Pathophysiology of degenerative spinal disease causing lumbar and cervical spinal pain

요추 혹은 경추통증을 유발하는 척추질환의 평생 유병률(life-time prevalence)은 65-80%에 이르는 것으로 알려져 있으며[1,2], 최근 6개월간 한 차례 이상의 요통을 호소하는 비율이 40%에 이르며[3], 경추부통증의 경우에는 이전에 통증이 없는 사람의 15-20%에서 새로운 통증이 발현된다[4]. 요통의 경우 20대부터 발생하기 시작하여 전체 유병률은 65세까지 지속적으로 증가하는 양상을 보이다가 그 이후부터는 서서히 감소한다[5,6]. 급성요통의 경우, 특별한 치료 없이 시간이 경과함에 따라 호전되는 경우가 대부분인 것으로 알려져 있는데, 여러 가이드라인에서 급성 요통환자의 90%가 6주 내로 호전되며, 요통이 발생한지 1년이 지난 시점에서 통증이 호전된 비율은 54-90%에 달하는 것으로 보고되었다[7,8]. 이와 같이 As degenerative spinal disease among spinal diseases causing lumbar and cervical spinal pain is the endless repetition of “the biological healing of mechanical damage” occurring over a lifetime, spinal pain by degenerative spinal disease occurs as a series of successive changes through the repetitive damage-healing process of various spinal structures including the intervertebral disc rather than a temporary phenomenon of any given pathophysiologic change in one moment. Degenerative spinal disease generally begins with degeneration of the intervertebral disc. Then herniation of the intervertebral disc resulting in subsequent radicular pain occurs when the nucleus pulposus with degeneration located in the intervertebral disc tears and penetrates the annulus fibrosus. Subsequently, disc space narrowing occurs and alters the spinal biomechanics, followed by degenerative changes to the vertebral endplate, vertebra itself, and facet joint. Finally, these changes lead to spinal stenosis, which is the final destination of degenerative spine disease. Although the exact pathogenesis of spinal pain could be still unclear because of some inconsistencies between the degenerative changes in the spine and the clinical manifestations of spinal pain, an accurate understanding of the pathophysiology and future predictions for further mechanical injury as well as thorough history taking and careful attention to the long-term clinical courses and other associated risk factors including daily life posture and work posture are needed for successful treatment of spinal pain.