In the public consciousness there is still a mistaken belief, certainty even, that discopathy results in pain – we must live with it, without any prospect on improving, it won’t disappear on its own, it’s best to do absolutely nothing. After diagnostics, an operation is still sometimes presented as the only cure, even if clinical state of the patient is described as “good”. Unfortunately, there is a long way ahead to ensure that the situation will change; the Internet is full of health websites filled with old-fashioned, unverified convictions, and not facts. Similarly, a part of specialists still lives with their mind in the previous century. That’s why we are quick to help and explain everything.
The set of research presented below proves that degenerations and discopathy are natural processes. They are not the main cause of the pain – discopathy heals on its own, so miracles do happen. It is not required to lie down for a long period of time when sharp pain occurs, quite the opposite. Interestingly, the tests conducted on rats showed that it is not the pressure that generates the sensation of pain; the pain is caused mainly by chemical irritation, meaning it is present during the continuing inflammation or new sequester (active environmental acidity of the stem nuclei). It would explain the lack of symptoms accompanying the extrusion state, sequestration, and pressure on the root; it would also explain lack of efficacy of the anti-inflammatory medication and blockage treatment. Conversely, inflammation accompanying discopathy is a good sign – it is a regenerative component ensuring self-healing, therefore, decreasing the inflammation should be conducted with great care.
This research suggests that the mechanical stimulation of the lumbar discs does not always cause pain. The disc becomes sensitive to mechanical stimulus because of inflammation, which results in nociceptive (pain) information being transferred as a discogenic pain to the spinal cord by lumbar sympathetic system. This can partially explain variability of human symptoms of degenerative discs.
Another research aim was to verify the probability of a spontaneous regression (self-healing) of the herniated lumbar disc by using a systematic review. It was concluded that spontaneous regression amounts to 96% in the case of sequestration of the disc, 70% in the case of extrusion, 41% for protrusion, and 13% for disc bulging. The indicator of complete disc regression was 43% for sequestrated discs, and 15% for extruded discs.
Yet another research examines the inflammatory response in the regression of lumbar disc herniation.
Lumbar disc herniation (LDH) is closely connected with inflammation in the context of lower back pain. Currently, inflammation is connected to adverse symptoms linked to the stimulation of nerve fibers which can result in pain. However, inflammation was chosen as the main compound responsible for LDH regression. This apparent controversy presents inflammation as a good prognostic indicator of spontaneous regression of LDH. This overview/examination concerns molecular and cellular mechanisms engaged in LDH regression, including matrix remodeling and neovascularization, within the range of clinical decision concerning conservative and surgical intervention. Basing on the proof, a special emphasis is put on inflammatory response in the context of LDH, especially as a monocytes/macrophages. The phenomenon of spontaneous regression of LDH, described at length in literature, is consequently analysed with regard to modulatory role of the inflammation.
This research above concerns cervical spine disc degeneration on MRI in patients with Lumbar disc herniation and compares symptomatic and asymptomatic volunteers.
It was concluded, that there is a connection between the cervical spine disc degeneration progress and LDH. However, so far it has not been properly examined. Changes in intervertebral discs connected to age were examined with the help of MRI pictures of patients with LDH and, comparatively, with the MRI results of the healthy volunteers who did not feel any pain. The aim of this test was to answer the question if the frequency of symptom-less cervical spine disc degeneration is higher in patients with LDH than in healthy patients? The study was conducted on 51 patients diagnosed with LDH who had undergone MRI scan of the cervical spine. Patients consisted of 34 men and 17 women aged between 21 and 83 (of average age 46,9, give or take 14,5 years) at the time of the examination. Control group consisted of 113 healthy volunteers (70 men and 43 women) aged 24-77 (of average age 48,9, give or take 14,7 years) with no neck or back pain. The percentage of people with degeneration of the cervical spine discs was 98% in the LDH group, and 88,5% in the control group (p = 0,034). The presence of degeneration was connected to decrease in the intensity of intervertebral disc signal, and posterior disc protrusion in the cervical spine disc area. None of the MRI scans were significantly connected to the gender, smoking, sporting activity, or BMI.
In comparison to the healthy volunteers, patients with degeneration showed highest frequency of decreased intensity of the intervertebral disc signal and posterior disc protrusion on MRI scans of the cervical spine area.
The results of this research suggest that degeneration of the disc seems to be a systemic occurrence.
In the randomized research we compared the consequences of prescribing 2 days of bed rest (group 1) with the consequences of prescribing 7 days of bed rest (group 2). The research included around 203 patients with lower back pain: 78% with acute pain (decreasing or constant for 30 days) none of which whom showed the signs of explicit neurologic deficits. Control data was collected after 3 weeks (93%), and 3 months (88%). The patients from group 1 missed 45% less of work days than patients from group 2 (3,1 days vs 5,6 days, p = 0,01), no changes in physiological functions were observed. In the case of many patients without neuromotor deficits, clinicians can prescribe rather 2 days of rest than longer periods of time without the visible difference in clinical results.
Systematic overview of Polish literature illustrating characteristics of spinal degeneration in symptom-less populations.
Degeneration changes commonly occur in the spine imaging, but they are especially often encountered in patients who do not feel any pain, and also in patients who complain about pain. We tried to estimate the frequency of degenerative spinal conditions in relation to age by conducting a systematic review investigating the presence of degeneration on imaging in patients without symptoms.
Materials and methods:
We performed a systematic overview of the articles describing the prevalence of imaging results (CT or MR) in patients without any symptoms from the publications of English literature until April, 2014. Two reviewers rated every manuscript. We chose the age group according to decades (20, 30, 40, 50, 60, 70, 80 years old) specifying unique for the age estimations of spreading. For every found image we matched a generalized linear model of mixed effects for the age-specific clustering of prevalence estimate in our research, adjusting for the midpoint of reported age range.
Thirty three articles describing the results of imaging studies in 3310 symptom-less patients met our criteria of incorporating in examination. The frequency of disc degeneration in symptom-less patients increased from 37% in patients aged 20 to 96% in patients aged 80. The frequency of disc bulging increased form 30% in patients aged 20 to 84% in patients aged 80. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. Frequency of annular fissure increased from 19% in patients aged 20 to 29% in patients aged 80.
Imaging findings of spinal degenerations are present in a high percentage of symptom-less patients, increasing with age. A lot of degeneration characteristics based on imaging is probably a natural part of growing old, and is not connected with pain sensations. Those results should be interpreted in the context of the clinical state of the patient.
Table below shows the percentage of symptom-less patients with spinal deviations.
|Decrease of signal||17%||33%||54%||73%||86%||94%||97%|
|Narrowing of the disc||24%||34%||45%||56%||67%||76%||84%|