Chronic Low Back Pain
Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment like Fluid regenerative medicine therapy is offering great hope to patients.
Chronic Low Back Pain is a Common Occurrence
Chronic low back pain affects approximately 632 million people worldwide with prevalence as high as 68% in adults older than 60 years of age. It has both substantial social and economic impacts on patients and healthcare budgets resulting in the highest economic burden among all musculoskeletal complaints.
The exact causes of disc degeneration are complex and difficult to pinpoint; they involve aging, genetic predispositions, nutritional factors such as obesity, mechanical trauma, smoking and other related comorbidities.
Possible Causes of Chronic Low Back Pain
Aging is associated with lower water and proteoglycan content along with high collagen concentrations. Histologically, there is progressive loss of demarcation between the NP and AF with loss of the transition zone. This is due to a change in collagen synthesis by the NP cells from collagen II to collagen I with subsequent loss of proteoglycan and dehydration.
Loss of the disc’s intrinsic hydrostatic pressure owing to its dehydration, affects the disc’s resilience to mechanical loading. The result is disc space narrowing, bulging and eventually osteophyte formation with end-plate sclerosis. This causes pressure on the nerve roots leading to back pain and eventually weakness and numbness. With the progression of IVD degeneration, the disc tends to be vascularized increasingly starting peripherally via angiogenesis. Vascular ingrowth eventually extends centrally into the NP and is associated with innervation of the disc causing discogenic pain.
Another important factor to be considered in the cause of lower back pain is biomechanical loading stresses. It is now appreciated that the metabolism of disc cells is enhanced by physiologic intermittent compressive loading which increases production of both proteoglycans and tissue inhibitors of MMPs.
Genetic factors and familial predisposition are also recognized etiological factors for lower back pain. An immunogenetic epidemiologic study on 678 patients has strongly implicated both genetic and environmental factors in the etiology of degenerating disc. This was supported by further epidemiologic studies which concluded a strong familial predisposition to DDD. It has been shown that DDD may be accelerated in some individuals because of genetic polymorphisms in genes such as the aggrecan or the MMPs genes.
Obesity has been implicated in DDD owing to the biomechanical overloading as well as the metabolic element in these patients. A radiological MRI study on 129 middle-aged men showed a detrimental effect of obesity on DDD.
Complications Related to Spine Surgery
Complications related to spine surgery include deep vein thrombosis, infection, and myocardial infarction occurring in 6.6% of initial surgeries and in 6.3% of revisions.
Adjacent segment disease and proximal junctional kyphosis are recognized as sequela of spinal fusions by comprising the mechanics of the spine at levels above and below the fusion and ensuing abnormal stresses during spinal motion
Other complications include pseudarthrosis and hardware complications.
Fluid flow regenerative medicine therapy has advanced significantly over the past decade with numerous clinical trials aiming at providing a non-surgical biologic approach to improve pain and function in DDD. In this approach, the abnormal conditions of the diminished cellularity and altered cell phenotype are the targets for correction.
There are many problems in case of treatment of the patients reporting with degenerated disc with or without disc prolapse, desiccation, bulge, or compression of the adjacent nerves and its implications.
Fluid flow regenerative medicine therapy for low back pain is a promising alternative to the conventional surgical management and other non-operative alternatives. It is of great benefit to seek professional advice from a competent facility such as Premier Osteoarthritis Clinics of Pennsylvania before embarking on treatment of your chronic back pain.