What is Disc Height Loss?
Disc height loss is the reduction in the vertical space between vertebrae caused by breakdown and dehydration of the cushioning discs in your spine—think of it like a shock absorber in your car gradually flattening over time. 1
Understanding the Anatomy
The discs between your vertebrae are like jelly donuts with a soft, gel-like center (nucleus pulposus) surrounded by a tougher outer ring. These discs act as cushions that:
- Absorb shock when you move, jump, or lift things 2
- Allow your spine to bend and twist 3
- Maintain proper spacing between vertebrae to protect nerves 4
What Causes Disc Height Loss?
The primary cause is disc degeneration—a wear-and-tear process where the disc gradually loses water content and breaks down over time. 4 This can happen from:
- Normal aging (the discs naturally dry out as you get older) 4
- Injury or trauma to the spine 2
- Repetitive stress from heavy lifting or carrying 4
- Previous disc herniation or surgery that removed disc tissue 5
What Happens When Discs Lose Height?
When a disc loses height, several problems can occur:
- Increased stress on adjacent discs: The neighboring discs must work harder to compensate, which can accelerate their degeneration 3
- Altered spine mechanics: Your spine moves differently, with the affected segment becoming stiffer while adjacent segments become more mobile 3
- Nerve compression: As the space narrows, nerves exiting the spine can become pinched, causing pain, numbness, or weakness radiating into your arms or legs 2
- Facet joint problems: The small joints in the back of your spine can become overloaded and arthritic 6
How is Disc Height Loss Detected?
Disc height can be measured from X-rays and compared to normal values for your age and gender, though MRI provides more detailed information about disc degeneration. 1, 4 Interestingly, the first signs of disc degeneration visible on MRI (loss of the bright signal in the disc's center) occur before any measurable height loss appears 4.
Treatment Approaches
Initial Conservative Management (First 6-8 Weeks)
Non-operative treatment is appropriate for 75-90% of patients and should begin with acetaminophen (up to 4g daily) or ibuprofen (1.2g daily), combined with physical therapy focusing on core strengthening and flexibility. 6
If initial medications don't provide adequate relief:
- Increase ibuprofen to 2.4g daily, add acetaminophen, or switch to alternative NSAIDs like diclofenac or naproxen 6
- Continue physical therapy for at least 6-8 weeks 6
- Consider acupuncture as an adjunct 6
For Persistent Symptoms (2-3 Months)
If conservative treatment fails after 2-3 months, epidural steroid injections may be considered for nerve-related pain. 6
Surgical Options (After 6+ Months of Failed Conservative Treatment)
Surgery should only be considered after at least 6 months of comprehensive conservative management has failed. 6 Options include:
- Anterior cervical discectomy with fusion (ACDF): Removes the damaged disc and fuses the vertebrae together, achieving 80-90% success for arm pain relief 6, 7
- Cervical arthroplasty: Replaces the disc with an artificial one that preserves motion, recommended as an alternative to fusion in selected patients 6, 7
- Injectable hydrogels: Experimental treatments that can restore disc height and normalize spine mechanics by replacing lost disc tissue 3, 5
Important Considerations
The first stage of disc degeneration does not cause measurable height loss—height decrease only occurs as degeneration progresses, though the relationship is loosely correlated with considerable variation between individuals. 4
Acute disc height loss reduces motion at the affected segment while increasing motion at adjacent segments, potentially accelerating degeneration at those levels. 3