Lets learn about the normal changes that occur to the lower back with age. First lets learn some relevant low back anatomy.
What is a motion segment?
The components include:
1. the vertebrae (bone), 2. the intervertebral disc, 3. arteries, veins, lymphatics (not pictured here), 4. associated nerves and 5. ligaments (not pictured here).
What are the components of an intervertebral disc:
1. nucleus pulposus (the portion that herniates in a disc herniation) 2. annulus fibrosis
NORMAL changes in lower back discs from age 21 to 60+ years old:
age 21 to 30
– annulus – structurally weakened
– nucleus – 80% water transitioning from a gel to a fibrous viscous structure with necrotic degeneration in the center.
Already degenerating with the forces of gravity, time and our choices.
age 60 +
– annulus – elasticity decreases, collagen fibrosity increases, water content fairly constant
– nucleus – collagen content increases more fibrous component, elasticity decreases, disc becomes drier, nutrition from the vertebrae to the disc has decreased
the disc is stiffer and more resistant to deformation, less risk of disc herniation at this point
– vertebrae – is collapsing in the center which causes a concavity around the disc.
This is the normal aging process of the lumbar spine
Bogduk, N. Clinical Anatomy of the Lumbar Spine and Sacrum. Churchill Livingstone, 1997., Ritchie JH, Fahrni WH. Age changes in lumbar intervertebral discs. Can J Surg. 1970 Jan;13(1):65-71.
Lets look at an mri comparison of a normal 19 year old and a person with degenerative changes. Remember what you learned above about normal aging.
It is known that even individuals with a disc herniation reported on MRI do not always feel pain or feel pain from that site. This goes for “degenerative disc disease” as well.
Remember that some degenerative changes certainly DO cause pain. Lumbar facet joint pain from arthritis, a protruding disc pressing on and causing inflammation of a spinal nerve, most boney fractures etc. will cause pain AND you should seek advice and guidance from your Doctor and Physiotherapist.
Just remember that alot of the ‘degenerative’ changes reported on imaging are normal for the aging process and therefore should not cause great alarm to the patient when reported.
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