanding of degenerative disc disease, we need to take a closer look at the spine along with the various parts of a Jill Urban and Sally Roberts: Spinal discs show signs of aging earlier than do muscles. The human spinal discs can are soft yet sturdy pads that separate the bones of the spine (vertebrae) from one another. These specialized structures act as a ligament by holding the vertebrae of the spine together, a shock absorber, and as a pivotal point allowing motion. The adult intervertebral discs are the largest avascular (no direct blood supply) structures in the human body, consisting of three main components:

  • The Vertebral End-Plates
  • The Annulus Fibrosus
  • The Nucleus Pulposus

 

The Vertebral End-Plate

Both the top and the bottom of each vertebra is capped with a thin (approx. 1 millimeter) cartilaginous pad called the vertebral end-plates. There are vertebral end-plates in every spinal segment, except the first vertebra in the neck (C-1). Despite their name, these vertebral end-plates are not part of the bony vertebrae but interwoven into the disc.

The vertebral end-plates serves as an attachment to the bony vertebrae and as a platform from which the avascular spinal discs get the life-sustaining nutrients. The vertebral end-plates are like to the spinal disc. In fact, the water, proteoglycans (specialized protein chains), collagen (a cartilage-like substance) and cartilage content of the end-plates mirror that of a spinal disc. This similarity in biochemical makeup helps the diffusion of nutrients into the hungry avascular disc cells.

Vertebral end-pate and its link to generative disc disease.

Annulus Fibrosus

The Annulus Fibrosus is the outer layer of the disc. It provides the spinal discs with strong fibrous for support. Annulus Fibrosus has a higher collagen content, but yet little water content (60% water) when compared to the nucleus. Its function is to contain the pressurized nucleus in the center and to attach the disc to the vertebral end-plates and the ring apophysis (harder surface at the periphery of a vertebra). The Annulus Fibrosus contains about 15-25 concentric sheets of collagen called the Lamella. The Lamella is arranged in a particular configuration to give them the strength needed for support and to hold the pressurized Nucleus Pulposus. The Annular fibers are of high importance. In a healthy spinal disc, they connect bones and keep the nucleus in the center of a disc.

But when there are degrative changes, these specialized structures can tear. Once torn, it can lead to a slipped disc of varying severity. Hence, the importance of periodic chiropractic checkups for kids and adults.

The Nucleus Pulposus enables diffusion that prevents degenerative disc disease.

Nucleus Pulposus

The Nucleus Pulposus is the inner layer of the disc resembling a soft, jelly-like substance. It has high water content, which enables it to sustain the downward pressure while standing and sitting. Its function is to bear and carry the weight of the body and act as a “pivot-point” which allows for movements. Unlike the Annulus Fibrosis, the Nucleus Pulposus is water-rich (80%). Nucleus Pulposus is a gelatinous, soft, pulpy, highly elastic, and highly pressurized inner structure of a spinal disc. The nucleus is proportionally larger in the cervical (neck) and lumbar (lower back) due to their greater degree of mobility. The nucleus is the part of the disc the migrates (slips) when the annular ligaments are worn out (degenerated).

The gentle stretching and relaxing of non-degenerated spinal discs foster diffusion through a phenomenon called “imbibition.” Imagine a sponge filled with water. When the sponge is compressed, the water is forced out. By removing the compressive force, water is “sucked” back into the sponge. Imbibition is a process through which the Nucleus Pulposus stays healthy and functional.

The Impact of Diurnal Change

In the simplest terms, this is one method through which a normal healthy disc gets the vital nutrients needed. The other is diffusion enhanced by a phenomenon called “Diurnal Change.” Our bodies have the ability to expand and compress over the course of a day. During the recumbency of sleep, the loading decreases on the intervertebral discs, and as such, the spinal disc starts to swell and get bigger. The unopposed spinal disc starts to increase in size, resulting; in the disc absorbing fluids and increasing in volume.

In fact, a non-degenerated healthy spinal disc will expand some 20%, which in turn increases our stature by 19mm. A 19mm change in size corresponds to change of about 1.5mm in the height of each lumbar disc. And as such, our height is measurably increased in the morning. The nucleus is a protein called proteoglycan that attracts water. Typically, discs compress when pressure is put on them and decompress when pressure is relieved. When a disc is compressed, its fluid content decreases; by taking the compressive force away: water levels normalize. The change in the fluid levels of a spinal disc is the sole responsibility of the nucleus through a process called “imbibition.”

Diurnal changes and degenerative disc disease.

Advanced Treatment Options for Degenerated Spinal Disc in Malaysia

Imbibition is the method in which the nucleus acquires the life-sustaining nutrients from the vertebral end-plate. Without such transfer, the discs in their entirety will degenerate and eventually will cease to function. Jill Urban and Sally Roberts: Spinal discs show signs of aging earlier than do muscles and advanced technology to treat even a complicated spinal disc-related issue. Therefore, if you are in pain or suffer from a spinal disc disorder such as spondylosis, slipped disc, neck pain or sciatica, we are your best hope for a non-operative repair. Call one of our centers today to start living a healthy active life. Degenerative Disc Disease is the leading cause of disability if ignored!

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