What is Degenerative Disc Disease?

In degenerative disc disease (DDD), the discs that separate your spine's bones, or vertebrae, start to breakdown, or degenerate. The discs provide cushion between the vertebrae, absorb shock, and allow your spine to bend. When they start to break down, you can experience back pain along with other symptoms.

DDD can occur in any area of the spine, but the condition is most common in the cervical (top) and lumbar (bottom) sections. Your symptoms may vary based on where the breakdown is occurring on your spine.

Depending on the severity of symptoms, DDD can cause disability and significantly impact your daily life. However, a variety of treatment methods have been shown to improve symptoms.

Degenerative Disc Disease Symptoms

The most common symptom associated with DDD is pain. This pain can come and go, or it can be long-lasting, or chronic. You might feel pain in your back or neck, especially when you sit down, bend, twist, or lift items.

In some cases, the degenerated disc will slip out of place in the spine (herniate) and press against your nerves. This can cause pain, weakness, or numbness in your back, arms, or legs. It can also lead to sciatica, or pain that travels from your lower back down your leg.

Over time, DDD may lead to more severe symptoms, including:

• Difficulty walking or rising from a sitting position
• Bladder and bowel control problems
• Impaired movement
• Nerve damage

Each part of your spine may be at different stages of degeneration at once, which can impact your symptoms. For example, if the degeneration is happening in the lumbar section of your spine, you may only feel pain in your lower back.

What Causes Degenerative Disc Disease?

DDD occurs when the discs that separate your spine's bones start to breakdown, or degenerate. Aging is the most common cause of the condition as disc degeneration is a natural symptom of your body getting older.

As you age, your discs can dry out and begin to break down. Most people over the age of 40 experience some degeneration. However, not all people who have degeneration experience pain.

You can also experience DDD due to injury from sports or daily activities. When a disc tears, it can’t repair itself, so it may be more likely to break down.

Risk Factors

Some social and environmental factors such as smoking or working in jobs that require heavy lifting may play a role in the onset of DDD, but genetic factors likely have a bigger impact.

Research shows variations in certain genes, such as genes that control collagen production and the immune response, may make some people more likely to develop DDD than others.  

Collagen strengthens connective tissues including skin, bone, cartilage, tendons, and ligaments. It contributes to the structure of discs in the spine and helps make them more stable. A lower production of collagen could make the discs more likely to slip or breakdown.

People with more reactive immune systems may be more likely to experience inflammation and dehydration of the spinal discs.

How Is Degenerative Disc Disease Diagnosed?

A healthcare provider can use several tests to diagnose DDD, many of which help rule out similar conditions that might be causing your symptoms. 

Your healthcare provider may prescribe one or a combination of the following tests:

• X-rays: The imaging tests are often used to rule out other diagnoses, including scoliosis (curved spine), spondylolisthesis (slipped vertebra), fractures, or gross instability. X-rays allow a view of the structure and alignment of the bones in the spine, but they can’t show discs or soft tissues, meaning they can’t necessarily identify DDD. 
• Computed tomography (CT) scans: Used for similar purposes as x-rays, this test is particularly helpful for identifying pars defects (stress fractures in the lower vertebrae) or spondylolisthesis. 
• Magnetic resonance imaging (MRI) scans: These can provide similar results as x-rays and CT scans, but can also give a view of neural (nerve) structures and discs. If an MRI shows a dark disc, it may signal dehydration or loss of hydrogen ions inside the disc, which can be a sign of DDD. 

Treatments for Degenerative Disc Disease

Treatment for DDD may consist of a range of methods, including: 

• Physical therapy, particularly with core strengthening and stretching exercises.
• Lifestyle changes, including modifying or avoiding activities that make the pain worse.
• Medications, including non-steroidal anti-inflammatory medications (NSAIDs), steroids, and muscle relaxants. Certain medications that influence mood may also be used, such as GABA drugs, serotonin uptake inhibitors, and tricyclic depressants.
• Epidural injections, which inject anti-inflammatory steroids into the area around the sac of fluid encasing your spinal cord (this is different from numbing epidurals given before childbirth).
• Heat or cold therapy (cryotherapy) and massage for the management of pain, inflammation, and muscle spasms.
• Surgery, which is usually reserved for people whose symptoms severely impact their daily life and aren’t responsive to other treatment.

If you have DDD, your treatment plan may include care from several healthcare professionals, including but not limited to:

• Your primary care provider
• Physical therapists
• Physiatrists (specializing in physical medicine and rehabilitation)
• Neurologists (specializing in the brain and nervous system)
• Orthopedists (specializing in the bones, muscles, and joints)
• Neurosurgeons (performs surgery for conditions of the brain and nervous system)

Since DDD can cause disability and impact daily life, you may find seeking mental health care is beneficial to your overall well-being. Specifically, therapists trained in cognitive behavioral therapy (CBT) can help you cope and adjust to life changes.

How to Prevent Degenerative Disc Disease Flares

Many causes of degenerative disc disease cannot be prevented. However, making certain lifestyle changes may help reduce symptoms and prevent flares.

Your healthcare provider may recommend:

• Getting regular physical activity
• Eating a nutritious diet
• Managing your weight
• Avoiding smoking or drinking alcohol

These changes have been shown to provide additional improvements in quality of life for people with DDD when used in combination with treatment methods above. 

Related Conditions

There are several conditions associated with DDD, some of which may make it more likely for you develop DDD. These include, but are not limited to:

• Type 2 diabetes
• Metabolic syndrome
• Hypertension (high blood pressure)
• Hypothyroidism (under-active thyroid)

Many of the lifestyle changes for preventing flares of DDD overlap with lifestyle changes for managing and preventing these related conditions. 

Living With Degenerative Disc Disease

People with DDD can experience pain and limited mobility that can make it difficult to accomplish daily tasks. The condition may worsen with age, although the rate at which disc degeneration progresses can be unpredictable.

However, with a comprehensive treatment plan, people with DDD can lead a healthy life. Treatments like physical therapy and medications can help maintain mobility and manage pain. Getting mental health care and implementing lifestyle changes can help you cope and improve your quality of life.

In addition, new research on biological therapies shows promise. Researchers are looking for improved ways of treating the pain associated with DDD to offer more treatment options in the future.