The Link between Vascular Disease and Lumbar Spine Disease
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There is growing evidence that shows a relationship between diseases of the blood vessels and low back (lumbar) issues such as degenerative disc disease (DDD). To understand why, you need to know a little bit about the anatomy of the lumbar spine, its discs and what happens when they degenerate. The intervertebral discs are made of a mixture that includes water and collagen. The discs act as a cushion and help support the vertebral bones in our spine. These discs are avascular by adulthood meaning they do not have any blood vessels that directly supply nutrition to them; instead, the outer portions of the discs are supplied by passive diffusion from lumbar and sacral arteries branching from the aorta. In people who have cardiovascular disease such as atherosclerosis (plaque build-up in the arteries), the blood supply is significantly decreased in the smaller arteries and therefore the discs are not obtaining as much nutrition and are more prone to degeneration.
During our monthly multi-disciplinary journal club, we reviewed a study that looked at CT scans which showed atherosclerotic disease of the lumbar arteries and aorta correlated with lumbar DDD, facet arthritis, and spinal canal stenosis after adjusting for age.1 As mentioned above, we understand the mechanism of vascular disease and lumbar DDD, but this was the first study to show that vascular disease can also affect other degenerative issues of the spine such as facet arthritis and spinal stenosis. These findings make sense when you understand the degenerative cascade. 2 The discs and the facet joints are part of a three-joint complex and pathology of one component (such as the discs) influences deterioration of the other components (facet joints) and eventually causes spinal stenosis. This overall degeneration of the spine is known as spondylosis.
At Desert Spine and Sports Physicians we recommend healthy habits such as routine exercise to improve cardiovascular health, yoga, and a proper diet. There is not much you can do about vascular risk factors such as age or genetics, but you can start taking steps to address modifiable risk factors such as obesity3, smoking, high cholesterol and high blood pressure. Addressing these issues can not only help with overall well-being, but now research shows it can also affect the health of your spine.
1Beckworth WJ, Holbrook JF, Foster LG, et al. Atherosclerotic disease and its relationship to lumbar degenerative disk disease, facet arthritis and stenosis with computed tomography angiography. PMR. Epub ahead of print.
2Choi Y-S. Pathophysiology of Degenerative Disc Disease. Asian Spine Journal. 2009;3(1):39-44.
3Shiri R, Karppinen J, Leino-Arjas P, et al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010;171:135-154.
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