Current Pain and Headache Reports

, Volume 8, Issue 6, pp 512–517 | Cite as

Does osteoarthritis of the lumbar spine cause chronic low back pain?

  • David Borenstein
Article

Abstract

The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.

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References and Recommended Reading

  1. 1.
    Borenstein D, Wiesel S, Boden S: Low Back and Neck Pain: Comprehensive Diagnosis and Management. Philadelphia: Elsevier; 2004.Google Scholar
  2. 2.
    Boden SD, Davis DO, Dina TS, et al.: Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg 1990, 72:403–408.PubMedGoogle Scholar
  3. 3.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al.: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994, 331:69–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Hochberg MC: Osteoarthritis B: clinical features. In Primer on the Rheumatic Diseases. Edited by Klippel JH. Atlanta: Arthritis Foundation; 2001:289–293.Google Scholar
  5. 5.
    Altman RD, Lozada C: Clinical features. In Rheumatology, edn 3. Edited by Hochberg MC, Silman AJ, Smolen JS, et al. Edinburgh: Mosby; 2003:1793–1800.Google Scholar
  6. 6.
    Loeser RF, Shakoor N: Aging or osteoarthritis: which is the problem? Rheum Dis Clin North Am 2003, 29:653–673.PubMedCrossRefGoogle Scholar
  7. 7.
    Miller ME, Rejeski WJ, Messier SP, Loeser RF: Modifiers of change in physical functioning in older adults with knee pain: the Observational Arthritis Study in Seniors (OASIS). Arthritis Rheum 2001, 45:331–339.PubMedCrossRefGoogle Scholar
  8. 8.
    Gelber AC, Hochberg MC, Mead LA, et al.: Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med 2000, 133:321–328.PubMedGoogle Scholar
  9. 9.
    Fisher NM, Pendergast DR: Reduced muscle function in patients with osteoarthritis. Scand J Rehabil Med 1997, 29:213–221.PubMedGoogle Scholar
  10. 10.
    Yamashita T, Minaki Y, Ozaktay AC, et al.: A morphological study of the fibrous capsule of the human lumbar facet joint. Spine 1996, 21:538–543.PubMedCrossRefGoogle Scholar
  11. 11.
    Bogduk N, Engel R: The menisci of the lumbar zygapophyseal joints: a review of their anatomy and clinical significance. Spine 1984, 9:454–460.PubMedCrossRefGoogle Scholar
  12. 12.
    Adams MA, Hutton WC: The mechanical function of the lumbar apophyseal joints. Spine 1983, 8:327–330.PubMedCrossRefGoogle Scholar
  13. 13.
    Inufusa A, An HS, Lim TH, et al.: Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement. Spine 1996, 21:2412–2420.PubMedCrossRefGoogle Scholar
  14. 14.
    Butler D, Trafimow JH, Andersson GB, et al.: Discs degenerate before facets. Spine 1990, 15:111–113.PubMedCrossRefGoogle Scholar
  15. 15.
    Fujiwara A, Lim T, An HS, et al.: The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spin. Spine 2000, 25:3036–3044.PubMedCrossRefGoogle Scholar
  16. 16.
    Fujiwara A, Tamai K, An HS, et al.: Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop 2001, 385:86–94.Google Scholar
  17. 17.
    Mooney V, Robertson J: The facet syndrome. Clin Orthop 1976, 115:149–156.PubMedGoogle Scholar
  18. 18.
    Eisenstein SM, Parry CR: The lumbar facet arthrosis syndrome: clinical presentation and articular surface changes. J Bone Joint Surg 1987, 69:3–7.Google Scholar
  19. 19.
    Jackson RP, Jacobs RR, Montesano PX: 1988 Volvo Award in clinical sciences. Facet joint injection in low-back pain: a prospective statistical study. Spine 1988, 13:966–971.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwarzer AC, Wang SC, Bogduk N, et al.: Prevalence and clinical features of lumbar zygapophyseal joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 1995, 54:100–106.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Neill TW, McCloskey EV, Kanis JA, et al.: The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol 1999, 26:842–848.PubMedGoogle Scholar
  22. 22.
    Wybier M: Imaging of lumbar degenerative changes involving structures other than disk space. Radiol Clin North Am 2001, 39:101–114.PubMedCrossRefGoogle Scholar
  23. 23.
    Jarvik JG, Deyo RA: Imaging of lumbar intervertebral disk degeneration and aging, excluding disk herniations. Radiol Clin North AM 2000, 38:1255–1266.PubMedCrossRefGoogle Scholar
  24. 24.
    Weishaupt D, Zanetti M, Hodler J, Boos N: MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998, 209:661–666. This paper describes abnormalities that occur in individuals who are asymptomatic in regard to low back pain. Severe osteoarthritis of facet joints was absent in asymptomatic individuals.PubMedGoogle Scholar
  25. 25.
    Dolan AL, Ryan PJ, Arden NK, et al.: The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. Br J Rheumatol 1996, 35:1269–1273.PubMedCrossRefGoogle Scholar
  26. 26.
    Dieppe P, Brandt KD: What is important in treating osteoarthritis? Whom should we treat and how should we treat them? Rheum Dis Clin North Am 2003, 29:687–716. The therapy of osteoarthritis is multifactorial including physical therapy, drug, and injection modalities. Therapies that are effective for osteoarthritis in the appendicular skeleton are also effective for axial skeletal disease.PubMedCrossRefGoogle Scholar
  27. 27.
    Katz N, Ju WD, Krupa DA, et al.: Efficacy and safety of rofecoxib in patients with chronic low back pain: results from two 4-week, randomized, placebo-controlled, parallelgroup, double-blind trial. Spine 2003, 28:851–859.PubMedCrossRefGoogle Scholar
  28. 28.
    Kaplan M, Dreyfuss P, Halbrook B, Bogduk N: The ability of lumbar medial branch blocks to anesthetize the zygapophyseal joint: a physiologic challenge. Spine 1998, 23:1847–1852.PubMedCrossRefGoogle Scholar
  29. 29.
    Dreyfuss P, Halbrook B, Pauza K, et al.: Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophyseal joint pain. Spine 2000, 25:1270–1277.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • David Borenstein
    • 1
  1. 1.Arthritis and Rheumatism AssociatesThe George Washington University Medical CenterWashington, DCUSA

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