UPDATED January 19, 2020 – It keeps us upright, helps to carry a large part of our weight, and is equally flexible and stable. The human spine is an anatomical marvel that consists of millions of nerves that connect our brain to all nerves in the body. The spine is a highway for sending messages between the mind and body. Our spinal cord is protected by vertebrae bones that and form the shape of the spine. Even the slight injury, loss of disc height or degeneration to the back vertebrae or surrounding tissues can result in severe back pain.
What is DDD?
DDD or Degenerative disc disease is an age-related medical condition that gets diagnosed when one or more of the intervertebral discs (discs between the vertebrae of the spinal column) breaks down or deteriorates. Lower lumbar disc disease is often painful and can significantly impact the quality of a patient’s life. Disc degeneration is a normal part of the aging process, and for many senior individuals, DDD isn’t an issue. For others, however, a degenerated disc may cause severe pain and chronic discomfort in the knee joints, back, hip joint, shoulder joint, and neck areas.
Cause of Spinal Disk Deterioration
Degeneration of the spinal discs can happen for a variety of reasons. Simple events like walking, carrying heavy loads, repetitive movements, and shock playing sports cause micro-injuries to our spinal column day after day. Often these events go unnoticed thanks to the vertebrae that act as a shock absorber. Every time the shock absorbers get used, a tiny amount of synovial fluid gets released to help “lubricate” the joints. During the sleep cycle, the discs can rebound back to the initial stage, but over time, damage to chondrocytes and synovial cells from stress and inflammation causes this mechanism to loses its effectiveness. This damage over time leads to asymmetric joint space narrowing, osteophytes, subchondral sclerosis, and cyst formations. A healthy spinal disc is formed of a few parts including the nucleus pulposus at the center of the spine and surrounded by the annulus fibrosus, which is a fibrous ring. The center nucleus pulposus area is very soft, jelly-like substance that is well hydrated. Over time and constant wear and tear, the nucleus pulposus (NP) begins to get stiff and dehydrated. This dehydration leads to the reduction in disc height & disc space narrowing, which causes excess stress on the annulus fibrosis. This stress leads to cause damage to the annulus resulting in instability of posture and back pain. Such a scenario is diagnosed as intervertebral disc degeneration or DDD.
Spinal Lumbar Degeneration
This spinal degeneration disease occurs slowly and gradually but often are felt first in the lumbar spine region because they are exposed to heavier loads more often than the discs in the neck (cervical spine) region. The spinal degeneration of intervertebral discs between the ( L5-S1) lumbar vertebra L5 and the lumbosacral segment S1 are most frequently affected. With symptomatic degenerative disc failure, chronic lower back pain radiates towards the hips, or often there is a discomfort within the buttocks or thighs while walking, other symptoms such as sporadic tingling or weakness in the knees might also be evident. Physical pain or discomfort might also be felt while bending, sitting, lifting, and twisting.
Chronic neck pain may also be brought on in the upper spine. Patients often report discomfort or pain radiating towards the arms, hands, and shoulders. The distress the patients feel in the neck may interrupt healthy blood flow going to the brain, which then consequently affects the memory and other cognitive skills. This interruption in the blood flow might also trigger headaches and vertigo.
Types of DDD – Discogenic Pain
Its location and stage of deterioration typically describe the severity of DDD:
- Cervical Disc Disease: This kind of DDD happens in the neck (cervical spine) region of the spine
- Thoracic Disc Disease: This type of DDD happens in the middle-back area of the spine
- Lumbar Disc Disease: This type of DDD degeneration in the lower back region of the spine.
Any back related pain that is associated with intervertebral disc disruptions is referred to as “discogenic” pain. Depending on the severity of disc bulge, the pain can be mild or very sharp. Some patients report feelings of lancinating, stabbing or burning sensations while others commonly report frequent with numbness and tingling in extremities.
4 Stages of Degenerative Disc Disease
- Stage 1 of Degenerative Disc Disease is the very first sign of disk deterioration to the spine. In Stage 1, there may be damage to the shape/curvature of the spine, which affects posture. Surrounding nerves and joints are frequently inflamed due to stress and begin rapidly age. Despite the slight loss of disc height, some patients experience very little pain or overall discomfort.
- Stage 2 Degenerative Disc Disease occurs once the condition worsens, disc space narrows, and bone spurs (bone deformations) start to appear. The changes in a patients posture become more apparent, and disc desiccation and narrowing have begun. Stage two patients often report frequent discomfort and pain.
