[Pabloh]

Hello, everybody. I'm new here and was just wondering if anyone could give me a bit of advice about what to do if my G.P won't refer me to a Spinal Consultant after three years of having spinal problems. They referred me to a physio, gave me anti-inflammatories and later x-rayed me. The results of my x-ray showed lax ligaments that are not holding my spinal disks together properly resulting in too much movement and in turn degenerating the disks and bones a lot. I haven't found exercising to be very effective, if anything it makes it worse and also sitting or standing for a long time hurts. I'm not sure what the treatments would be for this particular condition and am worried about not knowing what is wrong with me. Thanks for reading this and for any comments or help that you can give.

[Bobbi]

Hmmm, I think I'd just flatly ask the GP, if it was my doc, why not refer to either a neurosurgeon or an orthosurgeon for a consult.

Too, there is also the option of seeing another GP .

[Pabloh]

Thanks for your advice, Bobbi.

I have actually thought about changing doctors because I am very unhappy with the way I have been treated.

I've asked to be reffered to an Orthopaedic Surgeon and he said he would but I've been redirected, I think to Physio instead (again). I don't know what's going on and am getting tired of all this.

[Bobbi]

If possible, maybe your Physio. can make referrals?

[Pabloh]

I could ask them when I go about seeing a Consultant Orthopaedic Spine Surgeon. I haven't had a lot of tests either, only an x-ray so I think they will probably do some more tests i.e. MRI and CT scan, blood tests, etc. I'm not sure that if I did see a Consultant if he'd need more things to work off to diagnose my condition. Thanks for the advice once again, Bobbi. I appreciate it.

[Pabloh]

Another thing I'd like some advice or opinions on is what the following symptoms could be;

The G.P talked to me about the x-ray results and said that I had lax ligaments that weren't supporting my spine, allowing too much movement and in turn grinding the bones together and degenerating them.

I am grateful for anyone's help. Thank you for reading my post.

[Bobbi]

Chances are, you're right; it sounds as if more films will be ordered to help doctors assess your spinal condition(s). Customary X-rays are useful, but are ltd. in scope in respect to MRIs, CT scans, etc.

With more in-depth imaging, it could also lead doctors to knowing more, for instance, about your lax ligaments - possible causes/contributors.

[GJZH]

Maybe this discription of what is happening to your spine will help you understand the aging process better. However, you seem young so you might want to find out why someone so young is experiencing this at your age...There are some things that might contribute to this, but I am certain your doctors could better explain that than people on a forum that do not know you very well and cannot make a diagnosis ....As you can see DDD has everything to do with the ligaments and our spine is made up of many different ligaments....Maybe I assumed you were young because of your post to someone else...but if not I apologize...

http://www.back.com/causes-mechanical-degenerative.html

http://www.globalspine.net/disc_dege...e_disease.html

http://www.mayfieldclinic.com/PE-DDD.htm

Anatomy of Degenerative Disc Disease
To best understand degenerative disc disease, it helps to know the anatomy of your back. Your back, or spine, is made up of many parts. Your backbone, also called your vertebral column, provides support and protection. It consists of 25 vertebrae (bones). There are discs, the source of the pain in degenerative disc disease, between each of the vertebra that act like pads or shock absorbers. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body.





Parts of the Spine

Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. Blood vessels provide nourishment. These parts all work together to help you move about, and it is the same parts that can cause pain in degenerative disc disease.




Degenerative disc disease weakens the spine, which can ultimately lead to a herniated (bulging) disc or a ruptured disc. When this happens, the soft nucleus pulposus escapes, either on one side or both sides, through a tear in the annulus fibrosus. This bulge may compress a nerve. The amount of pain associated with a herniated disc rupture often depends upon the amount of material that breaks through the annulus fibrosus—and whether it compresses a nerve or not. Any of these conditions can cause inflammation and pain in degenerative disc disease.

Symptoms of Degenerative Disc Disease
Degenerative disc disease (DDD) can affect any part of the spine, but it most commonly affects the low back (lumbar spine) or neck (cervical spine). Where you have pain will depend on what region of your spine has the disc degeneration.

Generally, people with degenerative disc disease have chronic back or neck pain. Sometimes, though, pain will flare up—that's called an acute episode. The main symptom, though, is pain, so you should pay attention to it and what makes it better or worse.

With DDD, you may notice pain patterns such as:


More pain when sitting for a long time, bending, lifting, or twisting
Less pain when walking or running
Less pain if you change positions frequently
Less pain when you lie down
It's important to treat your back and neck pain properly. Seek medical attention if your pain persists—and seek immediate attention if you have any of the emergency signs listed below.

