the generative dis disease is a very common cause of back pain by the age of 35 approximately 35% of people will show evidence of dis degeneration by age 60 more than 90% will show some evidence of D degeneration our spinal discs eventually wear down and in fact it's just one of Facts of Life but this doesn't mean that you can't still lead an active and relatively pain-free life today we are going to highlight the symptoms discuss some of the treatments and answer any other questions you may have on the episode of ask the doc send in your questions to questions at allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com welcome to ask the dock the show where we encourage our viewers to send in their health questions I'm Dr gorgi branik a minimalist invasive spine surgeon and today we are talking about degenerative dis disease our first question of the day comes from Vita from Facebook do you have any tips for improving sleep posture to help my back I wake up every day feeling sore I'm a sid sleeper Vita thank you so much for this question this is a super common issue because so many patients who have degenerative dis disease wake up a bit flexed forwards it takes them a few seconds to really stand up straight and usually those first few moments when they wake up they are in pain so it is natural to try to blame the way you sleep unfortunately we can really only control how we go to sleep we can't control how we actually sleep we all toss and turn and if you are waking up in pain that's a sign of a strong inflammatory response deep in your spine so if you're waking up in pain don't blame your mattress we just published an article in GQ on mattresses and in Forbes Magazine on pillow and I was um disheartened To Tell the readers that it is not the pillow of the mattress it is not how you sleep it is an internal problem so if you're waking up in pain I would get an opinion from a spine specialist thank you for your question question Vita Greta asks oh and uh um please feel free to log in to allhealth tv.com to post questions uh uh we have a uh Facebook uh account as well a YouTube account uh please don't hesitate so Greta asks from allhealth tv.com Dr branik I've been struggling with back stiffness and pain for a while now but it's gotten worse over the last few years my primary care physician told me that he thinks I might have degenerative disc disease what is it exactly and what can I do to feel better Greta thank you for sharing your story with us I'm happy to talk about degenerative this disease but before I do I highly recommend that you meet with a specialist an orthopedic surgeon or a sports specialist who could confirm the diagnosis and then recommend treatment so what is the generative dis disease what we have discs that separate the bones in our spine and as we age the discs dehydrate de generate become shorter become wider so that change that inevitably happens in all of us results in a painful response as our posture changes and as we start to irritate nerves that course right behind those very degenerative discs now it's not a dangerous problem but uh if you are suffering and you're waking up Flex forwards if you're having sciatica then you definitely don't have to live in pain and you can get better not necessarily with surgery either uh last but not least I've included a list of common symptoms of degenerative these disease so common symptoms you wake up in the morning um and you get out of bed and pain is just worse when you sitting while seated the discs of the lower back have three times more load than them than when standing pain gets worse with bending forwards a lot of patients will have a real difficult time bending forward to touch their toes lifting and twisting may be difficult as well now feeling better while walking or even running is not uncommon so seating is difficult but standing sometimes gets difficult too so many patients will say when I'm in the kitchen I bend door over this pain starts to build and build and I sort of have to sit down periods of pain that come and go is typical for the genery of this disease these can last from a few days to even a few months and they range from nagging disabling pain affecting the lower back buttocks thighs and if you have degenerative discs in your neck it may cause neck pain and pain going down the arms as well numbness and tingling starts to occur once those nerves are further compromised and finally when the nerves are truly compressed we can see weakness in the legs or arms even something as bad as foot drop from damage to the nerve rout our next question is from Augie who reached out to us through YouTube hi Dr B do you mind if I call you Dr B because if you do I get it and I won't do it again a you can call me Dr B A lot of people call me that my name is difficult to pronounce anyway I'm supposed to get back surgery soon but they want to know if I want open surgery or the kind that you do minimalist minimalist something or other I think you mean minimally invasive spine surgery aie can you tell me what is the difference I would love to thank you for reaching out aie so classic spine surgery versus minimally invasive spine surgery classic spine surgery attempts to get to your back via big open wounds usually that means all from the back now your back muscles end up getting stripped off the bone and that causes significant disability also by trying to reach the nerves and the spinal