Diagnosing Degenerative Disc Disease
Degenerative disc disease is a condition in which the discs, located between the individual vertebra, deteriorates and break down. The discs no longer provide support between the vertebrae, which leads to pain and other symptoms.
Degenerative disc disease can be a difficult condition to diagnosis, as it progresses slowly and can have multiple complications which may appear as related conditions. (link to article on progression & complications).
The first step is for an individual to visit their primary care doctor. This doctor will take a medical history by ask questions about the onset of symptoms. This may include question such as: when did pain or other symptoms start, where is the pain located, is there a family history of back problems, has the individual been a recent accident or had an injury that could affect the back, and what is the individual currently doing to deal with the pain and discomfort?
At this point, the primary care doctor will then do a physical examination. The doctor will feel the spine to see if there are any abnormalities or areas of increased pain. The individual will be asked to do certain movements to determine their range of motion, including walking. The doctor may also check reflexes to determine if there is any possible nerve damage.
After the physical exam, the primary care doctor may send the individual for some diagnostic tests. These test may include: blood work, X-ray, CT Scan, or MRI.
Based on the information that comes back from the tests, combined with the medical history and physical exam, the primary care doctor may be able to make the diagnosis of degenerative disc disease. If not, the doctor will then refer the individual to a spine specialist.
Spine specialists can be neurosurgeons, orthopedic surgeons or another type of doctor. The spine specialist will review the information sent by the primary care doctor. They will likely take their own medical history and do their own physical examination of the individual. They may order their own blood work, x-rays, CT-scans or MRI.
The spine specialist may also order different tests. If there is concern about possible nerve involvement or nerve damage, the individual may be sent for an electromyography (EMG) and/or a nerve conduction test. Bone scintigraphy is a nuclear medicine test that uses a dye with a radioactive marker to show where the dye is being absorbed into the bone. Areas that absorb more dye are called hot spots and these hot spots are areas of abnormal activity, like inflammation. The bone scintigraphy can show very specifically where there may be damage to the spine.
There are two procedures may be used to diagnose degenerative disc disease, a discogram or discography and a myelography. These procedures are done either by a spine specialist or a neuroradiologist.
A discogram or discography is a procedure which will confirm exactly what disc are the source of an individual’s pain. For this procedure, an individual will be given IV medication to relax. The doctor will clean and then will numb the skin with a local anesthetic. Once numb, the doctor will insert a small needle into the center of a spinal disc under x-ray guidance. This will then be repeated for all the discs in question. Once all the needles are in place, the doctor will then inject a small amount of contrast dye into the disc. If a disc is a source of pain, the injection will temporarily cause the individual to experience pain and other related symptoms. If a disc is not the source of pain, no discomfort should be felt from the injection.
A myelography is an imaging procedure to evaluate the spinal cord. The image it produces is know as a myleogram. It can be helpful in diagnosing disorders of the spine that cause myleopathy or spinal compression. Myelography can be broken down into two parts, the injecting of contrast dye into the space around the spinal cord and use of a x-ray, CT-scan or MRI to obtain imagines of the spine.The doctor will clean and then will numb the skin with a local anesthetic. Once the area is numbed, the doctor will then inject the contrast dye. After giving a few minutes for the contrast to work, the image is taken. Individuals may experience some pain or pressure when the contrast is injected.