Degenerative Disc Disease

“I have two damaged discs in my neck, one at C5/6 and one at C6/7. In addition, I also have osteophytes in the foraminal openings where the nerves exit to go down my left arm. This creates occasional numbness down my arm. Doctor, do you know of ways to heal this that don’t require an artificial disc or a 2-level fusion? I don’t want a 2-level fusion at 36, and I don’t have the money or insurance to get an artificial disc.”

Ah, the age-old question. And one with a long-winded answer:

First and foremost is a basic understanding of degenerative joint disease (DJD), otherwise known as arthritis. As I’ve said before, aging itself is a degenerative process. It is nothing more than accumulated damage at the cellular level that ultimately impairs structure and function. And yes, the same process affects different structures and causes dysfunction specific to the system involved. Accumulated age-related damage of the brain presents itself as MCI and potentially progresses to fulminant dementia. As blood vessels accumulate age-related damage, one develops atherosclerotic disease. The dreaded manifestation? Heart attack and stroke. Simply put, it’s a matter of geography: same process, different bodily location, and therefore different disease.

A case in point is “cervical spondylosis,” more widely known as arthritis of the neck. Call it what you’d like: “damaged discs,” “osteophytes,” or “spurs.” No matter. All have common underpinnings and are part of the same disease process. An indiscriminate process, arthritis affects the joints of the hands and feet, the knees, the hips, and shoulders.

It is the body’s response to chronic wear and tear, abnormal joint mechanics, or frank injury to the joint structures. Yes, degenerative arthritis (unlike those of the genetic subtype such as juvenile RA and ankylosing spondylitis) is an inflammatory response to joint damage, an effort if you will, on the body’s behalf to repair or limit motion in dysfunctional joints. Unlike the cylinders of a car with ZERO capacity for self-repair, our bodies can mount an inflammation-mediated reparative response to induce healing. Picture this: Your sinuses get invaded by a nasty bug. What happens? You mount a fever and an inflammation-mediated immune response that eradicates the offending organism. Defervescence. That is an acute inflammatory response, however. And as reiterated in the pages of Get Serious, acute inflammation is beneficial (and protective of the body). In contrast, chronic inflammation potentially positions you steps closer to the reaper (atherosclerotic disease is a disease with chronically inflamed blood vessels).

And while the smoldering, low-grade chronic inflammation associated with degenerative spine arthritis is not life-threatening, it can compromise function via the resultant pain and neurologic deficits. It can cause numbness and frank weakness of a leg or, in the case of cervical disease, an arm.

How do neurosurgeons treat such problems? That depends upon the severity of the symptoms. Frank weakness of an arm, for example, is treated more aggressively than pain or numbness and typically involves surgery (but not necessarily). Pain or numbness due to spurs or osteophytes compromising a nerve is typically treated with non-surgical measures. Successfully. Yes, most individuals with a radicular syndrome do not need surgery. One simply needs to address the intraneuronal inflammation that is present as a result of the compression. It is NOT the mechanical compression of the nerve root that directly induces the pain, but the induced inflammation (within the nerve root or what is termed the dorsal root ganglion) that is responsible for the symptoms. Yes, there are animal models that prove this. Keeping this in mind, the treatment is straightforward: Aggressive anti-inflammatory treatments and the re-establishment of normal neck mechanics. The former tempers the inflammation, and the latter thwarts the degenerative process by limiting future (additional) joint damage.

Anti-inflammatories come in a variety of forms. My two favorites are omega-3 fatty acids (high-dose) and aspirin (yes, aspirin). I use prescription-strength anti-inflammatories in my practice. These will not be named here. Readily accessible OTC varieties include ibuprofen and naproxen. The key is consistency. This will better your chances of squelching the inflammation. Use them daily for at least 6-12 weeks, barring any side effects or contraindications. Should these prove inefficacious, one may consider the next step in the treatment spectrum: injection therapy. Epidural steroid injections involve administering powerful anti-inflammatory agents into the spinal canal (at the pathologic cervical level). This obviously is an invasive treatment but can be accomplished with a high degree of safety. One may require more than one injection to break the cycle of inflammation. My patients are thereafter placed on an oral agent chronically to keep inflammation in check. Concomitantly, while undergoing any of the aforementioned, my patients are engaged in either formal physical therapy (with resistance training recommendations) or are encouraged to return to the gym, albeit in a light-duty manner. Remember, exercise induces the synthesis of anti-inflammatory mediators and opioid-like substances which modulate pain.

Lastly is surgery which involves physically removing the arthritis, thereby decompressing the nerves. There are many options in this regard; all involve a so-called decompression followed by either a stabilization procedure (“fusion”) or the application of motion-sparing technology (artificial disc prosthesis or TDR). Outcome studies are essentially equivocal. Both work. Multi-level arthroplasties can be technically challenging due to “balance” issues that will not be discussed here. They should be performed ONLY by experienced spine surgeons (who have performed at least 50 single-level procedures). A two-level fusion is technically straightforward and one of the world’s most commonly performed spinal procedures.

The above said, I would do everything possible to avoid surgery unless the symptoms become refractory (pain and numbness) to conservative treatments or include static or worsening motor deficits. One is not destined to undergo surgery simply because an MRI reveals “arthritis.” That means nothing out of context. Most of us have arthritis (at least to some degree) in our spines. So. If you are asymptomatic, does it matter? No. I operate on humans, not on MRI films…

So how does one live a painless existence, free of low back and neck pain? Easy. What? Yes, easy. Keep inflammation at bay with anti-inflammatory foods and daily supplements such as omega-3 fatty acids, curcumin, boswelia, and pharmaceuticals such as aspirin. I take 325mg of Ecotrin (enteric-coated aspirin) Monday, Wednesday, and Friday. Another essential supplement is Glucosamine/Chondroitin. It has demonstrable joint-sparing effects. After all, the spinal column has multiple joints at each of its 24 mobile segments. And that means 50-plus facet joints that are potentially exposed to the wrath of degenerative disease. And this doesn’t even take into consideration the intervertebral discs! (also capable of undergoing degenerative changes with resultant pain)

The intervertebral discs ideally should remain well-hydrated. This will preserve physiologic motion and the shock-absorbing properties of the disc. Remember, disc dehydration (or desiccation) is the first radiographically apparent change of the degenerative process. Try to avoid it. In this context, it is to your advantage to preserve physiologic motion within the discs by exercising with full ranges of motion while concomitantly strengthening the supporting muscles of the spine. The latter will protect the spinal column (in its entirety) from external forces to which it is exposed (expectedly and unexpectedly). In this regard, deadlifts and squats are keys. If you have access to a “4-way neck” machine (another Arthur Jones contribution to the field of exercise science), use it. Of course, practice proper lifting techniques (which you are essentially doing while practicing your perfectly-executed deadlifts, right?).

Lastly, be sure to sleep with your spine in a neutral position (and get adequate rest). That means sleep either on your back (supine) or on your side. Stomach sleeping (prone position) is potentially disastrous for your cervical spine.

Spine health is simple. Don’t become a statistic. You are not destined to develop “back problems” as you age. Train your back as you would any other area of your body. Its strength will be your salvation. My low back and hip musculature are undoubtedly the strongest of my body. There’s a reason for that. And guess what? Despite a 500-plus-pound deadlift at a body weight of 185 pounds, I have no low back pain. Go figure.