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Degenerative Disc Disease

What is in a Name?

Battié, Michele C. PhD; Joshi, Anand B. MD, MHA; Gibbons, Laura E. PhD; the ISSLS Degenerative Spinal Phenotypes Group

doi: 10.1097/BRS.0000000000003103
LITERATURE REVIEW
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Study Design. A systematic search and review

Objective. The aim of this study was 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 2016 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 3 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 versus lumbar regions.

Conclusion. 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

A systematic search and review of use of the term degenerative disc disease in the health sciences literature from 2007 to 2017 was conducted. Although the term was used with increasing frequency, it represents an underdeveloped concept, with greatly varying, disparate definitions documented, leading to confusion and miscommunication in medicine and science.

Faculty of Health Sciences & Western's Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada

Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC

Department of General Internal Medicine, University of Washington, Seattle, WA.

Address correspondence and reprint requests to Michele C. Battié, PhD, Professor & Western Research Chair, Faculty of Health Sciences & Western's Bone and Joint Institute, University of Western Ontario, London, ON N6G 1H1, Canada; E-mail: mbattie@uwo.ca

Received 31 October, 2018

Revised 20 March, 2019

Accepted 25 April, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: travel/accommodations/meeting expenses.

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