The Pain from Degenerative Disc Disease Don’t Always Match Up With Imaging Studies

Millions of Americans are affected by degenerative disc disease. It is not a fatal condition and surgery is not absolutely necessary. There is an important cushioning, shock absorbing function played by the intervertebral discs. Between each vertebra there is a disc which is mostly water and collagen. All together these discs allow significant range of motion. Just consider all of the various ways your back can twist and turn.

As a person ages, interestingly, they progressively lose water. It does not get replaced fully so the intervertebral discs start to get dehydrated and lose height. Most body parts and organs in humans have an active metabolism. For example, in the mouth mucosal cells get replaced weekly, and the CSF gets replaced numerous times a day.

The disc has an extremely slow metabolism, hence, a limited capability to heal. Studies have been done looking at the incidence of degenerative disc disease in patients in their 30’s and 40’s. Interestingly, over 40% of patients in their 40’s have signs of DDD on MRI and they don’t have ANY back pain.

So just having degenerative disc disease on MRI does not mean a patient will definitely have back pain. A person may have excruciating pain with insignificant evidence of DDD or it could be no pain with terrible DDD. One of the additional conditions patients may be dealing with at the same time is facet arthritis. The facet joints are in the back of the spine while the spinal disc is in the front area. If an individual’s disc is losing water and height, these joints may start to experience abnormal amounts of motion. This may end up in arthritis and pain in these joints.

If a patient is having low back pain with signs of degenerative disc disease on an MRI, the facet joints should be evaluated for signs of arthritis. But that can be elusive as well. A pain management doctor may perform a diagnostic injection in the area around the joint to see if the facet joint is actually the problem.

There really is no standard diagnostic injection that exists for the intervertebral disc. There is a procedure called a discogram which can help diagnose if the disc is truly the person’s pain generator. The doctor injects fluid into the disc to see if the pain is reproduced that the person has on a daily basis. If the answer is yes, the disc can be assumed to be the source of the patient’s pain.

Surgery for degenerative disc disease, at this point in time, consists of two options. One is to perform a spinal fusion, the second is an artificial disc replacement. Artificial disc replacement became FDA approved back in 2004 for the lumbar spine, and the hope was it would be a veritable “holy grail” for degenerative disc disease. So far, that has not been the outcome. Results have been approximately 70% good to excellent for either procedure.

The bottom line here is that low back pain from degenerative disc disease does not always correlate to the degree of the degeneration seen on imaging studies. The patient’s subjective complaints are more important than the MRI.

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