ChiroACCESS Article



Disc Degeneration and Low Back Pain: An Emerging Etiological Picture



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ChiroACCESS Editorial Staff

  

ChiroACCESS



Published on

February 5, 2009

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Disc degeneration has historically been believed to play a key role in a low back pain and sciatica. Research studies during the last few years give us reason to take another look at our previous model of disc degeneration. Until very recently, “Wear and tear” was believed to be the major cause of disc degeneration. However, a growing body of contemporary research is suggesting that this is not the case. It appears from many studies including some interesting epidemiological investigations, that the major factor in disc degeneration is genetics.

A study referred to as “The Twin Study”, along with some other recently published research, highlight the importance of genetics as a more significant factor in the etiology of disc degeneration than previously thought.A study referred to as “The Twin Study”, along with some other recently published research, highlight the importance of genetics as a more significant factor in the etiology of disc degeneration than previously thought. In a large multinational study, it was observed that other variables previously believed to be more important contributors to disc degeneration including, smoking, heavy labor, vibration, and obesity made little difference in the development of disc degeneration. The dominate predictor of disc degeneration in this study was the genetic material the twins shared. One twin might have a sedentary job and not smoke while the other twin might engage in manual labor and smoke, nevertheless if one twin developed disc degeneration, the other had a significant chance of developing it as well. Conversely, if one twin had healthy discs, the other would as well irrespective of lifestyle and environmental factors. The study points out that smoking, anthropomorphic variables, vibration, etc. do still play a role in disc degeneration but not nearly as significantly as previously believed. It appears that the manual lifting, smoking and other lifestyle issues contribute to triggering episodes of low back pain. Additional research is in progress to more clearly understand the interaction between the degeneration of the disc and the other variables.

In short, this excellent January 2009 review concludes that “Disc degeneration is now considered a condition that is genetically determined in large part, with environmental factors, although elusive, also playing an important role. Most of the specific environmental factors once thought to be the primary risk factors for disc degeneration appear to have very modest effects, if any.” As new research continues to change our understanding of disc degeneration it will have an impact on our chiropractic patient care.

As spinal experts, these are the kind of studies all chiropractors should be familiar with.


Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L.

BACKGROUND CONTEXT: Disc degeneration was commonly viewed over much of the last century as a result of aging and "wear and tear" from mechanical insults and injuries. Thus, prevention strategies and research in lumbar degenerative changes and associated clinical conditions focused largely on mechanical factors as primary causes using an "injury model." The Twin Spine Study, a research program on the etiology and pathogenesis of disc degeneration, has contributed to a substantial revision of this view of determinants of lumbar disc degeneration.

PURPOSE: To provide a review of the methods and findings of the Twin Spine Study project. STUDY

DESIGN/SETTING: Narrative review of the Twin Spine Study.

METHODS: The Twin Spine Study, which started in 1991, is a multidisciplinary, multinational research project with collaborators primarily in Canada, Finland, and the United States. The most significant investigations related to determinants of disc degeneration included occupational exposures, driving and whole-body vibration exposure, smoking exposure, anthropomorphic factors, heritability, and the identification of genotypes associated with disc degeneration.

RESULTS: Among the most significant findings were a substantial influence of heredity on lumbar disc degeneration and the identification of the first gene forms associated with disc degeneration. Conversely, despite extraordinary discordance between twin siblings in occupational and leisure-time physical loading conditions throughout adulthood, surprisingly little effect on disc degeneration was observed. Studies on the effects of smoking on twins with large discordance in smoking exposure demonstrated an increase in disc degeneration associated with smoking, but this effect was small. No evidence was found to suggest that exposure to whole-body vibration through motorized vehicles leads to accelerated disc degeneration in these well-controlled studies. More recent results indicate that the effect of anthropometric factors, such as body weight and muscle strength on disc degeneration, although modest, appear in this work to be greater than those of occupational physical demands. In fact, some indications were found that routine loading may actually have some benefits to the disc.

CONCLUSIONS: The once commonly held view that disc degeneration is primarily a result of aging and "wear and tear" from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences. Although environmental factors also play a role, it is not primarily through routine physical loading exposures (eg, heavy vs. light physical demands) as once suspected.

The following are additional citations and links to the abstracts of related work produced by Dr. Battie.

The Twin Spine Study: contributions to a changing view of disc degeneration.
Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L.
Spine J. 2009 Jan-Feb;9(1):47-59.

Genetic and environmental effects on disc degeneration by phenotype and spinal level: a multivariate twin study.
Battié MC, Videman T, Levälahti E, Gill K, Kaprio J.
Spine. 2008 Dec 1;33(25):2801-8.

Age- and pathology-specific measures of disc degeneration.
Videman T, Gibbons LE, Battié MC.
Spine. 2008 Dec 1;33(25):2781-8.

Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration: a five-year follow-up of adult male monozygotic twins.
Videman T, Battié MC, Parent E, Gibbons LE, Vainio P, Kaprio J.
Spine. 2008 Jun 1;33(13):1484-90.
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References

1.   

Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009 Jan-Feb;9(1):47-59.