Degenerative Disk Disease

What is degenerative disk disease?

Degenerative disk disease (sometimes spelled degenerative disc disease) isn’t actually a disease, but rather, it’s a condition that occurs when your spinal disks wear down. Spinal disks are rubbery cushions between your vertebrae (bones in your spinal column). They act as shock absorbers and help you move, bend and twist comfortably. Everyone’s spinal disks degenerate over time — it’s a natural part of aging.

When the cushions wear away, the bones can start to rub together. This contact can cause pain and other problems, like:

• Adult scoliosis, where your spine curves
• Herniated disk, also called a bulged, slipped or ruptured disk
• Spinal stenosis, when the space in your spinal canal narrows
• Spondylolisthesis, when vertebrae move in and out of place

Types of degenerative disk disease

Disk degeneration mostly affects your lower back (lumbar spine) or neck (cervical spine).

• Lumbar degenerative disk disease. Your lower back (lumber spine) has five vertebrae. These are the largest bones in your back. Healthcare providers call them L1 to L5. Disks in your spine (spinal disks) separate each of these vertebrae. Approximately 90% of degenerative disk disease occurs in the lowest portions of your lumbar spine.
• Cervical degenerative disk disease. This type of degenerative disk disease occurs in the seven vertebrae of your neck (cervical spine). These vertebrae are each separated by a spinal disk. Your cervical spine is responsible for all kinds of movements, including looking up and down and turning your head from side to side. Degenerative disk disease in this area can make those movements painful.
• Multilevel degenerative disk disease. Multilevel degenerative disk disease is when degenerative disk disease affects more than one disk or level of your spine. So, areas of your lumbar spine and your cervical spine could be affected.

How common is degenerative disk disease?

Almost everyone has some disk degeneration after age 40, even if they don’t develop symptoms. It can lead to back pain in about 5% of adults.

Symptoms of degenerative disk disease

The most common degenerative disk disease (degenerative disc disease) symptoms are neck pain and back pain. You may experience pain that:

• Comes and goes, lasting for weeks or months at a time
• Radiates down your lower back and buttocks
• Worsens with sitting, bending or lifting

What does degenerative disk pain feel like?

Degenerative disk pain:

• Can happen in your neck or lower back
• Can be mild, moderate or severe
• Can be sharp, aching or stiff
• May start and stop
• Can get worse after certain activities, like bending, twisting or lifting
• Can get worse over time

Degenerative disk disease causes

Spinal disks wear down as a natural part of aging. Especially after age 40, most people experience some disk degeneration. But not everyone experiences pain.

You might have pain if your spinal disks:

• Dry out. Your disks have a soft core that mostly contains water. As you get older, that core naturally loses some water. As a result, disks get thinner and don’t provide as much shock absorption as they used to.
• Tear or crack. Minor injuries can lead to small cracks in your spinal disks. These tears are often near nerves. Tears can initiate inflammation cascade, which involves nearby structures like nerves, which might be painful, even when they’re minor. If the outer wall of your spinal disk cracks open, your disk may bulge out of place, known as a herniated disk, which may compress a spinal nerve.

Risk factors for degenerative disk disease

Degenerative disk disease is most common in people age 40 and older. Some factors increase your risk of developing degenerative disk disease, including:

• Acute injuries, like falls
• Obesity
• Sex, with women being more likely to experience symptoms
• Smoking
• Working a physically demanding job

Does degenerative disk disease increase my risk for other conditions?

Degenerated disks can increase your risk of developing other spinal conditions. Common spine problems include:

• Osteoarthritis
• Scoliosis
• Spinal stenosis
• Spondylolisthesis
• Radiculopathy
• Spondylolysis

How doctors diagnose degenerative disk disease

To diagnose degenerative disk disease (degenerative disc disease), your healthcare provider may start by asking you about your symptoms. Questions may include:

• When did the pain start?
• Where do you feel pain?
• What activities cause the most pain?
• What activities decrease the pain?
• Did you have an injury or accident that led to pain?
• Do you have other symptoms, like tingling or numbness?
• How far can you walk?

