I get messages all the time from people in your exact situation. They’ve been given a scary diagnosis: Degenerative Disc Disease. The next recommendation is almost always spinal surgery, and they’re left wondering if there’s another way. If this sounds familiar, you are not alone. That diagnosis doesn’t always tell the whole story. Often, the true source of pain isn’t the disc itself, but the weakened tissues around it. Before you consider an invasive procedure, let’s explore what might really be going on and how your body can be supported to repair the damage.

  • I then write back, “what is the nature of your serious back problem?“
  • The answer? “I have significant degenerative disc disease showing up on MRI and I need a surgery. Can you help me avoid the surgery?”
  • I then answer, “How long have you had this back pain?”
  • The answer I usually get back, “I had this for years.”

Back Pain for Years, But Your MRI Looks “Normal”?

Over the years we have seen many patients with a long history of back pain. Most of the time it was nondescript back pain and no one was sure what was causing it. The problem, according to some patients, was the MRI did not show enough damage or irregularities to justify an aggressive surgical treatment. So the patient became “pain managed,”  with prescription medications, painkillers, anti-inflammatories, and possibly a few courses of physical therapy, possible chiropractic care, and then epidural steroid or cortisone injection. Eventually the patient will get a follow up MRI and one day, someone will find something on an their MRI that needs a surgery.

Sometimes the person will tell me they are lucky, if they have to get the surgery, they will only need a Discectomy or a minimally invasive microdiscectomy. Same day surgery. Regardless of the procedure, this person is sitting in our exam room because they do not want the surgery no matter how minimally invasive it is. A surgery is still a surgery and you need to be under general anesthesia.

I would like to invite you to review some of my other articles for your further research:

  • Epidural steroid injections do not prevent back surgery – they accelerate the need for it
  • The compelling research questioning spinal surgery based on MRI evaluation

Common Causes and Risk Factors

The primary driver behind degenerative disc disease is simply the natural aging process. However, some factors can speed up this wear and tear or make you more susceptible to symptoms. Genetics plays a role, so if your parents had back problems, you might be more likely to experience them too. A significant back injury from a fall or accident can also initiate or accelerate disc degeneration. Repetitive strain from a physically demanding job or certain sports can put extra stress on your spine over time. Additionally, lifestyle factors like obesity can increase the load on your spinal discs, contributing to their breakdown.

Symptoms to Watch For

The most common sign of degenerative disc disease is a persistent, aching pain in the lower back or neck. This pain can range from a nagging, low-level ache to severe and disabling pain that radiates into your arms or legs (a condition known as radiculopathy). Many people find the pain worsens when they sit for long periods, bend, or lift something heavy, and feels better when they walk or lie down. The pain isn’t always constant; it can flare up for a few days or weeks and then subside. If this pain is impacting your quality of life, exploring non-surgical options like PRP Therapy can be a way to address the underlying cause.

When to See a Doctor Immediately

While most symptoms of degenerative disc disease can be managed, there are a few red flags that require immediate medical attention. According to Johns Hopkins Medicine, you should see a doctor right away if you experience sudden muscle weakness in your arms or legs, or a loss of strength that makes it hard to stand or hold objects. Worsening numbness or tingling in your limbs is another urgent sign. If you have difficulty walking or experience any loss of bladder or bowel control, it could indicate a serious issue like severe nerve compression that needs to be addressed without delay.

What Mayo Clinic Researchers Discovered About Low Back Pain

Is It a Disc Problem or a Spinal Ligament Injury?

So when is it a disc problem that needs surgery and when is it a spinal ligament weakness problem that does not need surgery? Doctors at the Mayo Clinic (1) have published a paper entitled: Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. In this paper the Mayo Clinic researchers wanted to make a clear definition between two problems affecting low back pain patients.

  • First, that pain could be coming from the discs.
  • Second that pain could be coming from the spinal ligaments.

The Mayo researchers suggest that recognizing how the spine moves is essential for distinguishing between the many different types of spinal disorders, and a diagnosis which may ultimately, and erroneously lead to back surgery.

  • If a patient has instability, excessive movement, and decreased stiffness, doctors should examine for ligament damage.
  • If the opposite, less movement, more stiffness, the doctor should look for disc disease.

The Standard Path for Diagnosis and Treatment

If you’re dealing with persistent back pain, you’re likely familiar with the typical medical journey. It often starts with a visit to your primary care doctor and can lead to specialists, a series of tests, and various treatment plans. Understanding this standard path can help you make more informed decisions about your care. It’s a process designed to rule out serious conditions and find the source of your pain, but it often follows a predictable sequence of steps. This journey usually begins with a thorough conversation and physical check-up before moving on to more advanced diagnostics and treatments, which can range from conservative therapies to more invasive procedures if initial efforts don’t bring relief.

