Back pain: what disc diseases are and how they are treated

Together with the cold, back pain is the most common reason for visiting the general practitioner and represents the main cause of absence from work: according to the Global Pain Index, it affects 97% of Italians and about six out of ten suffer from it every week. . “From 20 to 40 years acute low back pain is quite common, which resolve within a month and are due to a banal cold, an effort, a trauma or to the well-known herniated disc”, says Dr. Marco Conti, physiatrist at the Polyclinic of the Terme di Castrocaro. “Subsequently, especially between 40 and 60 years of age, chronic low back pain is more frequent, which persist for more than three months or occur relapsing, often reaching the point of compromising the quality of life”. Among the main causes of chronic low back pain is the disc diseaseor a ‘alteration of the intervertebral discsthose elastic pads (about six millimeters high and composed of a pulpy nucleus rich in more than 80% of water) interposed between one vertebra and the other: “These fibrocartilaginous structures play a fundamental role in the vertebral column, because they allow it to move, bend and rotate: in their absence, our back would be completely rigid », explains the expert.

What is a disc disease

Over time, however, these discs tend to collapse and degenerate, so they stop doing their job: “In these cases we speak of discopathy, which therefore represents an alteration of the intervertebral discs and, usually, is due to their dehydration”. At that point the thickness of the discs is reducedwhich “crush” and tend to widen along the entire circumference, beyond their physiological boundary, forming the so-called protrusion“. The tissue that comes out of the natural site can touch very delicate structures, such as the spinal nerves, or it can imprint the dural sac, that is the external envelope of the spinal cord: “Depending on how wide the protrusion is, there can be various paintings of achemore or less intense, more or less localized ».

How to distinguish disc disease from simple back pain

Usually, the pain induced by a disc disease is “horizontal”, ie it is localized in the area where the disc protrusion is present and tends not to come out of that area. Sometimes, however, it can evolve into the well-known sciatica (recognizable by the pain that radiates both laterally and posteriorly to the thigh and leg towards the sole of the foot), which in its severe form is almost always due to a herniated disc: “In this case the disc is not only deteriorated, but comes to rupture leading to the escape of the nucleus pulposus, which invades the surrounding space compressing the nerve roots », describes Dr. Conti.

“To get to one precise diagnosis, a specialist visit is required that also makes use of some tests, such as radiography, CT scan or magnetic resonance imaging of the lumbosacral spine. Above all, the latter is able to accurately observe the hydration conditions of the intervertebral discs, to measure any protrusions and to assess whether these touch the surrounding nervous structures ». Usually, disc disease affects a single level (the most affected is the one located between the fifth lumbar vertebrae and the first sacral, the most overloaded), other times there are more discs affected by the problem and the classic symptom is stiffness of the spine vertebral.

What are the risk factors

The main cause of disc disease isphysiological aging, because the degeneration of the intervertebral discs is part of the normal wear that the body undergoes over time. “An additional risk factor is the overload of the spine, mainly due to overweight and obesity which cause greater crushing of the discs, but also to pregnancy, when it is easy for women to suffer from lower back pain.”

Another risk factor is the cigarette smoke, which reduces the oxygenation of the tissues and determines vasculopathies, that is an occlusion of the blood vessels, also at the level of the back, increasing the phenomena of vertebral degeneration. “And then the sedentary life, poor hydration and the lack of intense and constant physical activity, chosen on the basis of personal characteristics, have to do with it,” Dr. Conti points out.

How to cure

In case of acute low back pain, the pain can be relieved pharmacologically (through anti-inflammatory and analgesics) or withoxygen-ozone therapy, which consists of paravertebral intramuscular injections, therefore in the painful area, of a mixture based on oxygen and ozone, dosed using a special machine. “When, on the other hand, low back pain tends to become chronic because there is a disc disease, the first rule is re-educate yourself in everyday life: this means that the physiatrist and physiotherapist teach how to behave correctly in various situations, how to make correct movements, how to correct posture, how to keep moving.

Basically, the treatment must be active, in the sense that the patient is not the executor of medical prescriptions, but a conscious protagonist of his own therapy ». Enormous advantages can be obtained with hydrokinesitherapy, a therapy based on movement in water, possibly thermal with high mineralization, which allows the intervertebral discs to be decoaptured, i.e. to reduce the load on them, perform exercises to strengthen the abdominal muscles and trunk, in order to balance and bring the spine back on axis. Who to contact? «The first reference figures are the physiatrist and, immediately after, the physiotherapist. On the other hand, in the case of acute low back pain, which leads to suspicion of a herniated disc or other problems, the orthopedist and neurosurgeon also come into play », concludes Dr. Conti.