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Lower Back Pain

Lumbar Degenerative Disk Disease

Physicians do not know what causes degenerative disk disease. Besides age and injury, arthritis and osteoporosis can contribute to degenerative disk disease. It’s not known why some people have pain and others do not, but various factors can contribute to disk degeneration, including:

  • Autoimmunity
  • Environment
  • Genetics
  • Inflammation
  • Trauma

Lumbar Herniated Disk

A herniated disk may occur suddenly, such as with a fall or an accident, or it may occur gradually with repetitive straining of the spine. When a herniated disk occurs, the space for the nerves is diminished and nerve irritation results. The cause of a herniated disk injury often can be identified if someone develops severe arm pain or neck pain immediately after an accident or when lifting a heavy object.

Most people with a disk injury do not recall a specific event that provoked their pain, and the cause cannot be determined. People who perform heavy labor and use proper lifting techniques or play sports have nearly the same rate of injury as people who do not.

Lumbar Spinal Stenosis

The bony spinal canal normally has more than enough room for the spinal cord. Typically, the canal is 17 to 18 millimeters around, slightly less than the size of a penny. Spinal stenosis occurs when the canal narrows to 13 millimeters or less.

Spinal stenosis may develop for many reasons. Some of the more common causes of spinal stenosis include:

  • Congenital stenosis (born with a narrower-than-normal spinal canal)
  • Disk degeneration
  • Disk herniation
  • Spinal instability

Lumbar Spondylolisthesis

Spondylolisthesis can be present at birth or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy objects, weightlifting, football, gymnastics, trauma and general wear. As the vertebral components degenerate, the spine’s integrity is compromised.

A traumatic fracture in the bony ring can lead to slippage when the fracture goes completely through both sides of the ring. The facet joints can no longer provide a buttress, allowing the vertebra with the crack in it to slip forward.

The spine ages and wears over time. This also causes changes in the spine that can lead to spondylolisthesis. These changes affect the structures that normally support healthy spine alignment. Degeneration in the disk and facet joints of a spinal segment causes the vertebrae to move more than they should. The segment becomes loose, and the added movement takes a toll on the structures of the spine. The disk weakens, pressing the facet joints together. Eventually, the support from the facet joints becomes ineffective, and the top vertebra slides forward. Spondylolisthesis from degeneration usually affects people over 40. It usually involves slippage of L4 over L5.