Causes of Degenerative Disc Disease

Knowing what causes any condition is the best way to educate yourself on how to avoid it. Considering how painful and disruptive this condition can be, it’s helpful to learn more about the causes of degenerative disc disease in order to preserve the health of your spine.

Before discussing the factors that can lead to the development of degenerative disc disease, it’s important to note that having degenerative discs is just an MRI appearance, not a disease. By the time most people reach age 60, they will have developed some degree of degeneration but this may not necessarily lead to back pain.¹ Because of this, the term degenerative disc disease is actually a misnomer. Keep in mind that although degenerative disc disease usually affects the lower back, it can also affect the neck as well.

The Spinal Disc

Two parts make up the spinal disc: the outer annulus fibrosus and inner nucleus pulposus gel. The annulus fibrosus has the sole purpose of containing the nucleus pulposus. 22-25 layers of collagen fibers make up this outer section. The nucleus pulposus is the soft and gel-like core of the spinal disc.

An odd and critical fact about nucleus pulposus gel is that it leads to most spine symptoms only because the human body perceives the nucleus pulposus as being a foreign substance when it leaks through annulus fibrosus tears. As a result, our body mounts an attack against our leaking nucleus pulposus.

This attack causes inflammation, resulting in pain around the spinal nerves, discs, and any other tissue the gel leaks onto. This is what causes low back pain, sciatica pain, neck pain, and arm pain, and of course is one of the causes of degenerative disc disease.

It’s easy to imagine how this chain of events leads to degenerative disc disease because annular layers are paper thin and easily torn.

Annular Tears and Degenerative Disc Disease

Degenerative disc disease begins as a single annular tear in a disc that progresses into multiple annular tears. As these tears accumulate, they lead to disc degeneration. This chain of events leads to degenerated discs, bulged discs, herniated discs, dried discs, bone spurs, and joint arthritis. Together, they appear on MRIs as degenerative disc disease.

Because these discs have decreased height, bulges, or herniations, they don’t move similarly to normal discs. As a result, they can’t absorb shock as well as normal discs, so their associated facet joints develop arthritis.

Spine Arthritis & Bone Spurs

More specifically, spine arthritis occurs because flattened discs cause the vertebrae and facet joints to come closer together.

When they’re closer together, the facet joints rub each other, forming bone spurs and arthritis joint pain. Facet joint arthritis on MRIs appears as large, overgrown joints called “joint hypertrophy.” This joint hypertrophy causes bone spurs. Occasionally bone spurs grow into nerve hole openings (neural foramen), pinching spinal nerves. This is condition is “foramen stenosis”.

Therefore, almost every aspect of spine pain, whether it be pain from arthritis of facet joints, bone spurs, spinal nerves, muscles, or discs, all originate from small, seemingly innocuous annular disc tears.

Factors Leading to Degenerative Disc Disease

With all things considered, there’s only one factor that causes degenerative disc disease, annular tears. However other factors are worth mentioning because they contribute to annular tears. Some of these factors are preventable and others are not.

Remember that spinal discs are located in the front of the spine, not in the rear of the spine. Therefore damaging factors causing annular tears and degenerative disc disease include compression forces caused by forward flexion of the spine and shear forces caused by twisting of the spine.

Sports

Sports that cause annular tears and degenerative disc disease are those that require repetitive impact on the lower back or repetitive twisting. This includes running, tennis, golf, skiing, and weight lifting.

Despite all this, it’s still possible for one to workout safely and without risk of causing degenerative disc disease.

Swim with a stroke that moves the spine in unison, without twisting.
Run with good soles on soft surfaces, even if it’s a marathon.
Lift weights with a spotter, using your legs, and keep the weight against your body, your center of gravity.
Don’t ski down the fall-line, navigating moguls of a black diamond slope. Instead, think about your spine, go a little blue or green, and intermittently, enjoy a hot toddy in the lodge.

Spinal Disc Osmosis

A factor that prevents annular tears from healing is that discs have few to no blood vessels, unlike other parts of the body. For example, a facial laceration heals promptly, but an annular tear never completely heals.

