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Degenerative spinal disease

Degenerative spinal disease - a major cause of chronic disability in adult - takes care, be well & pain free for many years.   
The term degenerative spinal disease does not refer to any single disease or one pathology of the spine and should not be considered as pathological until the underlying abnormalities produce symptoms. It is a general term that encompasses many types of disorder which can occur simultaneously in the same patient and is usually a natural consequence of aging process aggravated by different factors including wear and tear that occurs to the bone and soft tissue of the spine during day to day activities.
Degeneration is a natural process and every one is susceptible to degeneration. The spine is the area of the human body where degenerative processes are more prone to occur.
Usually degeneration of spine is a problem of with advancing ages but it can start in early adulthood.
Though all human beings are susceptible to degeneration, some  are more prone to develop   these changes than others.
Why some people are more prone to the degeneration of spine:
Age : Though progressive involution of spinal structure begins after the 2nd Decade, people over the age of 40 year develop degenerative spinal changes at an accelerated  rate.
Occupation and habit: Those people who have to take additional stress and strain over their neck and back due to their nature of job & those people who does not maintain correct posture at work & leisure are also at a increased risk.
People in developing countries, including Bangladesh, are as an Asian ethnic group also predisposed to degenerative changes due to their socioeconomic and cultural heritage.      
Obesity:  Obese people are more susceptible to degeneration because of additional stress due to weight.
Few diseases predisposes to degenerative changes of spine: such as rheumatoid arthitis, haemachromatosis, paget disease, gout. 
Pathogenesis and localisation of degenerative changes
The cause of age related spinal degeneration
Are multiple and includes traumatic, metabolic, toxic genetic, vascular and infective.
Causes
Among them chronic overload or chronic duration trauma plays a key role in the degenerative process of spine. Abnormal stresses not sufficient to cause a fracture can be responsible for bone and disc damage if applied for a long time promoting degenerative changes. In most cases the alteration involves both the disc and vertebral body because of the morphological and functional relationship between these structures.
During life the spine undergoes continuous changes as a response to physiological axial load. The distribution of axial load is responsible for the typical localization of spine degeneration, in the cervical region. C5-6, C6-7 are involved in most cases because they are the sites of lordotic inversion. In dorsal spine, degeneration is rare because this part of spine is less mobile and involved minimally in the dynamic load transmission. In the lumbosacral region most frequently degenerated levels are L4-5, L5- S1 as they are the sites of highest static and dynamic load. Functional integrity of the spinal curvature also plays an important role in degenerative changes. Spinal curve allow optimal redistribution of axial load.
As long as the curve is preserved, the spine is 30 times more elastic than a straight structure. If correct spinal alignment is lost, an asymmetric load distribution may cause focal or diffuse spine degeneration. The age related changes are similar to pathological degenerative changes and are a common asymptomatic finding in adult and elderly persons . Progressive involution of spinal structure begin after the 2nd decade and invariably causes some degree of vertebral & discal changes. The first radiological sign of degeneration is the appearance of intranuclear clefts which are virtually present in 100% of patients after 40 years.
Clinical manifestation
Symptoms of degenerative spinal disease vary tremendously and includes:
Pain: Both in the back and neck and in the arms and legs, is a common finding
Neurological symptoms due to compression of spinal nerves or even the spinal cord itself can occur in advanced  cases
Secondary symptoms such as numbness, tingling, pain as well as motor symptom such as weakness or paralysis may also be the presenting feature.
Prevention
Maintain a standard weight: Extra weight puts excess pressure on the spine which increases the chance of degenerative disease and also speeds up its progression. When a person is overweight a plan should be taken up to lose weight
Diet to maintain a healthy bone/ supplements that support bone health :
Omega -3 Fatty acid and some carbohydrate helps to increase bone mass density and also helps to absorb calcium more efficiently. Food items that contain calcium and vitamin – D should be consumed daily to improve bone health. Most adults should aim to consume at least 1200mg of calcium per day. Protein is also needed to develop and maintain healthy bone. Food items containing sugar should be avoided or eaten in moderation. It has been established that refined sugar, especially in soft drinks decrease bone mineral density.
People who are unable to consume an adequate dietary calcium should take supplementary calcium in the form of calcium citrate, calcium carbonate, or calcium orotate.  Chromium and Vita-K supplement will increase bone density.
Regular exercise
Exercise can strengthen the muscles of the back and muscles that support the back, regular exercise can prevent the development of degenerative disease.  Exercise may consist of simple activities such as walking or exercises that target the back muscles.  Gentle weight bearing exercises are specially good.
Good habits needed for a healthy spine
Smoking is detrimental to bone health specially the spine, it has been linked to the degeneration of cartilagenious discs that lie between the vertebrae. So stop smoking immediately.  Alcohol can contribute to weight gain and can negatively interact with medication.
Treatment
Treatment for degenerative spinal diseases varies considerably depending on the specificities of each case. Most patients benefit from conservative treatment with rest, nonsteroidal anti-inflammatory drugs and physical therapy. Some other patients may benefit from non-surgical treatment with local infiltration of long acting steroid but some cases still require surgical intervention. However no generalization can be made as each patient is unique.  Patients should discuss about their most appropriate treatment plan with their personal physician.
There is some misconception about degenerative spinal disease and what it actually means When people hear degenerative spinal disease, they assume that this a disease that will worsen as age advances, but this is not always the case, except in the worst scenario. Most degenerative spine diseases do not get worse over time. The degenerative disease of the spine may be thought to be like “GRAY HAIRS OF THE SPINE,” but with proper care of the spine and lower back, it will serve you well for many years to come without any disability.  Take care of your back and enjoy the benefit of a healthy spine including preventing back and neck pain – no matter your age.
The authori is a Consultant Orthopaedic Surgeon.