Osteoarthritis

osteoarthritis degeneration back painDegeneration of the spine is a prevalent problem that generally advances with age, though is not always restricted to the elderly1.

The presence of osteoarthritis is not always consistent with pain either. While progressive joint failure may cause pain and disability, approximately 50% of people with osteoarthritic changes don’t have any symptoms2. This is known as the “structure-symptom discord”.

How the spine degenerates and how pain is experienced is multifactorial. Firstly, osteoarthritis begins when there is an imbalance of mechanical load that exceeds the limit of what joint tissues can handle. Bony changes and inflammation cause dysfunction and instability of the joints. Secondly, changes to the nervous system occur around the spine, then spinal cord, and finally brain. How people move starts to change; muscle strength changes; and finally sensory awareness of their body changes. When these systems break down, the person experiences persistent pain (Fig. 1).

biopsychosocial model structure symptom_550

Figure 1. Biospsychosocial model depicting the relation of structural pathology to the experience of pain

How such dramatic alterations in shape of the spine occur over time (Fig. 2) is primarily due to a decrease in nutrition to the discs between the vertebrae3. The primary source of nutrition for the intervertebral discs are the end plates of the vertebrae. As degeneration progresses, fissures, cracks, clefts and fractures occur in the end plates, resulting in them thinning and water volume being lost from within the disc. This reduces disc height, misaligning mechanical forces and changing the shape of the spine (Fig. 3). As a consequence, more stress and strain is placed on the joints of the spine creating back pain. Long term pain can lead to more permanent, dysfunctional changes in the central nervous system ■

spinal degeneration disc compression_550

Figure 2. Spinewave case example of degeneration of the lumbar spine over 23 years resulting in scoliosis to the right and persistent low back pain

disc degeneration

Figure 3. Qualitative stress distribution across vertebral end plate for normal and degenerated intervertebral disc under pure compressive and eccentric compressive loading

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