Disc Degeneration: What Is It?

by Christina Lasich, MD Health Professional

Spinal disc degeneration is not a disease. In other words, disc degeneration is not an abnormality in the normal human body. By itself, disc degeneration does not cause pain. Disc degeneration is the natural aging process that causes normal changes in the spinal discs.

Donald was sitting in the cold, sterile exam room. He comes here every year for his annual check-up with his doctor. But, this time he has a question on his mind. What is disc degeneration? His mother, who has had low back pain for a number of years, was told that her lumbar discs have degenerated. Because her pain has become so debilitating, she now uses a walker to get around. Being afraid of his future, Donald wants to learn about disc degeneration. He does not want the same fate as his mother's fate.

Even though it is inevitable, people worry about disc degeneration. All of the parts in the human body change as they age. Skin degeneration is the most visible sign of aging. Wrinkles, cracks, fissures, and looseness are all seen as the skin matures. The skin does not hurt, but it sure looks different over time. This same transformation also occurs to the spinal discs. By itself, an aging spinal disc, like the aging skin, is not painful. In fact, 80% of people who have disc degeneration do not have pain. They have "asymptomatic" (without an indication of disease) disc degeneration. Unfortunately, the deterioration process can cause a chain reaction of consequences. As the disc dries and cracks, it is likely to develop bulges, ruptures and tears. As the disc deflates, spinal stenosis and degenerative spondylolisthesis are the possible results (see related articles). These secondary problems are the reason an aging spine can go from being asymptomatic to having symptoms of pain, stiffness, and sciatica-symptomatic disc degeneration.

Donald's discs have been unknowingly degenerating since early childhood. But, unlike his mother, he does not have the secondary changes which cause pain (Yet). He wants to know if he is going to end up like his mother with terrible back pain. Hearing her patient's concerns, the doctor begins to ask about Donald's lifestyle and health. Her patient works as a contractor and smokes a pack of cigarettes per day. Occasionally, a twinge of back pain will disrupt Donald's life, but it is nothing compared to what his mother is experiencing.

Disc degeneration does start in early childhood; but, even with a magnetic resonance image (MRI) which shows the discs very well, it is hard to predict if and when pain will strike. These pictures just do not distinguish between painful structures and non-painful structures. Thus, prediction and prognosis are mainly focused on evaluating the risk factors. The risk for developing accelerated disc degeneration has been well studied because this rapid change in the spine is highly likely to cause secondary problems. Recently, a team of researchers have strongly concluded that genetic factors are the primary driving force behind disc degeneration. Bad backs run in families. Unfortunately, genetics are currently unchangeable. But, there are other risk factors that can be modified like occupations, smoking, and body mechanics. By minimizing the risks, one can certainly improve his/her chances of living with disc degeneration comfortably.

That is what most people do: live with disc degeneration comfortably. Change is inevitable and the body is able to adapt to the natural deterioration of the spine. Naturally, the spine will remain asymptomatic over a lifetime. But when pain strikes, it is important to make the distinction between "symptomatic" disc degeneration and "asymptomatic" disc degeneration because this distinction will point to the actual issue causing pain called the pain generator. Spinal disc degeneration is only the snowball at the top of the hill waiting to cause an avalanche of painful, secondary problems. Knowing the risks for tipping this "snowball" over the edge is how solutions for spine pain are discovered. Since researchers have laid the ground work of definitions, causes, and risks, everyone can now look forward to treatment and prevention which lie just around the corner.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.