How Doctors Diagnose DDD

The first step in addressing your back pain is getting an accurate diagnosis. For suspected degenerative disc disease, your doctor will use a combination of methods to understand what’s happening in your spine. This process is about gathering clues—from how you describe your pain to what imaging scans reveal about your spinal structures. The goal is to pinpoint the cause of your symptoms so a targeted treatment plan can be developed. It’s a systematic approach that combines your personal experience with objective medical evidence to form a complete picture of your condition and guide the next steps in your care.

Physical Exam and Medical History

Your initial appointment will likely involve a detailed conversation about your health. Your doctor will want to know about your symptoms, when the pain started, and what activities make it feel better or worse. Be prepared to discuss any other sensations you’re experiencing, like numbness or tingling, as this helps locate the affected nerves. A physical exam will follow, where your doctor will check your range of motion, muscle strength, and reflexes. This hands-on assessment provides crucial information about how the condition is affecting your body’s functional mechanics and overall stability. If you’re ready to begin this process, you can schedule a consultation to discuss your history.

Imaging and Nerve Studies

If your doctor suspects a structural issue, they will probably order imaging tests. An X-ray is often the first step to check the alignment of your vertebrae and look for bone spurs. For a more detailed view of your spinal discs and nerves, your doctor may recommend an MRI or a CT scan. These scans can reveal disc height loss, herniation, or other changes associated with DDD. While these images are incredibly useful, it’s important to remember they are just one piece of the puzzle and don’t always correlate with the level of pain a person feels, which is why a comprehensive evaluation is so important.

Common Non-Surgical Treatments

Before considering more invasive options, the standard approach is to try conservative, non-surgical treatments. The primary goal here is to manage your pain, reduce inflammation, and improve your function so you can get back to your daily activities. This phase of treatment can last for weeks or months and often involves a combination of different therapies. Many people find significant relief with these methods, which focus on strengthening the body and alleviating symptoms without the need for surgery. It’s a crucial step in finding a sustainable solution for your back pain and improving your overall quality of life.

Physical Therapy and Medication

Physical therapy is a cornerstone of non-surgical back pain treatment. A therapist will guide you through specific exercises designed to strengthen the muscles that support your spine, which can improve flexibility and reduce pressure on your discs. Alongside physical therapy, your doctor might suggest medications to manage your symptoms. Over-the-counter pain relievers like NSAIDs are commonly used to decrease pain and swelling. In some cases, prescription medications or muscle relaxants may be recommended to provide more significant, short-term relief while you work on long-term strengthening and stability through therapeutic exercise.

Injections and Other Procedures

When pain persists despite physical therapy and medication, your doctor might suggest injections. The most common type is an epidural steroid injection, which delivers a strong anti-inflammatory medication directly to the area around your spinal nerves. These shots are intended to reduce swelling and interrupt pain signals, offering temporary relief. Because they don’t address the underlying cause of disc degeneration, many people explore regenerative treatments like PRP Therapy, which uses your body’s own healing factors to target the source of the pain and promote tissue repair, offering a more foundational solution.

When Is Surgery Considered?

Surgery is typically seen as a last resort for degenerative disc disease. It’s usually only considered when you have debilitating pain that hasn’t responded to months of non-surgical treatments and significantly impacts your quality of life. Other red flags that might lead to a surgical consultation include progressive neurological symptoms, such as worsening leg weakness or numbness. Because surgery is a major decision with inherent risks, many people seek out non-surgical alternatives. Regenerative options like Stem Cell Therapy aim to help the body repair damaged tissue and avoid such an invasive procedure.

Spinal Fusion and Disc Replacement

Two of the most common surgical options for advanced DDD are spinal fusion and artificial disc replacement. During a spinal fusion, a surgeon removes the problematic disc and joins the adjacent vertebrae together into a single, solid bone. This procedure is designed to eliminate painful motion at that spinal segment. In an artificial disc replacement, the damaged disc is removed and replaced with a mechanical device that mimics the natural movement of a healthy disc. The choice between these procedures depends on various factors, including the extent of your condition, your age, and your surgeon’s recommendation.

Decompression Surgeries

If the primary issue is a nerve being pinched by a herniated disc or bone spur, a decompression surgery may be recommended. Procedures like a discectomy involve removing the portion of the disc that is pressing on the nerve. In other cases, a laminectomy or foraminotomy might be performed to remove small pieces of bone, creating more space for the spinal cord and nerves. These surgeries are focused on relieving pressure and alleviating symptoms like radiating pain, numbness, or weakness, rather than addressing the overall degenerative health of the disc itself.

