Degenerative diseases of lumbar spine
Authors:
P. Kozler
Authors place of work:
LPS II, PSSZ, Praha
Published in the journal:
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.
Summary
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
Zdroje
1. Steidlová, K. Vertebrogenní a myofasciální onemocnění a jejich podíl na dočasné pracovní neschopnosti a následně na invaliditě. Reviz. posud. Lék., 2007, 10, 3, s. 84–89.
2. Pirklová, M. Problematika posuzovaní degenerativních změn páteře a plotének, stavů po operacích výhřezu meziobratlových plotének a úrazech páteře. Reviz. posud. Lék., 2010, 13, 2, s. 47–55.
3. Hrádková, M. Failed back surgery syndrom – posuzování zdravotního stavu a funkčních omezení po operačních výkonech na páteři. Reviz. posud. Lék., 2011, 14, 2, s. 39–46.
4. Sovová, S. Vertebrogenní algický syndrom z pohledu pojistných a nepojistných systémů. Reviz. posud. Lék., 2012, 15, 2, s. 62–71.
5. Olejárová, M. Degenerativní onemocnění páteře. Med. pro praxi, 2014, 11, 2, s. 62–64.
6. Náhlovský, J. Chirurgická léčba degenerativního onemocnění páteře. Neurol. prax, 2008, 3, s. 133–134.
7. Štětkářová, I. Bolesti zad – příčiny a léčba. Interní Med., 2009, 11, 7 a 8, s. 345–348.
8. Hart, R. et al. Degenerativní onemocnění páteře. Galén, 2014, 291 s.
9. Bednařík, J. Akutní bolesti v lumbosakrální oblasti pro praktické lékaře z pohledu neurologa. Doporučený postup České lékařské společnosti JEP. Dostupné na www: http://www.cls.cz.
10. Kunc, Z. Chirurgická léčba lumboischiadického syndromu a její problémy. Zdravotnické nakladatelství, Praha, 1949, 258 s.
11. Šourek, K. Chirurgie bederních meziobratlových plotének. Avicenum, zdravotnické nakladatelství n.p., Praha, 1984, 216 s.
12. Kozler, P., Šourek, K. Možnosti a perspektivy využití termovizní techniky v neurochirurgii. Čas Lék čes., 1988, 127, 28, s. 873–880.
13. Kozler, P., Šourek, K. Nový pohled na etiopathogenezi vertebrogenního lumboischiadického syndromu. Čas Lék čes., 1987, 126, 16, s. 481–484.
14. Fencl, P., Kozler, P. Nukleotomie – nová metoda v léčbě lumboischiadického syndromu. Čas Lék čes, 1996, 135, 7, s. 211–214.
15. Kozler, P. Můj názor na operování bederních plotének. Čes. a Slov. Neurol. Neurochir., 2000, 63/96, 4, s. 244–245.
16. Wang, S. In vivo loads in the lumbar L3-4 disc during a weight lifting extension. Clin Biomech, 2014, 29, p. 155–160.
17. Vergroesen, P. P., van der Veen, A. J., van Royen, B. J., Kingma, I. et al. Intradiscal pressure depends on recent loading and correlates with disc height and compressive stiffness. Eur Spine J., 2014, 23, 11, p. 2359–2368.
18. Feng, C., Liu, H., Yang, M. et al. Disc cell senescence in intervertebral disc degeneration: Causes and molecular pathways. Cell Cycle., 2016, 15, 13, p. 1674–1684.
19. Kadow, T., Sowa, G., Vo, N. et al. Molecular basis of intervertebral disc degeneration and herniations: what are the important translational questions? Clin Orthop Relat Res., 2015 473, 6, p. 1903–1912.
20. Vergroesen, P. P., Kingma, I., Emanuel, K. S. et al. Mechanics and biology in intervertebral disc degeneration: a vicious circle. Osteoarthritis Cartilage, 2015, 23, 7, p. 1057–1070.
21. Wang, F., Cai, F., Shi, R. et al. Aging and age related stresses: a senescence mechanism of intervertebral disc degeneration. Osteoarthritis Cartilage, 2016, 24, 3, p. 398–408.
22. Daly, C., Ghosh, P., Jenkin, G. et al. A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic. Biomed Res Int., 2016, 2016, p. 5952165.
23. Brisby, H. Pathology and possible mechanisms of nervous system response to disc degeneration. J. Bone Joint Surg Am., 2006, 88, Suppl 2, p. 68–71.
24. Hayashi, T., Daubs, M. D., Suzuki, A. et al. Motion characte-ristics and related factors of Modic changes in the lumbar spine. J Neurosurg Spine, 2015, 22, 5, p. 511–517.
25. Ract, I., Meadeb, J. M., Mercy, G. et al. A review of the value of MRI signs in low back pain. Diagn Interv Imaging., 2015, 96, 3, p. 239–249.
26. Lu, Y., Guzman, J. Z., Purmessur, D. et al. Nonoperative management of discogenic back pain: a systematic review. Spine (Phila Pa 1976)., 2014, 15, 39, 16, p. 1314–1324.
27. Bydon, M., De la Garza-Ramos, R., Macki, M. et al. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech., 2014, 27, 5, p. 297–304.
28. Baliga, S., Treon, K., Craig, N. J. Low Back Pain: Current Surgical Approaches. Asian Spine J., 2015, 9, 4, p. 645–657.
29. Málek, V., Adamkov, J., Ryška, P. Syndrom neúspěšné chirurgické léčby degenerativního onemocnění bederní páteře (failed back surgery syndrom –fbss). Neurol. pro praxi, 2008, 9, 3, s. 149–154.
30. Baber, Z., Erdek, M. A. Failed back surgery syndrome: current perspectives. J Pain Res., 2016, 7, 9, p. 979–987.
Štítky
Medical assessment Occupational medicineČlánok vyšiel v časopise
Medical Revision
2017 Číslo 3-4
Najčítanejšie v tomto čísle
- Evaluation of liver cirrhosis for disamblement assessment, unjustified difference in evaluation of similar cases
- Degenerative diseases of lumbar spine
- Importance of psychosocial factors in evaluating the degree of bronchial asthma and for purposeful pharmacotherapy
- The most important changes in social security legislation in 2017 and 2018