Hello, bubba43!
It is not surprising that you are confronting a battle in proving
that your current disc degeneration is the result of your previous
injury. Prevailing opinion is that degenerative disc disease is a
merely a normal "by-product" of aging. However, there are many in the
medical community that are not so close-minded. I have found a number
of references that associate physical injury with the acceleration of
disc degeneration.
You may face the argument that the early stages of degenerative disc
disease are often seen in the younger population and that you likley
had some degeneration before the accident occurred. If this is the
case, you might want to take the position that no matter what "state"
your discs were in at the time of the injury, the degeneration was
likely made worse by the accident. You should also be aware of the
relation between spinal torsion as a precipitating factor in disc
injury since it is quite likely that a fall backwards under a heavy
load involved some twising of the spine.
I hope the following references provide you with some ammunition!
==================================
DEFINING DEGENERATIVE DISC DISEASE
==================================
From The Hospital for Joint Diseases Spine Center. New York.
http://www.hjd.org/hospitals/hjd/hjdspine/spondylosis.htm
"Condition where the spinal disc loses structural integrity from wear
and tear, aging, or trauma. Consequences may be: disc space narrowing,
osteophyte formation, disc bulging, or herniation."
==
From "Degenerative Disc Disease." Pagnanelli Neurosurgical Associates.
Mountain Neurosurgery and Spine.
http://myneurosurgery.com/spine/degenerativedisc.html
"It is so common that it is almost a "normal" part of our aging
process. Medical studies show that by the age of 35, 30% of people
have a degenerated disc at one or more levels in their lumbar spine.
By age 60, that figure is over 90%.
The intervertebral discs are cartilaginous plates surrounded by a
fibrous ring which lie between the vertebral bodies and serve to
cushion them. Through degeneration, wear and tear,
** or trauma,
the fibrous tissue (annulus fibrosus) constraining the soft disc
material (nucleus pulposus) may tear. This results in protrusion of
the disc or even extrusion of disc material into the spinal canal or
neural foramen. This has been called herniated disc, ruptured disc,
herniated nucleus pulposus, or prolapsed disc."
=============================================
PHYSICAL TRAUMA AND DEGENERATIVE DISC DISEASE
=============================================
From "Lumbar degenerative disc disease," by Peter F. Ullrich, Jr., MD.
Spine Health.com September 8, 1999 (Updated February 28, 2000)
http://www.spine-health.com/topics/cd/overview/lumbar/young/degen01.html
"Degenerative disc disease refers to a syndrome in which a painful
disc causes chronic low back pain.
** "The condition generally starts with a torsional (twisting) injury
to the disc space. The injury weakens the disc and creates excessive
micro-motion at the corresponding vertebral level because the disc
cannot hold the vertebral segment together as well as it used to. The
excessive micro-motion, combined with the inflammatory proteins inside
the disc that become exposed and irritate the local area, produces low
back pain."
"Unlike the muscles in the back, the disc does not have a blood supply
and therefore cannot heal itself and the painful symptoms of
degenerative disc disease can become chronic. While it is rare that
low back pain from degenerative disc disease will progress or
increase, the pain will tend to fluctuate and at times may become
significantly worse."
==
"Could sudden increases in physical activity cause degeneration of
intervertebral discs? by Michael A Adams PhD, Patricia Dolan PhD.
Lancet 1997; 350: 734-735.
http://www.spine-inc.com/glossary/p/physical-activity-degeneration.htm
(I have included this article in relation to the heavy lifting
preceding your subsequent fall)
"Epidemiological studies link high repetitive loading of the lower
back with degeneration of intervertebral discs, and experiments on
cadaver spines confirm that repetitive mechanical loading can disrupt
the lumbar discs in a manner characteristic of "degeneration".
...
