Patient-related risk factors and lifestyle factors for lumbar degenerative disc disease: a systematic review

• Published in: Neuro-chirurgie Vol. 69; no. 5; p. 101482
• Main Authors: Hoffeld, Kai, Lenz, Maximilian, Egenolf, Philipp, Weber, Maximilian, Heck, Vincent, Eysel, Peer, Scheyerer, Max J.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.09.2023
• Subjects: Back pain; Degenerative disc disease; Disk herniation; Female; Humans; Intervertebral Disc Degeneration - complications; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - etiology; Life Style; Low Back Pain - etiology; Lumbar disc degeneration; Lumbar Vertebrae; Middle Aged; Neurosurgery; Risk Factors; Surgery; Back pain; OR; HLDD; LDL; MCID; Degenerative disc disease; Lumbar disc degeneration; GRADE; MESH; Disk herniation; Risk factors; BMI; body mass index; low-density lipoprotein cholesterol; terms - Medical Subject Headings; approach - Grading of recommendations assessment, development and evaluation; herniated lumbar disc disease; Minimal clinically important differences; odd’s ratio
• ISSN: 0028-3770; 1773-0619; 1773-0619
• DOI: 10.1016/j.neuchi.2023.101482

•Intervertebral disc degenerations and herniations represent multifactorial events and various risk factors.•Smoking, family disposition, gender, diabetes mellitus, dyslipidemia, and cardio-vascular comorbidities emerged as the most significant risk factors.•Assessing and managing the risk factors through lifestyle modifications and targeted interventions may reduce the risk of developing or worsening lumbar disc problems. Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review. A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question. A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8). In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.