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Degenerative Disc Disease on MRI
Diagnosis of degenerative disc disease seen on MRI is deceptive, confusing, and misinterpreted.

Degenerative Disc Disease seen on MRI is the most common diagnosis as the cause of spine pain.

Despite how common it is, the diagnosis of Degenerative Disc Disease(DDD) is deceptive, confusing, and often misinterpreted.

Degenerative disc disease (DDD) is associated with changes in the intervertebral discs of the spine.

Difference between Healthy Disc and Degenerative Disc

Misinterpreting general pain as Degenerative Disc Disease (DDD) seen on MRI can have several negative consequences. It can result in increased fear, pain, disability, and excessive healthcare expenses on treatments that may not be effective or come with risks. Moreover, it can also hinder patients from identifying the underlying cause of their pain.

Many myths surround DDD that lead to its misdiagnosis. So, I’d like to debunk 5 myths about DDD that may make you question if this diagnosis was ever accurate, to begin with.

 

1)  Disc Degenerative Disease(DDD) is a Real Disease:

Many different diseases can cause chronic back or neck pain. A few examples are Multiple sclerosis, Rheumatoid arthritis, Lyme disease,  Ankylosis spondylosis…

Diseases are typically characterized by a specific set of signs and symptoms, which aid in their diagnosis using predefined criteria. However, DDD does not meet these criteria. DDD refers to the degenerative changes occurring in the intervertebral discs of the spine. 

Nevertheless, it raises the question of whether these degenerative changes should be classified as a “disease” considering their prevalence in individuals both with and without spine pain.

Degenerative changes observed in this data do not indicate a disease but rather reflect the natural effects of bodily use over time. This begs the question: why do we persist in labeling this common age-related adjustment as a “disease”?

Degenerative Disc Disease seen on MRI does not have clear diagnostic criteria. The criteria used to diagnose disc-related problems are ambiguous, inconsistent, & rely on questionable imaging findings.[3] 

The diagnosis of degenerative disc disease (DDD) is applied to a broad range of conditions, varying from minimal degenerative changes to extensive damage. However, it is important to note that these changes may not always be the direct cause of the pain experienced. 

Furthermore, DDD can be diagnosed in the presence of different disc anomalies, including mild disc height loss, disc cracks, as well as severe disc protrusions or extrusions.

Without a clear set of diagnostic criteria, the diagnosis of DDD will always be mislabeled.

2)  Disc Degenerative Disease is caused by old age.

Welcome to the human race: as you age, your spine deteriorates just like your skin wrinkles and your hair turns gray. We may even call it arthritis which is nothing but wrinkles inside.

But here is the real data. The graph explains the details. As you age, the degeneration of the spine gets worse, but when you see the prevalent back pain that is most common from age 40-60. 

Aging and lower back pain graph

Degenerative disc disease conditions are not only associated with the older population but also seen in young people as well.

A study of young women in their twenties found that 31% of the women enrolled in the study were living with degenerative disc disease that progressively worsened throughout the course of the study. [5]

Another study of patients under 21 years old found that for some, degenerative disc disease does begin earlier than in most. The study showed that 76 of the 1,877 young people included in the study had degenerative disc disease.[6]

3)  Disc Degeneration Disease (DDD) seen on MRI is causing all back or neck pain.

DDD is causing all the pain.

Disc degeneration usually gets diagnosed with MRI or X-ray after a patient complains of back pain. The truth is the vertebral discs don’t have a blood supply or nerve supply. So for all the wear and tear you subject on the disc, you will not experience pain in them at all. It must be something else.

But there are many studies that show how common disc degeneration changes are even in people without back pain.

A 2015 systematic review of 33 articles reported just how common degenerative changes are in individuals without pain.[1] The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. This study, and many others, demonstrate that these degenerative changes are a normal part of the aging process.[1,2] Pain likely is coming from something else.

4)   Diagnosis of Degenerative Disc Disease (DDD) helps you find the right and effective treatment.

The question is how exactly do you treat the diagnosis of DDD? There really is no specific medication or procedure to correct the degeneration. BUT there are established treatments for spinal stenosis, spondylolisthesis, spondylolysis (big words, I know), facet, and joint arthritis related to back pain. Most of the time, treatment for DDD consists of pain medications, injections, procedures, or surgery, just like all other chronic pain conditions.

All of them just put a Band-Aid on your symptoms and provide temporary relief. Eventually, the pain returns and comes with a price that is side effects and risks.

5)  Degenerative Disc Disease(DDD) is progressive and not curable.

You can slow down your degeneration by working on mobility and core strengthening exercises. If you are able to function independently with less pain, that wear and tear don’t matter much. Am I correct???

Myth # 5

The misdiagnosis of DDD leads to more problems & prevents chronic pain sufferers from ever finding the root cause of pain.

This data should make us question the diagnosis of DDD. Disc Degeneration changes seen on MRI can truly cause the pain? Or are those degenerative changes just an incidental finding? Could you have a normally aging spine with pain caused by factors not seen on an X-ray or MRI?

Statistically, it’s more likely that your stubborn pain is related to nervous system hypersensitivity than to disc degenerative changes seen on MRI. While you can have both, the best approach will address those invisible changes that occur in the nervous system and improve mobility and strength to focus on function.

Watch the video to understand at a deeper level.

That’s why:

I designed Therapeutic Pain Relief@ Programs that teach you more about those hidden nervous system changes that helps to persistent pain conditions, improve your mobility and function, and much more. The program goes in-depth into the neuroscience of pain & then addresses pain with nervous system retraining drills, strategies, and skills.

Learn more about our Therapeutic Pain Relief Programs.

References:

[1] Brinjikji, W et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR. American journal of neuroradiology vol. 36,4 (2015): 811-6. doi:10.3174/ajnr.A4173

[2] Malik, Khalid M et al. “Diagnostic criteria and treatment of discogenic pain: a systematic review of recent clinical literature.” The spine journal : official journal of the North American Spine Society vol. 13,11 (2013): 1675-89. doi:10.1016/j.spinee.2013.06.063

[3] Louw, Adriaan et al. “De-educate to re-educate: aging and low back pain.” Aging clinical and experimental research vol. 29,6 (2017): 1261-1269. doi:10.1007/s40520-017-0731-x

[4] Taylor, J R, and L T Twomey. “Age changes in lumbar zygapophyseal joints. Observations on structure and function.” Spine vol. 11,7 (1986): 739-45. doi:10.1097/00007632-198609000-00014

[5] Makino, Hiroto et al. “Lumbar disc degeneration progression in young women in their 20’s: A prospective ten-year follow up.” Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association vol. 22,4 (2017): 635-640. doi:10.1016/j.jos.2017.03.015

[6] Dimar, John R 2nd et al. “Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging.” The spine journal : official journal of the North American Spine Society vol. 7,3 (2007): 332-7. doi:10.1016/j.spinee.2006.03.008

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