Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. Pain that gets worse when bending, lifting or twisting. When these disks wear out, people typically experience back pain and stiffness. B. Age-related changes in thoracic skeletal geometry of elderly females. This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc). If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. J. Rheumatol. Osteoarthritis is the most common form of arthritis. J. Using Fibrin, an FDA-approved substance that is used off-label in this procedure, to encourage tissue growth in other parts of the body, the Discseel Procedure allows spinal disc tissue to grow and heal itself. Radiates down your buttocks and lower back. https://doi.org/10.1148/15.3.513 (1975). Incorrectly lifting, whether its a heavy box or weights, can damage your spinal discs by placing increased weight on your discs while you move in ways known to be damaging to your discs even when performing normal activities. The prevalence was 0.008% in 2005 and 0.049% in 2017, possibly reflecting increased use of medical imaging and/or recognition of the pathology. While no restriction was placed on the medical reason for ordering spine imaging, these patients do not represent a random sample of those over 65 because radiology was ordered for some reason. Association between age, sex, BMI and CT-evaluated spinal degeneration features. The strong your core muscles are, the more weight theyll be able to help support, taking some strain off your back and preventing annular tears. Accelerated intervertebral disc degeneration in scoliosis versus physiological ageing develops against a background of enhanced anabolic gene expression. You may try: Many patients do not need surgery for degenerative disk disease. Prevalence of diffuse idiopathic skeletal hyperostosis in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. At Another Johns Hopkins Member Hospital: Degenerative Joint Disease (Osteoarthritis of the Hip), 7 Ways to Treat Chronic Back Pain Without Surgery. While seated, the discs of the lower back have three times more load on them than when standing. At what age does degenerative disc disease typically start? He is the founder and owner of Champlain Spine and Pain Management and of Surgical Pain Center of the Adirondacks. Unique patient diagnoses per year were further evaluated as a function of age, gender, and obesity diagnosis. Age and time increase the odds of developing degenerative disk disease. Spinal disks are like shock absorbers between the vertebrae, or bones, of your . Slider with three articles shown per slide. You are using a browser version with limited support for CSS. The yearly prevalence of spine degeneration was 27.31.7% overall (meanstandard deviation among years). For young people suffering from degenerative disc disease, there are a variety of factors that accelerate this condition, including: Poor dietary habits Excess weight Smoking cigarettes Traumatic injury Strenuous physical activity Treatments for degenerative disc disease Medicare insurance claims represent a large database that can provide insight into the prevalence of spine degeneration and associated demographic factors. Spinal cord injury with a narrow spinal canal: Utilizing Torgs Ratio method of analyzing cervical spine radiographs. But if you have tried multiple nonsurgical treatments and have persistent pain and/or weakness, surgery may be a good option. Dr. Thierry Bonnabesse is a highly experienced physician practicing in Upstate New York. Participating in some form of regular exercise and watching your diet to avoid weight gain will avoid this. Her Oswestry Disability Index is 50%. Bey, T. et al. Rheum. Pediatric and adult three-dimensional cervical spine kinematics: Effect of age and sex through overall motion. Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nations most prestigious hospitals. The joints around the bones also experience too much stress. If taking the medicine once or twice a day works, then that is all that is needed. Juvenile degenerative disc disease: a report of 76 cases - PubMed BMC Musculoskelet. Not actually a disease, this is a condition in which a damaged disc causes pain. Oostveen, J. C., Van de Laar, M. A. In the meantime, to ensure continued support, we are displaying the site without styles Online Appendix 12 provides a more extensive summary of literature data. 18(6), 893900. The mean . Bone Jt. 23(8), 1441 (1996). AP and lateral upright weight bearing images show normal alignment and disc height (Figs 1A, 1B). A 501(c)(3) nonprofit organization. At 78, Jan Greer wanted to stay active and athletic. https://doi.org/10.1097/00007632-199712151-00005 (1997). He is board-certified by the American Board of Anesthesiology and is dedicated to staying on top of technological advances and cutting-edge techniques that help determine the origin of pain, to more effectively develop treatment strategy. Agnusdei, D. et al. This makes understanding what is causing this condition in young people even more important so that it can be prevented. That's why as we grow old, our back pains also seem to worsen. