WHATCAUSESIT?
The once commonly held view that disc degeneration is primarily aresult of aging and “wear and tear” from mechanical insults andinjuries was not supported by this series of studies. Instead, discdegeneration appears to be determined in great part by geneticinfluences. Although environmental factors also play a role, it is notprimarily through routine physical loading exposures (eg, heavy vs.light physical demands) as once suspected.
Previously, heavy physical loading was the main suspected risk factorfor disc degeneration. Recent research indicates that heredity has adominant role in disc degeneration, explaining 74% of the variance inadult populations studied to date.
mechanismofinjury
• wasthereaspecificevent?• wasitanunusualevent?• couldthatinjuryhavecauseddamage?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
mechanismofinjury
relationshiptoonsetofpain
• howsoondidthepainstart?• howsimilarwasthepainatthestarttothepainnow?• whenwasthelinkmade?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
mechanismofinjury
relationshiptoonsetofpain
preexistingproblems
• havetherebeensimilarproblems?• howlongago?• howmuchdegenerationispresent?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
mechanismofinjury
relationshiptoonsetofpain
preexistingproblems
currentpathology
• istheresomethingobjectivewrong?• doesitexplainthepain?• istraumaafactorinthatcondition?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
mechanismofinjury
relationshiptoonsetofpain
preexistingproblems
currentpathology
consistencyofpresentation
• abnormalillnessbehaviour• painbehaviour• credibility
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
mechanismofinjury
relationshiptoonsetofpain
preexistingproblems
currentpathology
consistencyofpresentation
TOTAL
1 2 3 4 5conditionbeingtreated
• isthesurgeryaimedattheacute injuryorthepreexistingcondition?
• isthereasimplerprocedurethatjustaddressestheacuteinjury?
1 2 3 4 5
1 2 3 4 5
conditionbeingtreated
nonoperativetreatment
• isthereaneffectivenonoperativetreatmentatthistime?
• hasnonoperative treatmentbeencompletedproperly?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
conditionbeingtreated
nonoperativetreatment
effectivenessofsurgery
• issurgerynormallyeffectiveforthisdiagnosis?
• inthiscircumstanceissurgerylikelytobemoreorlesseffective?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
conditionbeingtreated
nonoperativetreatment
effectivenessofsurgery
likelihoodofreturntowork
• isreturntoworkusuallyfeasibleafterthistypeofsurgery?
• inthiscircumstanceisreturntoworkmoreorless likely?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
conditionbeingtreated
nonoperativetreatment
effectivenessofsurgery
likelihoodofreturntowork
capabilityofsurgeon
• aretheiroutcomesusuallyfavourable?
• istherequestreasonable?
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
conditionbeingtreated
nonoperativetreatment
effectivenessofsurgery
likelihoodofreturntowork
capabilityofsurgeon
TOTAL
mechanismofinjury
relationshiptoonsetofpain
preexistingproblems
currentpathology
consistencyofpresentation
• abnormalillnessbehaviour• painbehaviour• credibility
• istheresomethingobjectivewrong?• doesitexplainthepain?• istraumaafactorinthatcondition?
• havetherebeensimilarproblems?• howlongago?• howmuchdegenerationispresent?
• howsoondidthepainstart?• howsimilarwasthepainatthestarttothepainnow?• whenwasthelinkmade?
• wasthereaspecificevent?• wasitanunusualevent?• couldthatinjuryhavecauseddamage?
conditionbeingtreated
nonoperativetreatment
effectivenessofsurgery
likelihoodofreturntowork
capabilityofsurgeon
• aretheiroutcomesusuallyfavourable?• istherequestreasonable?
• isreturntoworkusuallyfeasibleafterthistypeofsurgery?• inthiscircumstanceisreturntoworkmoreorless likely?
• issurgerynormallyeffectiveforthisdiagnosis?• inthiscircumstanceissurgerylikelytobemoreorlesseffective?
• isthereaneffectivenonoperative treatmentatthistime?• hasnonoperative treatmentbeencompletedproperly?
• issurgeryaimedattheacuteinjuryorthepreexistingcondition?• isthereasimplerprocedurethatjustaddressestheacuteinjury?