Degenerative diseases of lumbar spine
Authors:
P. Kozler
Authors‘ workplace:
LPS II, PSSZ, Praha
Published in:
Reviz. posud. Lék., 20, 2017, č. 3-4, s. 93-99
Category:
Original Articles, Review Articles, Case Reports
*Předneseno v upravené verzi na Konferenci lékařů posudkové služby Pracoviště ČSSZ pro Prahu a Střední Čechy ve dnech 20. 4.– 21. 4. 2017, Vzdělávací středisko Institutu pro veřejnou správu v Benešově.
Overview
Degenerative diseases of lumbar spine represent a complex process from etiological point of view and understanding of the origin is focused on degenerative processes of the lumbar intervertebral disc. The causes of degeneration of the disc may be classified to mechanic and biological ones, which do not exclude each other, since cellular physiological events are influenced by mechanic effects. This mutual relationship, called mechanobiology, is presently the main direction in the search for causes of intervertebral disc degeneration, which is the component of common ageing. The processes of intervertebral disc ageing and intervertebral disc degeneration are the same and difficult to discern. However, it is possible to define cellular events and biomechanical influences, which accompany the process of intervertebral disc degeneration. They include transformation of cells of nucleus pulposus, which have embryonic origin in notochord into chondrocytes producing collagen Type I and reduce concentrations of proteins, capable to bind water – proteoglycans and collagen Type II, the loss of osmotic and subsequently intradiscal pressure as a consequence of proteoglycan splitting, increased production of nitrogen oxides, which enhance apoptosis of the disc cells. The cellular properties and preservation of osmotic and intradiscal pressure secure intradiscal homeostasis, whereas degeneration is a manifestation of homeostasis disorder. The physiological process of ageing is facilitated and potentiated by risk factors (overload of the lumbar spine, smoking, diabetes). The present view of etiopathogenesis shows that degenerative diseases of the disc do not represent a real disease, but a concept describing common changes of the disc in the course of ageing. The degenerated disc, as an integral part of the system of three joints, connecting individual segments of the lumbar spine, induce the origin and evolution of degenerative changes on intervertebral joints, their hypertrophy, subluxation, the formation of osteophytes with stenosis of the spinal/vertebral canal, which generates clinical symptomatology as a consequence of compression of nervous tissue. The diversity of this clinical symptomatology is reflected in variety of therapeutic procedures in numerous medical branches. The most frequent surgical diagnoses include disc prolapse, lumbar stenosis and olisthesis, whereas clinical manifestations, which are treated by methods other than surgery, include lumbago, pseudoradicular syndrome and vertebral syndrome.
Keywords:
degenerative diseases of the spine – lumbar intervertebral disc– disc prolapse – osteoarthrosis – spondylosis – olisthesis
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