Facts About Degenerative Disc Disease and Sciatica

Article featured on MedicineNet

Sciatica can result from lumbar disc herniation (“ruptured disc”) or spinal osteoarthritis when nerves in the low back are irritated by the abnormal anatomy in the low back.

What is the design of the spine?

The vertebrae are the bony building blocks of the spine. Between each of the largest part of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae of the cervical spine), 12 vertebrae in the mid-back (thoracic vertebrae of the thoracic spine), and five vertebrae in the low back (lumbar vertebrae of the lumbar spine). In addition, in the mid-buttock beneath the fifth lumbar vertebra are five sacral vertebrae — usually fused as the sacrum bone followed by the tailbone (coccyx).

What is the purpose of the spine and its discs?

The bony spine is designed so that vertebrae “stacked” together can provide a movable support structure. The spine also protects the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a bony arch behind the spinal cord that shields the cord’s nerve tissue. The vertebrae also have a strong bony “body” in front of the spinal cord to provide a platform suitable for weight-bearing.

The spinal discs are pads that serve as cushions between each vertebral body that serve to minimize the impact of movement on the spinal column. Because the discs are situated between vertebrae, they are sometimes referred to as intervertebral discs. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) surrounded by a firmer ring of tissue (annulus fibrosus). With injury or degeneration, this softer component can sometimes rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Degenerative Disc Disease Symptom

Low Back Pain

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

What is degenerative disc disease? What causes degenerative disc disease?

As we age, the water and protein content of the cartilage of the body changes. This change results in weaker, more fragile, and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as degenerative disc disease, sometimes abbreviated DDD. Wear of the facet cartilage and the bony changes of the adjacent joint is referred to as degenerative facet joint disease or osteoarthritis of the spine. Trauma injury to the spine can also lead to degenerative disc disease.

Degeneration of the disc space and its contents is medically referred to as spondylosis. Spondylosis can be noted on X-ray tests or MRI scanning of the spine as a narrowing of the normal “disc space” between the adjacent vertebrae.

What are degenerative disc disease symptoms?

Degeneration of the disc tissue makes the disc more susceptible to herniation. Degenerative spondylosis is another name for degeneration of disc tissue. Degeneration of the disc can cause local pain in the affected area. Any level of the spine can be affected by disc degeneration. When disc degeneration affects the spine of the neck, it is referred to as cervical disc disease. When the mid-back is affected, the condition is referred to as thoracic disc disease. Disc degeneration that affects the lumbar spine can cause low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica). Lumbago causes pain localized to the low back and is common in older people. Degenerative arthritis (osteoarthritis) of the facet joints that can be detected with plain X-ray testing is also a cause of localized lumbar pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

What are the symptoms of radiculopathy and sciatica?

Radiculopathy refers to nerve irritation caused by damage to the disc between the vertebrae. This occurs because of degeneration (“wear and tear”) of the outer ring of the disc or because of traumatic injury, or both. Weakness of the outer ring leads to disc bulging and disc herniation. As a result, the central softer portion of the disc can rupture through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column.

It is important to note that many people have degenerative spines without having any symptoms. When nerves are irritated in the neck from degenerative disc disease, the condition is referred to as cervical radiculopathy. This can lead to painful burning or tingling sensations in the arms. When nerves are irritated in the low back from degenerative disc disease, the condition is called lumbar radiculopathy, and it often causes the commonly recognized “sciatica” pain that shoots down a lower extremity. This condition can be preceded by a localized low-back aching. Sciatica pain can follow a “popping” sensation at onset and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, lumbar radiculopathy can be accompanied by incontinence of the bladder and/or bowels.

How do health care professionals diagnose degenerative disc disease, radiculopathy, and sciatica?

Degenerative disc disease, radiculopathy, and sciatica are suspected when the symptoms described above are noted. The doctor can sometimes detect signs of irritated nerves during the examination. For example, increased radiating pain when the lower extremity is lifted supports the diagnosis of lumbar radiculopathy. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect the nerve irritation. Health care professionals can visualize degenerative spondylosis using plain film X-ray imaging of the spine, CAT, or MRI scanning. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.

What is the treatment for degenerative disc disease, radiculopathy, and sciatica?

