Lumbar Disc Disease (cont.)

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Lumbar disc disease is caused by normal degenerative changes that occur as a person ages. The lumbar spine is composed of motion segments. Each motion segment consists of two vertebral bodies, the intervertebral disc, and two facet joints. The intervertebral disc acts as the cushion, or "shock absorber," of the spine.

The intervertebral disc is made up mostly of water. This allows it to maintain its cushion-like properties. As people age, the intervertebral disc loses some of its water content. As this happens, the outer layers of the disc are more likely to develop cracks or tears. These can be a significant source of low back pain. This is the beginning of internal disc disruption.

When the outer layer of the disc cracks, the disc looses its normal water content. This reduces its ability to act as a cushion for the loads applied to the spine. Eventually, it leads to a collapse of the disc and degenerative changes in both the vertebral bodies and the facet joints of the spine. When this occurs, the condition is known as degenerative disc disease.

The final process in lumbar disc disease occurs when the degenerative changes lead to destruction of the ligamentous and other soft tissue restraints of the spine. This is known as segmental instability, which occurs when a loss of the normal structural stability of the spinal segment occurs.

People with lumbar disc disease typically develop complaints of chronic low back pain between the ages of 20 and 50 years. Often there is no history of a traumatic event preceding the onset of pain.

• Pain is often made worse with sitting or bending forward. There is localized tenderness in the lower back. Pain is persistent and lasts longer than six weeks.
• Men and women are equally affected.
• The symptoms of lumbar disc disease worsen as the degenerative changes in the spine progress from internal disc disruption to degenerative disc disease to segmental instability.
• With internal disc disruption, people have a deep ache in the low back that increases over several months. Pain is worse with motion.
• When this condition progresses, degenerative disc disease pain is present in the low back as well as the back of the buttocks and thighs.
• People with segmental instability have increasing pain radiating down the lower extremities. This pain is increased with movement and walking.

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