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Intervertebral disc degeneration: evidence for two distinct phenotypes
Author(s) -
Adams Michael A.,
Dolan Patricia
Publication year - 2012
Publication title -
journal of anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.932
H-Index - 118
eISSN - 1469-7580
pISSN - 0021-8782
DOI - 10.1111/j.1469-7580.2012.01551.x
Subject(s) - degeneration (medical) , sciatica , intervertebral disc , low back pain , annulus (botany) , medicine , buttocks , anatomy , lumbar , back pain , intervertebral disk , pathology , surgery , biology , botany , alternative medicine
We review the evidence that there are two types of disc degeneration. ‘ E ndplate‐driven’ disc degeneration involves endplate defects and inwards collapse of the annulus, has a high heritability, mostly affects discs in the upper lumbar and thoracic spine, often starts to develop before age 30 years, usually leads to moderate back pain, and is associated with compressive injuries such as a fall on the buttocks. ‘Annulus‐driven’ disc degeneration involves a radial fissure and/or a disc prolapse, has a low heritability, mostly affects discs in the lower lumbar spine, develops progressively after age 30 years, usually leads to severe back pain and sciatica, and is associated with repetitive bending and lifting. The structural defects which initiate the two processes both act to decompress the disc nucleus, making it less likely that the other defect could occur subsequently, and in this sense the two disc degeneration phenotypes can be viewed as distinct.