Research Shows Spinal Degeneration May Be There Whether You Have Back Pain or Not
Key findings: 60-second read
- Spinal degeneration is extremely common in people without any back pain - by age 40, nearly 80% of asymptomatic individuals have disc degeneration on imaging.
- Disc degeneration prevalence increases from 37% at age 20 to 96% at age 80 - this suggests degeneration is a seperate issue to pain, not the cause.
- Disc bulges are present in 30% of 20-year-olds and 84% of 80-year-olds - a finding often interpreted as pathological may be surprisingly common in pain-free individuals.
- Diss protrusions plateau at around 40-50% after age 50 - unlike other degenerative findings, protrusions do not continue increasing linearly with age.
- Imaging findings must be interpreted in clinical context - the presence of degenerative changes on MRI or CT does not automatically mean they are causing a patient's pain.
If you have ever had an MRI or CT scan of your spine and been told you have disc degeneration, a bulging disc, or arthritis, you may have left the appointment feeling worried. These terms sound serious. They sound like something is wrong with your back. But what if these findings are actually quite common?
A landmark systematic review published in the American Journal of Neuroradiology in 2015 (Brinjikji et al., 2015) set out to answer this exact question. The researchers analysed 33 studies involving 3,110 asymptomatic individuals - people with no history of back pain whatsoever - to determine how common spinal degeneration actually is in people who feel perfectly fine.
The findings are striking and have profound implications for how we interpret spine imaging and, more importantly, how we treat back pain.
"Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are unlikely associated with pain."
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Study design and methods
The researchers conducted a systematic review of English-language literature published up to April 2014, searching MEDLINE, EMBASE, and Web of Science databases. To be included, studies needed to report the prevalence of degenerative findings on spine MRI or CT in asymptomatic individuals (defined as those with no history of back pain).
After screening, 33 studies reporting imaging findings for 3,110 asymptomatic individuals met the inclusion criteria. Sample sizes ranged from 8 to 412 participants. Thirty-two studies used MRI, and one used CT.
The researchers examined the following imaging findings: disc degeneration, disc signal loss (desiccated disc), disc height loss, disc bulge, disc protrusion, annular fissures, facet degeneration, and spondylolisthesis. They calculated age-specific prevalence estimates for ages 20 through 80 by decade using generalized linear mixed-effects models.
Key methodological note: Asymptomatic individuals were strictly defined as those with no history of back pain. Studies including patients with minor or low-grade back pain were excluded. This strict definition strengthens the validity of the findings.
Disc degeneration: nearly universal by age 80
Disc degeneration was the most common finding, and its prevalence increased dramatically with age:
- Age 20: 37% of asymptomatic individuals
- Age 30: 52%
- Age 40: 68%
- Age 50: 80%
- Age 60: 88%
- Age 70: 93%
- Age 80: 96%
Disc signal loss ("black disc") followed a similar pattern, present in more than half of individuals older than 40 years, and by age 60, 86% of asymptomatic individuals had disc signal loss.
These numbers mean that if you are 50 years old and have no back pain, there is an 80% chance that an MRI would show disc degeneration. If you are 80 years old, that figure rises to 96%. This strongly suggests that disc degeneration is common with ageing, not a pathological process that directly leads to pain.
"Our study suggests that imaging findings of degenerative changes such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention."
Disc bulge and protrusion: common even in young adults
Disc bulges were also highly prevalent, even in younger age groups:
- Age 20: 30% of asymptomatic individuals
- Age 30: 40%
- Age 40: 50%
- Age 50: 60%
- Age 60: 69%
- Age 70: 77%
- Age 80: 84%
Disc protrusions showed a different pattern. Unlike degeneration and bulges, protrusion prevalence plateaued after middle age:
- Age 20: 29%
- Age 30: 31%
- Age 40: 33%
- Age 50: 36%
- Age 60: 39%
- Age 70: 41%
- Age 80: 43%
The finding that >50% of asymptomatic individuals aged 30-39 years have disc degeneration, height loss, or bulging suggests that even in young adults, degenerative changes may be incidental and not causally related to presenting symptoms.