Bones from the back you end up causing a lot of trauma now minimal invasive surgery uses techniques like little tubes specialized light specialized navigation which lets us see where we are without having to open the patient up in a big way like with open spine surgery so really minimally based spine surgery is an attempt to accomplish the goal of surgery without the trauma of big wide open spine surgery I think you will see most younger spine doctors these days doing surgery these ways but definitely inquire from your doctor if what they are doing is truly minimally invasive the next question is one of my favorites I get asked about it all the time it comes from Alexi who just text us from f Facebook hi doctor I hurt my back at work a few weeks ago like an idiot I was lifting heavy boxes with my back instead of my legs Alexi I don't think you're an idiot you just have to lift heavy things sometimes my back went out and I was in severe pain I was lying on the floor of the warehouse for almost two hours poor guy my lower back it's still hurts so I went online to try to figure out what I did to my back I narrow it down to two things herniated discs or degenerative discs what do you think Alexi I get asked this question all the time now I obviously can't diagnose you over the phone for obvious reasons but before I give you a quick tutorial on both disorders and share my opinion I highly recommend that you make an appointment with your primary care physician so the generative disc versus herniated disc they are really Shades of Gray now discs de generate with time part of that degenerative process may involve where a disc tears and a piece comes out a little piece of nucleus or the inner part of the disc as you bend forward to lift that heavy box you put a lot of pressure on that disc and if a big piece of disc sneaks out we call that a herniation but a herniation is a big step towards degeneration so theoretically the name of the diagnosis doesn't mean as much because the pain is the same it's back pain and pain going down the legs but you should know in general we reserve this herniations to diagnose younger patients and those who have symptoms that last less than six months versus the generative disc is where pain comes and goes comes and goes and often times lasts for years sometimes it goes to no pain but a lot of my mom patients young moms especially will say when I ask them when was the last time you actually remember being without pain they'll cry because they say I can't remember now that's a degenerative dis complaint in case you missed it the first time here's another opportunity to find out where to send in your questions send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe dooc page on our website allhealth tv.com welcome back to ask the doc this question comes to us from Douglas reached out through YouTube hi doc I finally caved after years of back pain and went to the orthopedist I was diagnosed with stage two the generative dis disease the doctor was going to discuss the diagnosis but he was called away on an emergency he was supposed to call me but that was over a week ago do you mind explaining the four stages to me especially stage two absolutely Douglas so these stages are really coming to us from Imaging from an MRI especially an MRI is a study where we can see the soft tissues the discs the nerves and if you have back pain then you really should consider asking your dock to get you an MRI so stage one of dis degeneration is where the dis loses its ability to retain water just like cartilage the inner core of the dis starts to dehydrate and lose height you develop tears of fissures on the outer periphery of the disc called the annulus and the outer layer may even allow the inner content to sneak out and remember if a big piece sneaks out we call that herniation now stage two Douglas that's prolapse or a bulging disc so imagine a disc is like a jelly donut it's not really like a hockey it's more like a jelly donut where if you keep putting pressure on it it gets wider and wider and gets smaller and shorter at some point the jelly may even start to come out so the bulging disc is before that jelly comes out as the disc starts to bulge towards the potential space behind where the nerves horse the inner core of the disc may cause the disc to bulge out this can put pressure on those nerves even the spinal cord and this may cause increased pain and discomfort that same old I wake up in the morning flexed forwards like an old man or a woman when I have dinner I have to keep fidgeting changing positions sitting in the car is painful that is that early disc degeneration now a rupture disc which is stage three is also known as a herniation so in this stage the outer layer completely tears and the inner content sneaks out so this is commonly known as a herniated disc or a slipped disc severe pain other symptoms May ensue not always but if you feel numbness tingling or weakness going down your arms or going down your legs your thighs then most likely there is a disc herniation now stage four is severe stage in advanced stage the discs may lose a significant amount of height you find that you are almost always flexed forwards you wake up Flex forwards you get out of the car flex forwards and to compensate for the loss of dis height the body may start to create bone spurs which essentially when you get inflammation around the dis eventually that