Atherosclerosis and Disc Degeneration/Low-Back Pain - A Systematic Review

Terveystalo Healthcare, Helsinki, Finland.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery (Impact Factor: 2.49). 04/2009; 37(6):661-70. DOI: 10.1016/j.ejvs.2009.02.006
Source: PubMed


Atherosclerosis can obstruct branching arteries of the abdominal aorta, including four paired lumbar arteries and the middle sacral artery that feed the lumbar spine. The diminished blood flow could result in various back problems. The aim of this systematic literature review was to assess associations between atherosclerosis and disc degeneration (DD) or low-back pain (LBP).
A systematic search of the Medline/PubMed database for all original articles on atherosclerosis and DD/LBP published until October 2008. The search was performed with the medical subject headings atherosclerosis, cardiovascular risk factor, or vascular disease and keywords "disc degeneration", "disc herniation", and "back pain" on the basis of MeSH tree and as a text search. In addition reference lists were studied and searched manually. Observational studies investigating the association of atherosclerosis or its risk factors and lumbar DD/LBP were selected.
The following data were extracted: study characteristics, duration of follow-up, year of publication, findings of atherosclerosis/cardiovascular risk factors and DD/LBP. Disc herniation was regarded as a form of disc degeneration and cardiovascular risk factors were regarded as surrogate for atherosclerosis in epidemiological studies.
One hundred and seventy-nine papers were identified. After exclusion of case reports, letters, editorials, papers not related to the lumbar spine, and animal studies, 25 papers were included. Post-mortem studies showed an association between atheromatous lesions in the aorta and DD, as well as between occluded lumbar arteries and life-time LBP. In clinical studies, aortic calcification was associated with LBP, and stenosis of lumbar arteries was associated with both DD and LBP. In epidemiological studies, smoking and high serum cholesterol levels were found to have the most consistent associations with DD and LBP.
Aortic atherosclerosis and stenosis of the feeding arteries of the lumbar spine were associated with DD and LBP. Cardiovascular risk factors had weaker associations, being clearly apparent only in cohorts on elderly people or in large study samples. More prospective clinical studies are needed to further clarify the association of atherosclerosis and low-back disorders.

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Available from: Leena Inkeri Kauppila, May 12, 2014
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    • "Concerning urological disorders, in addition to this, the presence of neurogenic bladder, as an LSS-related cauda equina symptom, may be associated. Aortic calcification was reported to correlate with degeneration of the intervertebral discs and spine [22, 23]. Diabetes mellitus, one of the causes of LSS, can also increase the risk of aortic calcification [24], and this may be an explanation of the association with the presence of LSS. "
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    • "Therefore, blood flow disturbance in the IVD has been proposed to play a role as a causative factor in the IVD degeneration (Nachemson et al., 1970; Buckwalter, 1995; Urban et al., 2004; Awata et al., 2005; Niinimäki et al., 2009; Shi et al., 2011). The lumbar IVD is mostly supplied by the capillaries of lumbar arteries feeding the vertebral endplates, and the blood supply can be disturbed by lumbar arteries narrowing due to atherosclerosis or by occlusion of endplate openings due to morphological changes (Kurunlahti et al., 1999, 2001; Benneker et al., 2005; Moore, 2006; Niinimäki et al., 2009; Kauppila, 2009; Wang and Griffith, 2011). Thus, atherosclerosis and other cardiovascular risk factors have received growing attention as potential underlying factors for IVD degeneration (Kauppila and Tallroth, 1993; Kurunlahti et al., 1999; Kauppila et al., 2004; Leino-Arjas et al., 2008; Kauppila, 2009). "
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