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The Degenerative Spine Cascade

The Degenerative Spine Cascade is the process by which the human spine changes and degenerates over time. A continuous process that can begin at any age, the degenerative spine cascade often takes 40-50 years or more to run its course and will affect 90% of the population to some degree during their lifetime.

The process of spinal degeneration usually starts at one level in the cervical, thoracic, or lumbar spine, and spreads to adjacent levels over a period of time. Commonly called spinal arthritis, spinal degeneration, and/or spondylosis, it is by far the most common cause of spinal conditions that individuals seek treatment for.  Spinal degeneration can be a naturally occurring process brought on simply by wear and tear over time, or it can be initiated by acute or recurring injuries. Major trauma, sports related activities, occupational factors, genetic predisposition, diet and nutrition, weight, general health, exercise or activity level, smoking, and certain medication are all factors that can play a role in when and how quickly spinal degeneration develops and progresses.

The following flow chart attempts to explain the Degenerative Spine Cascade and the many conditions that may develop during the process. All of these conditions can occur alone or in conjunction with other conditions, and can occur at one or multiple levels/locations. The flow chart also lists commonly referred to acronyms (AKAs) for the conditions, the effects conditions may have on surrounding structures, typical symptoms, and the various treatment options available.


The Degenerative Spine Cascade Flow Chart

Sprain / Strain

Age Range: All Ages
Also Known As: Thrown Back, Pulled Muscle, Trigger Point, Segmental Dysfunction, Joint Out of Place
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Generalized Pain, Superficial, Hurts to Touch, Sore
  • Point Tenderness, Trigger Point, Pressure Point, Very Localized
Treating Back Sprains and Strains
Non-Surgical Pain Procedure Surgery
OTC Medicine, Rest, Ice, Massage and Massotherapy, Stretching, Water Exercises, "Core" Exercise Program Including Pilates & Yoga, Aerobic Conditioning & Personal Training, Spinal Manipulation, Acupuncture, Gyrotonic, Decompression Traction Machines Trigger Point Injection, Prolo or Sclero Facet Injection, Facet Block Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery)

Herniated Disc

Age Range: All (20-50 most common)
Also Known As: Herniated Disc, Slipped Disc, Ruptured Disc, Bulging Disc, Pinched Nerve, Sciatica, Radiculopathy, Acute Disc Injury, Annulear Tear, Torn Disc
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Severe Tooth Ache, Throbbing, Thumping, Fairly Localized
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Tingling Pain, Burning, Numbness
  • Pain is Constant, Never Goes Away, Night Pain
Treating Disc Herniation
Non-Surgical Pain Procedure Surgery
OTC Medicine, Physical Therapy, Spinal Manipulation, Rx Medication, Decompresstion Traction Machines Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block Percutaneous Laser Discectomy, Percutaneous Nucleoplasty Coblation, Laminotomy, Laminectomy, Transforaminal Micro Discectomy, Microdiscectomy, Nucleus Replacement, Disc Stabilization Arthroplasty, Epidural Endoscopic Laser

Degenerative Disc Disease

Age Range: 20-50
Also Known As: Black Disc Disease, Desiccated Disc, Inflamed Disc, Internal Disc Disruption, Isolated Disc Resorption
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent
  • Morning Pain, Stiffness, Gets Better as Day Goes On
Treating Dynamic Lateral Recess Stenosis
Non-Surgical Pain Procedure Surgery
OTC Medicine, Water Exercises, "Core" Exercise Program Including Pilates & Yoga, Aerobic Conditioning & Personal Training, Decompression Traction Machines Epidural, Caudal-Epidural, IDET (Intradiscal Electrothermic Therapy) Nucleus Replacement, Disc Stabilization Arthroplasty, Artificial Disc Replacement, Artificial Facet Replacement, Interbody Fusion, Epidural Endescopic Laser