Mechanical loading and disc degeneration:
"The least equivocal sign of disc degeneration is a prolapsed disc
confirmed at surgery, and the most common risk factor for this is
repetitive and high mechanical loading (5). Experiments on cadaver
spines have shown how excessive loading applied to apparently normal
discs can create radial fissures in the postero-lateral annulus (6),
posterior herniation of nucleus pulposus (7), and internal disruption
of the annulus (8). There are complex changes in cell biology and
tissue composition in degenerated discs, but animal experiments show
that these can follow mechanical interventions (9), and they can be
explained in terms of disc-cell responses to an altered mechanical
environment (10). Biological changes may be consequences rather than
causes of structural failure."
...
"Fatigue failure:
"Few patients with disc degeneration recall injuring their backs.
However, the high risk associated with repetitive loading (5),
suggests that fatigue failure may be more important than trauma."
5. An epidemiological study of lifting and twisting on the job and
risk for acute prolapsed lumbar intervertebral disc. Kelsey JL et al.
J Orthop Res 1984;2:61-66.
====
From "News & Highlights - Lumbar Degenerative Disc Disease," by:
Pamela E Verkuilen, APNP NeuroSpine.
http://www.neurospinewi.com/newsletters/LumbarDDD.html
"Degenerative Disc Disease is most common at the L4-5 and L5-S1
levels.
** It often begins with a torsional injury to the disc space that
weakens the disc and creates microinstability at that vertebral
segment.
Furthermore, inflammatory proteins inside the disc become exposed and
irritate the surrounding tissue and neural elements. Unlike muscles,
discs have a poor blood supply and poor healing capacity. It’s failure
to heal leads to persistent microinstability and inflammation, which
together can produce episodes of low back pain."
===
From "Lumbar Degenerative Disc Disease," by Rajeev K Patel, MD.
EMedicine (Last Updated: December 26, 2001)
http://www.emedicine.com/pmr/topic67.htm
(This article is quite complex and best read in full. The author goes
through the various phases leading to disc degeneration, with Phase 1
starting with tears or fissures in the disc annula.)
History:
--------
**** "Classically, patients with discogenic pain describe an inciting
traumatic event, resulting in sudden forced flexion and/or rotational
moment; however, some patients describe spontaneous initiation of
symptoms.
Causes:
-------
"The cause of LDDD is unknown.
** Several theories cite traumatically induced acute annular tear as
the inciting pathologic event.
Other theories suggest that degeneration of the lumbar disc is a
natural part of aging;
** however, these theories do not explain spontaneously occurring
annular tears and disc degeneration in the young.
** Therefore, the cause of LDDD most likely is multifactorial. Various
genetic, environmental, autoimmune, inflammatory, traumatic,
infectious, toxin-induced, and other factors, alone or in various
combinations, may result in initiation and progression of degeneration
of the lumbar discs in a way that has not been elucidated yet.
=====
From "A Patient's Guide to Degenerative Disc Disease." University of
Maryland Spine Center.
http://www.umm.edu/spinecenter/education/degenerative_disc_disease.html
Excerpt:
Causes:
"With degenerative disc disease, the main problem lies within one or
more of the intervertebral discs. There is a disc between each of the
vertebra in your spine. The intervertebral discs are designed to
absorb pressure and keep the spine flexible by acting as cushions
during body movement. The discs are similar to shock absorbers.
Without the cushion effect of the discs, the vertebrae in your spine
would not be able to absorb stresses, or provide the movement needed
to bend and twist. Bones cannot sustain high stress repeatedly without
being damaged. Much of the mechanical stress of everyday movements is
transferred to the discs."
"A healthy intervertebral disc has a great deal of water in the
nucleus pulposus - the center portion of the disc. The water content
gives the nucleus a spongy quality and allows it to absorb spinal
stress.
** Excessive pressure or injuries to the disc can cause the injury to
the annulus - the outer ring of tough ligament material that holds the
vertebrae together
** "Generally, the annulus is the first portion of the disc that seems
to be injured. Small tears show up as in the ligament material of the
annulus. These tears heal by scar tissue. The scar tissue is not as
strong as normal ligament tissue. Over time, as more scar tissue
forms, the annulus becomes weaker. Eventually this can lead to damage
of the nucleus pulposus. The nucleus begins to lose its water content
due to the damage - it begins to dry up.
