Degenerative Disk Disease
What is degenerative disk disease?
Disk degeneration is a normal part of aging. It’s also known as degenerative disk disease (DDD).
The degeneration develops over time. It affects the rubber-like disks between vertebrae — the small bones that make up the spinal column (backbone).
The disks act like cushions between those bones. When the cushions wear away, the bones can start to rub together. This contact can cause pain and other problems, such as:
- Adult scoliosis, where the spine curves.
- Herniated disk, also called a bulged, slipped or ruptured disk.
- Spinal stenosis, when the spaces around your spine narrow.
- Spondylolisthesis, when vertebrae move in and out of place.
How common is intervertebral disk degeneration?
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.
Are certain people more likely to get DDD?
Certain people have a higher chance of developing disk degeneration:
- People who are very overweight.
- People who experience trauma to the spine.
- Professional drivers (for example, taxi and truck drivers).
Symptoms and Causes
What causes DDD?
A healthy back contains a number of rubbery cushions called disks. Each disk sits between a set of vertebrae, the bones that stack up to make the spinal column. Together, the discs allow a person to bend, twist and move freely.
As we age, our disks begin to wear away, for several reasons:
- Activities or sports can cause small tears in the discs over the years.
- Discs dry out or get weak over time.
- Injury can cause discs to break down faster.
Because discs are primarily composed of collagen and have a relatively poor blood supply, they do not heal like other parts of the body.
What are the symptoms of DDD?
When disks wear down too much, the vertebrae rub together. The grinding of the bones can cause:
- Tingling or numbness.
- Trouble with movement.
- Weakness in the legs or foot drop (can’t raise the front part of one or both feet).
What does degenerative disk pain feel like?
Degenerative disk pain:
- Can happen in the neck or lower back.
- May extend into the arms and hands or into the butt and legs.
- Can be mild, moderate or severe.
- May start and stop.
- Can get worse after certain activities such as bending, twisting or lifting.
- Can get worse over time.
Diagnosis and Tests
How is DDD diagnosed?
If you have symptoms of disk degeneration, you should tell a healthcare provider. The healthcare provider will:
- Review your medical history with you.
- Examine your body to see where it hurts.
- Ask you to describe what makes the pain worse or better.
- Ask you to rate your pain on a scale of zero to 10.
What tests might I get?
The healthcare provider might order some tests to take pictures of the bones and disks in your spine. The tests may include:
Management and Treatment
Treatment for DDD usually starts with medications to control pain. It also involves physical therapy, or rehabilitation.
Common medications used to treat DDD include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or meloxicam.
- Gabapentin, a membrane-stabilizer.
- Steroid injections into the disk area.
Physical therapy is also helpful to treat DDD. It can include many different strategies:
- Adjustments to the way you move (for example, how you lift a box) to lessen pain and avoid injury.
- Aquatic exercises, since being in the water takes pressure off your muscles and joints.
- Corrections to your posture.
- Joint mobilization or manipulation, which moves your joints in different directions to improve range of motion.
- Plans for exercising at home.
- Soft tissue mobilization, which puts deep pressure on muscles to stretch them and reduce tension.
- Strengthening your core, the muscles supporting your back.
- Stretches for flexibility.
- Traction, or gentle pulling of the arms and legs, often using ropes and weights.
How long will I need to do physical therapy?
Most people with DDD have rehabilitation one to three times a week for several weeks or months. Your rehabilitation needs will depend on:
- The severity of your symptoms.
- Your goals.
- Your insurance coverage.
You’ll “graduate” from physical therapy when you have reached your goals. Still, your healthcare provider will want you to exercise at home and stay active.
Will I need surgery for disk degeneration?
If more conservative options don’t work, some people choose to have surgery for disk degeneration. Options may include:
- Artificial disk replacement: Artificial disk replacement is also called total disk replacement. It involves surgery to remove the damaged disk (diskectomy). The surgeon then implants a manufactured device that looks and acts like a disk.
- Diskectomy and spinal fusion: A diskectomy surgically removes a damaged disk. Spinal fusion then joins vertebrae together for stability. To make the connection, the surgeon uses a bone graft. This piece of bone comes from elsewhere in your body or from a deceased donor. The graft fuses with your spine. The surgeon will also place screws, rods, hooks or plates into the bones of the spine. The hardware hold bones together so they fuse.
How can I reduce my risk of disk degeneration?
Disk degeneration eventually happens to everyone. You can’t prevent it, but you can slow it down and take action to protect your vertebrae:
- Focus on good posture.
- Keep your core muscles strong.
- Maintain a healthy weight.
- Quit smoking.
- Stay active.
- Use good technique when you move, twist and lift to prevent injury.
Outlook / Prognosis
What is the outlook for people with DDD?
Without treatment, disk degeneration usually gets worse over time. But pain medications, physical therapy and sometimes surgery can reduce pain and improve movement.
Researchers continue to study DDD, particularly ways to delay and treat it.
What can I do to help ease the symptoms of DDD?
Several strategies can help you manage DDD pain:
- Do your physical therapy exercises at home exactly as you were shown.
- Keep your core muscles strong to support your back and neck.
- Take your pain medications as prescribed.
- Use good posture when sitting and standing.
- Use heat and cold on the area that hurts.
A note from Cleveland Clinic
Disk degeneration is a natural part of aging once you turn 40. Still, if you develop pain in your neck or back that does not respond to over-the-counter pain medications, talk to a healthcare provider. Medications and therapy can control the symptoms of disk degeneration and help you stay active.