Multilevel Degenerative Disc Disease and Spondylosis Charlotte NC | What It Means | Clear Life Scoliosis

By Dr. Justin Dick, DC · Clear Life Scoliosis and Chiropractic Center, Charlotte, NC · Published October 28, 2026

"Multilevel degenerative disc disease" or "multilevel spondylosis" on an imaging report means age-related changes in discs or joints at more than one spinal level. It is common in people without pain: in a Hong Kong population study of 1,043 adults, 40 percent under 30 had lumbar disc degeneration on MRI and more than 90 percent had it by age 50 to 55. Multiple levels do carry more weight than one. In a Rotterdam study of 2,819 adults, disc space narrowing at two or more levels was more strongly associated with back pain (odds ratio 2.4) than narrowing at a single level.

I am Dr. Justin Dick at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. I hold CNMT and ARRT(N)(CT) imaging credentials. The word "disease" in this term alarms patients, and the findings need to be read against the exam before anyone decides what they mean.

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What the Terms Mean

Degenerative disc disease describes discs that have lost water content, height, or structure. Spondylosis is the broader term for degeneration of the spine, including discs, vertebral edges with bone spurs, and facet joints. "Multilevel" means the change appears at more than one level. None of these words alone describes a cause of pain, and none predicts how a person will feel.

How Common It Is Without Symptoms

Brinjikji and colleagues pooled imaging of 3,110 people with no back pain. Disc degeneration rose from 37 percent at age 20 to 96 percent at 80, and disc bulging from 30 percent to 84 percent. Cheung and colleagues found lumbar disc degeneration in 40 percent of adults under 30 in a population sample, with L4-L5 and L5-S1 most often affected, and some people had skipped levels with normal discs between degenerated ones. In the neck, Nakashima and colleagues found disc bulging in 87.6 percent of 1,211 people without symptoms, including 73 to 78 percent of people in their 20s.

When the Findings Are Linked With Pain

A second Brinjikji meta-analysis compared adults 50 or younger with and without back pain. Disc degeneration was more common in those with pain (odds ratio 2.24), as were disc bulge (7.54), extrusion (4.38), protrusion (2.65), and Modic type 1 endplate changes (4.01). Cheung and colleagues found a higher total degeneration score was associated with back pain. De Schepper and colleagues found narrowing at two or more levels was more strongly tied to pain than one level. These are associations at the group level. In an individual, the exam decides whether a level is clinically relevant.

What It Means for Treatment

There is no treatment that reverses disc degeneration on imaging. Care targets function and symptoms. Hayden and colleagues' Cochrane review of 249 trials in chronic low back pain found exercise reduced pain by about 15 points on a 100-point scale compared with no treatment or usual care. When a degenerated level narrows a nerve opening and causes radicular symptoms, management follows the nerve problem; my post on pinched nerve vs herniated disc covers that.

Multilevel Changes After an Accident

Multilevel degeneration seen soon after a car crash pre-dates it. Degenerated segments can still be injured or aggravated. Documenting that requires comparing pre-injury and post-injury function and, when available, prior imaging. My page on pre-existing degeneration vs new injury vs aggravation explains the approach.

How Dr. Justin Dick Reads Multilevel Findings at Clear Life

At our Charlotte office, each level on the report is matched against the history, neurological exam, and motion findings. Levels that match symptoms guide care; levels that do not are recorded as background. Patients receive a plain-language explanation of their report.

Comparison

Research and Evidence

Evidence tiering: Brinjikji's two papers are systematic reviews of observational imaging studies; Cheung, Nakashima, and de Schepper are cross-sectional population studies; Hayden is a Cochrane review of randomized trials. Associations between imaging findings and pain are group-level and cannot attribute pain to a level in one patient.

My own published work includes degenerative and post-traumatic findings. The refractory lumbar pain case, Refractory Lumbar Pain Following Motor Vehicle Collision in a Geriatric Patient With Prior Lumbar Surgery (Cureus, 2026, PMID 41694169), describes one older patient and is case-level evidence.

References

1. 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):811-6. doi:10.3174/ajnr.A4173
2. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-9. doi:10.3174/ajnr.A4498
3. Cheung KM, Karppinen J, Chan D, et al. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine. 2009;34(9):934-40. doi:10.1097/BRS.0b013e3181a01b3f
4. Nakashima H, Yukawa Y, Suda K, et al. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015;40(6):392-8. doi:10.1097/BRS.0000000000000775
5. de Schepper EI, Damen J, van Meurs JB, et al. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine. 2010;35(5):531-6. doi:10.1097/BRS.0b013e3181aa5b33
6. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2
7. Dick JM. Refractory lumbar pain following motor vehicle collision in a geriatric patient with prior lumbar surgery: clinical resolution after multimodal conservative spinal structural rehabilitation. Cureus. 2026;18(2):e103540. doi:10.7759/cureus.103540

Frequently Asked Questions

Service Area

Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin Dick.

Related Pages

• MRI Disc Findings Without Pain
• How to Read a Spine MRI Report
• Disc Bulge, Protrusion, Extrusion
• Spine Structure, Pain, and Degeneration
• Pre-Existing Degeneration vs New Injury
• Pinched Nerve vs Herniated Disc
• Spinal Stenosis Exercises With Scoliosis
• Getting Shorter With Age
• Radiographic Imaging Credentials
• Dr. Justin Dick Research

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If your report lists multilevel degeneration and you want to know which levels matter, Dr. Justin Dick reviews the images against a full exam at our Charlotte office.

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