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers Compensation Board. 250., Naples, Florida 34102, 2490 W. 26th Ave. Suite A-10., Denver, Colorado 80211, @Mile-High-Sports-and-Rehabilitation-Medicine, 51 N. 5th Ave, Suite 301., Arcadia, California 91006, 13575 W. Indian School Road, Litchfield Park, AZ 85340, Active Life Physical Medicine & Pain Center, 1-1-35 Nishiawaji, Higashiyodogawa-ku, saka-shi, saka-fu 533-0031, 145 Inverness Dr E Suite 250 Englewood, CO 80112, 1390 S. Potomac St. Suite 100 Aurora, CO 80012, 4126 Southwest Freeway Suite# 1300 Houston, TX 770275, 9913 N 95th St., Scottsdale, Arizona 85258, Abstract: Safety and Efficacy of Fibrin for Chronic Low Back Pain, Intra-annular Fibrin to Diagnose and Treat Disc Pathology Excerpt, Watch Dr Pearl give an introduction to The Boston Stem Cell Center, Fellowship: Interventional Spine, University of Pennsylvania, Residency: PM&R, University of Pennsylvania, Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons, Medical Doctorate: Pennsylvania State University College of Medicine, Bachelor of Arts: Biology, Lehigh University, Bachelor of Arts: Psychology, Lehigh University, New York State Medical and Surgical License, Florida State Medical and Surgical License, Lehigh University Four-year Academic Scholarship, Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni), North American Spine Society, Outstanding Paper of the Year, 2003, President-Elect, International Spine Intervention Society, Founding Partner, Texas Spine and Joint Hospital, Commencement Speaker: Penn State University College of Medicine, Founding Chairman, Standards Committee, International Spine Intervention Society, Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation, Appointed Spine Advisor, Japanese Prime Minister, Appointed Spine Advisor, Allied Royal Families, Founding Partner & Principal, Texas Spine & Joint Hospital. The total number of enrollees included in the 5% LDS was determined for each year, as well as each individuals age and sex. While the nuances of eligibility for Medicare and how coverage works for individuals with additional private health insurance are beyond the scope of this work, broadly speaking, the vast majority individuals over this age in the U.S. will have their medical claims submitted to Medicare. In these two tests, a physician uses instruments to evaluate the muscles and nerves to see if they are carrying the signals from the spine to the arms properly. In some cases, adolescent scoliosis may develop symptoms with aging and require treatment. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery. Part 6: magnetic resonance imaging and discography for patient selection for lumbar fusion. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: The Wakayama Spine Study. Dr. Terebuh is also grateful to Discseel developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures. Kalichman et al. Spine 4(1), 18. Chin. This may not happen at all, or may happen to one or more discs for reasons not entirely understood. He is a true believer in biologics and their potential to help others feel and function better. Know why a new medicine or treatment is prescribed, and how it will help you. To obtain PubMed 0/5 Waddell signs. These tear allow the herniation of the central nucleus . He is passionate about functional medicine which focuses on restoring patients lives through healing using regenerative medicine procedures. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Womens Hospital. (2017) reported that 11.6% of females and 3.6% of males age 50+had osteoporosis of the lumbar spine19. The prevalence of diagnosed spondylitis and osteoporosis were similar in the overall group compared to the subgroup with radiology. Other studies have reported higher prevalences for certain demographics (Online Appendix 12). This part of the disc contains proteins that can cause the tissues they touch to become swollen and tender. Article Arthritis in the low back has similar symptoms and can cause pain in the back and sometimes into the buttocks. If the pain is more severe, then these medicines should be taken according to the instructions on the bottle. https://doi.org/10.1080/030097402320318422 (2002). Because annular tears are the underlying cause of this condition in young people, young people should also avoid all well known causes of annular tear development, such as any movements that cause compression of the spinal discs or twisting of the spine. Ishimoto, Y. et al. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine. A soft, jellylike core, the nucleus pulposus. 