DJD of the spine, or degenerative joint disease, is a form of osteoarthritis that affects the small joints connecting your vertebrae. These joints, called facet joints, allow your spine to bend, twist, and move while keeping it stable. Over time, the cartilage lining these joints wears down, leading to inflammation, stiffness, and pain. It’s one of the most common causes of back and neck pain, particularly after age 50.
How DJD Develops in the Spine
Your spine has pairs of facet joints at every level, formed where the bony projections of one vertebra meet the vertebra above or below it. These are synovial joints, meaning they’re lined with smooth cartilage and lubricated by fluid, similar to your knee or hip. They bear weight, absorb shock, and prevent your spine from rotating too far in any direction.
With age, repetitive movement, and mechanical stress, the cartilage inside these joints gradually erodes. As the protective layer thins, the bones underneath can harden and develop small bony spurs (called osteophytes) around the joint margins. The joint space narrows, inflammation sets in, and the surrounding tissues can stiffen. This process is the same basic mechanism behind osteoarthritis anywhere in the body, just happening in the spine. It’s sometimes called facet joint disease or spondylosis, and it most commonly affects the lower back (lumbar spine) and the neck (cervical spine) because these regions bear the most load and allow the most movement.
DJD vs. Degenerative Disc Disease
These two conditions are closely related and frequently confused, but they affect different structures. DJD targets the facet joints at the back of the spine. Degenerative disc disease (DDD) involves the rubbery discs that sit between the vertebral bodies at the front of the spine. In practice, the two often occur together: when a disc loses height, it shifts more stress onto the facet joints behind it, accelerating their breakdown. If you’ve been told you have “degenerative changes” on an imaging report, it may refer to one or both of these processes.
Common Symptoms
The hallmark of spinal DJD is stiffness and aching that tends to be worst in the morning or after periods of inactivity. Movement usually loosens things up, though prolonged standing or heavy activity can make the pain return. The location of symptoms depends on which part of the spine is affected.
In the lower back, pain typically stays in the back itself and sometimes extends into the buttocks or upper thighs. In the neck, pain can spread into the shoulder blades, shoulders, and down the arms to the hands. When the joint changes are severe enough to compress a nearby nerve root, symptoms can escalate to tingling, numbness, or weakness in the arms or legs. Progressive weakness, difficulty walking, or changes in bowel or bladder function are signs of serious nerve involvement that require prompt medical evaluation.
Many people with visible DJD on imaging have no symptoms at all. The severity on an X-ray doesn’t always match how someone feels, which is why doctors treat the person rather than the picture.
Risk Factors
Age is the strongest predictor. Arthritis prevalence rises steeply across the lifespan: roughly 3.6% of adults aged 18 to 34 have a diagnosed form of arthritis, compared to nearly 54% of adults 75 and older, according to 2022 CDC data. But aging alone doesn’t explain everything.
Body weight plays a significant causal role. A large genetic analysis found that higher BMI increases the risk of spinal disc degeneration by about 23%, low back pain by 28%, and sciatica by 33%. Notably, sedentary behavior accounted for a substantial portion of that effect. Roughly 40 to 50% of the link between high BMI and spinal degeneration was mediated by leisure-time inactivity, meaning that sitting for long periods compounds the damage that excess weight already causes.
Other established risk factors include genetics, smoking, physically demanding occupations, and prior spinal injuries. Jobs that involve repetitive bending, heavy lifting, or prolonged vibration (such as truck driving) accelerate wear on the facet joints.
How It’s Diagnosed
Doctors typically start with a physical exam, checking your range of motion, pain patterns, and whether any nerve function is affected. If imaging is needed, standard X-rays are the first step. Radiologists grade osteoarthritis on a four-point scale developed by Kellgren and Lawrence. Grade I shows subtle narrowing of the joint space with minor bony lipping. Grades II and III represent increasing narrowing and hardening of the bone beneath the cartilage. Grade IV, the most severe, shows bone-on-bone contact and visible joint deformity.
X-rays only reveal bone changes, though. They can’t directly show cartilage, inflammation, or nerve compression. When symptoms suggest nerve involvement or the diagnosis is unclear, an MRI provides a much more detailed picture. It can reveal cartilage damage, disc problems, and whether nearby nerves or the spinal cord are being compressed.
Treatment Without Surgery
Most people with spinal DJD manage their symptoms without surgery. When pain is limited to stiffness and soreness, a combination of heat or ice and gentle stretching is often enough. Regular low-impact exercise, including walking, swimming, or cycling, helps maintain joint mobility and strengthens the muscles that support the spine.
Over-the-counter anti-inflammatory medications can reduce pain during flare-ups. Physical therapy is one of the most effective tools, focusing on core strengthening, flexibility, and posture correction to take pressure off the affected joints.
When oral medications and physical therapy aren’t enough, corticosteroid injections directly into the facet joint are a common next step. Studies show that about half of patients experience at least a 50% reduction in pain after a single injection, with relief lasting up to three to six months. On average, pain scores drop by roughly 45 to 75% in the months following the procedure, though results vary depending on the severity of joint damage.
Diet and Inflammation
There’s growing evidence that what you eat affects osteoarthritis symptoms. The Mediterranean diet, which emphasizes vegetables, fruit, fish, olive oil, and whole grains, has the strongest support. In clinical studies, people following a Mediterranean diet saw inflammatory markers tied to cartilage breakdown drop by as much as 47%. The diet also supports weight loss, which compounds the benefit. Ginger has shown promise in reducing both pain severity and inflammatory markers in studies lasting 6 to 24 weeks. Tart cherry juice, pomegranate juice, and strawberries have all shown some ability to lower specific inflammation markers in people with osteoarthritis, though the evidence is still early.
When Surgery Becomes an Option
Surgery is generally reserved for people whose symptoms haven’t responded to several months of conservative treatment, especially when there’s significant nerve compression causing weakness, numbness, or functional limitations. The two most common procedures are decompression (removing bone or tissue that’s pressing on nerves) and spinal fusion (permanently joining two or more vertebrae to eliminate painful motion at that segment).
For people with both spinal stenosis and a vertebra that has slipped slightly out of alignment (a condition called degenerative spondylolisthesis), a major trial published in the New England Journal of Medicine compared decompression alone to decompression plus fusion. Both approaches provided meaningful relief. When the slipped vertebra is unstable and accompanied by mechanical back pain, the general consensus is that adding fusion leads to better long-term outcomes. For stable cases, decompression alone may be sufficient. The decision depends on the specific pattern of joint damage, instability, and symptoms.
Living With Spinal DJD
Spinal DJD is a chronic condition, but it doesn’t necessarily get worse in a straight line. Many people go through periods of flare and remission. Maintaining a healthy weight is one of the single most impactful things you can do. Even modest weight loss reduces mechanical stress on the spine and lowers the systemic inflammation that drives cartilage breakdown. Staying physically active, even when it feels counterintuitive, preserves joint function and prevents the stiffness that comes with inactivity. The combination of regular movement, weight management, and an anti-inflammatory diet gives most people a practical framework for keeping symptoms under control over the long term.