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

Kai Hoffeld; Maximilian Lenz; Philipp Egenolf; Maximilian Weber; Vincent Heck; Peer Eysel; Max J Scheyerer

doi:10.1016/j.neuchi.2023.101482

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

Neurochirurgie. 2023 Sep;69(5):101482. doi: 10.1016/j.neuchi.2023.101482. Epub 2023 Aug 14.

Authors

Kai Hoffeld¹, Maximilian Lenz², Philipp Egenolf², Maximilian Weber², Vincent Heck², Peer Eysel², Max J Scheyerer³

Affiliations

¹ University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany. Electronic address: Kai.hoffeld@uk-koeln.de.
² University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
³ University of Cologne, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany; University of Düsseldorf, Faculty of Medicine, Department for Orthopaedic and Trauma Surgery, Moorenstraße 5, 40225 Düsseldorf, Germany.

PMID: 37586480
DOI: 10.1016/j.neuchi.2023.101482

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Discussion: 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.

Keywords: Back pain; Degenerative disc disease; Disk herniation; Lumbar disc degeneration; Risk factors.

Publication types

Systematic Review
Review

MeSH terms

Female
Humans
Intervertebral Disc Degeneration* / complications
Intervertebral Disc Displacement* / complications
Intervertebral Disc Displacement* / etiology
Life Style
Low Back Pain* / etiology
Lumbar Vertebrae
Middle Aged
Risk Factors