What is the treatment for degenerative disc disease?

If you read my post first on what degenerative disc disease is, it makes sense the treatment depends on whether the bulging disc is the problem. Or has the degenerative disc been longstanding enough that canal stenosis and facet joint changes at this level are causing the pain.
A McKenzie Assessment by a McKenzie Qualified practitioner (www.mckenziemdt.org and click on locate a therapist) can identify your specifc cause which then guides the specific treatment.
If it is the disc at this level bulging (and the degeneration seen at this level is essentially not contributing to the symptoms), a specific exercise can be identified in over 80% of patients that will rapidly relieve symptoms. This exericise can be performed whenever pain arises, and can also be done on a preventative basis to stop recurrence when applied at important times (eg after periods of prolonged sitting or before/after bending activities such as gardening). 
If the McKenzie Assessment for example suggested the canal stenosis or facet joint is the symptom cause the exercises presribed would usually be done to “open” the joint and relieve pressure on the facet joint or compressed nerve (canal stenosis). 

Degenerative disc disease is a very broad diagnosis, encompassing a range of different conditions and varying from mildly annoying to severely painful and disabling. In my opinion exercise plays a vital role in management of most types of degenerative disc disease. Not just any form or exercise though! Please do not take up jogging, join a gym or a boot camp or even engage a personal trainer!

The first step should be a detailed assessment with an appropriate health professional. As Joel mentions above, it's really important that your programme is carefully structured to address the cause(s) of your pain. The McKenzie Method is often a very helpful approach.

Clinical Pilates with a Physiotherapist is another very good approach to exercise for those with disc degeneration. It focuses on maintaining or improving both mobiltiy and stability of the spine to help protect against further damage. There is a particular emphasis on posture, becoming more aware of how you move your body and learning to engage the ‘core muscles’ which are involved in stablising each level of the spine.  Many people with spinal pain have also developed patterns of muscle over-use which actually contribute to pain, so they need to learn how to let go these muscles.

Even though some degenerative changes may be irreversible, pain does not always correlate well with the degree of damage. Some people with severe degeneration on MRI do not experience a lot of pain. Others with minimal degeneration have a lot of pain. Improving spinal mobility and core strength in a safe and carefully supervised exercise programme can help minimise pain.

Severe degenerative disc disease may result in intolerable levels of pain and / or loss of function and this may require medical intervention such as injections or surgery. This requires referral to a specialist such as a neuro-surgeon or pain management specialist. Surgery is usually a last resort, but risks must be weighed up against the potential benefits. If you do undergo surgery it's advisable to follow up with at least 6 to 12 months of supervised rehabilitation exercises to help prevent recurrence of a similar problem at another level of the spine.

There are numerous treatments options vailable. Each should be seleceted for the individual to achieve the best prognosis.

Conservative Treatment for Degenerative Disc Disease

Most treatment plans involve a combination of self-administered treatments, medications, and therapeutic measures. Self-administered treatments include the following:

• Learn/practice proper posture and body mechanics
  
• Rest and restrict activities
  
• Limited bed rest to take pressure off the spine
  
• Mild activity (exercise) such as walking, biking, and swimming
  
• Apply cold and/or hot packs
  
• Wear a brace for support (may not be helpful in all cases)
  

Therapeutic treatments for DDD include the following:

• Chiropractic treatment to manipulate the spine and provide appropriate biomechanics and neural feedback
  
• Acupuncture to relieve pain
  
• Massage therapy to relieve muscle spasms and tension
  
• Physical therapy to improve function and increase flexibility and strength
  

Medications to Treat Degenerative Disc Disease

In some cases, medications are used to supplement conservative therapy. Medications that may be used include the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen)
  
• Pain relievers (e.g., acetaminophen)
  
• Muscle relaxants
  
• Spinal injections (anesthetics or corticosteroids)
  
• Antidepressants
  
• Sleep aids
  

Other non-surgical treatments include ultrasound therapy and transcutaneous electrical nerve stimulation (TENS) pain control units.


Surgery to Treat Degenerative Disc Disease

Symptoms of DDD usually can be managed without surgical intervention; however, patients who experience debilitating pain and disability that does not respond to other treatments may benefit from surgery. Primary reasons for surgery are to:

• relieve pressure on a nerve root or the spinal cord;
  
• stabilize an unstable or painful vertebral segment;
  
• prevent or limit radiculopathy (nerve damage); and
  
• reduce deformity or curvature of the spine
  

Discectomy and fusion involves removing the damaged intervertebral disc and replacing it with a piece of bone or another material. Over time, this replacement fuses with the adjacent vertebrae. A newer procedure, called microdiscectomy, accomplishes the same solution, but involves using smaller instruments and requires a smaller incision.In corpectomy, a section of the vertebrae and discs is removed to create more space for the remainder of the spine. A bone graft and/or metal plate with screws is then attached to stabilize the spine.Facetectomy, laminotomy, and spinal laminectomy are other procedures that involve removing a portion of the bony structure of the spine to relieve pressure on the nerve roots. Foraminotomy and laminoplasty can also be used to enlarge areas of the spinal column to make more room for the nerves and spinal cord.