Lumbar degenerative spondylosis

Lumbar foraminal stenosis (LFS) is one of the most frequent forms of lumbar degenerative spondylosis (LDS), a late consequence of intervertebral disc degeneration (IVD) and considered a wear-and-tear phenomenon that is at least partially age-related. The narrowing of the intervertebral space leads to secondary hypertrophy of the intervertebral joints as a reaction to overload, ligamentous overgrowth, and a reduction in intervertebral foramen diameter. This chain reaction is the main reason for nerve root impingement and distorted neurodynamics that lead to mixed pain in advanced spondylosis (axial and radicular pain) ¹⁾.

Although low back pain pathogenesis is very heterogenic, intervertebral disc degeneration (IVD) is commonly regarded as a cornerstone of the cascade of phenomena that produce lumbar degenerative spondylosis (LDS). It is estimated that the majority of the population is supposed to experience LBP at some point in their lives. The 1-year incidence of the first-ever LBP episode varies from 6.3 to 15.4%, while the 1-year incidence of any LBP episode varies from 1.5 to 36%, with episode remission at 1 year ranging from 54 to 90% ²⁾

The prevalence of low back pain due to lumbar spondylosis is estimated at 3.6% worldwide, and 4.5% in North America ³⁾

Elderly patients (>65 years of age) are sometimes considerably disabled due to lumbar spondylosis and may need major spine surgery ⁴⁾

Aggressive discectomy has been associated with reduced intervertebral height, which is thought to cause segmental instability and thus accelerate spondylosis ⁵⁾ ⁶⁾ ⁷⁾.

¹⁾

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1. PMID: 30854609.

²⁾

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):769-81. doi: 10.1016/j.berh.2010.10.002. PMID: 21665125.

³⁾

Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Härtl R, Bisson E, et al: Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J 8:784–794, 2018

⁴⁾

Glassman SD, Carreon LY, Dimar JR, Campbell MJ, Puno RM, Johnson JR. Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J. 2007;7(5):547–551.

⁵⁾

Cinotti C, Postacchini F. Biomechanics. In: Postacchini F, editor. Lumbar Disc Herniation. Springer-Verlag (Wien); 1999. pp. 81–93.

⁶⁾

Fruhwirth J, Koch G, Amann W, Hauser H, Flaschka G. Vascular complications of lumbar disc surgery. Acta Neurochir (Wien) 1996;138:912–916.

⁷⁾

Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine (Phila Pa 1976) 1978;3:319–328.