Conditions · Carrollwood · Tampa Bay
Degenerative Disc Disease
What the words on your imaging report actually mean, what they do and do not tell you, and how a doctor trained in spinal MRI interpretation connects the picture to the person.
It is 11pm, the report is on your phone, and the word your eye keeps returning to is disease. That word is carrying more than the anatomy underneath it: this is not an infection, it does not spread from one disc to the next, and it is not something you caught or can pass on. It is the label a radiologist uses when one or more discs, the cushions between the bones of your spine, no longer look on a scan the way a new disc looks. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reading the report with the person it belongs to is part of the examination here. Bring yours.
Degenerative Disc Disease Overview
What the words on your report mean
A spinal disc sits between two vertebrae, the bones of your spine, and does two jobs: it cushions, and it holds the two bones apart. It is built like a jelly doughnut, a tough outer ring of fibers called the annulus wrapped around a soft, water-rich center called the nucleus.
The vocabulary is not improvised. For the low back, the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology developed a shared nomenclature, an agreed vocabulary that keeps report wording consistent from one reader to the next and sorts individual terms into preferred, nonpreferred, nonstandard, and colloquial.1 Translating it is the first step. Whether any of it explains what you feel is the second.
1. Fardon DF, et al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-2545. PubMed
Degenerative disc disease, or DDD
The name written on a report when one or more discs do not look on a scan the way a new disc looks. It is a label for what the picture shows, at the level or levels where the radiologist saw it.
Also written as: DDD, degenerative disk disease, disc degeneration, intervertebral disc degeneration, degenerative disc changes, or the phrase degenerative changes with nothing after it. A report may name the levels, as in degenerative disc disease at L4-L5, L5-S1, or C5-C6, and may say multilevel when the same wording applies at more than one level.
Disc desiccation, or a dark disc on MRI
A disc holds a lot of water, and water looks bright on an MRI. Desiccation means a disc is holding less water, so it appears darker on the scan than the discs around it, which is where dark disc and black disc come from.
Also written as: desiccated disc, diffuse disc desiccation, disc dehydration, dehydrated disc, dark disc, black disc, loss of T2 signal, decreased T2 signal intensity, or loss of disc signal. T2 is a standard MRI setting, and signal is how bright something appears on it.
Disc space narrowing, or loss of disc height
These phrases mean the disc space measures shorter on the scan than a full-height disc space. A report may say collapsed disc for the same measurement, or note a vacuum phenomenon, a small pocket of gas in that narrowed space.
Also written as: narrowed disc space, loss of disc height, disc height loss, reduced intervertebral disc height, collapsed disc, degenerated disc, thinning disc, worn disc, or vacuum disc phenomenon.
Spondylosis, or degenerative spine disease
Umbrella words for changes described across the spine as a whole rather than at a single disc: the discs, the small joints at the back of each level, and the bone around them. Cervical means the neck, thoracic the mid-back, lumbar the low back, so cervical spondylosis and lumbar spondylosis are the same umbrella applied to different regions.
Endplate changes, also written as Modic changes
The endplate is the thin layer of bone and cartilage where a disc meets the spine bone above and below it. Endplate changes, which radiologists usually number as Modic type 1, 2, or 3, mean the MRI shows a difference in that layer, and the numbers describe the scan rather than what anything feels like.
Also written as: vertebral endplate changes, degenerative endplate changes, Modic type 1 or type 2, or endplate sclerosis, which means that layer of bone appears denser in the picture. A Schmorl’s node, often listed alongside these, is a small dip where disc material sits into the endplate.
Osteophytes, or bone spurs, and facet findings
An osteophyte, or bone spur, is extra bone along the edge of a vertebra or a facet joint, the pair of small joints linking each spine bone to the one above it. Facet arthropathy and facet hypertrophy are the phrases for those joints rather than the disc. Reports commonly list these in the same sentence as disc findings, so one paragraph can name several separate things at once.
Also written as: osteophyte formation, osteophytic spurring, spinal bone spurs, facet arthropathy, facet hypertrophy, degenerative joint disease of the spine, spinal osteoarthritis, arthritis of the spine, or the everyday phrase wear and tear of the spine.
Many reports name a bulge, a protrusion, or a herniation alongside these words. Those are a different family of findings with their own page: herniated and bulging discs. Two more words travel with all of it: discogenic means coming from a disc, and radiculopathy means a nerve root is irritated or compressed, so symptoms follow that nerve into an arm or a leg.
