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Degenerative Disc Disease (DDD) or Spondylosis refers to the gradual deterioration of the disc between the vertebrae in the backbone. This disease is very common, and affects as much as 40-50% of people over the age of 40. The disorder also becomes increasingly common as we age. It is a disease of wear and tear similar to osteoarthritis. It commonly happens in the lumbar spine (low back), though it can occur at any spinal level.
In DDD, the discs get flattened, losing their normal height. This disc height is what separates the disc above from the one below. Nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain, when the disc height is lost.
Degenerated discs become much thinner and sometimes the vertebrae also develop small, rough areas which irritate the nearby nerves. Severe neck pain and stiffness and pain down the arms and hands can result from this .
Cervical spondylosis is a very common condition where there is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). This is managed by cervical spine surgery where the worn out discs or bone spurs are removed - depending on the underlying problem. Sometimes the gap would be filled by a graft of bone or other implants made of metal combined with bone.
Slipped disc is a common term used to refer to a prolapsed disc. This is a disorder when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. The bulging disc may then press on nearby nerves and cause discomfort and pain. Back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands are the usual symptoms.
The Greek term for slipping of the spine is Spondylolisthesis. This term refers to the abnormal forward movement of one vertebra over the one below. It is in the lumbar spine that this forward slip of the vertebra happens most often. Pressure on the nerve roots associated with the affected vertebrae, as well as pain and dysfunction are caused by the slippage and herniation of the disc. The types of spondylolisthesis include:
Type 1 - Congenital spondylolisthesis
Congenital spondylolisthesis is a condition where a person is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. It happens at the L5-S1 level commonly and is associated with abnormality of the facet joints. Symptoms include back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).
Type 2 - Isthmic spondylolisthesis
Isthmic spondylolisthesis is a defect in a part of the bone called the pars interarticularis. This bone connects the upper joint of one vertebra to the lower joint. Stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth) usually causes this. Sometimes a defect may exist without any forward slip, and this is called spondylolysis. This can also be painful.
Type 3 - Degenerative spondylolisthesis
Forward slippage secondary to arthritis of the spine is known as Degenerative spondylolisthesis. This process is usually also associated with Spinal stenosis. Long standing degenerative disc disease, leading to weak facet joints in the back of the spine is the reason. This is usually seen at L4-L5 level. This is also called Lumbar Spondylolisthesis.
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