Disc Disease

Disc disease describes changes that occur to the intervertebral disc of the spine, either due to degenerative processes or injury. The medical term Disc Disease is sometimes used interchangeably with a bulging disc or herniated disc. This describes a physiological event where the disc wears out in its outer layer - the annulus fibrosis, causing part of it to bulge outwards or to tear completely. The annulus fibrosis is composed of type I and type II collagen, which makes it stiff and invulnerable to breaking, when it is young and healthy. Due to a number of possible factors, including simple aging, this outer envelope of the disc may become thinned and worn out to the point that its structural integrity becomes compromised. This outer wall may become frail to the point that it bulges outwards in one or more weak spots. When this happens, this condition is known as a bulging disc. When this outer wall gives away completely, the condition is known as a herniated disc.

When a disc does herniate the contents of its nucleus may escape out of it, either impacting the nerve roots or the spinal canal itself. When the spinal nerves of the spinal cord are impacted, the neurologic functioning of these nerves may be affected. Neurologic symptoms related to the compression of the nerves include sharp, burning pain, weakness of the structures supplied by that nerve, and the pins and needles feeling. If the cause of the nerve root compression is not successfully eliminated, the patient may experience a permanent loss of functioning in the part of the body supplied by that nerve. This is why doctors may recommend spinal surgery for herniated discs that do not respond to conservative treatments such as icing and physical therapy.

Other medical terms that are used interchangeably with disc disease include black disc, disc protrusion, torn disc, ruptured disc, and slipped disc.v How does a doctor diagnose disc disease as the cause of back pain or neck pain? A doctor will usually use the following tools and resources to diagnose disc disease:
  • A review of the patient's medical history

  • A comprehensive physical exam (physical examination)

  • Additional testing may include medical imaging (X-Rays, MRI, CT Scan, ultrasound), blood testing, or EMG testing.

Until relatively recently, it was thought that patients would only feel pain associated with disc disease when the nearby spinal nerves were affected. It was thought that pain did not originate from the discs themselves because the discs had few to no nerve endings. Today, it is understood that the discs themselves do have a nerve supply, and there are available tests to prove it.

So doctors do have access to all the technology they need to see if the cause of pain is due to a pinched nerve or disc pain (aka discogenic pain and axial pain). MRIs and CT Scans are usually used to get a detailed view of the spine to see if the bulging disc or herniated disc material from the disc's nucleus is pressing into the spinal canal or spinal nerves. These high definition medical imaging tests also show if the cause of pain is due to something other than a disc problem, such as spinal stenosis.

If disc pain is being considered for the cause of symptoms, a test known as a discogram may be ordered. A discogram will involve the injection of an anesthetic directly into the disc, under the guidance of X-Rays which feed images into a TV screen. The doctor can take X-Rays which will show instant results showing exactly where the injection needle is in the body. The injection delivers a pain relieving injection into the disc. If the patient's pain is caused by disc pain, then the patient will feel immediate pain relief.