A finding is not a diagnosis
Two research reviews sit on either side of this. In a research review of 33 studies covering 3,110 people who had no symptoms at the time of their scans, disc degeneration was reported in about 37% of people at age 20 and about 96% of people at age 80.2 In that review, it was reported more often in the older age groups, and about 63% of the 20-year-olds did not have it reported at all, so it is not present on every scan at every age. Now the other side. A meta-analysis of 14 studies covering 3,097 adults aged 50 or younger compared low back MRIs of people who reported low back pain against people who reported none. What did not line up: annular fissures, meaning small tears in the tough outer ring of a disc, and spondylolisthesis, meaning one vertebra sitting forward of the one beneath it, were not found significantly more often in the people reporting pain, and neither were Modic changes, narrowing of the spinal canal, or a bright area in the outer ring called a high-intensity zone. Disc degeneration was different. It showed up on MRI more often in the adults reporting low back pain than in those reporting none, with odds a little over twice as high (odds ratio 2.24, 95% confidence interval 1.21 to 4.15, meaning the estimate is compatible with anything from somewhat higher to about four times higher).6 That is an association measured across those studies, not a cause.
So it cuts in both directions, and both matter. A finding on your report is not automatically the source of your pain, and treating the picture instead of the person can mean treating the wrong thing. Your pain is also not less real because the same words appear on other people’s reports: in that meta-analysis, disc degeneration showed up more often on the MRIs of the adults reporting low back pain. Whether your finding explains your symptoms depends on which level it sits at, what it sits next to, and whether that lines up with where you hurt. The report is the starting point. The examination connects it to you.
2. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PubMed
Symptoms, and the warning signs we screen for
These words appear on the reports of people who describe very different days. Some come in with stiffness that is heaviest in the first hour after waking or after a long stretch in a chair. Some describe an ache in the low back or the neck that changes with position and comes and goes across a week. When a nerve root nearby is involved, the symptoms travel: pain, tingling, or numbness down a leg, the pattern many people know as sciatica, or down an arm from the neck. The grading words a radiologist adds describe the picture on the screen, not you.
Common, and examined here
- Back or neck pain with degenerative changes named on a report
- Stiffness after waking, or after sitting for a long stretch
- Pain, tingling, or numbness traveling into a leg or an arm
- Pain that moves around and is hard to point to
- An imaging report nobody has ever explained to you
Emergency, not an appointment
- New loss of bowel or bladder control
- New numbness in the groin, buttocks, or inner thighs, the area a saddle would touch
- Leg or foot weakness getting worse quickly, or a foot that drops or catches when you walk
- New clumsiness in the hands, trouble with buttons or a key, or a change in balance or walking
- New neck or back pain together with fever or chills
The first three can signal cauda equina syndrome, a surgical emergency. Hand clumsiness or a change in balance can signal pressure on the spinal cord in the neck. Go to the emergency department now. This is part of what the examination here screens for.
How we approach degenerative disc findings
The examination comes first, every time: your history, a physical and neurological examination, and your imaging report read with you, not at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for exactly this conversation, and the visit answers the question the report cannot: does what is on the film account for what you feel, and if not, what does? That is the whole point of the Pain Source Exam.
When conservative care fits, it is built from the examination rather than from the report: gentle techniques including flexion-distraction, which stretches the spine slowly with no thrust, instrument adjusting, hands-on soft tissue work, dry needling for muscles that are guarding an area, and movement you can actually fit into your week. It is monitored: we say what we expect to change and by when, and if that does not happen, the plan changes rather than repeats.
Some presentations belong with another physician, and we say so. Strength that is measurably slipping between visits, a report the examination cannot account for, a history that raises the question of fracture or infection, or a pattern that looks inflammatory rather than mechanical: those get a referral and your records sent with you. Making sure you are in the right room is part of the job here.
Hurt in a car accident? Care after a crash runs through a different door: Florida’s PIP law requires care to begin within 14 days. Start at our auto accident page.
What the research shows
The first two studies below are randomized trials, studies where people agreed to let chance assign them to surgery or to a nonsurgical program so the two paths could be compared fairly, and the third is a research review that pooled the results of many separate trials.
