Degenerative Disc Disease Symptoms, Causes, Treatments and More

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The Universal Guide to Degenerative Disc Disease: Everything you ever wanted to know, straight from the experts.

In This Article: Definition?   |    Causes   |    Symptoms    |    Diagnosis   |    Nonsurgical Treatments  |    Surgical Treatment   |    Living With   |    FAQs   |    Sources

There’s nothing inevitable in this world but death, taxes, and…degenerative disc disease? There’s plenty you can do at any age to keep your back strong and healthy, but time marches on and good luck trying to stop that. Sooner or later, your spinal discs – the shock absorbing pads between each vertebra – start to wear out. That can lead to degenerative disc disease (DDD).

The name is misleading: It’s is not actually a disease. DDD is a condition in which a damaged spinal disc causes pain. (While everyone has some wear and tear of their spinal discs; not everyone will have pain.) And although it may take decades before you feel pain (if you ever do), the degeneration process can start as early as your 20s.

Read on for more information about how DDD happens, who’s at risk, and what treatments help. 

part of the spinal column
Parts of the Spine
Photo Source: SpineUniverse.com.

 

What is Degenerative Disc Disease?

DDD is a common cause of back pain, especially as you get older. The discs that cushion the vertebrae – the long stack of bones in your spine – begin to dry out. Discs can also get damaged from normal wear and tear or an injury. 

Both the extent of the breakdown and how it affects people varies. One person may have severe disc breakdown but only mild pain, while another may have minor disc damage and excruciating pain. 

“It’s really about the individual,” says Neel Anand, MD, a professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. “Some spines can bear a lot of load. Others cannot.”

To better understand DDD, it’s helpful to know a bit about the spine’s basic structures and how they work:  

  • Vertebrae. Your vertebrae are the interlocking bones in your spine that support your entire body. They’re divided into three different regions: cervical spine (neck), thoracic spine (upper- and mid-back), and lumbar spine (lower back). DDD tends to occur in your neck or lower back, but it can happen anywhere along your spine. 
  • Discs. In between each vertebra are shock-absorbing discs, known as spinal discs or intervertebral discs. They cushion your vertebrae and allow your back to bend, flex, and twist. The outer part of a disc is firm and contains nerves, so a bulge or tear can be very painful. If the jellylike interior leaks out, you could hurt even more. That stuff contain proteins that cause any tissue it touches to become swollen or tender.
  • Cartilage. Each spinal joint is surrounded by cartilage, which protects and cushions the spine. Wear and tear can cause cartilage to break down, exacerbating DDD. 

Your spine is divided into regions:

  • Neck (cervical spine)
  • Mid-back (thoracic spine)
  • Low back (lumbar spine)
  • At the lower end of your spine, you also have the sacrum and the coccyx, which is commonly called your tailbone.

Degenerative disc disease is most likely to occur in your cervical spine or your lumbar spine.

What Causes Degenerative Disc Disease?

The spine starts degenerating somewhere between the ages of 20 and 25, explains Dr. Anand. But there’s a reason you don’t see most 20-somethings wincing from back pain: it takes a long time for spinal discs to wear down on their own.

Normal aging isn’t the only cause of disc degeneration. Other things can cause or contribute to it.

  • Your activity levels. Were you ever a runner, wrestler, dancer, or tennis player? Did you carry around kids or lift moving boxes? Whether that’s all in the past or part of your present, activities of daily living cause wear and tear on your spinal discs.
  • Injuries. Any back injury that causes swelling or soreness – from a car accident to that one wayward swing on the golf course – can increase your risk of DDD.
  • Genes. DDD tends to run in families, though scientists haven’t identified the genetic marker(s) known to increase risk. According to a 2016 study in Genes & Diseases, several genetic defects have been associated with changes inside the spinal disc that could make it weaker.
  • Spinal diseases. Certain back conditions, such as ankylosing spondylitis (an inflammatory spine condition that causes vertebrae to fuse together), can increase your risk for DDD.
  • Excess weight. Being overweight and obese increases the load your spine has to bear. That excess weight compresses the spinal discs. Compared with normal-weight people, those who are overweight and obese are more likely to have significant disc degeneration, according to a 2012 study in Arthritis & Rheumatology.
  • Smoking. Some evidence suggests that smoking contributes to the degeneration of spinal discs. Again, spinal disc breakdown doesn’t always cause pain, but it’s a key factor.

DDD cause smokingPlease just quit.

What Are the Symptoms of Degenerative Disc Disease?

