Objective: To identify key predictors of operative necessity in patients with degenerative disc disease (DDD), focusing on clinical, radiological, and psychological factors.

Methodology: This retrospective cohort study was conducted at the Department of Orthopaedics, Hayatabad Medical Complex, Peshawar, from June 2018 to June 2019. A total of 200 patients were included, divided into 100 conservative treatment and 100 surgical intervention groups. Preoperative data were collected, including demographic details, Oswestry Disability Index (ODI), Beck Depression Inventory (BDI) scores, MRI findings, and comorbidities. Statistical analysis included t-tests and chi-square tests, with a significance level of p < 0.05.

Results: The surgical group exhibited significantly higher preoperative ODI (37.5 vs. 32.4, p = 0.001) and BDI scores (18.3 vs. 14.2, p = 0.002), indicating greater disability and psychological distress. Radiological findings, including foraminal disc herniation (70% vs. 50%, p = 0.001) and retrolisthesis (15% vs. 10%, p = 0.205), were more common in the surgical group. The p-values for these variables confirmed their predictive role in the need for surgery.

Conclusion: This study demonstrates that preoperative disability, psychological factors, and radiological findings are significant predictors of the necessity for surgical intervention in DDD. A multidisciplinary approach considering both clinical and psychological assessments is essential for improving patient outcomes and guiding treatment decisions.