Overview
Degenerative disc disease (DDD) is not actually a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can occur throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).
The changes in the discs can result in back pain or neck pain and other problems such as numbness and weakness. These problems can affect your ability to perform daily activities and significantly impact your quality of life. While age-related wear and tear is the primary cause, injuries and genetic factors can also contribute to disc degeneration.
It's important to understand that everyone's discs degenerate over time, but not everyone experiences pain from disc degeneration. The severity of symptoms can vary greatly from person to person, and many people with evidence of disc degeneration on imaging studies have no symptoms at all.
Symptoms
The symptoms of degenerative disc disease vary depending on which disc is affected and the degree of degeneration. Some people may have no symptoms, while others experience severe, disabling pain. The most common symptoms include:
Common Symptoms
- Low back pain - The most common symptom, often worse when sitting
- Neck pain - When cervical discs are affected
- Leg pain - May indicate nerve compression (sciatica)
- Arm pain - When cervical disc degeneration affects nerves
- Paresthesia - Tingling or "pins and needles" sensation
- Loss of sensation - Numbness in affected areas
Additional Symptoms
- Shoulder pain - Often accompanies cervical disc problems
- Hip pain - May occur with lumbar disc degeneration
- Lower body pain - Radiating pain in buttocks and legs
- Joint pain - Secondary to altered spine mechanics
Pain Characteristics
The pain associated with degenerative disc disease often has specific characteristics:
- Pain that worsens with sitting, bending, lifting, or twisting
- Pain that improves with walking or changing positions
- Pain that comes and goes, lasting from a few days to a few months
- Pain ranging from nagging to severe and disabling
- Pain that may radiate to other parts of the body
Causes
Degenerative disc disease is primarily caused by the natural aging process, but several factors contribute to disc degeneration:
Natural Aging Process
As we age, our spinal discs undergo several changes:
- Loss of fluid: Discs lose water content, making them less flexible and more prone to tears
- Disc structure changes: The outer layer (annulus fibrosus) develops tiny tears or cracks
- Disc collapse: Loss of disc height brings vertebrae closer together
- Bone spurs: The body may form osteophytes in response to instability
Contributing Factors
- Daily activities: Repetitive stress from work or sports
- Injuries: Sudden trauma can start the degeneration process
- Genetics: Some people are predisposed to faster disc degeneration
- Spinal alignment: Poor posture or spinal deformities increase stress on discs
Unlike muscles, spinal discs receive very little blood supply. This means they cannot repair themselves effectively once damaged, leading to progressive degeneration over time.
Risk Factors
Several factors can increase your risk of developing symptomatic degenerative disc disease:
Non-modifiable Risk Factors
- Age: Most common in people over 40
- Gender: Slightly more common in women
- Genetics: Family history of disc problems
- Previous spine injury: History of trauma to the spine
Modifiable Risk Factors
- Smoking: Reduces oxygen supply to discs
- Obesity: Increases mechanical stress on discs
- Occupation: Jobs requiring heavy lifting or repetitive bending
- Sedentary lifestyle: Weak core muscles provide less spine support
- Poor posture: Increases uneven pressure on discs
Diagnosis
Diagnosing degenerative disc disease involves a comprehensive evaluation to rule out other conditions and determine the extent of disc degeneration:
Medical History and Physical Examination
Your doctor will ask about:
- Location, duration, and severity of pain
- Activities that worsen or improve symptoms
- Previous injuries or surgeries
- Presence of numbness, tingling, or weakness
Physical Tests
- Range of motion assessment
- Muscle strength testing
- Reflex examination
- Sensory testing
- Special tests like straight leg raise
Imaging Studies
- X-rays: Show disc space narrowing and bone spurs
- MRI: Best for visualizing disc degeneration, herniation, and nerve compression
- CT scan: Provides detailed bone images
- Discography: Invasive test to identify painful discs
It's important to note that imaging findings don't always correlate with symptoms. Many people have disc degeneration on MRI but no pain.
Treatment Options
Treatment for degenerative disc disease focuses on pain relief and improving function. Most people respond well to conservative treatment:
Conservative Treatment
Medications
- Over-the-counter pain relievers (NSAIDs, acetaminophen)
- Prescription anti-inflammatories
- Muscle relaxants for spasm
- Nerve pain medications (gabapentin, pregabalin)
- Short-term opioids for severe pain
Physical Therapy
- Stretching exercises to improve flexibility
- Strengthening exercises for core and back muscles
- Posture training
- Manual therapy techniques
- Heat and cold therapy
Lifestyle Modifications
- Weight loss if overweight
- Smoking cessation
- Ergonomic workplace adjustments
- Regular low-impact exercise
- Stress management techniques
Interventional Treatments
- Epidural steroid injections: Reduce inflammation around nerves
- Facet joint injections: Target arthritic joints
- Radiofrequency ablation: Disrupts pain signals
- Spinal cord stimulation: For chronic pain
Surgical Options
Surgery is considered when conservative treatment fails and pain significantly impacts quality of life:
- Artificial disc replacement: Replaces damaged disc with artificial one
- Spinal fusion: Permanently connects two or more vertebrae
- Decompression surgery: Removes bone or disc material pressing on nerves
Prevention
While you cannot completely prevent disc degeneration, you can take steps to slow its progression and reduce symptoms:
Maintain a Healthy Spine
- Practice good posture when sitting, standing, and lifting
- Use proper body mechanics during activities
- Sleep on a supportive mattress
- Take frequent breaks from prolonged sitting
Stay Active
- Engage in regular low-impact exercise (walking, swimming, cycling)
- Strengthen core muscles to support the spine
- Maintain flexibility with stretching or yoga
- Avoid high-impact activities that jar the spine
Lifestyle Choices
- Maintain a healthy weight to reduce spine stress
- Don't smoke - it accelerates disc degeneration
- Stay hydrated to maintain disc health
- Eat a balanced diet rich in calcium and vitamin D
When to See a Doctor
While some back pain is normal with aging, certain symptoms require medical attention:
Seek Immediate Medical Care If:
- Sudden loss of bladder or bowel control
- Progressive leg weakness or foot drop
- Severe pain following trauma
- Fever accompanying back pain
- Unexplained weight loss with back pain
Schedule an Appointment If:
- Pain persists for more than a few weeks
- Pain interferes with daily activities or sleep
- Over-the-counter medications don't provide relief
- You experience new or worsening numbness or tingling
- Pain radiates down your arms or legs
References
- Battié MC, Joshi AB, Gibbons LE. Degenerative Disc Disease: What is in a Name? Spine. 2019;44(21):1523-1529.
- National Institute of Neurological Disorders and Stroke. Low Back Pain Fact Sheet. Updated March 2020.
- American Academy of Orthopaedic Surgeons. Degenerative Disk Disease. OrthoInfo. 2021.
- Teraguchi M, Yoshimura N, Hashizume H, et al. Prevalence and distribution of intervertebral disc degeneration over the entire spine. Osteoarthritis Cartilage. 2014;22(1):104-110.
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.