inflammation turns to Bone now if nerves course right behind those discs then those very bony osteophytes or Spurs start to cause narrowing in the channel where the nerves sneak out and that's how you get that constant severe leg pain okay we got another question from allhealth tv.com you should really check this website out it has a chalk full of great information and you can post questions for us to be able to answer for me to be able to answer okay so this question is from Anastasia who asks preet Dr branik I guess Anastasia speaks Russian pret is how we say hello my back has been bothering me for a number of years and it finally got to the point where I had to see a doctor I was diagnosed with degenerative dis disease and he said I could do one of two things get surgery to fix the discs or go to physical therapy I'm not ready to go on the knife just yet but I'm not a fan of physical therapy either are there any other options you can suggest spba doctor that means thank you in Russian thank you Anastasia so there's a myriad there is a myriad of treatments for back pain you can lose some weight you can get a massage there's some electrical stimulation you can correct your posture exercising helps abdominal strengthening lower back stretching cold and hot therapy but in my book the best way to get out of this constant cycle of back pain is with an epidural steroid injection a properly targeted injection where a drop off a medicine known as a steroid gets injected uh may take away the local inflammation and all of a sudden you find that you have no pain and you have no pain if you have no pain but you have a degenerative disc then you don't have to have that disc corrected a steroid common name for it is cortisone is actually the best way to diminish inflammation hey we got another question this time from Facebook it comes to us from Phil and his question is hi Dr branic my father had sciatica and now I've been diagnosed with degenerative dis disorder does this mean I'm going to get stica too and what is sciatica exactly all I know is that it's painful you know thank you for reaching out out and good question by the way before I answer your question I want to share a quick video from the good Folks at the Mayo Clinic the sciatic nerve is composed of multiple different lumbar nerve roots that come from the spine Lumbar and sacral nerve Roots actually so sciatic has a little bit of a misnomer because usually the problem that's causing pain down the leg is just a compression of one of those nerve roots and not that whole big nerve usually it's the L5 or the S1 nerve rout Ro um the fifth lumbar nerve or the first sacral nerve Ro that's causing the problem and not the whole sciatic nerve so Phil check this out you see all these nerves coming out of your back and you see right here there's a little Channel where those nerves exit that's the channel that sometimes gets compressed now notice that as these nerves course through your pelvis I'm just going to gently turn this patient all the way to the back and all these nerves come together here with the sciatic nerve that's where the common term sciatica comes from and to us Sara means pain that starts in your back and then goes down your legs now look so many patients have it that it's impossible to blame it on your genetics and it's not a dangerous problem now that being said sciatica is usually how patients end up coming to the doctor because the pain just becomes too debilitating now sciatica is something possible in your upper extremities too and that's where pain starts to go deep to the shoulder blade all the way to the arm and sometimes all the way down to the fingers so if your father has it it doesn't mean that you're going to have it but so many patients get it and uh if you have sciatica you don't need to rush into surgery although surgery can correct the problem there are some really good Solutions like those steroid injections I've mentioned earlier if you if you have questions we've got answers and just in case you missed it the first couple of times here's yet another chance to find out where you can send in your questions send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com welcome back the next one in the queue comes to us from Instagram and it happens to be right up my alley Vanessa asks hi Dr branik my husband is going to be getting a disc replacement good next month and I'm very curious and maybe a little nervous about his upcoming procedure I wasn't there when he talked to the surgeon so would you mind walking me through the process is this safer and better than spinal fusion hi Vanessa thank you so much for your question like I said before this is really my sweet spot I'd be extremely happy to talk to you through it and allay your concerns I do disc Replacements all the time and it's lucky to be a spine surgeon in this day and age because I can truly cure back pain with dis replacement but first let's check out this video about dis replacement the disease disc is removed and replaced with prisk L which has a unique Central heel to provide immediate stability to the implant after implantation prisk L provides height restoration offloading pinch nerves the implant provides controlled and guided motion shown to be safe and effective over the long term so historically if you had a degenerative disc a bad disc that used to cause back pain and pain going down the leg all we could really