Dynamic Lateral Recess Stenosis & Foraminal Narrowing

Age Range: 20-50
Also Known As: Collapsing Disc, Spinal Instability, Vertical Instability, Torn Facet Ligaments, Facet Arthritis
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent
  • Morning Pain, Stiffness, Gets Better as Day Goes On
Treating Dynamic Lateral Recess Stenosis
Non-Surgical Pain Procedure Surgery
Decompression Traction Machines Facet Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Endoscopic Transforaminal Laser Decompression, Micro Transforaminal Decompression, Percutaneous Facet Fusion, Instrumented Fusion, Interbody Fusion,  Artificial Facets, Stabilization Bands

Degenerative Spondylolisthesis & Degenerative Scoliosis

Age Range: 50 and up
Also Known As: Slipped Vertebrae, Spinal Instability, Curvature of the Spine, Twisted Spine, Crooked Spine, Shifted Spine, Sway Back, Flat Back
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Tooth Ache, Throbbing, Thumping, Fairly Localized
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Tingling Pain, Burning, Numbness
Treating Degenerative Spondylolisthesis & Degenerative Scoliosis
Non-Surgical Pain Procedure Surgery
OTC Medicine, Ice, Heat, Massage and Massotherapy, Traction, Water Exercises, "Core" Exercise Program Including Pilates & Yoga, Physical Therapy, Bracing, Decompression Traction Machines Epidural, Transforaminal Epidural, Selective Nerve Block Percutaneous Spinal Fusion, Sextant, Spinal Fusion without Instrumentation and Implants, Spinal Fusion with Instrumentation and Implants, Major Spine Reconstruction, Laminectomy, Microdecompression Laminaplasty

Fixed Lateral Recess Stenosis

Age Range: 50 and up
Also Known As: Bone Spurs, Arthritis of Spine, Facet Degeneration
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent
Treating Fixed Lateral Recess Stenosis
Non-Surgical Pain Procedure Surgery
OTC Medicine, Traction, Water Exercises, Rx Medication, Decompression Traction Machines Epidural, Caudal-Epidural, Transforaminal Epidural, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Percutaneous Spinal Fusion, Sextant, Spinal Fusion without Instrumentation and Implants, Spinal Fusion with Instrumentation and Implants, Microdecompression Laminaplasty

Central Spine Stenosis

Age Range: 60 and up
Also Known As: Spinal Stenosis, Neurogenic Claudication, Pinched Nerve, Sciatica, Radiculopathy, Myelopathy, Spondylosis, Stiff Back
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Pain is Position/Activity Dependent
Treating Central Spine Stenosis
Non-Surgical Pain Procedure Surgery
OTC Medicine, Massage and Massotherapy, Traction, Water Exercises, "Core" Exercise Program Including Pilates & Yoga, Aerobic Conditioning & Personal Training, Rx Medication, Decompression Traction Machines Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Transforaminal Micro Decompression, Microdecompression Laminaplasty, MED (Micro Endoscopic Decompression), Laminotomy, Laminectomy, Laminaplasty (Cervical or Lumbar), Indirect Spinal Distraction Decompression (X-Stop), Spinal Fusion with Instrumentation and Implants

Multi Level Spondylosis

Age Range: 60 and up
Also Known As: Spinal Stenosis, Neurogenic Claudication, Pinched Nerve, Sciatica, Radiculopathy, Myelopathy, Spondylosis, Stiff Back
Location and Severity of Pain: Spine: Extremities:
Type of pain:
  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Pain is Position/Activity Dependent
Treating Multi Level Spondylosis
Non-Surgical Pain Procedure Surgery
OTC Medicine, Massage and Massotherapy, Traction, Water Exercises, "Core" Exercise Program Including Pilates & Yoga, Aerobic Conditioning & Personal Training, Rx Medication, Decompression Traction Machines Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Transforaminal Micro Decompression, Microdecompression Laminaplasty, MED (Micro Endoscopic Decompression), Laminotomy, Laminectomy, Laminaplasty (Cervical or Lumbar), Indirect Spinal Distraction Decompression (X-Stop), Spinal Fusion with Instrumentation and Implants