Persistent lower back pain (LBP) is a major cause of medical care and disability, resulting in a significant medical burden. Structural and functional abnormalities of spinal tissues such as the intervertebral disc (IVD), dorsal root ganglia, and muscles can trigger or exacerbate LBP, with intervertebral disc degeneration considered the most important factor in causing LBP and age being a key factor in IVD degeneration. A large number of existing articles have shown that macrophage polarization and inflammatory mediators infiltrate in both human and rodent degenerative IVD and that the number of macrophages is positively correlated with the degree of intervertebral disc degeneration. This article reviews current research advances in macrophage polarization in aging disc degeneration to understand the potential mechanisms of disc aging in order to help delay or ameliorate the age-dependent degenerative process and to provide important strategies for clinical prevention and treatment of LBP.