Because there are no blood vessels, discs nourish themselves through a process called “osmosis”. Osmosis causes good things to flow into discs through the disc endplates. These things include water, vitamins, and proteins. Likewise, osmosis causes bad things to leave discs through endplates. These bad things include acid and other metabolic byproducts.

Osmosis

We can help osmosis occur, and so it’s good to know how. Without getting too technical, osmosis occurs because of a balance of chemicals on both sides called the chemical gradient. Chemicals tend to want to balance each other on both sides and be in equal concentration. Another important force controlling osmosis is hydrostatic force, which is the pressure of a fluid at rest.

Hydrostatic Forces

Understanding hydrostatic forces matters because we can control them, and they definitely contribute to disc death and disc healing. Hydrostatic forces help osmosis occur, and they explain why some people experience increased low back pain during prolonged sitting in a movie theater or on a long car ride.

Think of it this way: gentle walking or moving around alternates hydrostatic forces back and forth. This “disc milking action” rids discs of their painful inflammatory constituents and metabolic byproducts and brings in healing constituents.

How to Help Your Spinal Discs

Lift with your legs, not your back, not flexing your spine forward. This avoids annular compression forces.
Turn with your legs without twisting your spine. This avoids annular shear forces.
Avoid prolonged sitting or standing. Instead, alternate sitting and standing to alternate hydrostatic forces. This helps disc osmosis which promotes “in with the good” and “out with the bad.” When you go for a long ride or sit during a long movie, even if you’re feeling good, periodically stop, get up, and walk for a few moments. This alternates hydrostatic forces, which nourishes discs.
Eat well. This is especially important after undergoing the Discseel^® Procedure because, for the first time, the disc has Fibrin to stimulate disc growth to heal the tears. The nutrients to make disc Collagen Type I and II should be ready to allow the Fibrin to do its thing.

Procedures That Cannot Correct Annular Tears & Degenerative Disc Disease

Lumbar traction. Studies have not found beneficial negative forces in the lumbar discs, proving that no forces can pull the disc bulge back into the proper place. In fact, negative forces are only perceived after the body disarticulates. The cadaver pulled apart when negative forces were detected in the cadaver discs.
Epidural Injections. Epidural injections are not FDA approved and the FDA posted a “Black Box Warning” against epidural injections of steroids. Further, epidurals are only able to temporarily stop inflammation pain caused by leaky torn discs. At best, epidurals allow patients to tolerate symptoms until the leaking disc stops leaking but epidurals don’t heal annular tears.
Physical Therapy. Physical therapy should teach proper lifting techniques and body mechanics, but cannot heal annular tears.
Chiropractic Therapy. Proper chiropractic therapy should teach proper body mechanics, and optimal nutrition and exercise. Chiropractic manipulation cannot heal annular tears.
Surgical Discectomy. Even minimally invasive discectomy can worsen discs because they cut into the annulus fibrosis, worsening annular defects and enlarging tears. Discectomy causes accelerated disc degeneration. Today, some surgeons attempt to prevent discectomy damage by performing the Discseel^® Procedure at the time of discectomy.
Fusion Surgery. Fusion has not been proven to correct annular tears or leaking discs. Fusions worsen adjacent discs by displacing damaging forces onto adjacent discs.
Artificial Disc Replacement or Disc Arthrodesis. These procedures have not been shown to correct annular tears and they can also cause accelerated degeneration of adjacent discs.

Healing Annular Tears

The bottom line is this: if the annular tears that appear in spinal discs could be repaired, almost all problems relating to degenerative disc disease would be avoided. Unfortunately, annular tears can’t repair themselves, and because tears leak, common injectable medicines or biologics meant to fix tears will also leak.

A tissue adhesive is required to seal annular tears and heal degenerative disc disease. In addition to sealing tears, it would also be optimal if this adhesive sealant stimulated new disc growth, thus healing annular tears as well. Fortunately, the Fibrin used in the Discseel^® Procedure does all of these things.

Articles. (n.d.). Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html

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