(104) The Aging Lumbosacral Spine and Development of Chronic Lower Back Pain

Abstract

Chronic lower back pain continues to be a leading cause of disability, loss of work, and medical expenditures in the United States. As our baby-boom generation continues to age, medical healthcare will become increasingly tailored to providing care for the elderly. The World Health Organization speculates the geriatric population will reach two billion by 2050.1 This is a literature review describing the anatomic changes in the lumbosacral spine angle that occur with aging possibly contributing to chronic lower back pain. Using PubMed database, a literature review was performed particularly focusing on lumbosacral spine angle, aging, and chronic pain. Conclusions: During advanced age the lumbar spine shows continuous loss of the lumbar lordotic curvature.2 Sagittal spine alignment measured prospectively over 10 years in elderly patients showed a decrease in lumbar lordosis and sacral inclination angle that occurred progressively with aging.3 Additionally, significantly decreased lumbar lordosis angle, sacral tilt and lumbosacral disc angle occurred in elderly compared to non-geriatric patients with lower back pain.4 The loss of lumbar lordosis and sacral inclination in the aging spine is related to degeneration of the lumbar discs resulting in decreased disc height and asymmetric wedging3. Additionally, increased lumbar spine extension is thought to augment pressure on the posterior ligaments and lumbar facet joints.2 Using CT lumbar spine images advanced lumbar facet joint degeneration was associated with increase in sacral slope, L1-L5 lumbar lordosis angle and decrease in sacral table and L5 vertebra posterior angle.5 Addressing the significant role of lumbosacral alignment angle in the painful aging spine may lead to innovative treatment strategies in the future. (1. Drzal-Grabiec, BMC Geriatr, 2013; 2. Chun, Spine J, 2017; 3. Takeda, J Orthop Sci, 2009; 4. Kocyigit, Pak J Med Sci, 2018; 5. Sahin, Spine [Phila Pa 1976], 2015).