DEGENERATIVE DISC DISEASE / CAUDA EQUINA SYNDROME

Degenerative Disc Disease

Between adjacent vertebrae sit flexible discs that provide movement and shock absorption in the spine. In the thoracic region these are completely fibrous while the discs in the lower back and neck are filled with a jelly like substance and surrounded by protective, fibrous rings. The discs of the lower back are the largest as they need to transmit higher loads through the spine.

As we age, these discs lose hydration, height and elasticity. Unfortunately, this also means that the discs are unable to provide the flexibility and support they previously did. Like any form of soft tissue, discs can also become sprained and are able to heal. It is also possible for these discs to bulge and even have the jelly contents spill out into the surrounding region.

You may have heard people talk about having a slipped disc, however this is a misleading expression as discs almost never slip out of place and are very securely attached to the bones above and below them.

WHAT HAPPENS AS THE DISCS DEGENERATE?

When these discs first begin to degenerate, abnormal stress is placed on the surrounding joints and muscles of the spine. Facet joints and the vertebrae themselves can also degenerate and produce small bony outgrowths called osteophytes, although these can occur independently of disc degeneration. During this period people may notice feeling stiff and sore at regular intervals. Symptoms are usually located in the neck and lower back.

As the degeneration progresses and the discs become less functional, episodes of pain will often be more frequent and more severe. Many people describe pain with prolonged sitting or standing, along with pain radiating into the hip or buttock region. Pain will often be relieved by changing positions, lying down or walking. Pins and needles or numbness may occur when the spinal nerves around the affected disc become irritated.

Disc degeneration is considered to be a normal part of aging, however research on twins has shown that a genetic predisposition to degeneration is the most accurate predictive factor. Smoking, poor nutrition, posture and biomechanics may also increase your chances of suffering from disc degeneration.

HOW IS IT DIAGNOSED?

Your therapist can diagnose this condition clinically with a thorough examination, including careful questioning and in depth assessment. In many cases imaging is not required, however if you have had previous medical imaging please bring this to your initial appointment.

An important thing to note in spinal pain is that many people can have severe back pain without an obvious finding on their imaging and other people have no pain with very significant structural changes in their back. Some people have even had their discs rupture and heal without realising it!

HOW CAN THERAPY HELP?

Treatment of any spinal disorder is often complex and your therapist will tailor your management plan to suit you. Many people respond well to specific strengthening exercises, particularly Pilates style exercise. Trigger point therapy or dry needling can help to relax muscles that are often abnormally tight, therefore reducing pain. Your therapist is also trained to safely mobilize the spine, which allows the back to move with improved range and reduced pain.

Your therapist will have a great deal of advice and education for you to assist in managing your symptoms. Diagnosis of a condition such as degenerative disc disease can be daunting, however it doesn’t have to be a life sentence of pain. For more information, speak to one of our friendly, experienced therapists about treatment options.

Cauda Equina Syndrome

Cauda equina syndrome is a rare condition that you may not have heard of, however it can have catastrophic consequences if it is not recognized and treated quickly. This condition occurs in about two percent of cases of herniated lumbar discs, causing loss of lower leg function, incontinence and lower back pain. It is one of the few medical emergencies related to back pain and can be devastating if symptoms persist.

WHAT CAUSES CAUDA EQUINA SYNDROME?

At the end of the spinal cord there is an area of spinal nerves arranged together in a bundle that looks a little like a horses tail. (In Latin horses tail is cauda equina). These nerves are encased in the spine at the lumbar region.

If for some reason these nerves are compressed, nerve signals to the bowel, bladder and lower extremities can become disrupted. Left untreated, this compression can cause permanent paraplegia and incontinence.

Common causes of compression are disc herniation associated with disc degeneration, tumours, inflammatory disorders, spinal stenosis or complications from surgery. Trauma-related cauda equina syndrome from knife wounds or motor vehicle accidents can affect people of all ages.

SIGNS AND SYMPTOMS

This disease is difficult to diagnose because its symptoms mimic many other conditions. However, there are a few symptoms that health professionals know to take very seriously. These include:

  • Sudden loss of reflexes in the legs
  • Unusual and rapid onset of Bladder/bowel incontinence or sexual dysfunction
  • Pain in one or both legs
  • Motor and sensory loss
  • Tingling or numbness in the saddle region (Groin and inner thighs)
  • Bilateral sciatica

These symptoms may be associated with severe low back pain and if you suddenly experience more than one, particularly incontinence, contact a health professional immediately.

TREATMENT OPTIONS

Treatment will depend on the severity and cause of the syndrome. However, most of the time cauda equina syndrome requires decompression surgery as soon as possible to relieve pressure on the nerves. The longer the period between symptom onset and surgery, the less likely it is for a full recovery. Most patients will need physiotherapy, pain management and counseling even if their condition is treated quickly. Recovery time is based on the amount of damage to the nerves.

While this a very rare condition, public education is important, as rapid treatment is vital to prevent permanent damage.

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