Overview
Between each pair of vertebrae in the spine are shock-absorbing inter-vertebral disc. With aging, these discs degenerate from routine "wear and tear." Many people also sustain injuries to the disc that may not cause any immediate pain. However, over time these repeated stresses and injuries gradually result in "degenerative disc disease."

Causes
An inter-vertebral disc has two components: a gelatinous center called the nucleus pulposus that absorbs stress, and an outer ring of tough ligament material called the annulus that holds the vertebrae together. When a person sustains minor disc injuries, the annulus is generally first to be injured. As the tears heal in the annulus, scar tissue forms. With more scar tissues, the annulus becomes weaker. This, in turn, may damage of the nucleus. As this degeneration continues, the nucleus may lose all its water and collapse. As a result, the space between the vertebrae above and below the degenerating disc narrows. Consequently, the facet joints at the back of the spine shift and do not function properly.

Symptoms
The most common early symptom is back pain. This often spreads to the buttocks and upper thighs. The degenerating discs may also cause "discogenic" pain that originates in a damaged disc, and bulging discs.

Diagnosis
The doctor will first take a complete history and do a physical exam to examine the cause of back pain. The doctor may also order X-rays and/or an MRI. X-rays can confirm a decrease in the space between vertebrae, the formation of bone spurs, or instability when flexing or extending your limbs. An MRI can verify loss of water in a disc, facet joint hypertrophy, or spinal stenosis.

Treatment Options
In most cases, appropriate exercise, modification of activities, and physical therapy will be sufficient to reduce the back pain. Medications such as Motrin or Alleve may also be helpful to reduce inflammation. Only rarely will surgery be necessary.

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