Annular fissures, facet degeneration and spondylolisthesis
Annular fissures (tears in the outer ring of the disc) had a relatively stable prevalence across age groups, increasing only modestly from 19% at age 20 to 29% at age 80.
Facet degeneration (arthritis of the small joints in the spine) was rarely reported in younger individuals (4-9% in those aged 20-30 years) but increased sharply with age, reaching approximately 50% by age 80.
Spondylolisthesis (slippage of one vertebra over another) was not commonly found in asymptomatic individuals until age 60 (23%), with prevalence increasing to 36% by age 80.
| Finding | Age 20 | Age 40 | Age 60 | Age 80 |
|---|---|---|---|---|
| Disc degeneration | 37% | 68% | 88% | 96% |
| Disc bulge | 30% | 50% | 69% | 84% |
| Disc protrusion | 29% | 33% | 39% | 43% |
| Annular fissure | 19% | 22% | 26% | 29% |
| Facet degeneration | 4% | 19% | 36% | 50% |
| Spondylolisthesis | 3% | 5% | 23% | 36% |
Clinical implications: why this matters for you
This systematic review has several important implications for patients and clinicians:
1. Incidental findings on imaging are extremely common. If you have an MRI for any reason (not just back pain), there is a high probability that the report will note some form of spinal degeneration. For a 40-year-old, that probability is around 50-70% depending on the finding. For a 60-year-old, it is closer to 70-90%.
2. These findings are often not the cause of pain. Just because an MRI shows disc degeneration or a bulge does not mean that is what is causing your back pain. The high prevalence of these findings in pain-free individuals means they are often incidental, not causal.
3. Be cautious about interventions based on imaging alone. The authors note that findings such as disc degeneration, facet hypertrophy, and disc protrusion are "often interpreted as causes of back pain, triggering both medical and surgical interventions, which are sometimes unsuccessful in alleviating the patient's symptoms."
4. Age matters. A disc bulge in a 20-year-old is less common (30% prevalence) and therefore more likely to be relevant than a disc bulge in a 60-year-old (69% prevalence).
5. The clinical correlation is everything. As the authors state: "These imaging findings must be interpreted in the context of the patient's clinical condition." An imaging finding that perfectly matches the location and nature of a patient's pain is more likely to be relevant than an incidental finding at a different level.
6. Everything has to happen for a reason. While the authors consistently relay these age-specific changes as a "normal part of the aging process", my clinical experience suggests there also has to be a reason why these specific parts of the spine have degenerated. Poor sitting postures and movement habits, stiff hips and poor mechanics may subtly change the way we load our spines over time. Essentially, it's more likely that time has allowed these less than ideal features to take a toll, where those who don't display these issues may expect to avoid these degenerative changes with age.
Key take-home message: "When degenerative spine findings are incidentally seen (ie, as part of imaging for an indication other than pain or an incidental disc herniation at a level other than where a patient's pain localizes), these findings should be considered as incidental changes rather than pathologic processes."
Study limitations
The authors acknowledge several important limitations:
- Selection bias: Many participants were recruited as volunteers, who may not be representative of the general population
- Observer variability: Many studies did not use multiple observers, and interobserver agreement for these findings is only moderate at best
- Lack of standardised nomenclature: Studies spanned >25 years and did not always use standard terminology
- No severity stratification: The findings were not stratified by degree of severity; it is possible that asymptomatic individuals have less severe changes than those with symptoms
The authors emphasise: "Our study does not imply or conclude that the above-mentioned degenerative findings are always age-related rather than pathologic. Our study applies more to cases in which such degenerative findings are incidentally seen in the evaluation of patients without low back pain or findings are found at a level that does not correlate with findings on physical examination."
Conclusions from the study
The authors conclude: "Imaging evidence of degenerative spine disease is common in asymptomatic individuals and increases with age. These findings suggest that many imaging-based degenerative features may be part of normal aging and unassociated with low back pain, especially when incidentally seen. These imaging findings must be interpreted in the context of the patient's clinical condition."
