Treatment for Degenerative Disc Disease: How to Find the Right One for You

The human spine is made of 33 connecting bones called vertebrae. In between these bones are cartilage discs, which work as shock absorbers. They protect the vertebrae from the impact of activities like running, jumping, and bending. ​​

With age, it’s normal for these discs to wear down. Some people’s discs wear down faster than others. When this happens, it can cause pain. This is called degenerative disc disease or discogenic pain. It’s more likely to occur in the neck (cervical spine) and low back (lumbar spine) than the mid back.

Treatment options are available, and research is underway on many others. Here, we’ll cover degenerative disc disease, its symptoms, and how to find the right treatment for you.

What is degenerative disc disease?

Degenerative disc disease (DDD) is a condition where changes in your spinal discs (disc degeneration) cause pain. As mentioned, it’s normal for discs to break down a little over time. The disc becomes thinner and tissues within the disc start to separate. 

As the disc degenerates, part of it might stretch beyond its normal shape (disc herniation).

There can also be bony overgrowth in the adjacent vertebrae (called osteophytes, or bone spurs). 

Many people don’t feel symptoms from age-related vertebral disc changes. In fact, about 80% of 50-year-olds without back pain have disc degeneration found on imaging tests. But when disc degeneration starts to cause pain, doctors call it degenerative disc disease.

Treatment options for degenerative disc disease

Treatment of DDD usually involves a combination of therapies. Your spine specialist or doctor can tailor a treatment plan just for you. Here are the most common options.

Rest

It’s a good idea to take a break from aggravating activities for a short while. But complete bed rest is not recommended, since this can lead to further stiffness and muscle weakness. If your work requires aggravating physical activity, talk with a healthcare professional and/or workplace about getting work accommodations. 

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Medications 

Medications can help relieve pain and make daily activities more tolerable. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen work to target inflammation causing neck or back pain. Studies don’t find that one NSAID is better than another. Over-the-counter (OTC) and prescription options are available. 

Other medications were common at one time, but studies show they don’t work very well for discogenic pain. They also have high potential for side effects. These include muscle relaxers (such as methocarbamol) and nerve pain medications (such as gabapentin). They might help if you also have muscle strain or nerve pain, but they’re not great for DDD. 

Most clinicians don’t recommend or prescribe opioids. This is because they are not effective for pain caused by DDD, and there’s a high potential for abuse and addiction. 

Physical therapy

A rehab program can make a big difference in living with back or neck pain. Physical therapy for DDD usually focuses on the muscles of the pelvis, trunk, and core. Physical therapists are experts in how the body moves, so they can recommend the best exercises and stretches to optimize your mobility and function. These simple stretches can get you started.

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) is a type of mental health therapy that focuses on the relationship between thoughts and emotions. It involves working with a mental health specialist to address your belief patterns and find coping strategies. CBT is helpful for many conditions, including degenerative disc disease. Research suggests CBT can decrease pain and disability in people with chronic low back pain but works best with other treatments like physical therapy.

Procedures

When noninvasive treatments don’t provide relief or stop providing relief, a minimally invasive procedure may be an option. This is typically performed by a spine specialist, who can help determine which one will be best for you. They’ll use X-ray or another type of imaging to make sure treatment gets to the right place. These procedures include: 

• Epidural injection: A specialist injects a steroid (powerful anti-inflammatory medication) into the space surrounding the spinal cord to reduce inflammation. 

• Radiofrequency ablation (also called rhizotomy): Heat from radiofrequency can destroy tissues. This procedure targets the sensory nerves in the disc and vertebrae so pain signals no longer register with the brain.

• Regenerative cell therapy: This treatment involves injecting materials from your own body into the unhealthy disc. This includes platelet-rich plasma (PRP), which uses growth factors from your blood, or mesenchymal stem cells (MSC) from your bone marrow or fat tissue. The goal is to help regenerate healthy disc tissue. While promising, more research is needed before these treatments are considered “standard of care.”

Surgery 

Surgery may be an option if DDD is accompanied by (or causes) other conditions like a herniated disc or spinal stenosis. This is especially true if symptoms are worsening despite conservative (nonsurgical) treatments.

