Degenerative Disc Disease: What It Means and How It's Treated
"Degenerative disc disease" is one of the most commonly reported findings on spine MRI — and one of the most frequently misunderstood diagnoses in medicine. Most people who have it have no significant symptoms. For those who do have pain, the treatment depends critically on which specific aspect of the disc disease is causing the problem.
What Is Degenerative Disc Disease?
Spinal discs are the shock-absorbing cushions between vertebrae. Like all tissues in the body, they change with age — losing water content, height, and elasticity. On MRI, this appears as disc space narrowing, loss of disc signal (dark disc), and sometimes annular tears.
Here's the important caveat: these findings are extremely common in asymptomatic individuals. Studies show that 60% of 40-year-olds and nearly all 70-year-olds have significant disc degeneration on MRI — the majority with no significant pain. Finding "degenerative disc disease" on an MRI does not mean that's the cause of your pain.
When Is DDD Actually the Pain Generator?
Disc degeneration can cause pain through several mechanisms:
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Annular tears and discogenic pain: Tears in the outer ring of the disc (annulus fibrosus) can cause pain within the disc itself. This is called discogenic pain and is diagnosed by provocative discography.
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Disc herniation: The degenerated disc becomes more prone to herniation, causing nerve root compression and radicular pain.
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Vertebrogenic pain: Modic changes in the vertebral body adjacent to a degenerated disc indicate endplate involvement and are targeted by the Intracept procedure.
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Secondary facet joint degeneration: As disc height decreases, increased load is transferred to the facet joints, causing facet arthritis — the most common pain generator in DDD patients.
Treatment by Pain Mechanism
Facet-mediated pain (most common): Medial branch blocks → radiofrequency ablation pathway provides 12–18 months of relief.
Disc herniation with radiculopathy: Epidural steroid injections, transforaminal approach for targeted nerve root relief.
Vertebrogenic pain (Modic changes): Intracept procedure — basivertebral nerve ablation.
Discogenic pain: Intradiscal treatments including ViaDisc (biologic augmentation), or intrathecal pump if severe.
Spinal stenosis from disc collapse: MILD procedure, Vertiflex spacer, or surgical decompression.
The Key Message
Degenerative disc disease on MRI is not a sentence. It's a structural finding that may or may not be causing your pain. Proper evaluation by a pain specialist — not just a radiologist's report — determines which component is truly symptomatic and what treatment is most appropriate.
Call 516-492-3100 to discuss your MRI findings and what they mean for your pain.