Degenerative disk disease with and without facet arthritis

Abstract

Degenerative disk disease (DDD) is a common cause of low back pain (LBP); however, the exact relationship between the two remains unknown. The functional spinal unit (FSU) consisting of an anterior intervertebral disk and two posterior facet joints undergo structural changes as a result of degeneration, which may lead to LBP. Over time we have come to understand that the pathophysiology of DDD is most likely a multifactorial process. Degeneration of the spine is an inevitable consequence of aging and can be due to repetitive biomechanical loading of the spine and genetic predisposition. Clinical presentation is a key to the diagnosis of DDD with the physical exam being an important adjunct in determining discogenic etiology of symptoms. Other disorders may elicit LBP and should be considered during the history and physical examination. Magnetic resonance imaging (MRI) is the gold standard diagnostic tool for the evaluation of DDD. Conservative management is reasonable as majority of these patients recover from their symptoms. The most common surgical interventions involve fusion and more recently artificial total disk replacement (TDR). In addition, each procedure and surgical approach has advantages and disadvantages with associated complications.