do was put screws above and below immobilize that segment the problem with that is that about 36% of patients would come back to have to have more surgery sometime later in life now we know that we need to restore patients height the whole problem begins with losing disc height and we know that we need to restore it with dis replacement and now that we've had over 20 years of good research and development we have learned how to restore patients height how to open the space for the nerves without immobilizing the spine without placing screws now this can also be said with this can also be done with a minely invasive technique so we can sneak in remove the pathological disc and place these devices that don't wear out that stay in place and allow one to get back to normal right away I do this for professional athletes I do this for mere mortals like myself and it's it's shocking how patients can wake up and say that they're paying is gone if your surgeon is telling you that you got to have a fusion it's possible because if there's deformity you may not be a candidate but most patients are candidates so talk to your doc if you about to have surgery about maintaining motion and about having a dis replacement our first our our next question of the day comes to us through allhealth tv.com so it's kind of fitting that we'll have another question through this wonderful website Dr branik my brother had a tear in his rotator cuff and was thinking about getting surgery on it but at 45 the doctor asked him if he was a professional athlete my brother said he played softball on a company team but no he wasn't a professional athlete then the doctor said why bother getting the surgery let me give you a cortisone shot the shot worked like a charm and that was that let me ask you this what the heck is cortisone what does it do and can I get a shot in my lower back I I love this question Kelvin so most of my patients are surprised when they flying to see me that I try to get them to avoid surgery cortisone is a medication that minimizes inflammation we use it in the drops we put on our eyes in Clear Eyes For example we use it as your brother had in his shoulder and we use it all the time in the back now if a disc degenerates if it develops a fissure you develop local redness or inflammation right behind that disc and if we were to place very very carefully with the guidance of x-rays a drop of steroid right behind that disc between the disc and a nerve in a manner called a transforaminal epidural you may find that the pain just disappears now everybody asks how many of these can I have and how long will it last well it's impossible to predict I believe you try one and you see what happens you don't need anesthesia for these you don't need to go to sleep or go to a surgical center these are very easy to do and you really want to find the best specialist Who does these injections all the time now I work closely with a pain management doctor and I actually derive some very important information from these injections so not only do we use these injections to help you avoid surgery we also use them to solidify the diagnosis now imagine you come to me with back pain and after we obtain an MRI we find that you have multiple degenerative discs now if you have nerve pain you can trace the nerve back to where it comes from and be fairly certain but even in that case you want to confirm which disk is the problem so if we inject l45 for example and then you tell me immediately after the injection that the pain disappears let's just say in that scenario the pain disappears but doesn't last I will tell you with complete confidence that if we go to surgery your pain will be gone so we mix the cortisone or the steroid with a drop of lto cane or a local anesthetic so if you place that medicine in a right spot and your pain disappears now you know exactly where that pain is coming from and I would not dare rush into surgery until I certainly confirm where the pain is coming from so to answer your question Kelvin these steroid injections are godsend for so many patients and they're a way to really be certain where the pain is coming from now you can have these injections in your neck as well the classic way to do these is with this single shot right in in the middle of your back where the needle penetrates the wide open area but this is a classic epidural it doesn't have nearly as much efficacy and it doesn't really uh provide as much information as a transforaminal epidural sorry to nerd out on this issue but if you have a if you're going to have an injection make sure that you're going to get a trans peramal epidural and if it works then you know that if it doesn't last and you have surgery your surgery will fix the problem well that's it for this episode of ask the doc I want to encourage you once again to please feel free to send in your questions via Instagram via Facebook via YouTube or through ask the do website I really appreciate you sharing these personal questions with me and even though I'm not uh uh I don't try to uh really diagnose you over the over the uh uh uh our medium I would really encourage you to seek a second opinion you don't have to suffer with the gener of this disease thank you so much and hope to see you next time send in your questions to questions allhealth tv.com or allhealth gu on Facebook or YouTube or visit the askthe dooc page on our website allhealth tv.com e