For DDD alone, surgery is reserved for when all other treatment options have failed. This is because surgery success rates aren’t great, especially in the long term. And there are many risks and possible complications associated with any surgery, including surgery on the spine. That said, it makes sense to look into all the options if you’re suffering. 

The most common procedures include: 

• Spinal fusion: A spinal fusion involves using a bone graft to get the vertebra above and below the problematic disc to fuse together. This realigns them or eliminates movement at that level. This usually improves pain due to DDD, but it can cause problems above and below the level of fusion later.

• Discectomy: This surgery removes the herniated portion of a disc that’s causing problems. A discectomy is often performed with fusion, especially if you have DDD and disc herniation. 

• Disc replacement: This is a newer treatment than fusion. It involves replacing the degenerated disc with an artificial one, which allows more movement. Disc replacement also allows for a quicker recovery time than with fusion. But durability of artificial discs remains a concern. 

Your spine surgeon will help you decide which procedure, if any, might be right for you.

How does degenerative disc disease develop?

There are many factors that contribute to DDD:

• Disc thinning and damage occurs from age, injuries, or other stresses on the spine. 

• The circular fibers in the outside of the disc start to separate and fray.

• The discs lose water over time, becoming less resilient.

• The cartilage part of the disc (and in the facet joints nearby) breaks down.

• The nearby vertebrae get bony spurs.

• The number of small pain-sensing nerves increases.

The combination of all these changes leads to inflammation, swelling, and pain. These processes can be triggered by an injury and/or other stress, but sometimes there’s no trigger.

Who’s most at risk for developing degenerative disc disease?

Certain factors may make someone more likely to develop DDD than other people. These are called risk factors, and they include:

• Increasing age 

• Genetics

• Mechanical stress on the disc (injury, heavy lifting, etc.)

• Female sex

• Having a body mass index (BMI) of 30 or higher, which is considered overweight 

• Smoking 

Symptoms of degenerative disc disease

DDD symptoms depend on the severity of disc damage, and whether the damage is contained to one area. Symptoms usually include:

• Pain in the neck or back

• Stiffness

• Limited motion 

• Difficulty sitting for long periods of time

Sometimes the changes in the spine affect nearby structures. For example, bony overgrowth or disc herniation can compress the space where the spinal cord or nerves travel. This can cause:

• Focal or shooting pain in the arms (from DDD in the cervical spine) or legs (from DDD in the lumbar spine) 

• Numbness or tingling in the arms (cervical) or legs (lumbar)

• Weakness or loss of dexterity in the limbs

In rare cases, spine problems in the low back can compress the nerve roots at the bottom of the spine. This is called cauda equina syndrome. In addition to the symptoms above, it also causes numbness in the genital region, changes in bladder or bowel control, and sexual dysfunction. If you have any of these types of symptoms, get medical attention immediately. 

How is degenerative disc disease diagnosed?

The discs aren’t always to blame for neck or back pain. Muscle strain is a common cause of back pain, for example. So the best way to figure out what’s causing your symptoms is to get a medical evaluation. 

This includes getting a full history of your pain, including when it started, what other symptoms you have, and anything that makes it better or worse. A thorough physical exam can usually help your doctor or other healthcare professional figure out the problem. They’ll probably also order imaging tests like X-rays or magnetic resonance imaging (MRI), especially if:

• You’ve had pain for more than a few weeks.

• Your pain started with an injury.

• You have concerning symptoms, like fever, bowel or bladder problems, or limb weakness.

You might also need blood tests to rule out autoimmune causes of back pain. Examples include ankylosing spondylitis and psoriatic arthritis.

A test called discography can help in rare cases. It involves injecting a substance into the disc to confirm the source of pain. It’s a specific test but was found to actually cause more harm to the disc, so most experts no longer recommend it.

What can you do to lower your risk of developing degenerative disc disease?

There are some things you can’t avoid, like your genetics, and getting older. But there are some steps you can take to lower your risk of DDD if you don’t already have it:

• Avoid heavy lifting and sitting or standing for long periods of time.

• Avoid or limit high-impact activities (like running). 

• Get to or maintain a balanced weight to take pressure off your spine.

• Quit smoking, if you smoke. 

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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