- Stage 3 of Degenerative Disc Disease is when the condition has reached advanced stages with multilevel disc desiccation, apparent changes in posture, disc thinning, damage to surrounding nerves, bone spurs, and formation of scar tissue due to constant inflammation. For most patients, this stage results in significant deterioration of the physical condition, chronic pain resulting in additional mental stress.
- Stage 4 of Degenerative Disc Disease is the most severe form of subluxation degeneration or diffuse disc bulges and sometimes not treatable even with stem cells. At this late stage, the damage to the spine can be severe with virtually no disc height ( bone on bone), reduction in flexibility, chronic back pain, damage to the root nerves, a fusion of bones resulting in additional scar tissue and minimal abilities.
Herniated Spinal Discs
A herniated disc is also known as a bulged, slipped or ruptured disc. This type of DDD occurs when the nucleus of a disc is pushed out of the center annulus, into the spinal canal. This is typically caused by a rupture or tear rupture in the annulus ( fibrous ring) and causes pressure on the surrounding nerves resulting in pain. About 90 percent of all cases herniated disc failure occurs in the lumbar spine region (lumbar disc herniation) but can also affect the thoracic spine (thoracolumbar) or sacrum (lumbosacral areas) of the spine. Risk factors that can increase the risk of having a herniated disk include Excess body weight, causing stress on the lower back discs. People with very physically demanding jobs also have a much higher risk of getting back problems. Unbalanced repetitive motions involving lifting, pushing, twisting, pulling, bending sideways can also increase the risk of getting herniated disks. Lastly, genetics plays a part for some as people can inherit mutated genes that increase the risk of you developing herniated discs.
Diagnosing DDD Spinal Stenosis
To diagnose DDD and cervical degenerative disc disease, an orthopedic doctor examines the patient medical history and performs a physical examination. An MRI scan is often needed to identify areas of damage but for patients
who are unable to have MRI Scans a computed tomography (CT) scan can be used to identify vacuum phenomenon, slippage of discs, cracks/defects in the bone structure or damage to soft tissue structures inside the spine. Our functional medical team can also use Radiology scans can also help identify spondylolisthesis (slippage) in surrounding discs so that patient can be graded and offered treatment depending on the scale and severity of the vertebra degeneration.
Treatment for Multilevel Degenerative Disc Disease
For early stage of DDD or to manage the initial pain of degenerative discs, a combination of treatments is available including:
- Over-the-counter pain medications & muscle relaxants can help treat temporary acute pain. Over long term use, these medications can cause serious side effects or be addictive so they must be used with extreme caution and sporadically as needed
- Ice and Heat compression can be used to improve blood circulation, which can help to reduce tension, muscle spasms and improve mobility
- Massage therapy can help to reduce muscle spams and stress in the low lumbar region. Thai massages are often used to reduce inflammation and pressure on the spine which can help to reduce pain
- Epidural steroid injections can be administered to reduce pain signals and inflammation. EDI injections are a temporary solution can be injected directly into the space surrounding the spine
Combination Treatment for Spinal Stenosis & Disc Space Narrowing
Surgery for DDD
Surgical treatment of DDD another option for mild to severe degenerative disc disease but is usually recommended if nonsurgical therapies were ineffective. Surgery for Degenerative Disc Disease can result in additional complications ( failed surgery) or irreversible damage along with extended recovery periods requiring frequent rehabilitating that can affect daily life. Operations to treat DDD can include:
- Lumbar Spinal Fusion Surgery, which is considered the standard surgical option for the treatment of lumbar degenerative disc disease. This type of fusion surgery joins two vertebrae together with the goal of reduction in pain by eliminating possible motion at the vertebral segments. Spinal fusion surgery can entirely remove the disc space (discectomy) or use bone grafting or artificial scaffolding implants to help stabilize the spine or end plates with screws and rods. The fusion surgery allows the vertebrae to grow together, changing two joints into one solid structure. Vertebrae Fusion can take months to heal and requires pain medications, physical therapy, and back braces to help stabilize & strengthen the lumbar region as the Vertebrae heal.
- Intervertebral disc annuloplasty (IDET) surgery used to seal/contain the damage by trying to eliminate the irritated nerves causing pain but heating the damaged disc to 194° F (90 °C) for 15 minutes
- Cervical corpectomy surgery is used for cases with cervical degenerative disc disease and seeks to remove portions of the vertebra and intervertebral discs to provide relief and to allow for natural decompression of the spinal nerves and cervical spine. Metal endplates, screws and bone grafts are then used to stabilize the area to allow the spine to heal
- Anterior cervical discectomy is a surgical procedure that targets the cervical spine and endplate sclerosis. The damages intervertebral cervical disc is first removed then replaced with a bone graft or artificial substitute, and over time, the graft fuses with the vertebrae.
