Degenerative Disc Disease
Common on an MRI. Treated by finding what actually hurts.

Discs lose water and height with age, and small tears can form. Despite the name, it is a normal aging process rather than a disease. Symptoms, when present, include low back or neck pain that worsens with sitting or bending and stiffness. If a nerve is irritated, pain can spread into the leg or arm.

In large imaging studies, disc degeneration shows up in about a third of pain-free people in their 20s and in most pain-free people over 60. Pain often does not match the pictures. That is why the exam and movement testing matter as much as the scan.

Repair first, surgery last:

• exam, movement testing and imaging review
• rehabilitation: core and hip strength, directional preference and graded loading
• medication review
• image-guided procedures performed with ultrasound or X-ray guidance where they fit: epidural steroid injections for nerve pain, only when needed, and medial branch blocks and radiofrequency ablation when the facet joints are the source
• regenerative options discussed selectively and honestly

Injections of PRP or cell-based treatments into the disc are still investigational for disc pain. Early studies are promising but limited, and they are discussed case by case.