Degenerative Disorders of the Lumbar and Cervical Spine

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Anatomy and composition

A thorough knowledge of vertebral and intervertebral disc anatomy is essential for understanding the pathophysiology, diagnosis, and rational treatment decisions for degenerative disc disease. A fundamental concept is the functional spinal unit, which represents the smallest segment of the spine that exhibits the biomechanical characteristics of the entire spine [1]. This segment includes two adjacent vertebrae, the intervertebral disc, and the spinal ligaments. A single motion segment is a

Effects on disc composition and structure

Disc degeneration is part of the normal aging process. A key factor in intervertebral disc degeneration is a distinct alteration in its biochemical composition. In comparison to older individuals, there is a higher concentration of proteoglycans in the nucleus pulposus of younger individuals. The aggregation of proteoglycans promotes enhanced hydration that in turn accounts for the disc's resilience [5], [9]. As aging progresses into the third decade, there is a decrease in the proteoglycan

Pain from motion segment degeneration

Axial back or neck pain may be multifactorial and often difficult to treat. Discogenic pain, or pain originating from the intervertebral disc, is caused by derangement of the nucleus pulposus or anulus fibrosus. Degeneration of the anulus itself may lead to loss of structural integrity and eventual tearing. Painful stimuli from annular tears are thought to occur by way of stimulation of the surrounding sinuvertebral nerves.

Other possible anatomic sources of pain include the facet joints,

Lumbar spine degeneration

A multitude of factors such as repetitive mechanical stresses, micro- or macrotrauma, and changes in metabolism, cellular nutrition, and biochemical composition lead to alterations in the integrity of the intervertebral disc. The intervertebral discs in the lumbar spine are particularly susceptible to the process of disc degeneration (Fig. 2).

An investigation of 600 lumbar intervertebral discs found a correlation between degeneration and disc levels subjected to higher mechanical stresses [25].

Cervical spine degeneration

Although degeneration of the cervical spine occurs as normal age-related changes, notable differences in the anatomy and loading characteristics between cervical and lumbar spines result in differences in the pattern of involvement, rate of degeneration, and clinical presentation. Similar to its function in the lumbar spine, the intervertebral discs in the cervical spine function to provide stability, facilitate movement, absorb shock, and separate the vertebral bodies and intervertebral

Treatment of degenerative disorders

Conservative treatment remains the standard of care in the symptomatic treatment of degenerative disc disease [43]. Modalities including nonsteroidal anti-inflammatory medications, analgesics, short-term bed rest, physical therapy, heat, electrical therapy, and lifestyle modifications represent some of the mainstays in the management of lumbar and cervical spinal degeneration. Spinal injections (including epidural, selective nerve root, and facet joint injections) can serve dual diagnostic and

Summary

The etiology of symptom manifestation in lumbar and cervical spine degeneration is multifactorial and includes cellular, biochemical, and biomechanical causes. Accurate identification of pain generators in the degenerative spine can be challenging. After a diagnosis is made, however, treatment measures must address the patient's pain, neurologic function, and spinal stability. The clinician must understand that degenerative disorders in the spine are normal, age-related phenomena and largely

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References (54)

  • B.H. Guiot et al.

    Molecular biology of degenerative disc disease

    Neurosurgery

    (2000)
  • J.A. Buckwalter et al.

    Articular cartilage and intervertebral disc proteoglycans differ in structure: an electron microscopic study

    J Orthop Res

    (1989)
  • J.A. Buckwalter et al.

    Proteoglycans of human infant intervertebral disc. Electron microscopic and biochemical studies

    J Bone Joint Surg Am

    (1985)
  • K.P. Pritzker

    Aging and degeneration in the lumbar intervertebral disc

    Orthop Clin N Am

    (1977)
  • M.D. Humzah et al.

    Human intervertebral disc: structure and function

    Anat Rec

    (1988)
  • M. Rudert et al.

    Lymph and blood supply of the human intervertebral disc. Cadaver study of correlations to discitis

    Acta Orthop Scand

    (1993)
  • J.A. Buckwalter et al.

    Age-related changes in cartilage proteoglycans: quantitative electron microscopic studies

    Microsc Res Tech

    (1994)
  • J.A. Buckwalter et al.

    Intervertebral disk aging, degeneration, and herniation

  • M.H. Coppes et al.

    Innervation of “painful” lumbar discs

    Spine

    (1997)
  • G.J. Groen et al.

    Nerves and nerve plexuses of the human vertebral column

    Am J Anat

    (1990)
  • T. Palmgren et al.

    An immunohistochemical study of nerve structures in the annulus fibrosus of human normal lumbar intervertebral discs

    Spine

    (1999)
  • N. Bogduk et al.

    The nerve supply to the human lumbar intervertebral discs

    J Anat

    (1981)
  • T.K. Taylor et al.

    Spinal biomechanics and aging are major determinants of the proteoglycan metabolism of intervertebral disc cells

    Spine

    (2000)
  • S.M. Iencean

    Lumbar intervertebral disc herniation following experimental intradiscal pressure increase

    Acta Neurochir (Wien)

    (2000)
  • M.C. Jensen et al.

    Magnetic resonance imaging of the lumbar spine in people without back pain

    N Engl J Med

    (1994)
  • A.L. Wallace et al.

    Humoral regulation of blood flow in the vertebral endplate

    Spine

    (1994)
  • M.A. Adams et al.

    Mechanical initiation of intervertebral disc degeneration

    Spine

    (2000)

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