What is an intervertebral disc wear?

It is a blessing that the intervertebral discs exist. They are the shock absorbers, the bearing between the vertebrae. Therefore they give stability to the spine and at the same time allow it to move. The intervertebral discs consist of an outer relatively solid fiber ring (fibrous annulus) and an inner gelatinous core (pulpous nucleus). The intervertebral disc cells of the gelatinous nucleus create structures (glucosaminoglycans) in their environment (extracellular matrix) that store the water. Over the course of life, the spine is often subjected to excessive strain. For natural wear, the discs lose their functionality; in fact the fluid needed by the supporting cartilage tissue can no longer be stored. This is because biochemical changes develop within the intervertebral disc and deactivate their elastic and cushioning function. There is a reduction in the number of cells but also changes in the quality of the tissues. Therefore the cracks in the intervertebral disc are a natural consequence.

With age, the presence of worn discs is normal. But if this happens beyond the natural level, it is called a diseased disc wear (degeneration). In contrast to a healthy disc without vessels of its own and without nerve endings, pathological vessels and nerve endings with pain receptors can be found in a degenerated disc. These changes of the degeneration are then the basis for further diseases such as disc protrusion or herniated disc, wear of the vertebral joint (facet syndrome), spinal stenosis, vertebral slippage spondylolisthesis (listhesis) or instability of the spine.

The process of degeneration can begin as early as the age of twenty

The wear process begins at a very young age - at the age of twenty years. And since the age of sixty, changes in over 90 percent of the population can be detected.

These are the causes of disc wear

The discs lose the ability to hold liquid and consequently lose their elasticity. They dry out and can collapse. As a result, they can no longer dampen the friction between the vertebrae. The causes of disc wear can also be traced to genetic factors, to an overload of intervertebral discs due to obesity, incorrect posture, lack of physical movement, unilateral movement such as sitting for long periods, incorrect diets or lifting heavy objects. Particularly at risk are people working in the construction industry, transport or nurses. It is not uncommon for already existing impairments of certain segments of the spine -such as herniated discs or stiffening- to further attract more healthy segments and accelerate their degeneration. Smoking is also one of the causes of early disc degeneration.

Pain radiation into arms and legs

Degenerative changes in the spine are processes that continually progress. Progressive wear of the intervertebral discs is often recognizable by pain in the back and neck. Particularly painful are the lifting activities of more or less heavy objects and the long activities performed while sitting. It is clear that the intensity of pain increases with the progression of the degeneration. The resulting instability leads to a feeling of "being broken in two parts". The adjacent vertebrae and small joints are heavily overloaded. Any movement can be agony. The loss of the intervertebral disc height leads to constrictions of the nerve exit channel, which can also lead to pain in leg or arm, tingling and numbness. Turn around while sleeping can be problematic. Often, pain is not the only symptom. It is usually accompanied by mental and psychosomatic complaints. Many people suffer from mood swings, depressive moods and a general malaise.

Diagnosis? Always start with a consultation!

The diagnosis begins with the so-called Anamnesis or medical history, i.e. the conversation between the patient and the doctor. In this conversation, data is gathered from the patient directly through questions such as: When did the pain begin? Where did it start? Are there any psychological problems? Only after having gathered all the information available through this interview, and the study of the patient's medical history, the doctor has at his disposal, a complete diagnostic procedure that allows him to carry out a precise neurological examination. Subsequently the study of the examinations made previously allows identifying the current state of the intervertebral disc. Hospitals generally use X-rays, computerized tomography and especially MRIs for diagnostic examinations. But it is the MRI that clearly shows not only the state of wear of the disc but also the neural structures and the segments that are close to it.

Treatment with minimally invasive disc-cell transplantation

The first steps to treat pain caused by disc degeneration are the so-called conservative therapies (painkillers, muscle relaxation, manual therapy, physiotherapy, acupuncture, psychosocial interventions, etc.). However, to strengthen the back muscles and reduce pressure on the disc, physical exercises are performed and backstroke swimming style.
 
To treat intervertebral disc wear, the Avicenna Clinic performs a minimally invasive cell-transplantation, which provides biologically augmented endogenous cells to the worn disc. The implanted cells allow the disc to store a greater amount of fluid and in turn, increase its elasticity. Orthokin drug therapy injects higher levels of endogenous substances into the affected disc and therefore counteracts inflammatory changes. 

If there is a narrowness of the nerve exit site in the spinal canal (neuroforaminal stenosis), than microsurgery could expand these exit sites or relieve the nerve root. If there is instability, then other treatments such as stabilization, intervertebral disc replacement come into question.

We always recommend therapies with the greatest chance of success

The causes that generate pain can be different. Therefore, the factors taken into consideration when choosing the therapy are many: the frequency of pain, the type of pain, the results obtained from previous therapies, the results of neurological and physical examinations, the results obtained in magnetic resonances (MRI), the intensity and location of detected changes (disc herniation, multiple fractures, spinal cord involvement, etc.) patient age, other health problems, type of occupation, psychosocial circumstances and much more. We always recommend therapy with the highest probability of success and lower risks. We take care of the cause and not just the symptoms.

Prognosis of disc degeneration

Wear is irreversible. Just like other parts of the body, intervertebral discs also show signs of wear over the course of a lifetime - depending on the strain, they manifest themselves early or late, and complaints are mild or severe. But there are many ways to reduce the progression of the degeneration and to alleviate pain. Fortunately, the patient can do much by himself to delay the progression of the disease for a long time. The patient should try to lead a healthy eating life and (possibly) lose weight. Targeted workouts and exercises help to weigh the body properly rather than excessively. For sure: the pressure on the intervertebral discs must be reduced! This means: avoid lifting and carrying objects that are too heavy and consider buying a mattress suitable for the back. Physiotherapy and sports are recommended to strengthen the back muscles. Indeed a strong musculature allows to support the back and with it the intervertebral discs. The ideal is swimming because it trains the back and water relieves pain, furthermore the bodyweight does not weigh on the back. You should avoid jogging because it increases the pressure on the discs and on the contrary, cycling.

If possible, avoid the long-term wearing of support corsets because wearing them weakens your muscles and they should only be used for a short time. If you do experience pain again, take a painkiller. Enduring pain may sound honourable - but it creates relieving postures that are not conducive to rehabilitation.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

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The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

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Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.