Degenerative Disc Disease

Degenerative disc disease represents a broad category of back pain resulting from or associated with the degeneration of intervertebral discs. This can also cause pathologic changes that impact the vertebral bodies, facet joints, spinal ligaments, and exiting nerve roots. Important considerations for the clinician include eliciting a detailed history, examining the spine, and choosing appropriate imaging modalities to take a wide differential diagnosis and narrow it to determine the cause of a patient’s low back pain. Treatment for degenerative disc disease begins with conservative therapy, which includes physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and possibly an epidural steroid injection. Epidural steroid injections provide the most benefit when they are used to facilitate better participation in physical therapy and core-strengthening exercises, which are more likely to provide long-term pain reduction. When pain persists despite conservative therapies, surgical management may be considered. However, surgery is more beneficial than medical therapy only for patients with disc herniation or degenerative spinal stenosis, and the pain reduction usually does not last more than a few years. Future investigation to generate effective, long-term therapies for degenerative disc disease is needed to address the burden of this common condition.