Degenerative Disc Disease: What's in a Name?

Michele C. Battié, PhD; Anand B. Joshi, MPH, MD; Laura E. Gibbons, PhD

Disclosures

Spine. 2019;44(21):1523-1529. 

In This Article

Abstract and Introduction

Abstract

Study Design: A systematic search and review

Objective: To investigate the term, degenerative disc disease, to elucidate its current usage and inform clinical, research, and policy recommendations.

Summary of Background Data:Degenerative disc disease has long been a dominant concept in common, painful spinal disorders. Yet, despite its pervasiveness and important clinical consequences and controversies, there has not been a systematic examination of its use and meaning in the scientific literature.

Methods: We conducted a systematic search of publications using the term degenerative disc disease from 2007 through 2017 in Ovid MEDLINE (R), Embase, CINAHL and Scopus. Two investigators independently reviewed all publications in the primary sample. Publication and author identifiers, and qualitative study descriptors were extracted. Finally, the definition of degenerative disc disease was placed in one of eight categories. Data were summarized using descriptive statistics.

Results:Degenerative disc disease appeared in the titles of 402 publications in the primary sample and increased in frequency by 189% from the first to the last three years of the decade. No single definition was used in the majority of publications, and most frequently the term was used without any definition provided (30·1%). In other cases, degenerative disc disease specifically included radiculopathy or myelopathy (14·4%), or only back or neck pain (5·5%), or was equated with disc degeneration regardless of the presence of symptoms (15·4%), or with discogenic pain or disc degeneration as a presumed cause of axial pain (12·7%). Another 7·2% comprised a mix of broad ranging findings and diagnoses. The most notable differences in definitions occurred between surgeons and other disciplines, and when applied to cervical vs. lumbar regions.

Conclusions: Despite longstanding use and important consequences, degenerative disc disease represents an underdeveloped concept, with greatly varying, disparate definitions documented. Such inconsistencies challenge clear, accurate communication in medicine and science, create confusion and misconceptions among clinicians, patients and others, and hinder the advancement of related knowledge.

Level of Evidence: 4

Introduction

Low back pain is a leading cause of disability worldwide,[1] and drives a great deal of health care seeking and associated diagnostics. In the search for underlying pathology, intervertebral disc degeneration has long been a primary suspect in the development of painful spinal disorders. No clinical diagnosis more strongly conveys this belief than that of degenerative disc disease, a term that has become pervasive in spine care and related research. Weiner observed that a biomedical model of degenerative disc disease has dominated the care of low back pain for generations, with perceived pathomechanical issues treated with physical therapy (e.g., exercise), chiropractic, and surgical approaches (e.g., spine fusion, disc replacement surgery) and patho-chemistry considerations with medications.[2] Most recently, stem cell, protein, and gene therapies have been presented as potential treatment strategies for cellular and molecular pathophysiology associated with degenerative disc disease.[3] Yet, despite its widespread use and clinical implications, the term remains controversial.

Certainly, disc degeneration or failure plays a contributing role in some clinical conditions, such as lumbar spinal stenosis and disc herniation, but its importance in the vast majority of cases of back symptoms for which individuals seek care is unclear.[4] As noted in a recent Lancet series on low back pain, while "some imaging and clinical findings increase the likelihood that pain is arising from the intervertebral disc … there is no widely accepted reference standard for discogenic pain."[5] Failure to establish clear concepts, nomenclature, and standardized measures of disc degeneration and degenerative disc disease has been raised as a problematic issue in advancing related knowledge.[6] Yet, little attention has been given to this rather fundamental issue.

Given its important clinical consequences, we systematically searched and reviewed the use of the term degenerative disc disease in the health sciences literature to elucidate its current usage and to serve as a basis for related clinical, research, and policy recommendations. Specifically, we sought to determine the consistency with which degenerative disc disease is defined or operationalized in the health sciences literature and to investigate factors, such as spinal region, discipline, and country of origin, which might explain heterogeneity in use of the term.

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