Degenerative disc disease is one of the most common findings on lumbar MRI in adults over 40 — and one of the most misunderstood. Patients come in having been told they have DDD, often without a clear explanation of what that actually means or what can be done about it.
The question I get regularly: “My disc is degenerating. Does that mean nothing can help, or is VAX-D still worth trying?”
The honest answer is more nuanced than most patients expect. Here’s what the research actually shows, and how we think about DDD at West Hills Chiropractic Pain Center.
What “Degenerative Disc Disease” Actually Means
First, some clarity on terminology: degenerative disc disease isn’t really a disease in the traditional sense. It’s a descriptive term for the normal aging process of lumbar discs — a process that, for most people, doesn’t cause significant pain. Studies consistently show that the majority of adults with disc degeneration visible on MRI have no symptoms at all.
The degeneration process involves several changes:
- Disc dehydration: The nucleus pulposus — the gel-like center of the disc — gradually loses water content with age. A young disc is roughly 80% water; by the 6th or 7th decade, that can drop to 70% or below. Dehydration reduces the disc’s ability to distribute load evenly.
- Loss of disc height: As the disc dehydrates and loses structural integrity, the space between vertebral bodies narrows. This is the “collapsed disc” finding on X-ray.
- Annular tears: The outer fibrous ring of the disc can develop tears and fissures over time, which can be painful if they affect the outer third of the annulus (the only region with pain-sensing nerve fibers).
- End plate changes: The cartilaginous end plates at the top and bottom of each disc can develop Modic changes — bone marrow changes visible on MRI that correlate with painful disc segments.
- Osteophyte formation: The vertebral bodies can develop bony spurs in response to reduced disc height and altered mechanics.
This process, in isolation, doesn’t necessarily cause pain. But when it does — when a degenerated disc becomes mechanically sensitized, when it begins producing inflammatory mediators, when the altered mechanics begin to affect nerve roots or facet joints — it can produce chronic low back pain that is genuinely disabling.
The VAX-D Mechanism in the Context of DDD
Here’s where the picture gets interesting. Remember that the theoretical mechanisms of VAX-D include both structural decompression (creating negative intradiscal pressure to retract herniated material) and disc rehydration (drawing fluid and nutrients back into a dehydrated disc via imbibition).
For herniated discs, the retraction mechanism tends to drive the clinical improvement. But for degenerative disc disease — where the primary pathology is dehydration and loss of nutritional support — the rehydration mechanism is actually more relevant.
A degenerated disc is, in part, a desiccated disc. Adult discs don’t have direct blood supply — they depend on diffusion through the end plates to receive nutrients. This diffusion is driven by alternating compression and decompression (the “pump” effect of normal movement). A disc under sustained chronic load doesn’t get this pump effect efficiently. VAX-D creates an exaggerated version of this pump: the controlled negative pressure during treatment creates a strong fluid draw into the disc, potentially re-hydrating nucleus tissue that has become desiccated.
The question is: can you meaningfully re-hydrate a disc that has been degenerating for years or decades?
What the Research Shows
The evidence base here is more limited than for acute disc herniation, but it’s not absent:
Several small studies have documented increased T2 signal (MRI marker of water content) in lumbar discs following a course of motorized decompression, suggesting genuine rehydration is occurring. A 2011 study published in the International Journal of Medical Sciences showed structural improvement in disc height and disc signal intensity in patients receiving spinal decompression, including those with degenerative changes.
Clinically, patients with DDD tend to respond more slowly and less dramatically than herniation patients, and their improvement is more likely to require maintenance treatment to sustain. But a meaningful subset — particularly those who are younger (under 55-60), have relatively early-stage degeneration, and haven’t developed significant structural compromise — can achieve substantial and durable improvement.
Who with DDD is a Good Candidate for VAX-D
This is the honest clinical breakdown based on 27+ years of treating disc patients:
Better candidates:
- Adults 40-65 with one or two degenerative levels, without severe collapse
- DDD with superimposed bulge or herniation at the same level
- Discogenic pain (axial low back pain, worse with sitting, improved with movement) that hasn’t responded to PT or manipulation
- Patients with Modic changes at a single level who are not surgical candidates
Worse candidates:
- Severe multi-level degeneration with significant disc height loss at every level
- Advanced age (over 75) with severe osteoporosis
- Prior spinal fusion at the affected level (depends on hardware type — requires consultation)
- Significant spinal stenosis as the primary driver of symptoms
There’s an important distinction between “DDD is present on MRI” and “DDD is the actual pain generator.” Many patients over 50 have degenerative findings on imaging that are incidental — their pain is actually coming from a facet joint, from muscle dysfunction, or from a specific annular tear at one level. Treating the imaging finding rather than the actual pain source is one of the most common errors in spine care. We work to identify the actual pain generator before recommending any specific treatment.
The Realistic Expectations Conversation
If you have degenerative disc disease and are considering VAX-D, here’s what I’d tell you in a consultation:
The goal is not to reverse decades of degeneration. That’s not a realistic target for any non-surgical treatment. The goal is to reduce pain, improve functional capacity, and potentially slow the progression of degenerative changes by improving disc nutrition and reducing compressive load over time.
For patients in the right range — early to moderate degeneration, identifiable pain generators, no surgical contraindications already resolved — a course of VAX-D is a reasonable first option before escalating to interventional procedures or surgery. The risk profile is low. The potential benefit, for the right patient, is real.
For patients with advanced degeneration and severe structural collapse, the honest answer is that decompression is less likely to produce meaningful change, and other options — including pain management, surgical consultation, or targeted interventional procedures — may be more appropriate.
We’d rather tell you that upfront than take your money for 20 sessions that aren’t likely to help you.
Find Out If Your DDD Is a Candidate
Bring your imaging. We’ll review your MRI, identify the pain-generating level(s), assess your disc height and degeneration pattern, and give you a clear recommendation — including when decompression makes sense and when it doesn’t.
Call 631-659-2980 or schedule your evaluation online. West Hills Chiropractic Pain Center, 400 W Jericho Turnpike, Huntington, NY 11743.
— Dr. Tom Oddo, DC CSCS CEAS, West Hills Chiropractic Pain Center