- Facetectomy surgery is most often used in treatments for facet joint disease and surgically removes part of the facet joint to help increase the space and reduce pressure caused by spinal degeneration and collapsed discs
- Dynamic Stabilization surgery is usually done after discectomy. This procedure is performed with an implant that acts as a stabilization post and to relieve extra pressure from the spinal disc by focusing any pressure through the posterior section of the spine. Dynamic Stabilization surgery can be done with flexible rods, Dynesys screws (Pedicle) or Wallis ligament, which are interspinous spacers with bands. The goal of this surgery is to try to mimic natural movements and maintain mobility by allowing the section to flex and extend as naturally as possible.
- Laminoplasty surgery is used to try to create more space for the nerve roots and spinal cord and to try to relieve pressure on the spinal cord. The Laminoplasty procedure does not require the fusion of bones and can help preserve routine spinal rotations and movements.
- Foraminotomy surgery is used to enlarge the vertebral foramen, which helps to increase the space for root nerves. Foraminotomy surgery is often combined with laminotomy surgery but can also be done alone for symptoms of vacuum disc phenomenon
- Laminotomy surgery is used to remove pressure on the irritated nerve roots by removing a small portion of the lamina. This is a very risky procedure that requires a significant operation that often results in substantial residual scar tissue and postlaminectomy syndrome complication
- Microdiscectomy surgery is a new minimally invasive procedure that targets the damaged portions of herniated discs. In a Microdiscectomy procedure, the nucleus pulposus is removed using lasers or a surgical instrument that is guided by a microscope. This procedure is often used to treat sciatica leg pain but does carry some risk, and potential for failed surgery can lead to complications including cerebrospinal fluid leak (caused by dural tear), infection, additional Nerve root damage, Deep vein thrombosis and the potential to cause a buildup of fluids in the lungs resulting in pneumonia
- Spinal decompression surgery is considered a non-invasive procedure to temporarily enlarges the IVF region (intervertebral foramen) which can help to treat collapsed discs & rehydrate sections of the spinal discs
- Percutaneous disc decompression surgery is used to reduce or eliminate portions of a damaged / bulging disc through a needle that is inserted into the discs
- Spinal laminectomy surgery if most often used to treat spinal stenosis. Spinal laminectomy can help to relieve pressure on the spinal cord by removing, trimming, or widening portions of the lamina. This procedure can help to create additional space for the irritated spinal nerves
- Artificial Disc Replacement Surgery or Intervertebral disc arthroplasty is also referred Total Disc Replacement (TDR) or Artificial Disc Replacement (ADR.) TDR surgery is another alternative to spinal fusion surgery but mostly used in cases with advanced degenerative disc disease. The artificial spinal disc surgery first removes the damaged spinal disc (via discectomy) then implanting an artificial disc device to help return the disc space to a functional heigh.
The artificial spinal discs are typically made up of:
- Central core made of polyethylene (surgical-grade plastic) or metal alloys that can bend or turn natural and allow for movements at the spinal segment
- Two metal endplates that are covered in a bio-pours coating that can be attached to the vertebral bodies. The surface helps with the bone to graft itself to the device
Recovery from A Total Disc replacement surgery and pain relief can take 6-12 months and might require periodic spine adjusts to ensure successful grafting without additional complications.
Treatment for Desiccated Discs & Discopathy
When the discomfort and pain from degenerative spine & degenerative disc disease are severe, conventional operative therapies are often ineffective. For these inoperative conditions, adult autologous stem cells can offer an innovative non-surgical therapeutic method to reverse bulging disc degeneration and address the chronic low back pain at its root. Chronic lower back pain due to degenerative disc illness impacts an estimated 17 million individuals worldwide. While short-term solutions can be achieved by the use of analgesics, steroids, having enough rest and frequent physiotherapy, there are still many people diagnosed with discopathy whose conditions rapidly become worse despite the traditional treatments that were recommended by the orthopedic surgeons.
Treatment Options for Herniated or Bulging Discs
If you are in this type of situation, you are often left with no other alternative but back surgery. The risky surgical method usually involves a spinal fusion or sometimes complete replacement of the degenerated disc with an artificial disc. Stem cell injections for back pain and MSC+ cell treatment for degenerative disk disease is currently the most reliable alternative to back fusion surgery and to contain endplate osteophytes.