===
From "Spondylosis." The Hospital for Joint Diseases Spine Center. New
York
http://www.hjd.org/hospitals/hjd/hjdspine/spondylosis.htm
"Spondylosis is a general or "umbrella" term for the degenerative
disease process affecting the spine, in particular, the intervertebral
discs and the vertebral facet joints. Your doctor may use this term
or degenerative disc disease to describe the typical age-related
anatomic changes in the spine due to wear and tear.
** It is believed that these degenerative changes begin at the
intervertebral disc; for example, a tear in the outer layer of the
disc, known as the annulus.
These changes then have deleterious effects on the facet joints and
the ligamentous, neural, and bony relations of the spine. Narrowing
of the space between vertebrae (from disc degeneration) is an
important cause of many of these interdependent degenerative changes
to the lumbar spine [View Image]. Progressive degenerative changes in
the facet joints can lead to marked instability and both conditions
can entrap nerves and eventually lead to chronic nerve damage.
Advanced spondylosis can include thickening and ossification of spinal
ligaments that further contribute to nerve compression."
Symptoms:
Symptoms of lumbar spondylosis follow those associated with each of
the various aspects of the disorder: disc herniation, sciatica, spinal
stenosis, degenerative spondylolisthesis, and degenerative scoliosis -
all of which are discussed in further detail below. Pain associated
with disc degeneration may be felt locally in the back or at a
distance away. This called referred pain, as the pain is not felt at
its site of origin. Lower back arthritis may be felt as pain in the
buttock, hips, groin, and thighs.
==========
From The Pennsylvania Spine Institute.
http://www.thearlingtongroup.net/psi/options/index.asp
The Aging Spine:
"When you are born and into your early childhood the discs in the back
have an extremely high water content. This allows these discs to be
very elastic in nature to withstand a lot of forces. However, as we
grow older the discs begin to wear out and lose their elasticity. Poor
posture,
** injuries,
or even genetics can cause certain discs to wear out or even
degenerate faster than normal."
========
From "FAQ's." ESpine
http://www.espine.com/FAQ.htm#DDD
Q: I have been diagnosed with Degenerative Disc Disease. What does
this mean?
A: Degenerative Disc Disease refers to the loss of loss of hydration
in the disc and weakening of the annulus(outer lining of the disc).
** Trauma can cause the annulus to tear and disc material leaks out
and presses on a nerve. Degenerative disc disease is very common in
the human population but is not always symptomatic.
=====
From "Degenerative Disc Disease." Center for Sports Medicine and
Orthopaedics." http://www.sportmed.com/itnet/4857.htm
"Degenerative disc disease involves the stiffening of the spine due to
a loss of disc function. Spinal discs are found between vertebrae
(ver-ta-bray) and are made of a soft cushioning substance called
cartilage (kar-tillidge). These allow for movement and help absorb
shock between the bones of the spine. Discs are often worn down and
become less pliable as a person ages,
** or they may be weakened by some types of injury,...."
=====
From "Pathophysiology of Degenerative Disc Disease."
http://chirogeek.com/Pathophysiology%20of%20Degenerative%20Disc%20Disease.htm
"One theory hypothesizes that small, posttraumatic peripheral tears of
the anulus fibrosus lead to an acceleration in the dehydration of the
intervertebral disk, with resultant fraying of the nucleus pulposus."
8
8. Osti OL, Vernon-Roberts B, Moore R, Fraser RD: Annular tears and
disc degeneration in the lumbar spine: A post-mortem study of 135
discs. J Bone Joint Surg Br 1992;74:678-682.
=====
From "Excerpt from Lumbosacral Discogenic Pain Syndrome." EMedicine.
http://www.emedicine.com/sports/byname/lumbosacral-discogenic-pain-syndrome.htm
"Spinal abnormalities are more common in athletes than in nonathletes
in the general population. Any spinal injury pattern can be seen in
athletes who are subjected to trauma.
** Athletes are susceptible to degenerative disc changes at an early
age due to the repetitive loading activities involved in sports."
