When Good Discs Go Bad

Getting to the sources of the problem

The discs in the neck and back are basically space holders between different bones (vertebrae) in the spine — and they serve as cushions or shock absorbers. As we get older, “the discs begin to dehydrate, which contributes to wear and tear of the material that composes the discs,” explains Andrew Gitkind, M.D., vice chair of the Department of Physical Medicine and Rehabilitation and medical director of the Montefiore Spine Center at Montefiore Medical Center in the Bronx.

Genetic factors play a role, so if your parents had or have this condition (like mine do), you’re at higher risk. Playing heavy impact sports such as football, soccer or hockey, can increase your susceptibility, as can activities like running or golf. Meanwhile, excess body weight and smoking can worsen disc degeneration. “Smoking decreases the body’s ability to carry oxygen in the blood, which means the discs are likely to degenerate more quickly,” Gitkind notes.

Many people have degenerative disc disease without any symptoms. When symptoms do occur, pain and stiffness are the primary complaints. “The most common way people find out they have it is they have episodes of neck or back pain, seek appropriate medical care and get an MRI that shows degenerative changes,” Patel says. These changes can include bulging discs, like I had, small tears in the discs, herniated discs (when part of the disc’s center pushes through the outer edge) or flattened discs. In some cases, such as mine, these changes place pressure or impinge on the nerves, which can cause pain, tingling, numbness or weakness in the arms (if the problem occurs in the neck) or in the back and legs (if the wayward discs are in the mid- or lower spine).

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Unfortunately, there isn’t any way to reverse the problem. If you have signs of degenerating discs without symptoms, consider yourself lucky. But if you have back or neck pain, “we start with conservative management — physical therapy and strengthening of the surrounding muscles, particularly the abdominal, oblique and back muscles,” Gitkind says. “The more support we can provide the spine, the less wear and tear there is.”

If flare-ups of pain occur in the back or neck, taking an anti-inflammatory drug such as ibuprofen may help. If there are neurological symptoms from pressure on the nerves in the spinal cord, cortisone injections may be in order,  Gitkind says. If there’s severe disc degeneration and nerve compression in the back or neck, you might be a candidate for minimally invasive microdiskectomy, which involves removing the disc fragment that’s putting pressure on the spinal nerve, Patel says. If stenosis gets more severe, surgeons begin to consider “more invasive surgery such as spinal fusion, in which the problematic disc is removed and the adjacent bones are knitted together,” he adds. 

Talking ’bout my degeneration

I wasn’t a good candidate for surgery or cortisone injections. My neurologist decided we should take a watch-and-wait approach with some considerable modifications to my lifestyle. That meant: no more running (too jarring to the spine), no more riding roller coasters (a serious bummer for my kids), avoiding activities that involve hyperextension of the neck (including certain yoga postures, breaststroke, even the way I have my hair washed at the salon), and making postural adjustments to my desk chair and computer height. 

If you spend a lot of time in front of a computer, experts say that using a sit-to-stand desk might help take some of the pressure off your neck and spine, for example. If you must sit, set a timer to cue you to get up every 30 minutes to stretch and walk around. 

Seven years later, I still get occasional stiffness and achiness in my neck and, less frequently, tingling sensations, but I’m happy to report that my symptoms have greatly improved over time. I’m hoping to maintain these improvements for as long as possible. If my condition does get worse down the road, hopefully new treatments will be available by then. “There is a tremendous amount of work being done to look for ways to treat degenerating discs,” Patel says, “but it’s still in the early stages.”