By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 6 min read

What is degenerative disc disease?

Your lower back (the lumbar spine) is made of five vertebrae stacked on top of one another. Between each pair sits an intervertebral disc: a cushion with a soft, jelly-like core (the nucleus pulposus) held in place by a tough, layered outer ring (the annulus fibrosus). Healthy discs keep the bones apart and soak up the jolts of everyday life.

Over the years, discs gradually dry out, stiffen and lose some height and bounce. This disc degeneration is a normal part of ageing and shows up on scans of many people with no pain at all. The label ‘degenerative disc disease’ is used when a worn disc is thought to be the real cause of ongoing symptoms. Despite the name, it does not spread and does not mean your spine is crumbling.

Symptoms

Pain that comes from the disc itself is described as discogenic. A worn disc can trigger inflammation in the tissues around it, which may lead to:

• A deep ache across the lower back, often with flare-ups that come and go
• Pain spreading into the buttocks or the backs of the thighs
• Stiffness, particularly after sitting or first thing in the morning
• Tight, tender muscles around the lower back

Sometimes the outer ring of the disc weakens and splits, letting part of the soft core push towards a nerve. This is a slipped (prolapsed) disc. Pressure on the nerve can produce sciatica: pain travelling below the knee, often with pins and needles, a burning feeling, numbness or weakness in the part of the leg that nerve serves.

Why does it happen?

Disc wear is largely down to age and the genes you inherit. Extra body weight adds to the load on each disc and can worsen symptoms, so steady weight loss can make a real difference for people who are significantly overweight.

How is it diagnosed?

Your specialist will start with a detailed history and examination. An MRI scan shows the discs clearly, but because worn discs are so common in pain-free people, the images must be read alongside your symptoms.

Before surgery is ever discussed, your surgeon needs to be confident that one particular disc is generating the pain and that other possible causes have been looked for and excluded. In selected cases a specialised test such as discography may help.

Treatment options

Non-surgical care comes first

The great majority of people with a painful worn disc never need an operation. Treatment usually combines:

• Physiotherapy to build core strength, flexibility and confidence in moving
• Appropriate pain relief, reviewed regularly by your GP or specialist
• Keeping as active as you can, pacing activity rather than resting for long spells
• Lifestyle changes such as losing excess weight and stopping smoking
• A pain management programme for those whose pain has become long-standing

When might surgery be considered?

BASS patient information describes surgery for disc-related back pain as an option only for carefully selected people. Broadly, these are people who:

• have had extensive non-surgical treatment (physiotherapy, medicines and pain management) for at least a year without enough relief, or have had repeated disc prolapses pressing on nerves
• have had tests that pin the pain on a specific disc, with other causes ruled out
• do not have risk factors that would make a successful fusion unlikely

The usual operation is a lumbar interbody fusion. The worn disc is cleared out and replaced with a spacer, called a cage, packed with bone graft. BASS explains that over roughly 6 to 12 months your own bone grows through the graft, so the two vertebrae knit into one solid block, often held still meanwhile by screws and rods. The disc can be reached from the back (TLIF or PLIF), the front (ALIF) or the side (LLIF/XLIF or OLIF); your surgeon will suggest the route that suits you best.

The aim is to stop movement at the painful level, not to give you a brand-new spine. BASS patient information reports good relief of back and leg symptoms in about 70% of people (up to 7 in 10) after this kind of surgery, though the benefit often builds over several months. Numbness or weakness that was severe beforehand may not fully recover, even when the operation itself has gone well.

Risks and complications of fusion surgery

All operations carry some risk. The figures below come from BASS patient information on surgery for degenerative lumbar disc disease. They are approximate, and your surgeon will explain how they apply to you.

Risk	Approximate frequency (BASS)
Nerve root injury	Under 1 in 100 for a first operation; up to 10 in 100 for repeat surgery
Tear in the dura (the lining around the nerves), which may leak fluid	Fewer than 5 in 100
Return to theatre to repair a persistent leak	Less than 0.05%
Superficial wound infection	Up to 4 in 100
Deep wound infection	Fewer than 1 in 100
Blood clot in the leg or lung (DVT or PE)	Fewer than 1 in 700
Screw placed in the wrong position	2 in 100
Bones fail to fuse (non-union)	Up to 5 in 100
Cage or implant moves	Up to 2 in 100, with about 1 in 100 needing another operation
Death from injury to major blood vessels or organs	About 1 in 10,000
Fatal complication of general anaesthetic	About 1 in 250,000

Other recognised problems include bleeding, nerve pain from scar tissue, pressure injuries from positioning on the operating table (very rarely including loss of sight), late breakage of screws or rods, and pain that does not improve or occasionally worsens. Very rarely, a blood collection (haematoma) in the spinal canal or loss of blood supply to the nerves can cause paralysis.

Approaches through the abdomen add their own risks. For front (ALIF) and oblique (OLIF) surgery, BASS reports injury to the large blood vessels in up to 15 in 100 cases (less often with experienced surgeons), retrograde ejaculation in under 1 in 100 men, and a temporary standstill of the bowel (paralytic ileus) in about 11 in 100. Side-on surgery (LLIF/XLIF) can irritate nerves near the hip muscles, causing thigh pain, numbness or weakness when lifting the leg.

Recovery and outlook

According to BASS, most people go home 1 to 2 days after a fusion, and irritated nerves can take eight weeks or more to settle. Typical advice is no driving for at least four weeks, around four weeks off work (up to eight for physical jobs), no heavy lifting for up to three months, and no flying for six weeks (or up to three months for long-haul) because of the clot risk.

With or without surgery, most people learn to live well with a worn disc. Flare-ups usually settle, and staying strong and active is the best long-term protection. Mr Sadek’s video on maintaining spinal wellbeing has practical tips.

Further reading

• BASS patient booklet: Symptomatic Degenerative Lumbar Disc Disease
• NHS: Back pain
• Spinemathema: Lumbar spinal fusion (TLIF and ALIF)
• Spinemathema: Slipped disc

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist.