Case Study Analysis – 64-year-old Male with Degenerative Disc Disease
Case Study Analysis – 64-year-old Male with Degenerative Disc Disease
The case is of a 64-year-old male presenting with complaints of gradual weakness in his dominant arm. He has had ongoing numbness and tingling starting from his elbow but has been dropping items lately due to weakness. His history is positive for an unmanaged crushing injury to the left thumb four years ago and an unmanaged head injury several years ago. He fell backward, striking his head on the end of a car. Findings revealed a slightly elevated, non-fasting FBS and mild-to-moderate degenerative disc disease (DDD) at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root.
The manifestations of progressive function loss demonstrated by dropping items due to weakness and peripheral neuropathy demonstrated by numbness in the extremities are common presentations in neurodegenerative disc disease. Neurodegenerative disc disease occurs when the spinal discs wear out. The neuromuscular pathophysiologic principle underlining the development of a degenerative disc disease stems from its anatomy and functionality. The intervertebral disc is composed mainly of the annulus fibrosus and pulposus. Both provide mechanical stability to the spine. In this disease, a progressive decrease in disc activity and the number of discs is apparent. This decrease may be associated with mechanical loading, genetics, and defects in nutritional support. This usually affects the production of proteoglycan, a component of the disc that provides flexibility to the spine (Kos et al., 2019). Over time, collagen metabolism is affected by subsequent alterations in the distribution of collagen. Additionally, the loss of proteoglycans affects the hydtration of the disc, affecting their ability to bear hydrostatic press. An annular bulge then results, consequently compressing the nerve root in the affected area. This can be seen as a neuroforaminal narrowing in the affected spine area (Scarcia et al., 2022). X-ray findings in the case revealed a neuroforaminal narrowing, reflecting the pathophysiological process underlying his suffering.
The neurological pathophysiology of degenerative disc disease is underlined by nerve root compression. In this case, an annular bulging C6-C7 spine results in the neuroforaminal narrowing, slightly impinging the nerve root in the area. C6 provides sensation to the thumbs, while C7 controls sensation to the wrist extensor muscles and the triceps. The functional losses seen on his arm are highly suggestive of a C6-C7 defect. The common manifestations of peripheral neuropathy and muscle weakness are often a consequence of the loss of innervation to the muscular areas. In the case presented, peripheral neuropathy was the focal neuronal sign, while muscle weakness was the predominant neuromuscular sign.
Several factors are known to interplay in the development of DDD and, subsequently, the physiological functioning of these individuals. Genetic and environmental factors have been implicated in the development of this disease. The genetic influence is evident through cytokine polymorphism associated with ethnicity. DDD attributed to mechanical strain has also been found to have an ethnic predilection.
A genetic predilection to DDD coupled with an environmental predisposition to the disease contributes to the development of the disease. In the presence of genetic variables, individuals with family members having the disease are likely to have the disease (Goode et al., 2022). This is because the occurrence of the disease is highly suggestive of cytokine polymorphisms in the family line. Ethno-environmental factors in DDD are mostly seen in DDD attributed to mechanical strains. Ethnic minority groups that tend to be involved in more physically straining jobs are known to suffer more from degenerative diseases of the spine (Goode et al., 2022). Additionally, other sociocultural variables apparent in these groups, such as poor health-seeking behaviour, can contribute to their disease. This may be the scenario in the patient case above. His injuries can be attributed to his falling while at work. The fact that he did not seek any medical attention while downplaying his injuries may be the reason for his current presentation.
References
Goode, A. P., Cleveland, R. J., George, S. Z., Schwartz, T. A., Kraus, V. B., Renner, J. B., Gracely, R. H., DeFrate, L. E., Hu, D., Jordan, J. M., & Golightly, Y. M. (2022). Predictors of lumbar spine degeneration and low back pain in the community: The Johnston County Osteoarthritis Project. Arthritis Care & Research, 74(10), 1659–1666. https://doi.org/10.1002/acr.24643
Kos, N., Gradisnik, L., & Velnar, T. (2019). A brief review of the degenerativ