Enfermedad Del Disco Lumbar

During the last 15 years, beliefs regarding the determinants
of disc degeneration have changed markedly. Previously
it was believed that the primary determinants
included age, gender, cigarettesmoking, exposure to vehicular
vibration and, in particular, occupational physical
loading.1 More recently it has been demonstrated
that most of these factors have at most relatively minorinfluences on disc degeneration2–4 and routine loading
may actually have some benefits for the lumbar discs in
terms of slowing desiccation.5 Alternatively, genetic factors
have been shown to be strongdeterminants of disc
degeneration.6–8
Despite the significant role of genetic influences, there
remains a large amount of disc degeneration, especially
in the lower lumbar spine, which is notexplained by
either genetics or currently investigated environmental
factors.7 One possible important determinant of disc degeneration
that has undergone limited investigation is
previous back injury.Injury in this context and for the
rest of this manuscript refers to a specific significant incident
or accident, involving excessive loading or trauma
likely to result in tissue damage. Injury mayinfluence the
disc structure and mechanics in a manner that accelerates
the degenerative process. Animal studies have shown
rapid disc degeneration after surgically induced peripheral
anularlesions.9 Two previous studies investigating
the relationship between vertebral fractures and disc degeneration,
found conflicting results.10,11 Kerttula et al10
found young people with previous vertebralcompression
fractures had greater amounts of disc degeneration than
healthy controls. This study has been criticized for failure to
control for important confounders, including genetics, butprovides preliminary evidence for an association between
injury and disc degeneration.12 Another piece of evidence
suggesting that injury, in the form of a needle puncture,
may influence disc...