Degenerative spinal disease

Back pain is one of the most common disorders worldwide. A global burden of disease study from 2010 [1] ranks it sixth between HIV and malaria in terms of its impact on disability-adjusted life years. Degenerative disease of the spine is considered the most common etiologic cause. Mechanical, traumatic, nutritional, and genetic factors all play a role in the cascade of disk degeneration. The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals. The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators. The role of imaging is to provide accurate morphologic information and influence therapeutic decision making. A necessary component, which connects these two purposes, is accurate natural history data. This is critical because the justification of an intervention, whether diagnostic or therapeutic, requires the intervention to have a more favorable outcome than the untreated natural history of the disease process. In order to fully understand the value of imaging findings on therapeutic thinking, the following five considerations are critical: first, the reliability and reproducibility of imaging findings; second, the prevalence of findings in asymptomatic and symptomatic populations; third, the natural history and behavior over time; fourth, the prognostic value of the findings; and fifth, the treatability of the condition.