Is the radiating pain from degenerative disc disease causing damage?
It depends. If you are having progressive numbness, tingling, and weakness, and this is getting worse, it is possible that this is causing increasing damage to the nerves.
If you are not having those symptoms, and your primary concern is pain, it is unlikely it is causing irreparable damage.
But, I think we need to define the term damage.
Does damage mean a structural change to the nerve itself?
Does it mean that there is compression and localized inflammation?
Does it mean that if you don’t improve symptoms that there will be pain, forever?
I think these are worthwhile questions to ponder and answer, and truthfully, questions we don’t have 100% clarity on as a healthcare profession.
This is the question that I received that sparked this article.
Disclaimer!
Degenerative disc disease is a normal, age-related process that everyone will develop. It’s not a disease, it’s simply how our body ages.
Many people will experience no symptoms from this, similarly to how many people will not have any symptoms from a torn rotator cuff, a meniscus tear in the knee, or osteoarthritis of the knee.
Some people will develop stenosis and compression of nerve roots, which will in turn produce pain (sometimes). And interestingly enough, some people think that you can become paralyzed from DDD, but I more or less squash that (with one caveat) in the article I wrote (linked above).
It’s important to note that compression does not always produce symptoms, which, further thickens the plot of why you might have symptoms, when your friend, doesn’t.
Others will experience arthritis-type pain, as ultimately DDD is osteoarthritis of the spine. The good news is that arthritis-type pain usually improves throughout the day and gets better when you move more and get warmed up.
If you’re looking for some exercises to help with your symptoms related to DDD, just tap the link.
Radiating pain from degenerative disc disease
What is nerve damage?
This is a loaded question as the answer is not clearly defined, even when you look into the scientific literature. I’ll define it briefly below.
Structural nerve changes
If you are experiencing worsening numbness, tingling, and weakness, it’s possible that if you received a nerve conduction velocity test (NCVT) that you would show a decreased speed and strength of electrical activity in the nerves.
If you have pain, and no other symptoms, it’s unlikely that you would have this type of structural disturbance to the nerve.
If the nerve conductivity of the nerve itself is affected, this can be due to several factors, including physical compression of the neural tissue itself, severe inflammation which can also decrease conductivity, and several other factors that I won’t get into in this article.
Does a compressed nerve always cause pain and other symptoms?
Interestingly enough, no, it does not. You would expect that if there was compression of a nerve, particularly in the lumbar or cervical spine, that you would experience symptoms.
This is not the case.
There are many people with disc bulges, stenosis, DDD, spondylolisthesis, and various other conditions that do not have any symptoms whatsoever.
This is why it is important to treat the symptoms, not the x-ray or MRI.
Why does DDD cause nerve pain?
DDD has the potential to lead to nerve pain if it leads to stenosis, or a narrowing of the foramen where the nerve root exits the spinal cord.
As DDD progresses, the height of the intervertebral discs reduce, closing the gap between the vertebral openings on either side, called foramens, that allow for the nerve roots to pass through.
If the compression gets intense enough it can cause symptoms.
As discussed at the beginning of this article, though, compression does not always cause symptoms.
Believe me, this leaves me scratching my head too.
My only thought on this is that maybe some peoples physiology is just better suited to withstand compression and their body is more resilient to inflammation.
If you’re the lucky one that didn’t get that physiology, sorry :(.
How long can a nerve be compressed before it causes permanent damage?
Unfortunately, there is no good answer for this. Everyone is just kind of taking a shot in the dark.
My rule of thumb for my patients is that if they are experiencing progressive numbness, weakness, and bowel and bladder changes, along with pain, that they go and see their surgeon.
The most concerning symptoms to me are profound weakness where you are now having difficulty holding a coffee mug if your symptoms are in the cervical spine, or, if symptoms are in the lumbar spine and you are unable to lift your leg up or you start tripping, daily, due to foot weakness.
See your surgeon if those points of weakness are happening.
If it’s primarily pain, that isn’t getting worse but is staying steady, and there are none of the above symptoms i’ve described, or they aren’t getting worse, then I wouldn’t be as concerned that this is causing permanent nerve damage where you are losing the electrical signal.
I’m sorry that there isn’t a better answer for this like “2 months,” or something more clear. I will continue to look through the literature to see if there is a more definitive answer to this.
I did write another article about potential longer term effects of DDD if you are curious!
What does DDD at L4/L5 feel like?
Pain, numbness, tingling, that starts in the back and wraps around the leg going down the front of the thigh, shin, and sometimes into the big toe.
You may also experience some weakness in your quadricep muscle (front of the thigh), as the L4 nerve root contributes to the femoral nerve.
The femoral nerve receives contributions from L2, L3, and L4 and if one of these is impacted you can experience weakness in the muscles that are innervated by this nerve.
What does DDD at C5/C6 feel like?
If your C5 or C6 nerve roots are affected you will likely have symptoms along that dermatomal pattern.
Symptoms would present around the side of the shoulder, the bicep, and even into the forearm and pinky finger, plus the lateral half of the fourth digit.
You can have pain, numbness, tingling, or weakness with this.
Does degenerative disc disease cause stenosis?
Yes, DDD can cause stenosis. As discussed above, if the disc loses enough height, the vertebral bodies will be much closer together, often closing down the space between the nerve roots, significantly.
This compression may or may not lead to an increase in symptoms.
Can degenerative disc disease cause groin pain?
Yes, it’s possible. If you have symptomatic compression at the obturator nerve which receives its supply from L2-L4, you could have symptoms in the groin.
If you are having pelvic pain that goes into your genitals (male or female), this could be the pudendal nerve with contributions from the S2-S4 nerve roots of the sacral complex.