Overview
Degeneration of the intervertebral disc, often called "degenerative disc disease" (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one's life. While disc degeneration is a normal part of aging and for most people is not a problem, for certain individuals a degenerated disc can cause severe constant chronic pain.

Symptoms
With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting. Chronic neck pain can also be caused in the upper spine, with pain radiating to the shoulders, arms and hands.

Understanding disc pain
After an injury, some discs become painful because of inflammation. Some people have nerve endings that penetrate more deeply into the annulus fibrosus than others, making discs more susceptible to becoming a source of pain. The scientific community has the opinion that the healing process involved in the repair of trauma to the outer annulus results in the innervation of the resultant scar tissue, and subsequent pain in the disc, as these nerves become inflamed by nucleus pulposus material. Degenerative disc disease can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life. When pain from degenerative disc disease is severe, traditional nonoperative treatment is often ineffective.

Pathologic changes
Micrograph of a fragment of a resected degenerative vertebral disc, showing degenerative fibrocartilage and clusters of chondrocytes. HPS stain.

Degenerative discs typically show degenerative fibrocartilage and clusters of chondrocytes, suggestive of repair. Inflammation is, usually, not present. Histologic examination of disc fragments resected for presumed DDD is routine to exclude malignancy.

Treatment options
Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, chiropractic manipulative therapy (CMT) and other chiropractic treatments, osteopathic manipulation, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs, traction, or spinal injections often provide adequate relief of these troubling symptoms.

Surgery may be recommended if the conservative treatment options do not provide relief within two to three months. If leg or back pain limits normal activity, if there is weakness or numbness in the legs, if it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary, most often spinal fusion. There are many surgical options for the treatment of degenerative disc disease. The most common surgical treatments include:
    * Anterior cervical discectomy and fusion
    * Cervical corpectomy
    * Facetectomy
    * Foraminotomy
    * Intervertebral disc annuloplasty (IDET)
    * Intervertebral disc arthroplasty
    * Laminoplasty
    * Laminotomy
    * Micro-discectomy
    * Percutaneous disc decompression
    * Percutaneous Laser Disc-Decompression (PLDD)
    * Spinal decompression
    * Spinal laminectomy

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