=====
From "Degenerative Disc Disease."
http://www.physicaltherapy.ca/ortho/DegenerativeDisc1.html
"However, a trauma such as a car accident or a fall can cause some of
these degenerative changes to occur more quickly than normal aging
would."
=====
From "Causes of back pain." Cedar Sinai.
http://www.latimes.com/extras/cedars-sinai/june/story02.html
"Degenerative disc disease:
** "This condition usually starts with a twisting injury to the disc
space. The injury weakens the disc and allows too much motion at the
vertebrae. Because the disc can’t hold the vertebrae section together,
the area becomes inflamed and produces low back pain."
=====
From "DEGENERATIVE DISC DISEASE AND THE ATHLETE." From the book, Prolo
Your Sports Pain Away, Excerpts from Chapter 17, Prolo Your Sports
Back Pain Away, contributor Jean-Paul Ouellette, M.D.
http://www.sportsprolo.com/disc_disease_and_prolotherapy.htm
"In athletes, DDD can be seen even at a very early age (late teens or
early 20s) as a result of sports injuries that never healed. When, at
a young age, an athlete permanently overstretches the ligaments of the
low back, the lumbar spine becomes unstable, and excessive movement
occurs at that segment of the spine. This results in excessive stress
being exerted on the disc. The disc cannot sustain the excessive
pressures and, gradually, fissures and tears develop in the outer
layer of the disc.
** The process of degenerative disc disease is thus accelerated,
especially if the athlete continues to play. Eventually many or all of
the lumbar discs become degenerated. Degeneration of a disc begins as
soon as the lumbar ligaments become loose."
"If not corrected, a vicious cycle is perpetuated and vertebral
instability and degeneration will be inevitable. The cycle starts with
ligament injury, which leads to increased stress on the disc, which
causes thinning of the disc. This puts more pressure on other discs
and increases the degenerative disc disease. This causes instability
in the lumbar vertebrae, which increases the stress exerted on the
disc. More fissures develop in the outer rim of the disc, worsening
the DDD, and the process continues to repeat itself. The worse the
degenerative disc disease, the worse the instability, and vice versa."
====
From "Degenerative Disc Disease." SpineSolver.com
http://www.spinesolver.com/degenerative_disc_disease.htm
WHO GETS DEGENERATIVE DISC DISEASE AND WHY:
"Discs are the cartilage that lies between the bony vertebral bodies
of the spine. Since motion occurs in this area, these are considered a
joint. As a natural phenomenon of the aging process, discs lose their
water content and degenerate. Concurrently, tears occur in the outer
lining of the disc (the annulus). In adults, the annulus has nerve
fibers while the center of a disc does not. A tear in this outer
annulus can be quite painful. Although these degenerative processes
are part of the natural aging of the spine, the discs of some people
degenerate much more quickly than others. Also, for reasons as yet
unknown, some individuals experience much more pain from these
degenerative changes than others (see section under imaging studies
about results of MRI).
The symptoms of DDD typically follow one of three courses:
* a significant injury followed by sudden and unexpected back pain;
* a trivial injury accompanied by significant back pain; and
* a gradual onset and worsening of midline low back pain;
1. Sudden and unexpected back pain following a significant injury:
Some individuals can identify specific episodes (such as weight
lifting, a fall onto the legs or buttocks, or a sudden twisting
motion) immediately preceding the onset of back pain. For these
individuals, the sudden or unexpected episode may have brought to
light an already degenerating disc or caused a new annular tear to a
degenerated disc. The unexpected incidents are usually of a form that
causes vertical pressure upon the spine, compressing or pushing
together the disc space. Examples include jumping onto your feet from
a height, or putting weight on your head. This form of compression is
often referred to as "axial load".
===
Also read "Degenerative Disc Disease from Accident?"
http://www.spinalmedicine.com/ask/q991228b.html
Also read "CAN DISC DAMAGE ACCELLERATE OR CAUSE DEGENERATIVE DISEASE?"
