Degenerative disc disease sounds like something serious that will only get worse. It ISN’T really a disease, and for most people it doesn’t mean a crumbling spine.
It’s a label for the normal wear that happens to the discs, the cushions between the bones of your spine, as you get older. Almost everyone has some disc wear after 40, and many of them have no pain at all.
If your back hurts and a scan shows disc wear, the wear may be part of the story, or it may just be your age showing. Exercise, staying active and time help most people.
Surgery is for a small group.
What the label actually means
- Discs dry out with age. Each disc has a tough outer ring and a softer, jelly-like center. Over the years the center loses water, and the disc gets a little flatter and stiffer
- “Degenerative” means changing with age. It doesn’t mean wasting away
- “Disease” is misleading. It describes how a disc looks on a scan. It isn’t a diagnosis of what’s causing your pain
- A “black disc” on an MRI is a disc that has lost some water, so it shows up darker on the scan. It’s very common
- Other words you may see include disc bulge, loss of disc height, bone spurs and facet joint arthritis. They often turn up together, and they’re common in people without pain too
How common disc changes are without pain
Scans of adults with NO back pain show disc wear in more than 1 in 3 people in their 20s, rising to more than 9 in 10 by age 80. More than 8 in 10 pain-free 60-year-olds have at least one “black disc”.
- Your scan may look older than you feel. The wear was probably there for years before your pain started
- How bad it looks doesn’t predict how much it hurts. Some people with a lot of wear have little pain, and some with very little have plenty
- Wear doesn’t mean fragile. Your spine is strong and adapts to the loads you put through it. For most people with disc wear, bending, lifting and exercise are safe
Disc wear is like gray hair on the inside. Almost everyone gets it, and it doesn’t decide how your back feels.
So what’s causing the pain?
Back pain is usually a mix of things: sore joints and muscles, sensitive nerves, how strong and active you are, sleep, stress and worry. Worn discs can be part of it, but they’re rarely the whole story.
If a worn disc bulges or pushes out and presses on a nerve, it can cause pain down the leg. That’s a different problem with its own path. See slipped disc and sciatica.
With age, wear can also narrow the space around the nerves, causing leg ache and heaviness when you walk. See spinal stenosis.
Will it get worse?
Disc changes on a scan usually creep along slowly with age.
Pain doesn’t follow the same path. Back pain with disc wear tends to come and go, with good spells and flare-ups. A flare-up doesn’t mean your spine is getting worse.
What helps
- Keep moving: walking and staying active help more than resting. Long spells in bed slow recovery
- Exercise you’ll stick with: strengthening, Pilates, yoga, swimming and walking all help back pain. No single type is clearly best, so choose one you enjoy and can keep doing
- Break up sitting: get up and move every 20 to 30 minutes
- Physio: a physio can build your strength and confidence, and give you a plan for flare-ups
- Pain relief for flare-ups: anti-inflammatory painkillers help some people. Check with your pharmacist that they’re safe for you
- Look after sleep, stress and general fitness: they change how much back pain you feel
When surgery is considered
Most people with degenerative disc disease don’t need surgery.
- Leg pain from a pinched nerve that stays severe despite good nonsurgical care, or leg weakness that’s getting worse. Here an operation to take pressure off the nerve can help
- Back pain alone is harder to fix. When fusion has been compared with an intensive program of exercise and education for long-standing back pain, results were broadly similar, and the operation carried extra risks. See spinal fusion recovery
- Disc replacement swaps a worn disc for an artificial one. It’s an option for a carefully selected few, and it isn’t offered everywhere
- Ask what the operation will change. A good surgeon can tell you in plain words which symptom it should help, and by how much
Go to the emergency department now if
These can be signs of cauda equina syndrome, where the bundle of nerves at the bottom of the spine is being squashed. It’s rare, but it needs hospital assessment the same day. Don’t wait to see if it settles.
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Numbness around your genitals, buttocks or inner thighs, the area that would touch a saddle
- Weakness or numbness in BOTH legs, or pain down both legs
- New problems getting an erection, or loss of feeling during sex
Get it checked if
- Your foot catches or slaps when you walk, or a leg is getting weaker
- New back pain isn’t improving at all after 4 to 6 weeks
- You also have a fever, weight loss you can’t explain, or a history of cancer
- The pain is constant and worse at night, whatever position you’re in
Your discs show your age, but your strength and activity decide how your back feels.