Degenerative disc disease in the spine is basically wear and tear of the discs. As we get older, the water, the hydration within the discs tends to leave and you end up with a drier disc.
Now, degenerative discs don’t necessarily cause any pain. It’s very common to get an MRI and see degenerative discs that are totally asymptomatic. When discs cause pain, it’s because there’s a tear inside of the disc and the inflammatory proteins on the inside of the disc have oozed out and they’re irritating the outer third of the crust of the disc where there are nerve fibers.
When degenerative disc disease is causing axial lower back pain, the treatment approach generally focuses on taking away the inflammation from around the disc and stretching and strengthening the appropriate muscles through exercise, through physical therapy, to help take the pressure off of the disc so that the pain doesn’t return. Often that starts with exercise, with physical therapy, with stretching and strengthening, and getting all the mechanics right with posture to unload the spine to take the pressure off to allow the disc to, essentially, heal.
There are some other modalities along the way. Oral medications can help control the pain, allow a person to continue with physical therapy. Within physical therapy, there are other modalities, passive modalities like TENS units, and ultrasound, and manual manipulations, and massage to help control the symptoms and also, in a smaller way, to help take away the inflammation from around the disc.
When symptoms are persistent despite these exercise physical therapy modalities, or if the pain is getting in the way of a person actually participating with the exercises, then there are other modalities, such as injections, to help take away the inflammation from around the disc, typically through an epidural steroid injection.
An epidural steroid injection is not going to fix a disc. It’s not going to put hydration back into the disc, nor will it necessarily change, nor will it change the tear within the disc. But it will do is it’ll reset the inflammatory clock back down to zero. And what this does is it allows a person to take advantage of this window of opportunity, during which they can do more with the physical therapy. They can tweak the biomechanics so that, ideally, the inflammation doesn’t return because the same stresses aren’t going through the disc.
In rare instances. when discs aren’t responding to more conservative measures and the pain is just persisting and it’s interfering with quality of life, it’s certainly appropriate to have a conversation with a spinal surgeon about surgical alternatives.