Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 56. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Degenerative Disorders Section 539 20 Degenerative Lumbar Spondylosis Martin Merkle Beat Wälchli Norbert Boos Core Messages Morphological abnormalities in the lumbar spine are frequent in asymptomatic individuals but severe endplate Modic changes and severe facet joint osteoarthritis are rare in healthy individuals less than 50 years of age Specific back pain related to degenerative lumbar spondylosis disc degeneration facet joint osteoarthritis is rare 10-15 Proinflammatory cytokines seem to play an important role in the generation of discogenic back pain and pain in facet joint osteoarthritis Segmental instability is defined clinically and lacks objective criteria Clinical findings in patients with painful lumbar spondylosis are rare Facet joint blocks and provocative discography in diagnosing specific back pain must be interpreted with care Cognitive behavioral treatment is key for a successful conservative treatment approach Spinal instrumentation with pedicle screw fixation enhances fusion rate but not clinical outcome to an equal extent Combined interbody and posterolateral fusion provides the highest fusion rate Non-union and adjacent level degeneration are frequent problems related to spinal fusion Minimally invasive techniques have so far not been shown to provide better clinical outcome than conventional techniques Total disc arthroplasty is not superior to spinal fusion There is limited scientific evidence to favor spinal fusion over an intensive rehab program including cognitive behavioral treatment Epidemiology Degenerative lumbar spondylosis refers to a mixed group of pathologies related to the degeneration of the lumbar motion segment and associated pathologies or clinical syndromes of discogenic back pain facet joint osteoarthritis and segmental instability 102 . Lumbar spondylosis and degenerative disc disease can be regarded as one entity whether or not they result from aging are secondary to trauma or wear and tear or degenerative disease and .
