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KMID : 0948920170160010008
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Clinical Pain
2017 Volume.16 No. 1 p.8 ~ p.15
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Disorders of Posterior Column of Lumbar Spine by Degenerative Cascade
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Min Kyung-Hoon
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Abstract
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Degenerative spondylolisthesis (DS) is believed to result from the degenerative cascade. In the postulation, disc degeneration precedes facet joint degeneration and to be a primary pathology of spondylolisthesis. It occurs most frequently at L4-L5 and more common in females over the age of 50 years. Patients usually present with low back pain and report their pains vary according to mechanical loads. With spinal or foraminal stenosis, leg symptoms appear which shifts from side to side. If there are not neurologic deficits, the prognosis of DS is favorable. The slip rarely deteriorates over grade I. The posterior elementssuch as facet joints and paravertebral muscles have substantial influences in resisting the shearing force at the lumbar spine. In addition, the spinopelvic relationships are thought to play a role in the progression of DS. The risk factors of DS include old age, female gender, more sagittal facet angles, facet joint tropism, and high pelvic inclination angle. The loss of posterior elements can induce DS and facet joint dysfunction usually accompanies with DS. Facet arthrosis is also most common at L4-L5. The pain from facet arthrosis is aggravated during lumbar extension and the pain areas are usually limited above knees. In additionto physical examination, diagnostic interventions such as medial branch block or joint injection are required to diagnose the pain originated from facet joints. Cross sectionalarea and fat-infiltration of paravertebral muscles are correlated with back pain. More research is required to reveal the cause-and-effect relationships between muscle charactersand back pain.
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KEYWORD
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Degenerative spondylolisthesis, Facet joint, Spinopelvic relationship, Paravetebral muscle
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Listed journal information
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