Degenerative Disc Disease

There is no syndrome of degenerative disc disease. This is just an anatomical condition, in other words, something commonly found on MRIs. The vast majority of degenerative disc disease is not painful. When this is on your MRI report is usually means nothing. Degenerative disc disease is dictated more by your genetics than your lifestyle. This is often surprising to patients who assume that the “wear and tear” seen on their discs is from the “wear and tear” of life.

Degenerative disc disease itself does not hurt. It may be associated with pain through several theoretical mechanisms. First, as the height of the disc diminishes, the ligamentous structures that provide support lose their tension. This allows for potential “toggling” between the adjacent vertebral bodies. Although this toggling is virtually never identifiable on dynamic (flexion/extension X-rays), it is suggested by some surgeons to cause a slight amount of instability (not detectable radiographically, but inferred clinically because of the pain). This concept is then used to justify a fusion procedure. This is a common rationale for surgery despite being unsubstantiated by the body of available literature. Fusions done for degenerative disc disease are common and often leave patients disappointed. Other possibilities for back pain connected to degenerative disc disease are related to the excess stress on the facet joints with the loss of height of the disc space and “crowding” of the nerves from hypertrophic bone that manifests not only as leg pain but also as back pain.

Bottom line: degenerative disc disease is largely genetic in its origin. Back pain also runs in families, but there is only a loose correlation between the two entities. When you come to the office with this entity, I will not likely be able to confirm that it is the cause of your pain. I will likely recommend some non-surgical treatments for your back pain in this setting.