Current perspectives on the role of biomechanical loading and genetics in development of disc degeneration and low back pain; a narrative review
Current perspectives on the role of biomechanical loading and genetics in development of disc degeneration and low back pain; a narrative review
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DOI：
10.1016/j.jbiomech.2019.109573
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发表时间：
2020-03-26
影响因子：
2.4
通讯作者：
Fairbank, Jeremy C. T.
中科院分区：
文献类型：
--
作者：
Urban, Jill P. G.;Fairbank, Jeremy C. T.
椎间盘退行性改变长期以来一直是人们感兴趣的；它们被认为与下腰痛密切相关，并由不适当的负荷或受伤引起。然而，与职业性脊柱负荷的大小无关，双胞胎研究发现腰椎间盘退变的遗传率为34-74%。这一发现导致了对易感基因的密集搜索；一些与椎间盘退变相关的基因已经被发现，尽管所有这些基因对退变过程的影响都很小。退行性改变的复杂性表明，许多不同的基因参与其中，与环境因素的相互作用影响着退行性改变的进程。腰背痛本身似乎也是可遗传的(30-46%)。然而，最重要的临床问题不是椎间盘如何退变，而是椎间盘退变是否与下腰痛有关。成像研究发现，许多患有退行性腰椎间盘的人，甚至是具有突出等病理特征的腰椎间盘患者，都没有症状。然而，由于缺乏对腰椎间盘退变和下腰痛表型的一致定义，结果变得模糊起来。流行病学研究可以帮助理清这些复杂的关系，但只有在发展出一致的椎间盘退变和下腰痛的分类和表型后，这些研究才会成功。(C)2019年由爱思唯尔有限公司出版。
Degenerative changes in the disc have long been of interest; they are thought to be strongly associated with low back pain and caused by inappropriate loading or through injury. However, independent of the magnitude of occupational spinal loading, twin studies find that the heritability of lumbar disc degeneration is 34-74%. This finding has led to intensive searches for susceptibility genes; some genes associated with disc degeneration have been identified, though all with small effects on the degenerative process. The complex nature of degenerative changes suggests that many different genes are involved, and that interactions with environmental factors are influential in progression of degeneration. Low back pain itself also appears heritable (30-46%). The most important clinical question though, is not how discs degenerate but is disc degeneration related to low back pain. Imaging studies find many people with degenerate discs or even with discs showing pathological features such as herniations, are asymptomatic. However results are obscured by the lack of consistent definitions of the phenotypes of disc degeneration and of low back pain. Epidemiological studies could help disentangle these complex relationships, but they will only be successful once consistent classifications and phenotypes of both disc degeneration and low back pain are developed. (C) 2019 Published by Elsevier Ltd.