Your healthcare provider may use imaging scans, like X-ray, CT or MRI to help with the diagnosis of degenerative disk disease. These tests can show your healthcare provider the state and alignment of your disks. Your provider may also conduct a physical exam to check your:

• Nerve function. Your provider may use a reflex hammer to check your reactions. Little or no reaction could mean you have damaged or compressed nerves.
• Pain levels. Your provider may touch or press on specific areas of your back to measure your pain levels.
• Strength. Muscle weakness or shrinking (atrophy) could mean you have nerve damage or degenerated disks.

What are the stages of degenerative disk disease?

Healthcare providers use the following four stages when diagnosing degenerative disk disease:

1. Dysfunction. Your spinal disks have started to degenerate, and you may be experiencing mild degenerative disk disease.
2. Dehydration. Your spinal disks have started to dry out, causing them to lose some of their height and flexibility. Your neck and back pain may worsen at this stage.
3. Stabilization. At this stage, your spine tries to stabilize itself, which can cause spinal stenosis and severe pain.
4. Collapse. Your spinal disks continue shrinking and the bones in your spine rub together. The damaged disks press against your nerves, causing severe pain.

How do you treat degenerative disk disease?

Usually, your healthcare provider will recommend noninvasive degenerative disk disease treatment options first. Your treatment may include:

• Physical therapy: Participating in strengthening and stretching exercises with a trained physical therapist
• Medications: Taking nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, neuromodulation medication or steroids
• Steroid injections: Injecting medicine near your spinal nerves, disks or joints to reduce inflammation and pain
• Radiofrequency neurotomy: Using electric currents to burn sensory nerves and prevent pain signals from reaching your brain

Degenerative disk disease self-care

Some people find pain relief through at-home remedies. At-home treatments may decrease pain for a short time. But they’re not a long-term treatment for severely degenerated disks. You may try:

• Physical activity. Low-impact activity like walking or swimming can strengthen back muscles and relieve some pain.
• Hot and cold therapy. Alternating ice packs and heating pads every 10 to 15 minutes up to four times per day may reduce soreness and inflammation.
• Stretching. Gentle yoga and stretching throughout the day may improve posture and relieve tension.
• Traction. Traction may improve symptoms and relieve tension.

Degenerative disk disease surgery

Most people don’t need surgery for degenerative disk disease. But if you’ve tried multiple nonsurgical treatments and have persistent pain and/or weakness, surgery may be a good option.

Your surgeon may use one of a few types of spinal decompression surgery:

• Diskectomy: Removing part of a spinal disk to relieve pressure on your nerves
• Foraminotomy: Expanding the opening for your nerve roots by removing tissue and bone
• Laminectomy: Taking out a small portion of bone from your lower spine (lamina)
• Osteophyte removal: Removing bone spurs (osteophytes)
• Spinal fusion: Connecting two or more vertebrae to improve stability

How can I prevent degenerative disk disease (degenerative disc disease) from getting worse?

You can prevent or slow the progression of spinal degeneration through lifestyle changes. Some of these include:

• Achieving and maintaining a weight that’s healthy for you
• Avoiding or quitting smoking
• Getting regular physical activity to increase strength and flexibility

Can you fully recover from degenerative disk disease?

Most people who have surgery for degenerative disk disease experience long-term pain relief. But even after surgery, you need to continue exercising and stretching to keep your back strong and healthy.

Many people use nonsurgical and at-home treatments to manage pain long term. If you have mild to moderate back pain, you’ll need to continue treatment to keep the pain at bay.

What should I avoid if I have degenerative disk disease?

Things to avoid with degenerative disk disease include:

• Smoking. Smoking can worsen your pain and make treatment less effective.
• Lifting heavy objects. Heavy lifting stresses and strains the disks in your back, especially when you do it often.
• Drinking alcohol. Drinking too many beverages containing alcohol increases your risk of back pain.
• Staying seated for long periods. If you spend too much time sitting on the couch or at your desk, your back pain will increase. So, make sure to get up and move around once in a while.
• High-impact physical activity. Sports and other physical activities that involve jumping, running and other high-impact movements can be hard on your back. Instead, try low-impact physical activities like walking and swimming.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What’s the most likely cause of my degenerative disk disease?
• How can I slow the progression of the disease?
• What nonsurgical treatments are most likely to relieve my pain?
• What will happen if I choose not to have surgery?
• How can I prevent pain from returning after surgery?