Could a Misdiagnosis Lead to Unnecessary Back Surgery?

In our own published peer-review research appearing in the July 2018 in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018, (2) we examined treating spinal ligaments with low back pain. Below is an explanatory adaption of the introductory paragraph of that study. It gives a good understanding of the importance of understanding that we should be looking at the ligament problems in back pain.

  • An Orthopaedic Knowledge Update from the American Academy of Orthopedic Surgeons tells its surgeon members that muscle strains, ligament sprains, and muscle contusions account for up to 97% of low back pain  in the adult population (3)
  • Additionally, researchers wrote in the Spine Journal that spinal ligaments are often neglected compared to other pathology that account for LBP (4). This could be due to the overreliance of MRIs to guide physicians to correct diagnoses. They write: The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint pain are described being related to these ligaments.When these ligaments are damaged or weakened, they serve as generators of low back pain.
  • Two studies illustrate that patients without symptomatic back pain displayed MRI abnormalities including degenerative disc changes [5,6].
    • In the first study researchers wrote that “imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant. . . Many treatments (therefore) have proven inefficacious, and some have proven counterproductive, (because of errounous interpretation)
    • In the second study, researchers wrote that in making treatment decisions, “patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management. These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance.”
  • Yet patients with these same diagnoses are recommended for surgery without a thorough understanding of their pain generator.
  • Canadian researchers found that 55.7% of lumbar spine MRIs were considered inappropriate or of uncertain value to diagnosis [7].

What the research shows us is that surgeons to be on the look out, 97% of the time it is not the discs causing pain. The MRI can be misleading and send a patient to surgeon with a “disc problem.”

Why You Might Still Have Pain After Back Surgery

Researchers in Germany take the idea of discs vs ligaments a step further, they suggest that while surgery can repair the obvious problems of disc disease and be successful, the surgeon must be keenly aware that soft-tissue damage, the ligaments and supportive structures of the spine, can be significant and severe and the surgeons must balance surgical and non-surgical intervention to prevent surgical failure.(8)

Can Regenerative Medicine Help Degenerative Disc Disease?

I have written many articles on stem cell therapy and how they change the degenerative disease environment of the inner spine to a healing environment. When stem cells are injected into the spine or joint they initially set up a line of communication with the native immune system and begin exchanging messages. The stem cells tell the immune cells to call healing factors to the site of spinal damage and to meet them at the points where repair is needed. This is when healing begins.

A recent paper (9) from Australian researchers explains how this change of  environment works.

  • When introduced into a diseased joint or spine, stem cells display plasticity and multipotency. This is the ability to change/morph into other cell types and multiply. They also signal the native stem cells and other growth factors to regroup and begin repairing damaged joints.
  • Mesenchymal stem cell MSCs (connective tissue stem cells) suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The treatment inhibits damaging chronic inflammation.

Is It a Simple Back Sprain or a Surgical Disc Problem?

In these and other papers and studies I will cite below, the indirect injection treatment of a degenerative discs and resulting strengthening of the spinal ligaments and tendons suggest that maybe doctors should think the patient only has a back sprain and not a disc related surgical condition.

The chronic lower back pain patient typically experiences some type of trauma or overuse to the lower back that causes injury to the iliolumbar, interspinous, and supraspinous ligaments, the ligaments that hold the pelvis to the vertebrae and spinal processes in place.

Ligaments are designed to handle a normal amount of stress that stretches them to their natural limit, returning to their normal length once the stress is removed. If additional (traumatic) stress is applied, and this stretches the ligament beyond its natural range of extension, the ligament does not return to its normal length but instead remains permanently overstretched, diminishing its integrity and attachment to the bone.

Unlike muscle tissue, ligaments and tendons have a very limited circulatory system and a poor supply of blood to regenerate them. This is why ligaments may not heal and instead can remain in a weakened and irritable inflammatory state.

Here is a remarkable statement from the medical journal Spine:
“As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature.”(10). In other words, very few doctors are looking for a back sprain as cause of chronic low back pain.

How Stem Cell Injections Work for Herniated Discs

Because these surgical procedures and MRIs deal with the problems of the spine as being disc related, there is an assumption that our regenerative non-surgical injections of Platelet Rich Plasma and  stem cells are injected directly into the disc. This is not how our treatment works. Our treatment works by regenerating and repairing the damaged supportive tissue of the spine; the ligaments I mentioned above and the tendons at the enthesis. The enthesis is the special connective tissue that attaches the ligaments and tendons to the bones.When these supportive tissues are rebuilt, the spine sometimes does something really wonderful, it heals the pain by slowly pulling that vertebrae back into alignment and with it, the herniated bulging disc.

