If you’ve ever experienced back pain, you are not alone — not by a long shot. “Back pain is one of the most frequent patient conditions we see in healthcare. The vast majority of people will have back pain symptoms at some point,” says Harvey E. Smith, MD, Penn Medicine physician and orthopaedic surgeon. As you get older, your spine ages right along with the rest of you — which can cause disc degeneration. And disc degeneration can lead to back pain. Here are 4 ways this can happen.
1. Herniated Disc
In order to understand what happens when you have a herniated disc — and most other back pain caused by disc degeneration— it’s important to first understand the different parts of your spine.
Your spine is made up of bones, called vertebrae, that are stacked on top of one another. Soft, rubbery discs located between the vertebrae act as shock absorbers and provide your back with flexibility. They’re kind of like small, almost-flat water balloons between the bones in your spine. The outside of each disc is made of cartilage. The inside is filled with a jelly-like substance, called nucleus.
These discs can become weakened over time as you age. This can increase the risk of a herniated disc, also called a ruptured disc. When this happens, the jelly-like nucleus substance leaks out into the spinal canal, putting pressure on the nerves. This can cause:
- Back pain
- Leg/foot weakness
- Leg/foot tingling or numbness
But people of all ages can suffer from a herniated disc. In addition to age-related degeneration, discs can herniate because of:
- Lifting heavy objects improperly
- Smoking
- Being overweight
- Putting sudden pressure on the spine
- Performing repetitive, strenuous movements or activities
While herniated discs can be painful, most of the time, they are treatable without surgery. Treatment may include:
- Pain relievers and anti-inflammatory medications
- Heat or cold compresses
- Back and abdominal-strengthening exercises
- Steroid injections to decrease nerve irritation
In rare cases, surgery to remove all or part of the herniated disc may be necessary.
2. Spinal Stenosis
In addition to vertebrae and discs, your spine also has a spinal cord — a long bundle of nerves — that runs through the center of your vertebrae.
Sometimes the area around the spinal cord narrows. This puts pressure on the cord and nerve roots in the spine.
The most common cause of spinal stenosis is arthritis-related disc degeneration. As the discs degenerate — which also happens as a normal part of aging — the spaces between the vertebrae shrink, which can lead to spinal stenosis.
Symptoms of spinal stenosis include:
- Back pain
- Burning pain in the legs or buttocks (called sciatica)
- Numbness or tingling in the legs or buttocks
- Weakness in the legs
Nonsurgical treatment for spinal stenosis is aimed at relieving symptoms and may include:
- Physical therapy
- Anti-inflammatory medications
- Steroid injections
Surgery is typically only used to treat spinal stenosis that is causing severe pain and weakness. Surgery involves decompressing the spinal nerves by removing nearby bone, bone spurs, and ligaments in a procedure called a laminectomy. In addition to decompression, spinal fusion may also be needed to stabilize the spine.
3. Degenerative Spondylolisthesis
Sometimes, vertebrae slip forward and out of place. This is called spondylolisthesis. While this can happen because of a broken bone in the back (called spondylitic spondylolisthesis), it is more often caused by the wear and tear that comes with aging (called degenerative spondylolisthesis).
Like spinal stenosis, degenerative spondylolisthesis (DS) can happen because of age or arthritis-related disc degeneration and narrowing of the spinal canal. In fact, spinal stenosis is common in people who have degenerative spondylolisthesis.
Symptoms of degenerative spondylolisthesis include:
- Pain in the legs and/or lower back
- Weakness in the legs, usually after standing or walking for long periods of time
- Numbness or tingling in the legs
The goal of nonsurgical treatment for degenerative spondylolisthesis is symptom relief. This treatment may include:
- Physical therapy
- Pain relievers and anti-inflammatory medications
- Steroid injections
As with spinal stenosis, surgical treatment involves decompression and spinal fusion and is typically only used when pain and weakness are severe.
4. Degenerative Scoliosis (De Novo Scoliosis)
While you may be tempted to think of scoliosis as something that only develops during childhood or adolescence, adult-onset scoliosis (called degenerative scoliosis or de novo scoliosis) can also occur because of age-related disc degeneration.
In this case, the spine curves abnormally as the space between the discs collapses.
Symptoms of degenerative scoliosis are similar to symptoms of other degenerative disc diseases, and may include:
- Back pain
- Numbness
- Pain that shoots down the legs
Treatment can include:
- Over-the-counter pain medications
- Exercises to strengthen core, abdominal, and back muscles as well as increase flexibility
- Bracing (for short-term pain relief)
- Steroid injections for temporary pain relief
In severe cases, surgery may be necessary in order to:
- Decompress the nerve roots for pain relief
- Stabilize the spine with metal rods
- Fuse the bones of the spine into a straighter position
- Realign the spine
Treating Back Pain at Penn Medicine’s Spine Center Program
No matter the cause of your back pain, Penn Medicine’s Spine Center is ready to help.
"The Spine Center embraces a multidisciplinary team approach to care,” says Dr. Smith. “We introduce you to your care team early on, and are with you through the diagnostic work-up and beyond.
Dr. Smith adds that the multidisciplinary approach allows for providers to collaborate across the different Spine Center specialties and gives patients access to new and innovative treatments and technologies
No matter the cause or course of treatment, the goal in treating back pain caused by age-related disc degeneration is always the same: restoring your quality of life.