Jeffrey R. Carlson, MD
There are some medical terms that confuse patients. There are some medical terms that mean the same thing. There are medical terms that we research on the internet and then find we are more confused than before doing research. Degenerative disc disease (DDD) seems to be one of these terms.
On its face, “Degenerative Disc Disease” means exactly that. A disc in the spine is degenerating or wearing out. The word “disease” seems to be what makes the terminology confusing. Unfortunately, the word “disease” is used loosely in this medical phrase. We tend to think of diseases as bad and assign devastating consequences to medical conditions with the term “disease”. In the case of “degenerative disc disease”, the word “disease” suggests that the disc itself is not normal. Now, that doesn’t mean the disc has a devastating problem and the patient will be disabled. What this means is the disc itself has lost some of its hydration and is becoming arthritic. Therefore the disc is not like a healthy. normal, younger disc. The term “disease” could be dropped from the phrase “Degenerative disc disease” and still have the same meaning. Degenerative disc disease can also be called “arthritis of the spine”, “disc bulging”, “bone spurs” and “degenerative disc disorder”. All of these terms mean basically the same thing.
We all get degenerative disc disease if we live long enough. I’m often asked if degenerative disc disease is hereditary. Certainly, there are families whose genes will predict an earlier onset of arthritis in the back, but being genetically human also increases the risk of degenerative disc disease. There is most likely a host of factors contributing to degeneration of the disc, including diet, exercise, trauma, as well as genetic predisposition. There have been several studies that looked at the prevalence of DDD. Those studies suggest that almost all patients over 30 years of age will have some form of degenerative arthritis in the spine AND as we get older, the severity of the arthritis will increase.
Fortunately, our bodies also compensate for the degeneration. This is why the majority of people live happy lives despite the arthritis. The arthritis does not have to be a source of back pain. It certainly may be, but your doctor should investigate other reasons for your pain prior to assigning your symptoms to the arthritis. DDD is generally treated by your primary care provider, as a majority of patients will not need surgery. Anti- arthritis medications, physical therapy and chiropractic care will usually be enough to get you feeling better. Referral to an orthopaedic spine surgeon is needed when the nerves become compressed, causing pain or weakness in the arms or legs. When the arthritis pinches a nerve, the patient will experience pain along the path of the nerve that goes into the arm or leg. Pinched nerve pain is different from arthritic back pain, as pinched nerves are not a source of back pain. Loss of function in the arms or legs due to a compressed nerve should be evaluated quickly by a spine surgeon, as this may indicate the need for spine surgery.