LUMBAR

DEGENERATIVE DISK
DISEASE
Prepared by:
Thania Mohd Radzuan
C 111 11 850
Resident:
dr. Zulpan Zulkarnain
dr. Ricky M. Tambunan
Supervisor: dr. Jainal Arifin, Sp. OT (K) Spine

 Lumbar degenerative disc disease (DDD) is a common

condition in aging adults.
Definition: Degeneration of an individual disc space typically
refers to loss of disc height, loss of water content, fibrosis,
end plate sclerosis/defects, osteophyte complexes, etc.

Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis. Literature Review: Lumbar Spine Fusion for Chronic Low Back
Pain Due to Degenerative Disc Disease. Lippincott Williams and Wilkins. 2013

EPIDEMIOLOGY
2nd leading cause for physician visits
Lifetime prevalence: 60%80%
By 30 years, almost 50% adults have
experienced a substantive episode of low
back pain
Most symptoms are short-lived; 80-90% of
episodes resolve within 6 weeks of onset
regardless of the type of treatment.
Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis. Literature Review: Lumbar Spine Fusion for Chronic Low Back
Pain Due to Degenerative Disc Disease. Lippincott Williams and Wilkins. 2013

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

ANATOMY OF VERTEBRA

Consist of 33
vertebrae :
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd Edition.

ANATOMY OF VERTEBRA
Natural curvature in
sagital plane
Cervical lordosis - average
of 9o
(concave bacwards)
Thoracic kyphosis -average
of 39o (concave forwards)
Lumbar lordosis - average
of 57o

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd Edition.

ANATOMY OF LUMBAR

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd Edition.

INTERVERTEBRAL DISC ANATOMY

Spongy center
Nucleus
pulposus
Surrounded by
a tougher outer
fibrous ring
Anulus
fibrosus

FUNCTIONS OF IVD

LUMBAR DISC
Lumbar disc degeneration occurs because of a variety of factors:
1. Insufficient nutritional supply
2. Reduction in amount of viable cells
3. Vascular ingrowths
4. Loads placed on the disc
5. Cell senescence and apoptosis
Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

DEGENERATIVE PROCESS CLASSIFICATION

Kirkaldy Willis and Farfan

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

DEGENERATIVE PROCESS

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6th Ed 1st Vol. 2001. pg 846-875

PATHOPHYSIOLOGY

SYMPTOMS
The most common: LBP
Over lumbosacral spine &
sacroiliac joints radiates into
buttock & post. thigh
Exacerbated with sitting and
prolonged walking
Neurologic symptoms (radicular
pain and neurogenic
claudication) may occur
secondary to neural
compression

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol.
2001. pg 846-875

DIAGNOSIS
Medical history. Questions about symptoms, severity, treatments done
Physical examination.
Tenderness over lumbal spine (midline & sacroiliac joints)
Decrease in ROM of spine esp flexion
extreme flexion continued with extension discomfort
Extension relieve pain
Straight leg cause posterior thigh pain (stretching / pulling sensation)
No radicular pain to knee (if +ve, foraminal stenosis), deep tendon
reflex normal

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

DIAGNOSIS

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

NON OPERATIVE TREATMENT

Bed rest (2 days max)
Stay active
Medications
anti-inflammatory: reduce swelling, pain
muscle relaxants: calm spasm
narcotic painkillers: acute pain.
Cold/heat therapy, especially during the first 24-48 hours.
Spinal injections (ig epidural), intradiscal injections: low back and leg
pain.
Physical therapy (eg gentle massage, stretching, therapeutic exercise,
bracing, or traction): decrease pain and increase function
Brace wears
In conjunction with treatments: education about healthy posture and
proper body mechanics.
Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875

OPERATIVE TREATMENT

Andersson GBJ, Biyani A, Ericksen ST. Rothman-Simeone The Spine. 6 th Ed 1st Vol. 2001. pg 846-875