What is Degenerative Disc Disease?

Fig. 1: Degenerative disc disease
(larger view)

Degenerative disc disease is one of the most common causes of low back pain, and also one of the most misunderstood. Many patients diagnosed with low back pain caused by degenerative disc disease are left wondering exactly what this diagnosis means for them. Common questions that are often on patients’ minds include:

• If I have low back pain from degenerative disc disease in my thirties, how much worse will it become with age?
• Will the degenerative disc disease become a crippling condition? Will I end up in a wheelchair?
• Should I restrict my activities?
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• Can I still play sports?
• Will the degenerative disc disease spread to other parts of the spine?
• Will the low back pain from degenerative disc disease cause any permanent damage?

Degenerative disc disease is a misnomer

A large part of many patients’ confusion is that the term “degenerative disc disease” sounds like a progressive, very threatening condition. However, this condition is not strictly degenerative and is not really a disease:

• Part of the confusion probably comes from the term "degenerative", which implies to most people that the symptoms will get worse with age. The term applies to the disc degenerating, but does not apply to the symptoms. While it is true that the disc degeneration is likely to progress over time, the low back pain from degenerative disc disease usually does not get worse and in fact usually gets better over time.
• Another source of confusion is probably created by the term "disease", which is actually a misnomer. Degenerative disc disease is not really a disease at all, but rather a degenerative condition that at times can produce pain from a damaged disc.

Disc degeneration is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.

Medical practitioners disagree on degenerative disc disease

Finally, many patients are confused about degenerative disc disease because many medical professionals don’t agree on what the phrase describes. In practical terms, this means that few practitioners agree on what does and does not constitute a diagnosis of degenerative disc disease. Even medical textbooks don’t usually attempt to give an accurate description. Therefore, while many practitioners believe that degenerative disc disease is a common cause of low back pain in young adults, very few agree on the implications.

While there is still a lot of debate in the medical community about degenerative disc disease, a few aspects of the condition are known. This article will discuss aspects of degenerative disc disease that are more commonly accepted, such as the theory of the degenerative cascade, as well as some areas of theory that are still a source of debate in the medical community.

• Peter F. Ullrich, Jr, MD

November 29, 2005

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