Research in the medical journal Stem cells translational medicine suggests that stem cells, without direct injection to the site of disc lesions in the spine, can repair disc lesions by changing the healing environment of the spine.

Highlights of this research:

  • Stem cells are effective in inhibiting disc degeneration and disc herniation by way of the complex interplay between themselves and immune system cells in achieving successful disc tissue regeneration. The stem cells regenerated the outer tissue of the disc and contained and lessened the bulge.
  • Remarkably, stem cells were able to bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Everything heals with more oxygen.
  • Stem cells were able to reduce or prevent herniation by suppressing the non-healing inflammation.(11)

Exploring PRP Therapy for Low Back Pain

Research has shown Platelet-Rich Plasma Therapy (PRP) to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability and stimulating the regeneration of the discs indirectly (discs were not injected directly but showed an increase in disc height).

The same research cites that as in any medicine, the sooner the degeneration is addressed, the better the results in patient satisfaction. PRP is no exception. “The administration of PRP has a protective effect on damaged discs in the acute and delayed injection settings representing clinical treatment with PRP in the early versus late stages of the degenerative process. It appears that earlier intervention in the disease process would be more beneficial than PRP treatment of already severely degenerated discs.”(12)

In our research, Treatment of Chronic Low Back Pain with Platelet-Rich Plasma Injections, published in the journal Cogent Medicine (13) we wrote:

  • Platelet-Rich Plasma (PRP) is a non-invasive modality that has been used to treat musculoskeletal conditions for the past two decades. Based on our research, there were no publications that studied the effect of PRP on unresloved lower back pain. The aim of this study was to report the clinical outcomes of patients who received PRP injections to treat unresolved lower back pain.

Methods: 

  • 67 patients underwent a series one, two, or three PRP injections into the ligaments, muscle, and fascia surrounding the lumbar spine.
  • Patients who received two treatments received injections a mean 24 days apart and patients who received three treatments received injections a mean 20.50 days apart.
  • Baseline and posttreatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared to baseline and between groups.

Results: 

  • Patients who received one PRP injection reported 36.33% overall improvement and experienced significant improvements in active pain relief.
  • These same patients experienced improvements in resting pain and functionality score, yet these results were not statistically significant. Patients who received a series of two and three treatments experienced significant decreases in resting pain and active pain and reported 46.17% and 54.91% total overall improvement respectively. In addition, they were able to perform daily activities with less difficulty than prior to treatment.

You can read more about this paper and link to the study here: Darrow research study PRP back pain

References:

1 Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin. 2015 Sep 24:1-10.
2 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461. 5/
3 An HS, Jenis LG, Vaccaro AR (1999) Adult spine trauma. In Beaty JH (Eds.). Orthopaedic Knowledge Update 6. Rosemont, IL: American Academy of Orthopedic Surgeons pp. 653-671
4 Hammer N, Steinke H, Lingslebe U, Bechmann I, Josten C, Slowik V, Böhme J. Ligamentous influence in pelvic load distribution. Spine J. 2013 Jun 5. pii: S1529-9430(13)00402-6. doi: 10.1016/j.spinee.2013.03.050.
5. Kovacs FM, Arana E (2016) Degenerative disease of the lumbar spine. Radiologia 58(1): 26-34.
6 Franz EW, Bentley JN, Yee PPS, et al. (2015) Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine 22(5): 496-502.
7 Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE (2013) Overuse of Magnetic Resonance Imaging. JAMA Intern Med 173(9): 823-825.
8 Roetman B, Schildhauer TA. [Lumbopelvic stabilization for bilateral lumbosacral instabilities: indications and techniques]. Unfallchirurg. 2013 Nov;116(11):991-9. doi: 10.1007/s00113-012-2338-1. German.
9 Davatchi F, et al. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016 Mar;19(3):219-25
10  Von Forell GA, Stephens TK, Samartzis D, Bowden AE. Low back pain: A biomechanical rationale based on “patterns” of disc degeneration. Spine (Phila. Pa 1976). 2015 May 20.
11 Cunha C, Almeida CR, Almeida MI, Silva AM, Molinos M, Lamas S, Pereira CL, Teixeira GQ, Monteiro AT, Santos SG, Gonçalves RM, Barbosa MA. Systemic Delivery  of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration. Stem Cells Transl Med. 2016 Oct 11. pii: sctm.2016-0033.
12 Gullung GB1, Woodall JW, Tucci MA, James J, Black DA, McGuire RA. Platelet-rich plasma effects on degenerative disc disease: analysis of histology and imaging in an animal model. Evid Based Spine Care J. 2011 Nov;2(4):13-8. doi: 10.1055/s-0031-1274752.