Although the spine is in a near-constant state of degeneration after our 20s, most people don’t start to experience symptoms of DDD until they reach their 60s or 70s, Dr. Anand says. “Seventy to 80% of people have some sign of degeneration on an MRI, but not everyone has symptoms. Others have severe pain with pretty normal-appearing backs. It’s the way the spine bears the weight,” he explains.

He adds that in most cases, the degeneration of the spine is a very gradual progression, so you may not notice any symptoms at all in the early stages. 

When you do start to have symptoms, the first one is probably going to be back pain. You may also notice it spreading, especially to your buttocks or upper thighs (hello, sciatica). That’s common in DDD because, while the problem may disc damage, it usually affects other nearby structures – including nerves.

What if your experience with back pain is entirely different? Disc degeneration may still be the culprit. Symptoms vary widely and may include:

  • Feeling like your back has “seized” or “locked up” 
  • Neck pain
  • Loss of motion in your spine
  • Stiffness in your back
  • Pain that radiates through your buttocks and legs or arms and hands
  • Pain that worsens with extended periods of sitting
  • Leg or foot weakness in severe cases

How Is Degenerative Disc Disease Diagnosed?

Back pain is so common that you might be tempted to ignore it or treat it at home with over-the-counter pain relievers. That may be fine if your pain is mild and temporary, but you should see a doctor if the pain is bothersome or recurring.

Whether it’s your first or 50th appointment to address back pain, it will include a “history and physical.” (That means medical history and physical exam, in doctor speak.) Your doctor will first talk to you about your back symptoms and concerns, then physically examine your body for signs of trouble: stiffness, swelling, or anything out of the ordinary.

When a doctor takes your history, expect questions like:

  • When did the pain begin?
  • Did you have a recent injury?
  • Where does it hurt?
  • What is your pain level?
  • What makes your back feel better or worse?

The history and physical will be your starting point, although diagnosing DDD requires more than that. You’ll need imaging studies: Special pictures that show what’s going on with your spine, such as:

  • X-rays. These can show a decrease in the space between your discs, bone spurs (bony growths on your vertebrae), fractures, and other problems related to your bones. X-rays don’t show soft tissue very well.
  • MRI (magnetic resonance imaging). This scan can reveal problems with your soft tissues. It can also show if your discs have shrunk, if your spinal canal has narrowed, or if your spinal discs are damaged.

lumbar degenerative disc diseaseAn example of lumbar (low back) degenerative disc disease in an imaging study. Photo Source: SpineUniverse.com.

What Are Some Non-Surgical Treatments for Degenerative Disc Disease?

One of the main challenges in treating DDD is that it is such a broad condition that affects everyone so differently. “DDD is a vague diagnosis with no specific etiology and no great treatment,” says Jason M. Highsmith, MD, a neurosurgeon at Charleston Brain and Spine in Charleston, SC.

Many symptoms of DDD can be relieved with simple methods. These fall under the umbrella of “conservative treatment,” since they don’t involve surgery.

Non-drug treatments. Feeling better doesn’t always require medication. Your symptoms may improve with:

  • Rest and ice for acute back pain episodes
  • Stretching
  • Physical therapy
  • Massage
  • Heat therapy: heating pads, packs, or warm showers and baths
  • Chiropractic care
  • Yoga

Medications. Depending on where you are on the pain scale, your doctor may recommend over-the-counter (OTC) or prescription drugs.

  • OTC or prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil) and naproxen (Aleve)
  • Opioid (narcotic) pain relievers for short-term relief for severe pain
  • Muscle relaxants, if you are having muscle spasms due to DDD

Therapeutic injections. When you need more relief than you’re getting from oral medications and non-drug therapies, injections are usually the next step. For DDD these include:

  • Epidural corticosteroid shots, in which a powerful anti-inflammatory drug (the corticosteroid) goes into the fluid-filled space around your spinal cord
  • Nerve blocks, in which pain-relieving medication goes directly into a nerve
  • Trigger point injections, in which pain-relieving medication goes into the nearby muscle

Like DDD itself, Dr. Anand points out that treatment is very individualized. What works for one person may not work for the other, so it may take some trial and error before you land on a treatment regimen that helps relieve your specific symptoms. 

What Are the Surgical Treatment Options for Degenerative Disc Disease?

Most of the time, DDD does not require surgical treatment. However, some cases of DDD don’t improve enough with conservative management. Dr. Anand explains that the following criteria may be used to determine if your DDD could require surgical intervention: 

  • Your pain is increasing over time
  • Your pain has lasted without much relief for 12 weeks or more
  • Your pain is so severe it can only be relieved with opioids
  • Your pain is so severe that you are no longer able to do your normal activities 
  • Your legs are getting weaker 

The goals of surgery for DDD vary by procedure. These are three common surgical approaches for DDD.

