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  • Q&A with Australian Health Practitioners

    What is degenerative disc disease?

    Related Topics
    Back & Neck Pain Pain
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    Joel Laing

    Physiotherapist

    I am a McKenzie Method specialised physiotherapist, with a Diploma in Mechanical Diagnosis & Therapy. Using the McKenzie Method I predominantly treat low back and … View Profile

    It refers to a disc that on MRI looks degenerated (usually the fluid in the middle has reduced so the disc looks darker or black and is called a dessicated disc), and typically over time this disc will have reduced height (referred to on the scan as disc narrowing). 

    This happens to everyone as we age, which is why we get shorter!

    The issue is that is disc that shows degeneration on a MRI is not necessarily causing pain. If it is the painful source it is usually the nature of the disc bulging at this level, and not the degeneration as such. Disc dessication (a narrowed, darker degenerative disc) can occur at one isolated level or two (as opposed to the gradual changes seen in the majority of discs with ageing). 

    What causes this dessicated disc is usually some kind of traumatic injury to the disc, which causes micro-fractures in the vertebral end-plate (the edge of the vertebra that touches the adjacent disc). This end plate fracture is so tiny it would not typically show up on x-ray. Blood vessels come in to repair the end-plate fracture, and these blood vessels contact the adjacent disc (which does not usually get exposed to a blood supply). This contact with the blood vessels changes the metabolism of the disc, and it shrinks (darkening on MRI scans, and reducing in height) over time.

    This in itself is NOT thought to cause pain.

    The main issue is that over time if the height of a particular disc is narrowed, the space behind the disc for the nerves (the spinal canal) gets reduced. This can eventually give rise to canal stenosis (leg pain that typically occurs in older individuals while walking, from the nerves getting compressed in the spinal canal that has a reduced space. The narrowing of the disc also causes the facet joints (joints that connect one vertebra to another) to be closer approximated, which can contribute to facet joint pain (more common over age 55+). 

    SO IN SUMMARY
    A degenerated disc in itself is not usually the source of pain can increase your incidence of facet joint problems or canal stenosis down the track over many years.

    Many people with a degenerated disc that are young do experience pain, but it is usually from the disc bulging (due to certain postures and positions adopted) and not from the degenerative disc as such. eg your disc could cause identical issues without degeneration

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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Disc degeneration is considered a normal part of aging and for most people and does not present with symptoms. However, for certain individuals a degenerated disc can cause severe constant chronic pain.

    Degenerative disc disease remains a debated topic within health sciences, however attempts have been made to explain the changes that occur.

    Degenerative discs typically show degenerative fibrocartilage and clusters of chondrocytes, suggestive of repair. Inflammation may or may not be present. There may be splits in the annulus fibrosis (outer edge of the disc), permitting herniation of elements of nucleus pulposus (protein within the disc, similar to a thick toothpaste). There may also be shrinkage of the nucleus pulposus that produces prolapse or folding of the annulus with secondary osteophyte formation at the margins of the adjacent vertebral body.

    End stage degenerative disc disease may lead to protrusion,spondylolysis and/or subluxation of vertebrae (sponylolisthesis) and spinal stenosis.

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