The treatment of degenerative disc disease, radiculopathy, and sciatica ranges from nonsurgical (medical) management to surgery. Medical management of radiculopathy includes patient education of the condition, medications to relieve pain (NSAIDs, analgesics) and muscles spasm (muscle relaxants), cortisone injection around the spinal cord (epidural injection), physical therapy (heat, exercises, massage, ultrasound, electrical stimulation), chiropractic manipulation and rest (not strict bed rest, but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (producing a small hole in the bone of the spine surrounding the spinal cord), laminectomy (removal of the bony wall adjacent to the nerve tissues), by needle technique through the skin (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

What is bony encroachment and spinal stenosis?

Any condition that results in movement or growth of the bony vertebrae of the spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foramen narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slipping of one vertebra relative to another), and spinal stenosis (narrowing of the spinal canal causing by compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). For example, lumbar spinal nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities.

Spinal stenosis (narrowing of the spinal canal) can occur at any level of the spine, but it’s most common in the lumbar spine of the low back. Symptoms depend on the level affected. For example, lumbar spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking poor circulation of the lower extremities).

Treatment of these conditions varies (depending on the severity and condition of the patient) from rest to epidural cortisone injection and surgical decompression by removing the bone that is compressing the nervous tissue.

What is the outlook (prognosis) of degenerative disc disease, radiculopathy, and sciatica?

The outlook of degenerative disc disease, radiculopathy, and sciatica depends on the severity of the condition, its precise cause, and the interventions used to treat the patient. When patients respond to conservative treatments, the result can be complete healing. Surgical repairs can require postoperative rehabilitation, including physical therapy.

Is it possible to prevent degenerative disc disease, radiculopathy, and sciatica?

Avoiding injury can prevent degenerative spondylosis and resulting nerve irritation. When the disease already exists, aggravation of existing symptoms can be avoided by limiting stressing or overusing the involved spine.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

3 Signs You Have a Slipped or Bulging Disc

Article features on Spine-Health

When a disc in your lower spine bulges or tears, you may feel pain in your lower back and/or your leg. Here are 3 unique signs of a herniated or protruding disc to help you identify the underlying cause of your lower back problem:

1. Pain while sitting

An activity that exerts tremendous pressure on your lower spinal discs is sitting. If you have a herniated or bulging disc, this increase in pressure within your disc may cause the bulge to become more pronounced, which may aggravate your lower back pain when you sit.

2. Radiating pain into your leg (sciatica)

The discs in your lower back typically herniate or bulge in the posterior (back) and/or lateral (side) region, which is in close proximity to your spinal nerve roots. Herniated discs may affect these nerve roots through one or both of the following 2 methods:

  • Direct compression. When the disc’s bulge or leaking inner contents directly press on a spinal nerve root as it exits the spinal canal.
  • Chemical irritation. When a herniated disc leaks out acidic chemical irritants from the disc material, which may cause inflammation and irritation in the area around the nerve root.

The function of the affected nerve root is then altered, and you may feel a burning pain along with numbness, weakness, and/or tingling along the front and/or back of your thigh, leg, and/or foot. These symptoms are commonly referred to as sciatica. The symptoms and signs of sciatica typically affect one leg at a time.

3. Pain aggravated by specific activities

Your lower back pain and/or sciatica may worsen when you perform certain activities, such as:

  • Bending forward/down
  • Lifting a heavy object
  • Pushing or pulling a heavy object
  • Coughing
  • Sneezing

Lumbar herniated disc pain usually comes on fast. In most cases, there is no single, clear reason for the pain, such as a specific injury or traumatic event. Yet, the pain feels sudden.

This condition can be very painful, but for most people, the symptoms don’t last too long. Nearly 90% of people who experience painful lumbar disc herniation report within 6 weeks that they no longer feel the pain, even if they received no medical treatment for it.

Warning signs and when to see a doctor

Visit your doctor if you exhibit these 3 telltale signs of a herniated disc. Your doctor may recommend a combination of nonsurgical treatments, such as pain-relieving medications and a guided physical therapy program, as well as referral to an interventional pain specialist for image-guided lumbar injections—to help decrease inflammation and relieve the pain.

If you experience any difficulty in controlling your bowel and/or bladder movements, numbness in your inner thigh and genital area, and/or problems in starting urination, consult your doctor immediately. These symptoms and signs may indicate cauda equina syndrome, a serious medical emergency, which is possible with certain severe lower back disc herniations.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Cervical Disc Surgery: Disc Replacement or Fusion?

Article featured on WebMD, medically reviewed by Sabrina Felson, MD

The vast majority of people — more than 90% — with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen to the point that weakness in your arms and or legs develop. This is called a cervical myelopathy and surgery is recommended.