  • Spinal fusion: When a disc is severely damaged, it may be removed. To re-stabilize this part of the spine, the surrounding vertebrae are fused (permanently joined) together.

  • Artificial disc replacement: The damaged disc is removed and replaced with an artificial, or prosthetic, disc. In the neck especially, it can have fewer complications than spinal fusion.  

DDD treatment fusionSpinal fusion can sometimes help back pain caused by DDD by eliminating painful movement of vertebrae.

Dr. Anand points out that many people believe because DDD is considered a normal part of aging and they have to just live with the pain. He disagrees. Dr. Anand says symptoms that are interfering with your normal life need to be addressed. In fact, he adds, “If you are not getting better after 12-16 weeks, you have to seek treatment aggressively.”

What Are Some Tips for Living with Degenerative Disc Disease?

DDD cannot be completely prevented, but you may be able to slow down the progression of the condition and ease your painful symptoms. Some of the best ways to minimize the advancement of DDD are to:

  • Achieve and maintain a healthy weight
  • Live an active lifestyle that incorporates a mix of different exercises
  • Build a strong core to support your back
  • Do low-impact exercise, such as aquatics or Pilates

Being sedentary can make DDD worse, so be sure to incorporate a lot of standing and walking breaks into your day – especially if you have a job that requires you to sit a lot. In addition, if you ever lose control of your bladder or bowel, you should seek medical attention right away. This can be a sign that your DDD has affected your nerves.

However, keep in mind that severe complications from DDD are rare and most people with the condition can go onto to enjoy their normal activities of daily living. The important thing to remember with DDD is that if you’re in pain, speak with your doctor about treatment options that can get you back on your feet—literally.   

FAQs

  • What causes degenerative disc disease?

    In most cases, DDD does not have one specific cause, but is simply the result of normal aging in the spine.
  • How can I prevent degenerative disc disease?

    The best way to keep your spine strong is to lead a healthy lifestyle, which includes getting regular exercise, eating a well-balanced diet, and avoiding harmful risk factors such as smoking and carrying excess weight.
  • How fast does degenerative disc disease progress?
    Typically, the disease progression for DDD is very slow. Most people don’t even notice the effects of DDD until they are well into their 60s or 70s.
  • How is degenerative disc disease diagnosed?

    DDD is diagnosed after an evaluation with your doctor, which will include a physical exam, assessment of your symptoms, and imaging studies such as X-ray and a MRI to get a closer look of what’s happening with your spine.

Sources

Intro: Cedars Sinai. (N.d.) Degenerative Disc Disease.  https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html

What is DDD:  Cedars Sinai. (N.d.) Degenerative Disc Disease. https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html

University of Michigan. (N.d.) Degenerative Disc Disease. https://www.uofmhealth.org/health-library/uh2039spec

International Journal of Inflammation. (2016). Inflammatory serum protein profiling of patients with lumbar radicular pain one year after disc herniation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879232/ 

Causes: Cedars Sinai. (N.d.) Degenerative Disc Disease.  https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html

Genes and Diseases. (2015) Genetic factors in intervertebral disc degeneration.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016799/

Arthritis and Rheumatism. (2012) The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults. https://onlinelibrary.wiley.com/doi/full/10.1002/art.33462

PLOS One. (2015) Effects of Tobacco Smoking on the Degeneration of the Intervertebral Disc. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547737/

Diagnosis: National Institutes of Health. (N.d.) History & Physical Exam. https://training.seer.cancer.gov/diagnostic/history.html

University of Michigan. (N.d.) Degenerative Disc Disease. https://www.uofmhealth.org/health-library/uh2039spec

Conservative treatment: University of Michigan. (N.d.) Degenerative Disc Disease. https://www.uofmhealth.org/health-library/uh2039spec

NYU Langone health. (N.d.) Therapeutic Injections for Degenerative Disc Disease. https://nyulangone.org/conditions/degenerative-disc-disease-in-adults/treatments/therapeutic-injections-for-degenerative-disc-disease

Surgery: NYU Langone health. (N.d.) Surgery for Degenerative Disc Disease. https://nyulangone.org/conditions/degenerative-disc-disease-in-adults/treatments/surgery-for-degenerative-disc-disease

Updated on: 11/16/20
Neel Anand, MD
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