16(1), 7982. Daily activities and sports, which cause tears in the outer core of the disc. You might have pain if your spinal disks: To diagnose degenerative disk disease, your healthcare provider may start by asking you about your symptoms. Last reviewed by a Cleveland Clinic medical professional on 05/27/2021. Parenteau, C.S., Lau, E.C., Campbell, I.C. It often happens as people get older. https://doi.org/10.2106/00004623-199609000-00003 (1996). Lateral and axial MRI studies reveal a central disc bulge, high intensity zone, and disc desiccation at L4-L5 (Figs 3A, 3B). As you get older, the jelly part of the disc begins to dry up. Dr. Foxx has been in private practice since 2004. Arthritis medicines, such as aspirin or aspirin-like medicines (called anti-inflammatories or non-steroidal anti-inflammatory drugs, or NSAIDs), can also be taken. Another sign of nerve involvement is tingling and numbness (called paresthesia) in the arm or fingers. https://doi.org/10.1007/s00776-013-0455-5 (2013). Kalichman, L., Kim, D. H., Li, L., Guermazi, A. All Rights Reserved. Degenerative disc disease (DDD) is a condition where one or more discs in the back lose their strength. https://doi.org/10.1097/brs.0b013e3181ab65c6 (2009). Spinal disks are rubbery cushions between your vertebrae (bones in your spinal column). When the cushions wear away, the bones can start to rub together. Exercising regularly to increase strength and flexibility. A spine specialist can help you determine which treatment is best for you. https://doi.org/10.1016/j.spinee.2009.10.018 (2010). Spine Surg. As the disc dries up, the radial tire part starts to collapse. Spine J. 130 Tamiami Trail North, Suite 210 Naples, FL 34102, 6500 W.143rd St., Overland Park, Kansas 66223, 3443 Dickerson Pike Suite 590 Nashville, TN 37207, 6860 Perimeter Drive, Suite A., Dublin, Ohio 43016, 294 Tom Miller Rd, Plattsburgh, New York 12901, 62 E 88th Street, New York, New York 10128, 600 Worcester Rd, Ste 301, Boston, Massachusetts 01702, 5750 Coventry Lane, Suite 101, Fort Wayne, Indiana 46804, 831 Coral Ridge Drive, Coral Springs, Florida 33071, 130 Tamiami Trail North, Ste. What nonsurgical treatments are most likely to relieve pain? Torg, J. S. et al. Or your surgeon may use one of a few types of spinal decompression surgery: You can prevent or slow the progression of spinal degeneration through lifestyle changes. Sometimes the arthritis can be fairly severe and still have no symptoms. Degenerative Disc Disease | Johns Hopkins Medicine Scoliosis is curvature of the thoracic or lumbar spine in the coronal plane, whether toward the left (levoscoliosis) or the right (dextroscoliosis). Osteophytes develop in response to alterations in localized pressure. Degenerative Disc Disease Diagnosis & Treatment - NYC | Columbia For example, Viano et al. This condition causes the spongy layers of cartilage that cushion the bones of the spine to deteriorate, often as a natural part of aging. Looker et al. https://doi.org/10.1093/ageing/12.3.225 (1983). Additionally, most prior studies rely on data collected at a single institution, and depending on the local population could be skewed by factors such as demographics, economics, or predominant types of occupations. The doctor will take your history and do an examination of the muscles and nerves in your arms. Wong, H. K., Hui, J. H., Rajan, U. The Medicare Claims 5% limited data set (LDS) was queried on a yearly basis to identify enrollees with selected spine pathologies using ICD-9 and ICD-10 codes. Prev. Like airbags in a car, the disks prevent the vertebrae from hitting each other and act as shock absorbers. Weakness in the leg muscles or foot drop, a possible signof damage to the nerve root. At-home treatments may decrease pain for a short time. The causes have been categorized into environmental factors and genetic factors. Figure3 shows the prevalence of spine degeneration type for enrollees coded as obese and those not coded as obese. He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. Since they do not have calcium in them, they cannot be seen directly on X-ray, but they can be seen with magnetic resonance imaging (MRI). Chul-Hyun Park, Kyoung-Bok Min, Don-Kyu Kim, Woon Tak Yuh, Minjung Kim, Chi Heon Kim, Jeffrey R. Cooley, Tue S. Jensen, Jeffrey J. Hebert, Siegmund Lang, Nike Walter, Markus Rupp, Chao Li, Jillian M. R. Clark, James S. Krause, Anne Buzzell, Jonviea D. Chamberlain, Martin W. G. Brinkhof, A. Buzzell, J. D. Chamberlain, for the SwiSCI study group and the Swiss National Cohort, Jin-Sung Park, Jae-Young Hong, Seung-Woo Suh, Nicole D. DiPiro, David Murday, James S. Krause, Scientific Reports The patient is of child-bearing age, and thus I would prefer to avoid an anterior operation (i.e. If the disc tears in this area, it can become quite painful. Theodore, N. Degenerative cervical spondylosis. Disclaimer: All information presented in this website is intended for informational purposes only and not for the purpose of rendering medical advice. https://doi.org/10.3174/ajnr.a4173 (2015). Brinjikji, W. et al. J. Emerg. PubMed Central Especially after age 40, most people experience some disk degeneration. Bone Jt. Parenteau, C., Caird, M., Kohoyda-Inglis, C., Holcombe, S. & Wang, S. Characterization of thoracic spinal development by age and sex with a focus on occupant safety. Osteoporos Int. If you or a loved are a young person living with chronic neck or back pain caused by degenerative disc disease, the way you deal with your condition will depend on the severity of your pain as well as whatever is determined from consultation with your doctor. Degenerative Disc Disease in a 30-Year-Old Female Nachemson, A., Schultz, A. In this study, we only analyzed individuals aged 65 and older, the age at which most U.S. legal residents become eligible for coverage. The patient underwent a minimally invasive TLIF (Figs 5A-D) with screws at L4 and L5 (Figs. Degenerative Disc Disease in Young People - DiscSeel - Non-Surgical One possible factor is the higher prevalence of osteoporosis in older females compared to males. Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Lumbar flexion (Fig. Res. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.Watch Dr Pearl give an introduction to The Boston Stem Cell CenterDr. Eur. Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. Your treatment may include: Some people find pain relief through at-home remedies. As a result of growth and opportunity, Dr. Foxx partnered to create Midwest Orthopedic Network Kansas and surgery center in Overland Park, KS. He maintains his dual board certifications in Physical Medicine and Rehabilitation as well as in Pain Medicine. This curve usually starts in the lower back. Another study of patients under 21 years old found that for some, degenerative disc disease does begin earlier than in most. Current Treatment Strategies for the Painful Lumbar Motion Segment: Posterolateral Fusion Versus Interbody Fusion. 6B). Its well known that back pain is a symptom of stress and mental health issues such as anxiety and depression can increase a persons pain sensitivity, making back pain feel worse. In some cases an X-ray will be necessary to see if the discs are collapsing or if there are any bone spurs. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. With more than a third of the total US population aged 65 or older1, and with the high prevalence of obesity2, it is relevant to identify any association between these objective demographic factors and the prevalence of spine degeneration. This patient had done core stabilization, a normal BMI, and was having job Impairment in spite of trying all of the appropriate nonop care. He has performed and supervised over thirty thousand guided spinal procedures. The degenerative disc disease of the cervical spine usually involves the most mobile segment that is the C5-C6 followed by C6-C7 and C4-C5 disc levels. Google Scholar. This wear and tear of the joints is not only common in the knees and the hips but also in the spine. Degenerative Disc Disease in a 30-Year-Old Female Case Study: A 30-year-old female presents with low back pain that started 6 months ago and poor range of motion, but no history of trauma. Chronic pain, tingling, cramping, burning or numbness in your lower back, buttocks and thighs Pain that doesn't come from one specific nerve area that comes and goes Weakness that happens anywhere between your hips and your toes Cannot walk without assistance (i.e., you need a walker, cane, two crutches or another person to help you get around) These tests can show your healthcare provider the state and alignment of your disks. Disord. The prevalence of specific diagnoses were calculated based upon ICD-9 and ICD-10 codes corresponding to each of seven categories of degenerative spine pathologies. The spine is mostly straight. The prevalence and under-diagnosis of vertebral fractures on chest radiograph. (10/2010 10/2014). Boden, S. D. et al. Dr Bonnabesse has also trained multiple physicians since 2005 through his pain fellowship. Am. His true passion is to treat his patients like his family and friends. Degenerative disk disease is when your spinal disks wear down. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. One of the more unfortunate aspects of getting older is that your joints begin to wear out, oftentimes for no good reason. Kalichman, L., Guermazi, A., Li, L. & Hunter, D. J. The prevalence of osteoporosis was higher in females than males (14.3% vs. 2.1%). Dr. Travis Foxx grew up in Emporia, KS. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.Dr. Once a disc is injured, it cannot repair itself, and a spiral of degeneration can set in with three stages that appear to occur over 20 to 30 years: Several factors can cause discs to degenerate, including age. Online Appendix 10 reports the number of enrollees by spine degeneration type, age group, sex, and obesity coding. If that does not work, you should contact your doctor for an evaluation and a prescription for stronger medicine. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. How can I slow the progression of the disease? Radiology 115, 513524. In 2004, he completed his residency in anesthesiology. Google Scholar. There are a number of things that can cause annular tears, some of which are out of anyones control, but there are a few things you can do to help prevent their development. Scientific Reports (Sci Rep) Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. Google Scholar. Feeling better changing positions often or lying down. Article When pain is severe, you may benefit from spinal injections or spine surgery. Spine degeneration diagnosis prevalence by age group and sex. Degenerated disks can increase your risk of developing other spinal conditions. Genetic background of degenerative disc disease in the lumbar spine https://doi.org/10.1016/j.joca.2012.06.018 (2012). "The disks of the spine are like shock absorbers in a car," says . Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)s Residency Review Committee for Anesthesiology. Journal of Neurosurgery: Spine. Disc Degeneration Degeneration of spinal structures is somewhat inevitable as we age. The Do's and Don'ts When You Have Degenerative Disc Disease The exact reason why the joints of the spine begin to wear out is not known and may be a combination of factors, such as doing a lot of lifting, having a family history of spine problems or having an injury to the spine. A study of young women in their twenties found that 31% of the women enrolled in the study were living with degenerative disc disease that progressively worsened throughout the course of the study. He graduated from Kansas University School of Medicine in 2000. Questions may include: Your healthcare provider may use imaging scans such as X-ray, CT or MRI. Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Skelet. Hendrix, R. W., Melany, M., Miller, F. & Rogers, L. F. Fracture of the spine in patients with ankylosis due to diffuse skeletal hyperostosis: Clinical and imaging findings. But what does that really mean? Vertebral ossification stiffens the spine and may redistribute loadbearing to other regions. Spine curvature is quantified using metrics like the Cobb angle. Juvenile Disc Disorder | Spine-health The American Board of Regenerative Medicine. Mayo Clinic Q and A: What is degenerative disk disease? 2005; 2: 660-667. Am. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute. https://doi.org/10.1148/radiology.164.3.3615879 (1987). More than one-third of cumulative enrollees were in the 6569 age group, irrespective of sex. He has extensive experience with intradiscal therapies and is honored to be selected as one of the few physicians in the country trained in the Discseel Procedure. 2023 Cedars-Sinai. DISH occurs most commonly in the thoracolumbar spine. Radiol. However, the spinal disc is known to be a source of back pain in young people, because it is annular tears that cause degenerative disc disease pain. She then received her M.D. This pain can range from nagging to disabling. We cannot verify that these criteria were consistently applied for all diagnoses in the Medicare database. Degenerative disc disease (DDD) is the most frequent cause of back pain among people older than 45. Neurosurgery. SAE Technical Paper 2020-01-0520. https://doi.org/10.4271/2020-01-0520 (2020). A firm, tough outer layer, the anulus fibrosus. Early onset degenerative disc disease causes - USA Spine Care - Laser Trends in diagnoses over time were evaluated using Pearsons correlation coefficient. By submitting a comment you agree to abide by our Terms and Community Guidelines. The prevalence of acquired stenosis in the lumbar spine has been reported to increase with age and body mass index29,30. Bring someone with you to help you ask questions and remember what your provider tells you. Should they sign up for a weight loss program that is pragmatic and doable? The increase was greatest for DISH, irrespective of age group. We do not endorse non-Cleveland Clinic products or services. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: pain is inevitable but suffering is optional. If the patient is above ideal body weight, I would recommend weight loss. The Medicare data suggest a very low prevalence of 0.0170.014% for DISH overall. Mummaneni PV, Haid RW, Rodts GE: Lumbar Interbody Fusion: State of the Art Technical Advances. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. All authors reviewed the manuscript. 6A, 6C), and interbody spacer at L4-L5 (Fig. He completed a Physical Medicine & Rehabilitation residency at The Ohio State University (96) after graduating from Georgetown Medical School (92). Mummaneni PV, Rodts GE. AJNR Am. The prevalence of spine disease was greater with obesity for all spine disease types, except osteoporosis. While its understandable how participation in sports or a students school bag could affect their spine, the stresses of school and potentially even stress from a young persons personal life can affect their back pain as well. By age 70, most cervical spines show significant degeneration visible on X-rays as well as on MRI imaging, even though few people feel or notice any symptoms. Inflammation may result when ligaments, tendons, or joints of the spine are acutely injured. In some instances where the neck pain is severe and not helped by the other medicine, cortisone pills for one week may be helpful. J. Orthop Sci. https://doi.org/10.1007/s00586-009-0932-x (2009). Takao, T. et al. The prevalence was highest for disc degeneration (12.20.9%). Eur. Degenerative Disc Disease | Cedars-Sinai
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