The basis of initial evaluation involves plain radiographs (X-rays) of the lumbar spine. Reduced disc height and narrowing of the facet joints are very common findings on the X-rays in degenerative disc disease and osteoarthritis of the spine. Osteophytes and sclerosis of the upper and lower endplates are frequent radiographic findings for degeneration. Narrowing of the lateral recesses and the spinal canal can be visible on CT or MRI of the spine. Radial or concentric tears, cystic spaces and disruption of the annulus fibrosus can be identified with MRI which is showing better resolution for soft tissues.
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Instability of the spine results in a lack of normal spinal segmental displacement pattern under physiologic loads. Hence, there is an increased risk of neurological deficits, incapacitating spinal deformity and pain.
According to Kirkaldy-Willis and Farfan, there are three functional phases of degenerative disc disease:
- Temporary dysfunction without instability;
- Unstable phase;
- Stabilisation phase following calcification of ligaments and spondylophyte support.
During the early phases of degenerative disc disease, there is an increased microscopical structural deterioration resulting in an increased functional impairment.
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