The natural history of lumbar degenerative disc disease is relatively benign. The pain tends to be intermittent, and although at times the pain may seem to be getting worse, the painful symptoms are generally not progressive.
While the disc degeneration will progress, the low back pain and other symptoms do not tend to get worse with the progression of the degeneration.
Understandably, many patients worry that if they have a lot of low back pain when they are only 35 years old, the pain will become much worse and they may be in a wheelchair by the time they are in their sixties.
However, if patients can find a way to manage their back pain and maintain their function, the natural history is really quite favorable. With continued disc degeneration, all the inflammatory proteins within the disc space will eventually burn out, and the disc will usually become stiffer, thus decreasing micro-motion.
In fact, someone who is 65 years old is actually less likely to have discogenic back pain than someone who is 35 years old.
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Therefore, degeneration on an MRI scan cannot be used as the sole diagnostic tool for lumbar degenerative disc disease.
Disc degeneration present on an MRI scan, often described as disc dessication or a black disc/dark disc, is not synonymous with a diagnosis of lower back pain that is caused by degenerative disc disease. The MRI findings need to be corroborated by the findings of the patient's history and physical exam.