Stem Cell Therapy for Degenerative Disc Disease
The Regeneration Center offers cutting edge cell based treatments for spinal diseases such as DDD. The cellular approach is unique as it uses therapeutic levels of enhanced Mesenchymal stem cells (MSC+ Cells.) These MSC+ cells can differentiate into stem cells of chondrogenic lineage. This lineage of cells is especially beneficial for patients with DDD for therapeutic cartilage regeneration. The powerful exogenous cells can differentiate into chondrocyte cells and help to modulate the local areas of damage, help support new growth, promote anti-inflammatory cytokines (pro-inflammatory cytokines) and enhance the bodies natural immunomodulatory functions. Disc regeneration therapy offers an effective alternative to back surgery is disk regeneration using enhanced stem cells for pain management, help heal and restore nerve sensations. The Regeneration center offers the most advanced treatment for sports-related injuries and chronic degenerative disc disease. Our stem cell injections for back pain is much safer than invasive surgical procedure and seeks to treat the actual cause of the disease and reverse the condition through a targeted multi-step treatment to regenerate the damaged discs to their normal, healthy state.(23951558)
Stop Back Pain without Surgery
Alternative to Fusion and Back Surgery
The Regeneration Center offer mesenchymal stem cell therapies for neurological & spinal conditions to repair the degenerative state of the spinal disks and surrounding tissue. We offer Autologous and Allogeneic stem cell therapies using CD34+ stem cells is safe and effective for those with advanced degenerative disc disease and severe back pain due to failed surgeries. Our center uses isolated and expanded MSC+ cells that have immunomodulatory properties and decrease the damage of tissue by immune cells. These MSC+ cells take advantage or the paracrine cell signaling mechanism to secrete neuroprotective factors and recruit angiogenic properties that help to restore the damaged areas of the spinal cord and also help to increase blood supply to surrounding tissues. (19584814) Patients with severe degeneration, peripheral neuropathy or multiple ailments including strokes, ataxia or artery disease may require a combination therapy using a combination of stem cells from Umbilical Cord Tissue or Placenta-derived stem cells. Patients undergoing disc regeneration for DDD can expect minimal discomfort with safe cell isolation methods and delivery systems. Improvements are noticed pretty quickly after the first treatment starting with a reduction in pain while the body starts going through its natural regenerative cycle. (22593830).
CLINICAL TREATMENT PRECAUTIONS & RISKSPlease note Stem Cell Therapies for Spinal and Orthopedic conditions are not appropriate for all injuries. Patients with severe scarring, multiple injuries, or underlying conditions that create travel restrictions may not qualify for the 2-week treatment protocol we offer. Please contact us for eligibility requirements
If you are currently experiencing slight to moderate discomfort or pain from a bulging disc or Herniated disc with lupus and you may be an ideal candidate for our innovative treatment using the proven safe and effective adult stem cell therapy for allowing the spinal discs to regenerate without surgery.
Stem Cell Treatment for Degenerated Discs
Total Number of Cell Infusions for DDD will depend on patient needs. Most patients with mild to moderate DDD require multiple infusions of Hematopoietic Mesenchymal (MSC+) Stem cells per Treatment stage. Severe cases with multiple comorbidities may require several stages for sustained recovery.
Types of Stem Cells and Delivery Methods: Enhanced MSC+ Mesenchymal cells & disc regenerative therapy protocol will depend on the severity of the underlying degeneration as needed. Our cell enriched treatments do not require any invasive surgeries, and the delivery of the cells are made via radio guidance (when necessary) or more commonly through an Intravenous Drip, Direct injection or Intrathecal Injections. To learn about the basics of stem cells, visit here.
Post-Treatment Physical Rehabilitation & Pain relief: Physical Rehabilitation after your treatment for DDD is optional depending on your travel restrictions. Complete physical rehab is available for 2-4 hours per day and up to 5 days per week. Also, regenerative medical packages, medical visas and extended stay accommodations for the patient + family/friends can be provided upon request.
DDD Treatment Guidelines
Safety and efficacy are very important therefore all clinical treatments for degenerative discs with stem cells require a minimum of 14-16 nights in Bangkok, Thailand. Due to the varying degrees of spinal disc damage experienced by each person, our orthopedic stem cell team will need to qualify all potential candidates before a detailed treatment protocol can be provided. Upon approval, the detailed treatment plan will be furnished and include the specifics such as day by day treatment calendar with all appointments, the exact total number nights required along with the total medical related costs (excluding accommodations or flights). To begin the treatment qualification process for our multi-stage DDD treatment in Bangkok, please prepare your recent medical records such as (MRI or CT Scans) and contact us today.