Degenerative Disc Disease
Degenerative disc disease is one of the most alarming-sounding diagnoses in medicine and one of the most common findings on an MRI. It describes the normal wear that discs undergo with age. Most people with it have no symptoms. When it does cause pain, the treatment is overwhelmingly nonsurgical.
What the term actually means
Discs lose water content and height over time, small tears develop in the outer ring, and the neighboring bone and joints adapt. Radiologists describe these findings as degenerative disc disease. The word "disease" is unfortunate; these changes are as normal as gray hair, and many people with dramatic-looking discs on MRI are pain-free. What matters is whether the disc changes are the source of your symptoms, and that is a clinical question, not an imaging one.
When it does hurt
A degenerated disc can cause pain in its own right, felt in the low back or neck rather than the arm or leg. Typical features are pain worse with prolonged sitting or bending forward, stiffness after rest, and flare-ups that settle over days to weeks. Disc degeneration can also contribute to a herniation, to narrowing of the canal, or to a slipped vertebra, each of which is addressed on its own page.
Treatment
The foundation is conditioning: a strong, well-coordinated core and hips take load off the discs. Physical therapy, regular aerobic exercise, weight management, and not smoking each have a measurable effect. Anti-inflammatory medication helps during flares. Injections are used selectively, including diagnostic blocks of the facet joints when they may be contributing.
Surgery for disc-related back or neck pain alone is uncommon and reserved for a small group with severe, persistent pain clearly localized to one or two levels after extensive nonsurgical care. When it is considered, the options are a fusion or, in the neck, a disc replacement. Dr. Michael discusses these candidly, including the reality that results for back pain alone are less predictable than for nerve-related leg or arm pain.
Common questions
Is degenerative disc disease going to get worse?
The imaging findings continue with age, but symptoms do not follow a steady downward path. Many people improve with conditioning and have long stretches with little or no pain.
Do I need surgery for degenerative disc disease?
Most people do not. Surgery is considered only for a small number with persistent disabling pain despite thorough nonsurgical care, and the decision is made carefully.
Should I stop exercising?
No. Appropriate exercise is the most effective long-term treatment. Physical therapy can help you find the right starting point if pain has made you cautious.