Let’s have a look a the causes of low back pain and how it could be related to degenerative disc disease and herniated discs.
- common complaint among adults
- lifetime prevalence in working population up to 80%
- 60% experience functional limitation or disability
- second most common reason for work disability
- despite advances in imaging and surgical techniques LBP prevalence and its cost are relatively unchanged
- 90% people age >50 have Degenerative Disc Disease
- Large disc herniation does NOT always need surgery
- Neurologic loss is NOT an absolute indication for surgery
- Small disc bulge is NOT always normal
- Surgery does not have an 80% success rate
- Conservative treatment is reversible. Surgery is not.
Causes of low back pain – Click to enlarge
Back pain causes:
- Spasm
- Sprain/strain
- Biomechanical
- Disc herniation
- Disc bulge
- Degenerative osteoarthritis
- Facet syndrome
- Spondylolithesis
- Spinal stenosis
- Osteoporosis
- Inflammatory
- Infection
- Cancer
Normal Vs Disc Degeneration – Clic to enlarge
Disc degeneration (arthrosis)
- Changes in hydrostatic pressure
- Lack of oxygen
- Lack of glucose
- Changes in pH levels
- Death of proteoglycans
If the cells of the disc failed to get proper nutrients – such as oxygen, or glucose – or if the pH level of the disc drops (because waste is not being diffused out of the disc and it becomes anaerobic), disc cells would die and stop producing the vital proteoglycan aggregates. The disc loses its water content (dehydrates) and loses its hydrostatic pressure (osmotic pressure).
Symptoms of lumbar disc disease are the result of either herniation of the nucleus pulposus through a mechanically weak annulus fibrosis or from tearing of the annulus itself. This can lead to Radiculopathy from nerve root compression and/or Radiculitis – an inflammatory process affecting nerve roots or the spinal cord. Herniation is thought to be the result of a defect in the annulus fibrosis, most likely the result of excessive stress applied to the disc.
Three types of annular tears:
- Rim lesion – horizontal tearing of the very outer fibers of the disc near their attachments into the ring apophysis;
- Concentric tear – splitting apart of the lamellae of the annulus in a circumferential direction
- Radial tear – horizontal or obliquely horizontal tears