During adulthood, the soft center of an intervertebral disk (nucleus pulposus) binds less water, and the outer ring (annulus fibrosus) undergoes minor tearing as the disk dehydrates/shrinks. This is disk degeneration or degenerative disk disease (DDD). If the disks shrink too much, spinal ligaments may loosen, rendering the spine less stable, and possibly more injury prone. Healthy disks lack pain receptors. Degenerated disks do possess pain-sensing nerves (nocioceptors), so DDD may be painful. DDD (and DISH) may present as low back pain (with or without buttock pain) that may be worse with activity, and occasional night pain. Laying usually improves the pain. Parts of spine may be a little tender to the touch, and there is usually no pain down the legs. If the disks shrink so much that the veretrbae come close together, either arthritis or sciatica may occur. However, in large studies, MRI visualized disk herniation does not correlate well with pain, and studies suggest there is no direct link between DDD (as well as degenerative arthritis) and low back pain. [16,19-23]
DISH syndrome is a type of arthritis in which degenerated disks fuse with arthritic (extra growth) vertebral bones. Extra bone growths, called osteophytes (like you see with bunions) form after long term wear and tear to vertebral bone. “Bridging osteophytes”, bone/disk complexes grow together as damaged disks start to “ossify” – become like bone. These fusions of vertebrae and disks/confluent osteophytes create spinal rigidity of the involved vertebrae, making the affected portion of the spine unable to move well. This condition mainly affects men over 60 years of age. As a more chronic and indolent condition, the back pain tends to be mild, and includes morning and evening spinal stiffness as well as regions of decreased spinal motion. X-ray findings may demonstrate loss of disk height/space, osteophytes, and/or a “vacuum sign”. An advanced complication occurs when the vertebrae above and below the fused area get overused, and can become damaged and unstable from the wear and tear at those sites. Treatments include physical therapy, walking, non-steroidal antiinflammatory medication and pain management with non-narcotics, narcotics, and sometimes anti-depressants.
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