Degenerative lower back pain can be caused by rare cases of pathological spinal aging or accelerated structural deterioration due to injury or anatomical defect. Degeneration is a naughty word in the dorsalgia treatment sector, since it is unfairly blamed for more painful expressions than any other singular source process. While degeneration can create pain in select patient profiles, most spinal aging is normal, expected, universal and in absolutely no way symptomatic. This truth is supported by decades of proven research and clinical experience gained by physicians the world over. Somehow, despite this fact, degeneration continues to be unjustly implicated as the villain in the majority of lower back pain syndromes.
This dissertation examines how spinal aging and its degenerative effects can influence the vertebral column and surrounding musculature. We will provide some examples of pathological aging processes, as well as detail the extensive range of conditions that are virtually never symptom-generating, yet are often blamed for pain without any evidence of pathology occurring.
Innocent Degenerative Lower Back Pain
In our experience, most degenerative lower back pain diagnoses are faulty and incorrect. They consist of documenting normal degrees of spinal aging and attributing pain to these expected occurrences without any evidence of pathology. It is like blaming pain on graying hair or skin wrinkles… Therefore, we caution patients to always seek multiple diagnostic opinions when any of the following typical spinal aging processes are implicated as the cause of their lumbar pain:
Degenerative disc disease is not a disease and is simply an age-related universal phenomenon in the human spine. It is normal for spinal discs to lose mass and moisture as they age. Disc desiccation is usually already present in earnest by the age of 30 in the lower back. Yes, a reduction in disc spaces does bring vertebral bones closer together and does incite the osteoarthritic processes, but these occurrences are also normal and not generally symptomatic.
As mentioned above, osteoarthritis is completely normal to experience in the lumbar spine. The condition is facilitated by disc degeneration and general motion-related wear and tear on the spinal facet joints and vertebral bodies. Evidence of arthritis will accumulate in the central canal creating spinal stenosis, but rarely to a asymptotic degree. Arthritic evidence will also reduce the patency of the foraminal spaces, but will seldom contribute to pinched nerves. Facet joint changes will also occur universally, but are considered normal in most severities and not cause for any alarm.
Intervertebral bulging and herniation is now considered basically normal in the lumbar spine. Most adults will demonstrate one or more herniated lumbar discs, most often at L4/L5 or L5/S1. Most herniated discs are incidental to any pain which might exist.
Degenerative spondylolisthesis is commonplace in older adults and usually is classified as grade 1 or 2, making it a nonissue that should be monitored, but rarely treated.
Pathological Degenerative Lumbar Back Pain
All of the above conditions have the potential to become symptomatic, although these circumstances represent the extreme exceptions to the rule of asymptomatic nature in most people:
Spinal stenosis might become a real problem when multiple cause act together to reduce the effective size of the central canal to the point where cauda equina syndrome results. This is a medical emergency that most commonly necessitates surgery.
Foraminal stenosis can eventually close off the opening through which a spinal nerve root exits the vertebral column, most often at L4, L5 or S1. A compressive neuropathy is the outcome of such significant structural change.
Marked, focal osteoarthritic change can create pathologies in the facet joints and also enact mechanical pain syndromes from increased vertebral body interactions.
Some age-related herniated discs can compress spinal nerves, causing a diversity of symptoms, or might leak interior proteins onto sensitive nerve fibers, causing chemical irritation.
More clinically severe cases of degenerative spondylolisthesis might reach grade 3 or 4 classifications and require dramatic surgical interventions.
Various age-related general heath issues can affect the spine as well, including low bone density and osteoporosis inciting compression fractures, as well as diabetes enacting neuropathy in the spinal nerve roots.
Degenerative Lower Back Pain Truths
You can see from the lists above that the degenerative conditions which are categorized as innocent and pathological consist of the exact same diagnoses. In most instances, the condition will qualify as asymptomatic or only minorly and occasionally symptomatic, necessitating medical monitoring, but not active care. In exceptional cases, the diagnosis might progress to a symptomatic or even disabling degree, but these events are very, very uncommon and certainly do not describe the average case of spinal degeneration in the lumbar vertebral column.
Patients should always consider this truth when evaluating their own diagnostic verdicts. Statistically, virtually all people whose lower back pain is blamed on one of the circumstances detailed in the innocent degenerative lower back pain section are misdiagnosed. Meanwhile, only a slim percentage of the total patient population will demonstrate the objective and evidence-based pathology that places them into the symptomatic category of spinal degeneration.
Therefore, we must repeat our advice to always seek diagnosis with a spinal neurologist and seek more than one diagnostic opinion before agreeing to any type of care. Proactivity is your best weapon against the most common threat facing all lower back pain patients: incorrect diagnosis. Do not take chances with your health or your life. Be sure before seeking treatment for anything. Learn all you can and then use your newfound knowledge to advocate for your best healthcare outcomes. We have made it easy for you by consolidating all the information about lower back pain into our sites of The Cure Back Pain Network, including this trusted topic-specific resource, Low-Back-Pain.Org.
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