Degenerative disc disease is one of the leading causes of pain and disability. Various surgical treatments are available, but the literature does not provide a comparative overview of their long-term outcomes. This article synthesizes the available long-term evidence on the treatment of degenerative disc disease. Fusion for degenerative disc disease has recently shown good long-term clinical outcomes, yet several studies strongly suggest that it may accelerate the degenerative process at adjacent levels. Arthroplasty shows at least equivalent long-term outcomes and is not expected to accelerate adjacent degeneration, but speculative concern remains about its safety, especially in regard to wear debris and facet joint arthrosis. Many other treatment devices are in various stages of development, but long-term studies are not yet available for most of them. When making treatment decisions, physicians and patients must consider the long-term outcomes, because the devices remain implanted indefinitely, and back pain could recur at any time if the degeneration progresses or the device fails. Before making a treatment decision, surgeons and patients should thoroughly discuss the long-term clinical prognosis, the safety of various procedures, the degrees of certainty in our currently available medical knowledge, and the patient's preferences. No one solution will be right for every patient, but we are entering a golden era of choices, where most patients with degenerative disc disease should be able to find a treatment that substantially improves their condition.