Cervical disc disease is caused by an abnormality in one or more discs — the cushions — that lie between the neck bones (vertebrae). When a disc is damaged — due to degenerative disc disease (or DDD) or an unknown cause — it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots or spinal cord.

Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

Often, a procedure is performed to close the space that’s left when the disc is removed and restore the spine to its original length. Patients have two options:

  • Artificial cervical disc replacement
  • Cervical fusion

In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Since then, several artificial cervical discs have been developed and approved. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. It’s also not known how the artificial discs will last over time. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Understanding Spinal Disk Problems — the Basics

Article Featured on WebMD

What Are Spinal Disk Problems?

Anybody who has experienced a damaged spinal disk understands how painful it is. Every movement seems to make it worse. This pain is a warning signal that you should heed. If you take appropriate action, the discomfort usually stops, and the problem can be corrected.

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Lumbar Spine Surgery

Article Featured on Spine Health

Lumbar surgery refers to any type of surgery in the lumbar spine, or lower back, between one or more of the L1-S1 levels. There are two general types of lumbar spine surgery that comprise the most common surgical procedures for the lower back:

Lumbar Decompression

The goal of a decompression surgery is usually to relieve pain caused by nerve root pinching. There are two common causes of lumbar nerve root pressure: from a lumbar herniated disc or lumbar spinal stenosis.

This type of pain is usually referred to as a radiculopathy, or sciatica.

A decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal. The most common types of decompression surgery are microdiscectomy and laminectomy.

There are also a few alternatives available to the above two standard procedures, such as an X-STOP which is a possible option instead of a laminectomy for lumbar spinal stenosis.

Lumbar Fusion

The goal of a lumbar fusion is to stop the pain at a painful motion segment in the lower back. Most commonly, this type of surgery is performed for pain and disability caused by lumbar degenerative disc disease or a spondylolisthesis.

A spinal fusion surgery involves using a bone graft to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices), bone graft procedures, and a bone stimulator are sometimes used along with spinal fusion.

There are also many surgical approaches to performing spinal fusion, such as ALIF, PLIF, XLIF, TLIF, posterolateral gutter fusion, anterior/posterior fusion, and certain minimally invasive approaches.

In addition to the above conditions, decompression and/or spinal fusion may be performed to address other types of lumbar spine pathologies, such as infection or tumors.

Lumbar Spine Surgery Alternatives

In addition to the traditional one-level fusion or decompression surgery that is done for lumbar degenerative disc disease or spinal stenosis, respectively, there are a number of surgical alternatives available. Several of the most common ones include:

Artificial Disc Replacement

Artificial disc technology can be used in specific cases of lumbar degenerative disc disease.

Motion Preservation Technologies

It should be known that while spinal fusion has been a classical treatment for ongoing pain and disability from the lumbar spine, alternatives to fusion do exist for posterior conditions (problems in the back of the lumbar spine) such as spinal stenosis. Inserting an interspinous process spacer, such as the X-STOP device, can actually preserve motion as opposed to stopping it via fusion.

Vertebral Augmentation

A surgery called vertebral augmentation may be done to treat pathological fractures from tumors or osteoporosis.

Multilevel Lumbar Fusion

Lumbar spine fusion surgery for symptomatic degenerative disc disease is typically done on one level of the spine (most commonly toward the bottom of the spine, at L5-S1 or L4-L5). In certain cases it may be done on two levels, and only very rarely would it be considered on 3 or more levels. Multilevel spine fusion may be indicated in cases of scoliosis.

There are only two things that surgery can do. Surgery can decompress a nerve root or it can stabilize a painful motion segment. So we have to identify a nerve root that’s pinched or we have to identify a painful motion segment. And if we can do that, that would make you a candidate for surgery. Just having pain and having failed conservative treatment is not an indication for surgery if there is no pathological cause of the pain – it doesn’t mean there’s not pain, but we have to identify the cause of pain in order to be able to correct it. The only thing surgery can do is actually correct an anatomical defect, so we have to be able to identify it.


Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What Is Degenerative Disc Disease?

By Brian McHugh, MD | Featured on Spine Health

Degenerative disc disease is one of the most common causes of low back and neck pain, and also one of the most misunderstood.

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How to tell if you have a Herniated Disk

Article Featured on AAOS

A common source of back or neck pain is a herniated disk. Sometimes called a “slipped” or “ruptured” disk, this condition most often occurs in the lower back, as well as the smaller disks in the neck.

Although a herniated disk can sometimes be very painful, most people feel much better with just a few months of simple, nonsurgical treatments.

Read more