Degenerative Disc Disease

What is degenerative disc disease?

Degenerative disc disease is the progressive deterioration of the discs between the vertebrae in the spine, as well as arthritis in the spine’s facet joints. An overgrowth of bone spurs associated with the arthritis can also produce narrowing of the spinal canal, resulting in spinal stenosis, causing pain, numbness and weakness in the legs due to compression of the neural elements.

Degenerative disc disease in the neck (cervical DDD) or upper back (thoracic DDD) can occur, but lumbar degenerative disc disease (DDD in the lower back) is most common, since this portion of the spine bears heavier weight loads. Similarly, this condition can affect a single disc, but multilevel degenerative disc disease (affecting multiple discs) occurs more often.

Other conditions associated with or co-occurring with DDD include lumbar radiculopathy (including what is commonly known as sciatica), neurologic claudication, and degenerative spondylolisthesis.

Degenerative disc disease animation

What are the symptoms of degenerative disc disease?

The primary symptom of degenerative disc disease is back pain, specifically mechanical back pain. Mechanical back pain is low back pain which is exacerbated by activities that place axial load (downward vertical force) throughout the spine. Activities that involve flexion (forward bending) of the spine or carrying a heavy load place increased pressure through the discs, which results in pain.

Rest and lying supine (flat on your back, face up) generally provide relief. Pain often is located just above the belt line and can span across both sides of the low back. Unlike sciatic or radicular type pain, which frequently radiates to the extremities, DDD pain often is isolated to the low back.

What causes degenerative disc disease?

Degenerative disc disease results from a combination of factors such as genetics, environmental conditions or lifestyle behaviors, and the natural aging process.

Genetics

HSS researchers have found evidence to suggest that some genetic biomarkers may be associated with a greater risk of developing this condition. Genes that affect disc structure as well as genes that affect inflammation have been shown to play a role in the complex pathophysiology (mechanical changes in the body that result from a medical condition) of degenerative disc disease. Continued study of the identified genes may one day help doctors better predict who is at risk and inform the development of new treatments or preventative care.

Environment and lifestyle

Environmental factors such as smoking, along with concurrent health problems like diabetes and obesity have also been associated with degenerative disc disease. Additionally, it has been shown that low estrogen levels, such as that in postmenopausal females, may also impact the integrity of intervretebral discs.

Aging

As individuals age, the nutritional supply and vascular (blood) supply to discs decrease and this ultimately results in structural changes to the disc which can lead to degenerative disc disease.

How fast does degenerative disc disease progress?

The progression of DDD is generally a slow process, but it varies widely from person to person and may be accelerated in people who have multiple risk factors. For example, if two people in the same family are genetically predisposed to DDD, but one of them has an occupation involving heavy lifting, both may experience the condition but at different rates of progression.

Is degenerative disc disease serious?

Although degenerative disc disease is not a lethal condition, it can result in significant pain which can lead to diminished quality of life.

What type of doctor treats degenerative disc disease?

Both non-operative doctors, such as physiatrists, sports medicine doctors and pain management physicians, as well as spine surgeons take care of degenerative disc disease. Generally, the condition can be treated with non-operative management. However, in severe cases, which have not responded to non-operative management, surgery may be an option.

How is degenerative disc disease diagnosed?

Diagnostic imaging such as spine X-rays and an MRIs can detect loss of disc height, bone spurs, and facet joint overgrowth that are associated with DDD. MRI imaging is advantageous in that it allows clinicians to interpret severity of DDD by visualizing changes in both bone as well as the surrounding soft tissues.

There are several classification systems that are helpful. The Pfirrmann classification exhibits the changes of disc degeneration progression from one stage to the next. The Modic classification system is used to show various inflammation and vascular patterns along the vertebral endplates (the portion of vertebra that abuts the spinal disc). These changes have been correlated with DDD and low back pain.

Provocative discography is a more invasive test that some consider to be gold standard confirmatory test. This involves using a discogram (an injection of contrast into the disc and subsequent assessment of symptoms) to “provoke” a pain response. A positive test is when the injection results in the reproduction of the patient’s exact pattern of back pain. Further, there must be negative control levels. This is tested by conducting the same test on one or more nearby discs that is not believed to be causing pain issues to ensure that no pain response is detected.

Will degenerative disc disease get better without treatment?

No. The structural changes involved in DDD will not improve but it is possible for symptoms (back pain) to improve over the course of time with treatment.

Can you stop degenerative disc disease from getting worse?

Generally, once the cascade of microscopic changes that result in DDD have started, there is nothing that will alter this other than replacing the disc or a lumbar spinal fusion to fuse the interveterbral segment. That being said, the symptoms caused by DDD (mainly back pain) can certainly be alleviated.

What is the best treatment for degenerative disc disease?

There are many modalities of treatment for DDD. Generally, non-operative measures are employed first. If these do not work, other interventions may be tried. Surgery is considered a last resort if all other treatment modalities fail.

Noninvasive treatments involve trial of oral medication such as nonsteroidal anti-inflammatories (NSAIDs, such as ibuprofen) and/or muscle relaxants. Supplements such as fish oil, which are high in omega-3 fatty acids, can also be helpful. Physical therapy with or without concurrent medication is also recommended.

Injections – such as epidural steroid injections or facet joint injections – may also be used to decrease inflammation and help with symptoms. If a facet joint injection is tried but fails to provide relief, radiofrequency ablation may be used

Does degenerative disc disease require surgery?

Surgical management is reserved for motivated patients who have failed all conservative measures. Surgery is not for everyone, and one must consult with a surgeon to find out if he/she is a good surgical candidate. Surgery usually involves fusion of the intervertebral segment, though there is some literature to support disc replacement in select patients.

What should you not do if you have degenerative disc disease?

Things to avoid with degenerative disc disease may include high-impact activities that result in increased axial load (downward vertical forces) through your spine. In general, this consists of running or exercising on hard surfaces and lifting or carrying heavy objects. Smoking and obesity are both modifiable risk factors to keep in mind as well.

Is walking good for degenerative disc disease?

Walking is generally OK for patients with DDD, as it is not considered a high-impact activity.

Learn more from the articles and other content below, or find a doctor at HSS who treats degenerative disc disease.

Updated: 8/12/2024

Reviewed and updated by Zachary J. Grabel, MD