At some point in life, low back pain affects the majority of the population and is a leading cause of disability worldwide. Excluding pain related to trauma, degenerative disc disease (DDD) is the most common spinal disorder. When the nucleus of the intervertebral disc dehydrates and can no longer cushion the two vertebrae, pressure increases on the spinal cord causing neurological impairment. This can lead to chronic pain in the lower back that requires surgical intervention through arthrodesis (fusion) or arthroplasty (total disc replacement). Although over 200,000 fusion surgeries are performed annually, a subset of this patient population may be candidates for total disc replacement. Therefore, it is important that nurses and case managers are familiar with DDD and the treatment options available today. This continuing education activity will review surgical treatment options for axial pain caused by DDD and new clinical evidence that assists spine surgeons in selecting the most effective treatment plan for appropriately indicated patients. It will provide an overview of the prevalence of axial back pain and DDD, followed by brief discussions of the relevant lumbar spine and intervertebral disc anatomy and the clinical implications of DDD. Conservative and surgical treatment options will be reviewed, with a focus on lumbar arthrodesis and lumbar arthroplasty. Key clinical evidence for each of the surgical treatment options will be summarized.