Low back pain from degenerative disc disease can be severe and cause depression, lost time from work, and hinder recreational activities. How does a doctor diagnose the problem? And then how does a doctor guarantee that the problem intervertebral disk is the cause of one’s back pain?

The intervertebral lumbar disk is made of two parts analagous to a jelly donut. The inside part, the jelly, is known as the nucleus pulposus and does not cause any pain. The outer part, the anulus fibrosus, does have nerve endings and if they are injured the individual can have acute and potentially chronic back pain as a result.

When a patient has back pain, the work up includes the following.

1. History and Physical – Typically the patient has pain located in the low back, and often aggravated while sitting and in flexion posture. Studies have shown flexion positions actually increase pressure on the lumbar disc.

2. X-rays – Plain films are a standard initial imaging workup. Plain films can show degenerative disc disease as a decreased space between the vertebrae so there is less space between the bones. Hence, this is an indirect diagnosis. Be aware that x-rays may show a decrease in disk height that reflects degenerative disk disease but may not in fact be the source of one’s pain.

3. MRI – A Magnetic Resonance Image is very good at noticing differences in the soft tissues of the musculoskeletal system. If a lumbar disk is degenerated, the MRI will detect the loss of water and the disc will show up dark on the scan. Also an MRI can sometimes show a tear in the outer part of the lumbar disk, the anulus. As with x-rays, an MRI can suggest that a lumbar disc that is degenerative may be producing back pain, but may just be an incidental finding.

4. Lumbar Discogram – A discogram is a study meant to delineate if the lumbar disk is the source of low back pain. Discograms are done with sedation, however, the patient is not out completely since the pain doctor needs input during the study from the patient. Usually a control level is included at a disc level thought to be normal. The pain doctor places the needle into the disk space and injects dye along with the fluid. This fluid is designed to raise intradiscal pressure and produce pain from the degenerated disk. There are three potential answers. One is the person has no pain. Two is the patient has pain from the fluid that is unlike what he experiences on a daily basis. That constitutes a negative study at that particular level. Three is the individual has the exact same pain he or she has on a daily basis. That is therefore a positive study. A diskogram therefore has no true therapeutic benefit and does not relieve pain, it actually creates it! The study serves a diagnostic benefit for pre-operative planning.

Currently the studies used to diagnose degenerative disk disease, known as DDD, are the best modern medicine has to offer. There is not one study that is definitive.

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  Cervical Stenosis Treatment

Stenosis of the spine can occur in different areas of your spine and produce different symptoms. But basically all types result from a narrowing of the spinal canal–most often the result of arthritis. As the spinal canal narrows, the liklihood increases that it will come into contact with the arthritic material and pain is the result. Cervical stenosis is localized in the neck and shoulders

The vertebrae are a series of bones connected to each other forming the neck, also known as the cervical spine. The spinal canal, which encloses the spinal cord, runs through the vertebrae. The spinal cord contains major nerves that allow arm and leg movements, sensation, including bladder control and bowel movements.

Cervical stenosis occurs with age as the intervertebral discs starts to lack water content and hardens. The discs can shrink in height and stick out into the spinal canal. Spinal joints also bulge and protrude into the spinal canal. When the spinal canal narrows, the resulting pressure on the spinal cord leads to another condition called cervical myelopathy, which affects nerve functions.

Cervical Stenosis Symptoms

Symptoms of cervical stenosis usually are imperceptible at first. If the stenosis has advanced to cervical myelopathy, the patient may experience neck and arm pain, weakness, and difficulty in moving the arms and legs. Incontinence also occurs in later stages of the disease. Symptoms may appear gradually or develop rapidly.

Early detection plays a crucial role in the prevention and treatment of cervical stenosis and cervical myelopathy. Your doctor will perform a physical examination and diagnostic tests and recommend an MRI (Magnetic Resonance Imaging ) and CT (Computed Tomography) scan to be able to see the level of narrowing of the spinal canal. You may have to undergo other tests for a complete diagnosis.

Treatments for Cervical Stenosis

Depending on the stage of cervical stenosis, treatments may be operative or  non-operative . Usually, patients who have severe fragility and pain in the affected areas and difficulty in walking require surgery. Non-operative or conservative treatment, which includes cervical stenosis physical therapy, is ideal for mild cases.

Patients should understand that  cervical stenosis physical therapy  would not reduce the narrowing of the spinal canal or bring it back to normal size. The goal of cervical stenosis physical therapy is long-term pain management and increased function that will enable the patient to control pain effectively and function normally without having to undergo surgery.

Cervical stenosis physical therapy starts with improving flexibility in the neck, arms and legs through stretching exercises. It is also important to increase circulation and develop endurance in the arms and legs with cardiovascular exercises such as swimming and treadmill exercises. Your therapist may also add strengthening exercises in your program. While most of these exercises are always under professional supervision, your therapist will also provide you with exercises that you can perform independently.

Supervised cervical stenosis physical therapy may take three or more months. If your condition does not improve after cervical stenosis physical therapy, your physician will then recommend surgery.

Published by Stenosis Advisor

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By: Milos Pesic

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