Regenerative Orthopedics · Miami, FL
Lumbar Spine Arthritis & Degenerative Disc Disease Treatment in Miami
What Is Lumbar Spine Arthritis?
“Arthritis in the spine” can be confusing because the lumbar spine is not one joint. The facet joints can develop true osteoarthritis, much like other joints in the body. The disc can also degenerate, but degenerative disc disease is not a classic arthritis involving loss of cartilage and chronic inflammation. Arthritis of the spine involves complexities and nuances making each case unique.
Facet Joint Arthritis
Facet joints are small joints along the back of the spine that help guide movement, maintain stability and share load. Like a knee or hip joint, they contain cartilage that can wear down over time and develop osteoarthritis.
Finding facet arthritis on an MRI, however, does not automatically mean that the joint is causing the pain. Careful workup is needed to determine if facet joints are contributing to pain and require targeted treatent.
How Disc Degeneration and Facet Arthritis Are Connected
The disc and facet joints work together within each spinal segment. The disc helps absorb and distribute load, while the facet joints help control movement and provide stability.
As a disc degenerates, it may lose water and height, changing how forces move through that segment. This in turn can place greater stress on the facet joints, which is why disc degeneration and facet arthritis are often found together.
They may be connected, but they are not the same problem, and either one, or both, may be contributing to the pain.
What Is Lumbar Degenerative Disc Disease?
Lumbar degenerative disc disease describes changes in the discs of the lower back as they lose hydration, structural integrity, and some of their ability to manage load. As this progresses, mechanical or inflammatory irritation of nerve endings within the discs can directly cause pain (discogenic pain). Because the disc has such unique biology and relies heavily on the structures around it, degeneration can affect the mechanics of the entire spinal segment.
What Makes the Disc Different From Other Tissues?
Each disc has a soft, gel-like center called the nucleus pulposus, surrounded by a strong outer wall called the annulus. The annulus is not one solid shell. It is built in multiple layered rings, almost like the rings of a tree. Together, these structures allow the disc to hold water, distribute load, and still permit movement.
What makes the disc especially unusual is how it stays alive. The center of the disc has no direct blood vessels and naturally exists in a very low-oxygen environment. Instead of receiving a rich blood supply like many other tissues, oxygen, glucose, and other nutrients have to slowly move into the disc, primarily through the bony vertebrae above and below it. This junction is known as the vertebral endplate.
Those endplates do more than help feed the disc. They also help transfer load between the disc and the bones of the spine. The relationship works both ways: the disc depends on the endplates and surrounding structures to remain healthy, while those structures rely on the disc to maintain normal height, movement, and load distribution.
From Dr. Karli: “Think of the rings of a tree. Each layer has its own importance, and we have to consider how they are working together if we are going to understand how best to treat an abnormal disc.”
What Happens When a Disc Degenerates?
Disc degeneration is more than simple “wear and tear.” The gel-like center can lose the molecules that help it hold water, causing the disc to become less hydrated and less able to manage load. The annulus can weaken or develop small tears, and the disc may begin to lose height. Fluid can also be lost through the disc tears in a scenario known as a “leaky disc.”
As that happens, the mechanics of the entire spinal segment can change. More stress may be transferred to the endplates, facet joints, and other surrounding structures, which is one reason disc degeneration and facet arthritis are often found together.
Disc height also matters when considering treatment. Any kind of cell therapy may influence pain, inflammation, or the biology of a damaged disc, but it cannot simply “re-inflate” a severely collapsed disc or mechanically reverse narrowing that has already occurred. That is why advanced narrowing or stenosis requires careful evaluation rather than an automatic yes or no based on a single MRI finding.
Published intradiscal studies have often selected patients whose discs still retained roughly half or more of their normal height. That does not mean a patient with greater degeneration is automatically excluded. It means the degree of structural change is one of several factors that must be considered when determining what is realistically treatable.
Degeneration can involve several structures without all of them necessarily causing pain. The next question is determining which structure, or combination of structures, is actually the pain generator.
Is Your Low Back Pain Coming From a Disc or Facet Joint?
A disc and a facet joint can both cause low back pain, and sometimes more than one structure is involved. In the lumbar spine, any or all of the surrounding tissues can become pain generators, which is why a detailed and accurate workup becomes so important to determine if one or both structures are involved.
Certain pain patterns can offer clues, but symptoms alone usually cannot tell us with certainty where the pain is coming from.
Disc-Related Low Back Pain
Disc-related pain is typically felt more centrally in the lower back and may be affected by sitting, bending, lifting, or other activities that increase pressure through the disc. Discs can also “refer” pain into the buttock, groin or leg in certain cases.
But a degenerative disc on an MRI is not automatically a painful disc. Some people have significant disc changes with very little pain, while others may have substantial symptoms from changes that appear less dramatic on imaging.
Facet Joint Pain
Facet pain often behaves differently. It may be felt more to one side of the lower back and can worsen with standing, extending backward, rotating, or loading the affected joint.