Managing DDD for the Long Term

Prognosis and Lifestyle Adjustments

Getting a diagnosis of degenerative disc disease can feel overwhelming, but it’s important to remember that it’s a condition, not a sentence. The prognosis is often quite positive, and many people continue to lead full, active lives with the right management plan. The key is to shift your focus from a quick fix to a long-term strategy for spinal health. This involves addressing the underlying issues, not just masking the pain. Treatments like PRP Therapy aim to repair damaged tissues and reduce inflammation, creating a better environment for healing. However, the success of any treatment is amplified by your daily habits. Think of it as a partnership: the treatment provides the foundation for repair, and your lifestyle choices protect and build upon that foundation for lasting relief.

Preventative Measures to Protect Your Spine

Protecting your spine is an ongoing practice, and small, consistent changes can make a huge difference in managing DDD and slowing its progression. Maintaining a healthy weight is one of the most effective things you can do, as it reduces the daily load on your spinal discs. Regular, low-impact exercise like swimming, walking, or gentle yoga helps strengthen the core and back muscles that act as a natural brace for your spine. It’s also crucial to be mindful of your posture and ergonomics, especially if you sit for long periods. Simple adjustments to your chair or desk setup can prevent unnecessary strain. These proactive steps are essential for supporting treatments like Prolotherapy, which works to strengthen weakened ligaments, ensuring your spine remains stable and resilient for years to come.

Frequently Asked Questions

My MRI clearly shows degenerative disc disease. Does this automatically mean I need surgery? Not at all. An MRI is just one piece of the puzzle, and it’s important to remember that imaging results don’t always match up with pain levels. Research shows that many people without any back pain have signs of disc degeneration on their MRIs. Often, the true source of pain isn’t the disc itself but the weakened ligaments and other supportive tissues around it that are struggling to keep your spine stable. Surgery is a big step, and it’s worth exploring whether strengthening these underlying structures could resolve your pain first.

The post mentions ligament damage. How can I tell if my back pain is from my discs or my ligaments? This is a great question and gets to the heart of the issue. A key indicator can be how your spine moves. Generally, pain from disc degeneration is associated with stiffness and less movement in the spine. In contrast, pain originating from ligament damage often results in instability, a feeling of weakness, or excessive movement in your back. A thorough physical examination by a doctor experienced in regenerative medicine can help determine the true generator of your pain, moving beyond what an image alone can show.

How exactly do treatments like PRP and stem cell therapy help if they aren’t injected directly into the disc? Think of it like repairing the foundation of a house instead of just patching a crack in the wall. Our approach focuses on healing the entire support system of your spine. By injecting regenerative treatments into the damaged ligaments and tendons surrounding the vertebrae, we stimulate your body’s natural repair process. As these tissues get stronger and tighter, they provide the stability your spine needs. This increased support can reduce the pressure on the disc, alleviate pain, and create a healthier environment for long-term healing.

I’ve had back pain for years and tried everything from physical therapy to injections. Is it too late for regenerative treatments to work? It’s rarely too late to support your body’s ability to heal. Many of the patients we see have long histories of chronic pain and have tried numerous other treatments without lasting success. While earlier intervention is always ideal, regenerative medicine works by addressing the underlying instability and tissue damage that other treatments don’t. By targeting the root cause, it’s possible to find relief even after years of discomfort.

What’s the first step if I want to explore a non-surgical option for my back pain? The best first step is to get a comprehensive evaluation. This involves more than just looking at an MRI. It includes a detailed discussion of your medical history and a physical exam to assess your spine’s stability and movement. This helps identify whether ligament weakness is contributing to your pain. From there, we can determine if you are a good candidate for regenerative treatments and create a plan tailored specifically to your condition.

Key Takeaways

  • Look Beyond the MRI Diagnosis: A degenerative disc disease diagnosis often points to a symptom, not the root cause. The real issue is frequently spinal instability from weakened ligaments, a problem that an MRI doesn’t typically show.
  • Address the Cause, Not Just the Symptom: Many standard back pain treatments, including surgery, focus on the disc. Lasting relief comes from addressing the underlying instability created by damaged spinal ligaments, which is why some surgeries fail to resolve the pain.
  • Strengthen Your Spine’s Foundation: Regenerative treatments like PRP and Stem Cell Therapy are designed to repair and tighten the weakened ligaments around your spine. This restores stability naturally, which can resolve pain and help you avoid an unnecessary operation.