Clinical studies of isolated disc resorption in the lumbar spine

Rm, Venner; Hv, Crock

doi:10.1302/0301-620x.63b4.6457838

Cited by 22 publications

(8 citation statements)

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“…They stressed that the morphology of the ligament was inconstant and in some cases it was found to be compressing the nerve tightly against the ala of the sacrum, corroborating earlier reports by Hadley (1949) and Golub and Silverman (1969). Notwithstanding these detailed studies, analyses of failed attempts at surgical decompression of suspected nerve root entrapment published by Macnab (1977) and by Venner and Crock (1981) have suggested that the anatomical factors underlying entrapment syndromes are still not fully understood.…”

Section: Introductionsupporting

confidence: 55%

Extraspinal course of the fifth lumbar spinal nerve: An update of its topographical relationships

et al. 1991

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The fifth lumbar spinal nerve traverses a highly mobile transitional junction of the vertebral column. Evidence suggests that it is often implicated in the etiology of low-back pain, notably in entrapment syndromes. There appears to be a high incidence of unsuccessful attempts at surgical decompression in cases of suspected entrapment of the nerve, suggesting that perhaps the anatomical information on the topography of the nerve is incomplete. The present study examined the course and relations of the fifth lumbar spinal nerve by gross dissection of human cadaveric material. The results showed that the nerve and its subdivisions follow a complex, tortuous course as they cross the lumbosacral junction. The trunk and ventral and dorsal rami are all related to strong ligaments that are thought to be protective. The nearness of these nerves to ligaments in such an area of high mobility, however, predisposes them to impingement or entrapment in the event of joint or ligamentous pathology. It is suggested therefore that investigations of spondylogenic low-back pain should include a detailed evaluation of the status of all parts of the fifth lumbar spinal nerve as they traverse their individual osteoligamentous compartments.

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Section: Introductionsupporting

confidence: 55%

Extraspinal course of the fifth lumbar spinal nerve: An update of its topographical relationships

et al. 1991

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“…Such a process would affect the loading capabilities and segmental motion of the involved segment, thereby contributing not only to disc degeneration of the involved segment, but, because the distribution of stress forces will be altered, the adjacent level may be affected to some degree as well (49)(50)(51)(52)(53)(54).…”

mentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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Objective. Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD).Methods. As part of a large genetics-based study in southern Chinese individuals (n ‫؍‬ 1,989), a crosssectional analysis was performed in subjects exhibiting disc degeneration in >2 levels (n ‫؍‬ 838) who were then categorized as having SLDD (n ‫؍‬ 174) or non-SLDD (contiguous, multilevel; n ‫؍‬ 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.Results. Overall, 8.7% of the whole population (n ‫؍‬ 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n ‫؍‬ 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P ‫؍‬ 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P ‫؍‬ 0.004) and/or a history of back injury (P ‫؍‬ 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups.Conclusion. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.

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“…33 Age-related changes in disc mechanics are exaggerated if the disc shows signs of structural disruption such as anular fissures, endplate fracture, and gross height loss. 23 However, links between disc degeneration and segmental instability are not straightforward because some degenerative changes, such as vertebral osteophytes and disc resorption, 34 probably reduce spinal movements rather than increase them. Indeed, instability has been described as a transitional stage in the degenerative process, lying between some initial dysfunction and subsequent restabilization or repair 35,36 so naturally occurring spinal degeneration could be associated with hypermobility or hypomobility, depending on which stage has been reached.…”

mentioning

confidence: 99%