Those patterns can help guide the evaluation, but they are not definitive. Facet arthritis on an MRI does not automatically prove that the facet joint is the pain generator.
Why an MRI Alone Does Not Identify the Pain Generator
MRI is extremely valuable because it shows the condition of the discs, joints, nerves, and surrounding structures. The challenge is that an MRI shows what is structurally abnormal, not necessarily what is causing the pain.
There is also an important difference between an imaging report and a treatment decision. A radiologist’s role is to carefully review the images and describe what is seen. A treating physician looks at those same findings through a different lens: Do they match the patient’s symptoms? What is most likely contributing to the pain? Is there definitive evidence for what can or should be treated?
That distinction is especially important in the lumbar spine, where several abnormalities may appear on the same scan.
Dr. Karli evaluates the imaging together with the patient’s history, symptoms, physical examination, and how the pain behaves. Often that is enough to identify the most likely source, or sources, of pain. When it is not, a carefully targeted diagnostic injection may sometimes be used to temporarily numb a specific structure and help determine whether it is actually contributing to the pain.
The more precisely the source of pain can be identified, the more accurately treatment can be targeted. Sometimes more than one structure must be addressed because multiple tissues are contributing to the problem.
The goal is not to treat every abnormality on an MRI. It is to minimize educated guesses and identify the structure, or combination of structures, most likely responsible for the patient’s symptoms.
Am I a Candidate for Regenerative Medicine for Low Back Pain?
Possibly. Candidacy is not determined by age, one MRI finding, or the name of a diagnosis alone. It depends on what is causing the pain, how advanced the structural changes are, what function remains, and whether the problem is one that a regenerative treatment can realistically address.
When Regenerative Treatment May Be Appropriate
A patient may be considered when the evaluation identifies a specific disc, facet joint, spinal nerve(s) or combination of structures that reasonably matches the symptoms and can be safely accessed and treated.
Other factors matter too, including:
whether there is still enough viable tissue and structural integrity to make treatment reasonable; and
the patient’s overall health, goals, and expectations.
This is why two people with very similar MRI reports may receive very different recommendations.
When Regenerative Treatment May Not Be the Right Treatment
Some low back problems become predominantly mechanical. If the primary issue requires significant decompression, stabilization, or another structural correction, an injection cannot perform that mechanical job.
That does not mean every patient with narrowing, advanced degeneration, or multiple findings on an MRI is automatically excluded. It means the degree of the problem and what is actually producing the symptoms have to be understood before deciding whether regenerative treatment makes sense.
There are also cases where Dr. Karli may believe the likelihood of meaningful improvement is lower than he would like. When that happens, he discusses it openly with the patient rather than presenting treatment as more predictable than it is.
A lower likelihood of success does not automatically rule out treatment. If treatment can be performed reasonably and safely, the patient decides whether the potential benefit is enough to justify proceeding.
Per Dr. Karli: “Structural problems logically require structural solutions. While we can’t necessarily reverse structural problems with a chemical, biologic solution, we can often manage and control them effectively for a sustained period of time.”
The goal is transparency, not making that decision for the patient.
The decision comes down to matching the right diagnosis with a treatment that is medically reasonable, understanding the realistic probability of benefit, and allowing the patient to decide whether that opportunity aligns with their goals.
how long the pain has been present;
how it affects activity and function;
what treatments have already been tried;
the amount of degeneration or structural damage present;
Frequently Asked Questions
A degenerated disc has a limited natural ability to heal. Its very low blood supply, low-oxygen environment, and dependence on diffusion for nutrients make repair much more difficult than in many other tissues.
That does not mean the condition of a disc can never improve or that pain cannot improve, especially if they are identified and treated early. Symptoms may improve significantly even when the structure of the disc does not return to normal.
Current research into regenerative and cell-based treatments is trying to influence the biology within the disc, but that is different from claiming that a damaged disc can simply be rebuilt or “regrown.”
This distinction matters: improving pain and function does not require an MRI to look normal again.
They may help some appropriately selected patients. Human studies of cell-based treatments for degenerative disc disease have reported improvements in pain and function, but results are not the same for every patient.
Success depends heavily on the condition of the disc, the source of the pain, how advanced the structural changes are, and whether the disc is still a reasonable treatment target.
This is also why “stem cells can help degenerative disc disease” should not be interpreted as “stem cells regrow a normal disc.” The realistic goal is to improve the environment within the damaged disc and, when successful, significantly reduce pain, improve function and quality of life.
No. Having degenerative disc disease on an MRI does not automatically mean you need surgery.
Surgery may be considered when symptoms remain severe or when there is a mechanical problem that requires decompression, stabilization, or another structural correction.
The decision should be based on what is actually causing the symptoms and what needs to be treated, not simply how abnormal the MRI looks.
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Medically reviewed by David Karli, MD, MBA · Harvard-trained physician, researcher and published author
Last reviewed: September 30, 2026