Dr. John R. Hesselink defines degenerative spine disease as "a major cause of chronic disability in the adult working population. . . (According to Dr. Hesselink) spinal degeneration is a normal part of aging, and neck and back pain are one of life's most common infirmities. There are many potential sources of pain. . . Pain can originate from bone, joints, ligaments, muscles, nerves and intervertebral disks, as well as other paravertebral tissues. . . Most neck and back pain responds to conservative therapy. . ."
This represents one medical perspective on what degeneration is and most likely shares common themes that other MD's would agree with. However, it should be known that one point of contention to this definition is the "normal part of aging" clause. Although I think it is a common occurrence, I disagree that it is a normal part of agining.
Below I have described the common process of spinal degeneration. It also should be noted that spinal degeneration is not a perfect process, meaning that you may have aspects of two phases rather than be clearly in one phase or the other.
Phases of Degeneration
Degeneration Phase 1
The first stage of spinal degeneration is when there is a minor loss of normal spine balance and spinal curvature. All three curves (cervical, thoracic, and lumbar) have a normal standard. The surrounding anatomy of the spine such as nerves, discs, and joints begin to age quicker and are continually more stressed. This stage of the degeneration process rarely is accompanied with any major pain but will often be more common with the daily nagging pains that we commonly hear about such as burning between the shoulder blades, afternoon headaches, waking up with a "crick" in your neck. At this point, there is a good chance that with the proper chiropractic care and rehabilitation, you can return to normal function and reduce further degenerative effects.
Degeneration Phase 2
In the second stage of spinal degeneration, there is more disc narrowing and potentially deformation in the bones such as the onset of an early bone spur. Your posture is often beginning to deteriorate as well at this point. Most commonly seen is the enlarging hump at the base of the neck or the inability to rotate your neck side to side evenly. As the spinal canal, or opening begins to narrow, there are often significant aches and pains associated. They may also be severe and start causing your to miss work regularly. Fatigue and stress at the end of a "normal work day" are more common at this stage. There is a good chance of improvement at this stage with the proper care but rehabilitation usually requires a larger time commitment.
Degeneration Phase 3
In the third stage of spinal degeneration, there is significant physical and mental involvement due to the multitude of symptoms. There will most likely be some nerve damage as well as deformation of the bones and discs. There can also be more significant losses of joint and disc height at this point. Some reversal is possible but full restoration of the spine is highly unlikely. Once a patient enters this stage, regular care for a longer period is often mandated. Further, their rehabilitation often takes months to even years to improve posture and spinal function. Also, it is more common to see breakdown of multiple joints and discs in the spine as well as in the extremities such as the shoulders, hips, or knees because of the long-term compensation.
Degeneration Phase 4
In the fourth stage of spinal degeneration, most damage is permanent including advanced scar tissue, nerve damage, and spinal nerve and vertebral deformation. At this point, the condition is irreversible and management of pain and discomfort is often the only option. However, it should be noted that rehabilitation can improve range of motion and help to minimize stresses of daily activities. Most commonly, spinal manipulation (with the hands) is contraindicated and often times and Activator instrument will be substituted.
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