J Korean Med Assoc.  2014 Apr;57(4):300-307. 10.5124/jkma.2014.57.4.300.

Pathophysiology of degenerative spinal disease causing lumbar and cervical spinal pain

• Lee IS
• Chung SG

• KMID: 2064887
• DOI: http://doi.org/10.5124/jkma.2014.57.4.300

Abstract

As degenerative spinal disease among spinal diseases causing lumbar and cervical spinal pain is the endless repetition of "the biological healing of mechanical damage" occurring over a lifetime, spinal pain by degenerative spinal disease occurs as a series of successive changes through the repetitive damage-healing process of various spinal structures including the intervertebral disc rather than a temporary phenomenon of any given pathophysiologic change in one moment. Degenerative spinal disease generally begins with degeneration of the intervertebral disc. Then herniation of the intervertebral disc resulting in subsequent radicular pain occurs when the nucleus pulposus with degeneration located in the intervertebral disc tears and penetrates the annulus fibrosus. Subsequently, disc space narrowing occurs and alters the spinal biomechanics, followed by degenerative changes to the vertebral endplate, vertebra itself, and facet joint. Finally, these changes lead to spinal stenosis, which is the final destination of degenerative spine disease. Although the exact pathogenesis of spinal pain could be still unclear because of some inconsistencies between the degenerative changes in the spine and the clinical manifestations of spinal pain, an accurate understanding of the pathophysiology and future predictions for further mechanical injury as well as thorough history taking and careful attention to the long-term clinical courses and other associated risk factors including daily life posture and work posture are needed for successful treatment of spinal pain.

Keyword

Intervetebral disc degeneration; Physiopathology; Low back pain; Neck pain; Spinal stenosis

MeSH Terms

Intervertebral Disc
Low Back Pain
Neck Pain
Posture
Risk Factors
Spinal Diseases*
Spinal Stenosis
Spine
Zygapophyseal Joint

Figure

• 

  Figure 1 The degenerative cascade of L4-5 spinal segment. (A) Normal disc, (B) degeneration of the intervertebral disc, (C) herniated intervertebral disc, (D) disc space narrowing and facet joint degeneration, and (E) spinal stenosis with discovertebral degeneration and spondylosis.

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  Figure 2 The spectrum of pathogenesis of the degenerative changes in the intervertebral disc. MMPS, matrix metalloproteinases; ADAMTS, a disintegrin and metalloproteinase with thrombospondin motifs, TIMPs, tissue inhibitors of metalloproteinases (From Choi YS. Asian Spine J 2009;3:39-44, according to the Creative Commons license) [15].

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