Warning Signs You Need Immediate Help

Pain is getting worse
Disabling pain
Leg weakness, pain, numbness, or tingling
Loss of bowel or bladder control

Causes of Degenerative Disc Disease
Degenerative disc disease can be associated with an injury to the back, or it may just be a sign of aging. Long before proof of degenerative disc disease, can be seen with imaging tests (computer aided views of your body), biochemical and cellular changes have already occurred; these degenerative changes happen gradually.

In the early phases of degenerative disc disease, spontaneous or post-traumatic tears, degeneration, fibrosis (hardening), and collapse of the disc may make it difficult for you to move your back freely. You may have low back pain and possibly leg pain if a nerve is squeezed; this feeling is frequently associated with degenerative disc disease.

Over time, the collagen (protein) structure of the annulus fibrosus changes. Additionally, water-attracting molecules—and hence water—in the discs decrease. Both of these changes reduce the disc’s ability to handle back movement.

As degenerative disc disease progresses, structures fold and buckle and bone spurs form. This can cause a narrowing of the space for the spinal cord and nerves—that disorder is called spinal stenosis. Stenosis can put pressure on the nerves in the low back. Below is an illustration of lumbar spinal stenosis.



Just like other parts of the body, each intervertebral disc has a nerve supply—the annular nerves. The inner gel-like nucleus pulposus does not have nerves, but the outer third of the annulus fibrosus does. When the disc tears or ruptures, chemicals are released, and they can irritate the nerves, causing inflammation and pain. However, it is possible to have an annular tear and have no symptoms.

In addition, herniation may put direct pressure on the nerves, causing pain in other parts of the body. This is known as radiculopathy. One area of nerves especially susceptible to injury is the cauda equina or “horse’s tail.” The cauda equina is a bundle of nerves located at lowest end of the spine, and it is made up of nerve roots and rootlets from the spinal cord above.

Exams and Tests for Degenerative Disc Disease
Call your spine specialist if you have back pain that persists or is sudden. During your visit, your doctor will ask you questions and perform some exams. This is to try to locate the source of the lower back pain and develop a treatment plan for you—a way to manage your back pain and other symptoms of degenerative disc disease and to help you recover.




Your doctor will ask you questions about your current symptoms and remedies you have already tried.

Typical Degenerative Disc Disease Diagnostic Questions

When did the lower back pain start?
What activities did you recently do?
What have you done for your lower back pain?
Does the pain radiate or travel to other parts of your body?
Does anything lessen the back pain or make it worse?

Your spine specialist also will do physical and neurological exams. In the physical exam, he or she will observe your posture, range of motion, and physical condition. Movement that causes pain will be noted. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area also is in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.

Your spine specialist may order some tests to help diagnose degenerative disc disease, and you may need to visit an imaging center for these tests. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis, which might indicate degenerative disc disease. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show bulging discs and herniations. If the doctor suspects nerve damage, your doctor may order a special test called an electromyography (an EMG) to measure how quickly your nerves respond.

A degenerative disc disease diagnosis can require additional tests, such as:

Discogram or discography: A sterile procedure in which dye is injected into one of your vertebral discs and viewed under special conditions (fluoroscopy). The goal is to pinpoint which disc(s) may be causing you pain.

Bone scan: A technique used to create computer or film images of bones. A very small amount of radioactive material is injected into a blood vessel and then travels through the blood stream. It collects in your bones and can be detected by a scanner. The purpose is to help doctors detect spinal problems such as arthritis, a fracture, or infection.

Lab tests: A procedure where blood is drawn (venipuncture) and tested to determine if the blood cells are normal or abnormal. Chemical changes in the blood may indicate a metabolic disorder (medical condition).

[Pabloh]

Thank you both, Bobbi and GJZH for your advice.

I am 20 at the moment but started at 17 with back pain, GJZH so you are right about thinking that I am young.

I will also ask about getting some tests. I have been told that they reckon my back pain is congenital. Degenerative Disc Disease sounds very similar in symptoms to mine so that could be what I've got.

I have heard that they can replace ligaments in the spine (Graf Ligamentoplasty, etc) so I might ask them about that and see what they say as this sounds like the most appropriate treatment.

[Pabloh]

I'd just like some advice on whether or not fusion would be a good idea or not as I phoned my physiotherapist up and talked to them about what the treatment would be for lumbar spinal instability that causes my spine to move around more than it should which is caused by lax ligaments and they said it would probably be fusion. I also now have sciatica that runs down my leg which is hurts more some days than others. Has anybody had a spinal fusion for this sort of condition?