Spine Dr. Bulletin Board.
http://www.spine-dr.com/site/BB/index.cfm?page=Detail&ID=2268
===
From "What is degenerative disc disease (DDD)?" Back.com
http://www.back.com/faq-ddd.html
Dr. Mark Rosenthal:
"Degenerative disc disease is a deterioration of the discs that hold
the spine together. It can follow ** trauma, infection, or just be
part of the aging process."
Dr. John S Shiau:
"Degenerative disc disease can be caused by some type of ** trauma
that speeds up the process of degeneration
===
From "Traumatic Disc Injury and the Acceleration of Disc Disease and
Spondylosis," by Arthur Croft, DC, MS, FACO. ChiroWeb.
http://www.chiroweb.com/archives/13/01/03.html
(The following synopsis involves degeneration of the cervical discs
resulting from the trauma of whiplash. However, the concept of injury
accelerating disc degeneration is still applicable.)
"Although clinicians have long made the connection between the
development of spondylosis in the cervical spine and various forms of
trauma, it was Mason Hohl, MD, who first analyzed the long term
effects of trauma (whiplash in this case) on the cervical spine.1 In
this classic work it was demonstrated that patients injured in such
accidents develop spondylosis approximately six times more frequently
than age and gender-matched controls..."
"The exact mechanisms by which this degenerative process proceeds have
not been clearly defined but probably include an initial
destablilizing of the disc through direct injury from a high energy
combination of shear, compression, axial stretch, and torsion forces.
Mendel et al.,6 have discovered intradiscal receptors in normal
cervical discs. Damage to these receptors may result in an uncoupling
of important biomechanical feedback loops operating through both
intrinsic paraspinal and gross postural muscles. Loss of normal
ligamentous integrity will allow a direct biomechanical
destabilization of the spine and probably contributes significantly to
the overall degeneration scenario."
====
Subject: Tramatic fall and Excelerated DDD Related???
Topic Area: Neurology - General
Forum: The Neurology and Neurosurgery Forum -
http://www.medhelp.org/forums/neuro/messages/31789a.html
Question:
"Can any Dr. comment on this.In 1989 I had a traumatic fall. I ended
up with low lumbar strains/sprains and atheritis noted at L5-S1. In
2000 I had an MRI done and it showed I have DDD In the same area
L5-S1. I am aware that DDD is a natural process of ageing and find it
questionable both the injury and DDD is at the same location. Is it
possible/probable any medical connection.?? I am now 35 and do not
exercise my back for fear of re-injury and gained alot of weight the
past 12 years,40 lbs. I have not consulted a Dr. yet (Is it as least
as likely as not my present condition of DDD is a result of my
traumatic injury to L5-S1 area of back in 1989????) "
Answer Posted By: CCF-Neuro-M.D.-JT on Friday, May 17, 2002:
"Disc disease is well known to be caused from trauma. It is certainly
possible that you have a combination of both traumatic disc disease
and degenerative disease. But an isolated disc problem at the
relatively young age of 35 is more suggestive of trauma being a bigger
component of the cause rather than degenerative disc disease."
=====
From "Ask the Experts." MedicineNet. April 26, 2002
http://www.medicinenet.com/script/main/ques.asp?qakey=4717
Viewers Question
----------------
"I have been told I have a bulging disc. I continue to have several
problems from sitting, bending, coughing, standing, etc... I then had
a MRI performed and was told that it was negative for a herniated disc
and then I was diagnosed with arthritis. Can arthritis be caused by a
trauma to the back? Also, is a bulging disc and herniated disc the
same? According to some articles they are one in the same only varying
in degrees of degeneration."
Doctors Answer
-------------
"Yes, arthritis (inflammation of the joints of the spine) can be
caused by injury to these joints in the back. This form of arthritis
is called osteoarthritis. Osteoarthritis is a form of joint
inflammation (arthritis) that occurs as a result of cartilage wear (or
degeneration) over time. Osteoarthritis is also referred to as
degenerative arthritis.
Degenerative disc disease is a wearing of the tissues of the disc with
aging.
** Degenerative disk disease can be promoted by injury as well.
Degenerative disc disease leads to both bulging and herniation of the
disc. These are absolutely not the same problem."