The first was a single trial, and a small one: 64 adults aged 25 to 60 who had low back pain for more than a year and disc degeneration at L4-L5, L5-S1, or both agreed to be assigned either to fusion surgery or to a nonsurgical program of education and exercise. The trial was single-blind, meaning the examiner scoring the results was not told which treatment each person had received. At the one-year visit both groups had improved on the Oswestry Disability Index, a standard questionnaire scoring how much back pain limits everyday activities: the score fell from 41 to 26 after surgery and from 42 to 30 after the nonsurgical program, a difference between the groups that was not statistically significant, and leg pain improved more in the surgery group.3
The second trial was larger. In it, 349 adults aged 18 to 55 who had low back pain for at least a year and were considered candidates for spinal fusion were assigned either to fusion surgery or to an intensive rehabilitation program built on cognitive behavioral principles, an approach that works on how a person thinks about and responds to pain while rebuilding activity. Over the two years of the trial both groups reported less disability, improvement the authors noted was possibly unrelated to the treatments themselves. The one statistically detectable difference, on the same Oswestry disability score, favored surgery, and it only just reached the level the researchers had defined in advance as clinically meaningful. The authors concluded that no clear evidence emerged that fusion surgery was more beneficial than the rehabilitation program.4
The research review asked a broader question: does exercise help long-lasting low back pain at all? It combined 249 trials of adults who had low back pain for more than 12 weeks without a specific cause identified. In that review, exercise therapy was associated with less pain than no treatment, usual care, or placebo, about 15 points on a 0 to 100 pain scale, the difference the reviewers had set as clinically important, and the authors graded this as moderate-certainty evidence, meaning exercise is probably effective for pain. The improvement in day-to-day function was smaller, about 7 points, which did not reach the 10-point level the reviewers defined as clearly meaningful to a patient. That is evidence about chronic low back pain in general, not about disc degeneration specifically.5
All three are group results, not a prediction for you, and working out what any of it means for the person holding your report is what the examination is for.
3. Brox JI, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine (Phila Pa 1976). 2003;28(17):1913-1921. PubMed
4. Fairbank J, et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ. 2005;330(7502):1233. PubMed
5. Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. PubMed
6. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394–2399. PubMed
Common questions about degenerative disc disease
Is degenerative disc disease actually a disease?
Not in the way that word usually lands. It is the name for what a scan shows when one or more discs no longer look like a new disc. It is not an infection, it does not spread from one disc to the next, and there is nothing to catch or pass on. What it means for you is settled by an examination.
My report says degenerative disc disease at L4-L5 and L5-S1. Does that mean my spine is wearing out?
Those are level names, the two lowest discs in the low back, and they tell you where the radiologist saw something. They do not tell you what you can lift, how long you will hurt, or what happens next. Two people can have the same two lines and be having completely different weeks, which is why the report is read alongside the examination.
Is this going to keep getting worse?
Nobody can read that off a report. A scan is one day. What can be done is measure where you are now, what moves, what does not, what has strength and what is losing it, and recheck those same measures on a schedule so change is observed rather than guessed at. If the measures move the wrong way, that is the signal to escalate or refer.
What does disc desiccation mean on my MRI?
A disc holds a lot of water, and water is bright on an MRI. Desiccation means a disc is holding less water than it once did, so it looks darker than the discs around it, which is where dark disc and black disc come from. Whether it has anything to do with your symptoms is an examination question.
I was in a car accident and my report says degenerative changes. Does that mean the crash is not why I hurt?
That is a question about cause, and a scan does not answer it alone. An imaging report describes what a picture looked like that day, not when anything began. We examine you, document what we find, and record how you function now against what you could do before. Florida’s PIP law puts a clock on it: care must begin within 14 days. Start at our auto accident page.
Is degenerative disc disease the same thing as arthritis in my spine?
They are different words about different parts of the same report. Degenerative disc disease describes the disc, the cushion between two spine bones. Spinal arthritis, facet arthropathy, and degenerative joint disease describe the facet joints, the pair of small joints at the back of each level. Which of them, if any, is producing your symptoms is what the examination sorts out, and joint pain is examined the same way.
Does degenerative disc disease mean I will end up needing surgery or a fusion?
That is not something a report decides. Surgical decisions belong to surgeons, and they rest on the examination, the symptoms, and how someone responds to care rather than on a phrase in a radiology report. When the examination raises a surgical question, the job is to get you in front of the right physician with your records.
Can chiropractic care help degenerative disc disease, or could getting adjusted make it worse?
The examination decides, and it decides before anything is done. Technique is chosen for the person in front of us: flexion-distraction, which stretches the spine slowly with no thrust, instrument adjusting, soft tissue work, and dry needling are all available, and so is the answer that manual care is not the right fit for you right now. Two findings weigh heavily on that choice: how much height the disc has already lost, and whether there is arthritis in the same segment. Both show on imaging, both change what is appropriate, and Dr. Koser works through that decision with you rather than for you. You will be told which technique you are getting and why.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring the report. Have it explained to you.
A complete examination with Dr. Bobby Koser, DC, your imaging report reviewed with you, and your findings explained the same day.