While my clinical experience as a physiotherapist would suggest we should aim even higher than just labelling these changes "a normal part of the aging process", their presence should not factor into the back pain conversation as much as it likely still does.
This systematic review provides essential reference data for clinicians and patients alike. Knowing that a finding is common in pain-free individuals of the same age does not prove that it is not causing pain in a particular patient, but it does mean that caution is warranted before attributing symptoms to that finding and especially before pursuing invasive interventions based on imaging alone.
One key insight from this systematic review
"By age 40, 68% of asymptomatic individuals (people with no back pain) have disc degeneration on MRI. By age 60, that figure rises to 88%, and by age 80, it reaches 96%. These findings suggest that spinal degeneration may not be a factor in a person's back pain."
Frequently asked questions about spinal degeneration and imaging
Does this study mean my disc degeneration is definitely NOT causing my back pain?
No. The study does not say that. It says that these findings are very common in people without pain, which means they are often incidental. However, a finding can be common in pain-free individuals and still cause pain in some people. The key is clinical correlation. If your imaging finding perfectly matches the location and nature of your pain, and if that finding is less common in your age group, it may be more likely to be relevant. Your physiotherapist or doctor should interpret your imaging in the context of your full clinical picture, not in isolation.
If I have back pain, should I get an MRI?
Not necessarily. Clinical guidelines generally recommend against routine imaging for non-specific low back pain without red flags (such as trauma, fever, unexplained weight loss, or neurological deficits). The high prevalence of incidental findings means that imaging can lead to false reassurance (if nothing is found) or unnecessary worry and intervention (if something is found that is actually incidental). Imaging is most useful when there is a specific clinical suspicion of a serious underlying condition or when conservative treatment has failed and more invasive options are being considered.
Can physiotherapy help even if my imaging shows degeneration?
Yes. In most cases, absolutely. The presence of degenerative changes on imaging does not mean you cannot improve. Physiotherapy focuses on improving function, strength, mobility, and pain management regardless of what the imaging shows. Many people with significant imaging findings become completely pain-free with appropriate conservative care. The goal is not to reverse the degeneration (which is a normal age-related process) but to optimise how your body moves and functions despite it.
How do I know if my imaging findings are incidental or relevant?
This is a clinical judgment that requires a thorough assessment. Relevant findings typically: (1) are located at a spinal level that corresponds to your pain pattern, (2) are consistent with the nature of your symptoms (e.g., nerve compression causing radiating leg pain), (3) are less common in your age group, and (4) correlate with physical examination findings. A physiotherapist or spine specialist should integrate your imaging findings with your history and physical examination to determine relevance.
Should I be worried about the word "degeneration" on my report?
No. The word sounds frightening, but in the context of the spine, degeneration may not be clinically relevant. The study shows that by age 80, 96% of people without any back pain have disc degeneration. It is not a disease that needs to be cured; it could be incidental.
As a physiotherapist, I see patients every week who are distressed by the findings on their spine MRI. They have been told they have "degenerative disc disease" or "bulging discs" and they worry that their spine is falling apart. They often feel hopeless, believing that surgery is their only option.
This study is potentially powerful because it provides perspective. If you are 60 years old and your MRI shows disc degeneration, you are in the company of 88% of your peers who also have no back pain. Your spine is not uniquely damaged. You are common.
This does not mean your pain is not real. It is very real. But the cause of your pain may be more related to how you move, how you load your spine, your stress levels, your sleep, and your activity patterns than to the incidental findings on your MRI. The good news is that all of those things can be changed.
If you have been told your back pain is due to "degeneration" and you are not sure what to do next, I am here to help. I see patients in Port Macquarie and via telehealth to assess the whole person, not just the imaging report. Together, we can develop a plan to help you move better, feel better, and get back to the activities you love.
- Grant
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If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a more nervous-system-focused approach. Learn more about our back pain physiotherapy services in Port Macquarie.
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If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.
Disclaimer: This information is for educational purposes and does not replace individualised medical advice. Always consult a qualified health professional for your specific situation. This blog post summarises a published systematic review (Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816); the original source should be consulted for full methodological details. Individual responses to back pain and treatment vary.
