Anatomical and Clinical Studies on Lumbar Disc Degeneration

Friberg, Sten; Hirsch, Carl

doi:10.3109/17453674908991095

Cited by 185 publications

(78 citation statements)

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“…However, it has also been demonstrated by Friberg & Hirsch ( 5 ) , that the degenerative changes inside the disc can exist in spite of a normal roentgenogram. Since disc degeneration in the lumbar spine also has becn connected with symptoms of low back pain disorders (3, 7 , 8, 9 ) other procedures e. g .…”

Section: )mentioning

confidence: 99%

In vivo Discometry in Lumbar Discs with Irregular NucleogramsSome Differences in Stress Distribution between Normal and Moderately Degenerated Discs

Nachemson

1965

Acta Orthopaedica Scandinavica

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Section: )mentioning

confidence: 99%

In vivo Discometry in Lumbar Discs with Irregular NucleogramsSome Differences in Stress Distribution between Normal and Moderately Degenerated Discs

Nachemson

1965

Acta Orthopaedica Scandinavica

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“…Several grading systems for lumbar disc degeneration have been proposed, the most widely used being based on macroscopic features [11,23]. The general problem of reproducibility and comprehensiveness was addressed by Thompson et al, who introduced a five-category grading system based on gross disc morphology [30].…”

Section: Grading Of Changesmentioning

confidence: 99%

“…Various classifications of lumbar disc degeneration have graded the changes macroscopically [11,23,30], by MRI [35], and by discography [2]. The histologic features of lumbar disc degeneration have been described in detail [8,26,27, 34], but no histologic grading system has been proposed.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is conceivable that degenerative changes within this "three joint complex" influence each other, but the sequence of changes and their outcome are still matters for debate [6,15, 28]. However, a recent histologic investigation in sheep has clearly defined the possible development of facet joint arthritis as a response to disc degeneration [22].Various classifications of lumbar disc degeneration have graded the changes macroscopically [11,23,30], by MRI [35], and by discography [2]. The histologic features of lumbar disc degeneration have been described in detail [8,26,27, 34], but no histologic grading system has been proposed.…”

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confidence: 99%

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Early histologic changes in lower lumbar discs and facet joints and their correlation

Gries

Berlemann²,

Moore

et al. 2000

European Spine Journal

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IntroductionThe precise etiology of low back pain is difficult to establish and remains unclear. It is believed, however, that degenerative changes in the spinal motion segment play an important role. These may occur in discs and associated facet joints, which are regarded as an interdependent functional spinal unit (FSU). Biomechanical studies clearly show the importance of the facet joints as a motion-restricting, as well as a stress-and load-sharing factor for the disc [1,9,13,19]. Therefore, it is conceivable that degenerative changes within this "three joint complex" influence each other, but the sequence of changes and their outcome are still matters for debate [6,15, 28]. However, a recent histologic investigation in sheep has clearly defined the possible development of facet joint arthritis as a response to disc degeneration [22].Various classifications of lumbar disc degeneration have graded the changes macroscopically [11,23,30], by MRI [35], and by discography [2]. The histologic features of lumbar disc degeneration have been described in detail [8,26,27, 34], but no histologic grading system has been proposed.Abstract Biomechanical and histologic studies have highlighted the close functional relationship between lumbar discs and their associated facet joints, and it is conceivable that their degenerative changes are interdependent. However, separation of cause from effect remains controversial. Hitherto, no study in humans has correlated the changes histologically. The present study assessed histologic changes in lower lumbar discs and their associated facet joints in patients under the age of 40 years using classification systems developed for this investigation. A specific objective was to correlate changes in discs and facet joints. Data from 15 lower lumbar spine specimens were obtained. Three parasagittal sections per disc and one section per facet joint were graded histologically. The results were correlated with age, within the functional spinal unit (FSU), and with the adjacent level. Histologic changes were found in discs and facet joints from all FSUs. There was no correlation between the age of the subject and the degree of degeneration of the disc or facet joints at either level. The extent of disc degeneration at L4/5 correlated significantly with changes at L5/S1 (P < 0.01). There was no correlation between changes in discs and the associated facet joints at either level. The results of the study showed that microscopic changes are seen in the disc and facet joints from an early age and can be quite marked in some individuals before the age of 40 years. A correlation of degenerative changes within the FSU could not be established.

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“…A major controversy exists as to whether ASD is caused by aging or is secondary to mechanical stress after fusion [2,13,14,36,41,45,46]. In an attempt to determine the etiology of ASD, several authors have tried to identify the risk factors for ASD, and have reported the following risk factors: postmenopausal status [11], fusion length [37,44], sagittal alignment [11,38,43], lamina horizontalization [32], facet tropism [32], and rigid instrumentation [11,19].…”

Section: Discussionmentioning

confidence: 99%

Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

et al. 2013

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Purpose Adjacent segment degeneration (ASD) is one of the major complications of lumbar fusion. Several previous retrospective studies reported ASD after PLIF. However, few reports evaluated whether decompression surgery combined with fusion surgery increases the rate of complications in adjacent segments. The purpose of the current study was to investigate the degeneration in decompressed adjacent segments after PLIF. Methods A total of 23 patients (12 men, 11 women; average age, 58.6) who underwent PLIF surgery [1 level (n = 9), 2 levels (n = 8), 3 levels (n = 4), 4 levels (n = 2)] were included. Additional adjacent decompression above or below the level of interbody fusion was performed at 25 levels and no adjacent decompression was performed at 15 levels. We retrospectively investigated ASD by X-ray films of all 40 adjacent segments (above and below fusion level) and clinical outcomes of all 23 cases.Results Of the 40 adjacent segments, 19 (47.5 %) showed ASD and 9 (22.5 %) showed symptomatic ASD. In the 19 segments with ASD, ASD occurred in 16 of 25 (64.0 %) segments at decompressed sites compared with 3 of 15 (20.0 %) non-decompressed sites. The ratio of ASD in adjacent segments was significantly higher at decompressed sites than at non-decompressed sites (p \ 0.01). Conclusion ASD occurs frequently in association with additional decompression above or below the level of PLIF. In cases in which the adjacent segments require decompression, a surgical strategy that preserves as much of the posterior complex as possible should be selected.

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Anatomical and Clinical Studies on Lumbar Disc Degeneration

Cited by 185 publications

References 1 publication

In vivo Discometry in Lumbar Discs with Irregular NucleogramsSome Differences in Stress Distribution between Normal and Moderately Degenerated Discs

In vivo Discometry in Lumbar Discs with Irregular NucleogramsSome Differences in Stress Distribution between Normal and Moderately Degenerated Discs

Early histologic changes in lower lumbar discs and facet joints and their correlation

Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

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