Degenerative disc disease is a bit of a misnomer and is not necessarily a ‘disease.”
The long-term prognosis of DDD is quite favorable. Back pain is actually at its highest in people in their 50s, not in their older age, even though DDD is more common in people who are in their 60s, 70s, and 80s.
As described in this article: https://pubmed.ncbi.nlm.nih.gov/22883425/
If you are wondering what causes DDD at a cellular level, check out this in-depth article I wrote a little while back.
Will DDD progress as I get older?
It is likely that the loss of disc height will progress as you get older.
However, this does not mean that you will have increased pain.
You may experience increased pain from this, but you may also not experience any pain at all.
This is the main challenge with making a definitive diagnosis for something like lower back pain. There can be many causes but we can almost never say for certain that one thing is the cause of it.
Most of us want to know the one exact cause because we think it will change the treatment, however, this isn’t the case.
I think part of the reason we believe this is that for other conditions, like chronic kidney disease, cancer, or diabetes, the disease is clear, and the treatment methods are fairly straightforward.
With musculoskeletal pain this is not the case. This is even more-so true with back pain. There are dozens of structures that could be pain generators and then it’s possible that there is nothing that shows up on the MRI but there could be some microscopic cellular changes that are taking place that we can’t visualize.
Our diagnostic ability for lower back pain and determining cause and effect is in its infancy at the moment.
Pain and Diagnostic Imaging Are Weakly Correlated
I’ve shared this before in previous articles but it’s worth mentioning again. An imaging finding of a disc bulge, degenerative changes, meniscus tears, labrum tears, and other findings may or may not be correlated with pain.
It’s critically important to do a clinical examination that includes an in-depth history taking and physical examination.
More often than not when I am performing this in-depth history and physical examination I find that the symptoms that my client is experiencing is not even related to the imaging finding. Many times the imaging finding is on the opposite side of where it hurts! Go figure!
Is Surgery Ever Indicated For DDD?
If the pain becomes so severe, you’ve gone through at least 3+ months of physical therapy, you’ve received injections, and you tried a variety of different treatment methods, then a surgical procedure may be the appropriate option.
There are many different types of surgical options available now in 2020 and beyond including disc replacement, laminectomies, and more. It’s not only spinal fusions that are available.
Spinal fusion surgery has largely been a failure and I rarely recommend this to folks who have stable spines without and neurological changes.
If you have severe spinal stenosis causing neurological changes, it’s possible that a fusion or other procedure may be appropriate but this is always going to be best decided by having a conversation with your surgeon.
Get a second opinion
Prior to deciding whether you should get spine surgery or not, I recommend getting a second, third, and sometimes even fourth opinion to see if there is consensus on what should be done.
This takes time and money to complete however it’s better to do your due diligence before undergoing surgery which is not a reversible process.
Physical Therapy and Conservative Rehab Can Take a Long Time
If you were only in physical therapy for 6 weeks it’s very possible this was not enough time to improve.
I’ve worked with clients who required over a year of consistent movement therapy to start seeing significant progress.
The key here is that the program should be changing over time and new things should be tested to make sure they are working.
Too often I’ve had clients who went to therapy before for six weeks, it “didn’t work,” and then all of a sudden they have a surgery scheduled… but what they don’t know is that most people take six months to recover from the issue without surgery… not six weeks!
If your expectation is not in line with the reality of the recovery process you will always be disappointed.
- Neck and back pain peaks in middle age and then decreases as we get older (on average)
- Degenerative disc disease usually does not need to be treated surgically
- If you do not have progressive neurological symptoms, conservative treatment (non-operative) is the best option