"Bulging of a disc is not at all necessarily abnormal, as it is found
in nearly half of normal individuals by MRI scanning."
"The discs of the spine are located in between the vertebrae (bony
building blocks of the spine). The disc is designed somewhat like a
jelly donut being composed of an inner gelatin-like core (the nucleus
pulposus) surrrounded by a firm outer ring (the annulus fibrosus)."
"When the disc structure wears, because of processes such as aging or
trauma, it becomes weakened and susceptible to injury. In this
condition, stresses on the spine can cause the inner core to protrude
outward through the boundary of the disc’s outer ring. The is referred
to as herniation of the disc."
===========
From "Degenerative Disc Disease." Bay Area Pain Medical Associates.
http://www.bayareapainmedical.com/dgndisc.html
"Degeneration of the disc occurs when the vertebral endplate tears
from its connection to the intervertebral disc. The disc itself has no
blood supply and relies upon osmosis of nutrients and Oxygen from the
vertebral endplates above and below. When there is an interruption
from one of the endplates the disc begins to show damage due to lack
of nutrients and Oxygen. Gradually this process spreads to other parts
of the disc. In fact this may be a normal part of the way that the
spine degenerates with age,
** but often the more rapid degeneration caused by abrupt injury
results in a painful reaction."
===
From "Lumbar Disc Disease." Oregon Health and Science University
http://www.ohsuhealth.com/neuro/hdisc.asp?sub=1
"What causes lumbar disc disease?
"Lumbar disc disease is due to a change in the structure of the normal
disc. Most of the time, disc disease comes as a result of aging and
the degeneration that occurs within the disc.
** Occasionally, severe trauma can cause a normal disc to herniate.
Trauma may also cause an already herniated disc to worsen."
====
Injury and Predisposition to Degenerative Disc Disease:
------------------------------------------------------
From "Does football cause an increase in degenerative disease of the
lumbar spine?" by Gerbino PG, d'Hemecourt PA. Curr Sports Med Rep.
2002 Feb;1(1):47-51.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12831647&dopt=Abstract
"At this time, it can be said that football players, in general,
increase their risk of developing low back pain, DDD, and FD as their
years of involvement with their sport increase. Because specific spine
injuries like fracture, disc herniation, and spondylolysis are more
frequent in football players, the resulting DDD and FD are greater
than that of the general population. The weightlifting and violent
hyperextension that are part of American football are independent risk
factors for degenerative spine disease."
=====
From "Pain Generated by the Spinal Disc." Spine Health.com
http://www.spine-health.com/research/discupdate/artificial/artificial02.html
Degenerative disc disease:
"Mechanical dysfunction may also cause disc degeneration and pain
(e.g. degenerative disc disease). For example, the disc may be damaged
as the result of some
*** trauma
that overloads the capacity of the disc to withstand increased forces
passing through it, and inner or outer portions of the annular fibers
may tear. These torn fibers may be the focus for inflammatory response
when they are subjected to increased stress, and may cause pain
directly, or through the compensatory protective spasm of the deep
paraspinal muscles.
====
From "Degenerative Disc Disease." The Neurology and Neurosurgery
Forum.
http://www.medhelp.org/forums/neuro/messages/32459a.html
"In young patients, trauma is a major cause for early degenerative
spine disease..."
*******************************************
It is hard to imagine that a doctor would not be open to the possible
association between a serious injury like the one you incurred and the
progressive nature of symptoms that you are now experiencing. Serious
injuries often have a range of symptoms that appear "over time" rather
than appearing ONLY at the time of the accident.
I hope you can find an open-minded doctor that recognizes the long
chain of physical symptoms that can appear long AFTER an injury is
sustained. And, I hope the references I have provided are of some help
in making your case.
I wish you good luck!
I also wish you relief from your pain.
Sincerely,
umiat
Google Search Strategy
cause of degenerative discs in lumbar spine
injury AND degenerative disc disease
+trauma +cause "degenerative disc disease"
PubMed search for injury and degenerative disc disease |
,
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