Degeneratieve aandoeningen

Degeneration of the spine can affect the lumbar disc but also facet joints, that can become hypertrophic and painful, and the ligaments.

The lumbar disc consists of a central gelatineous nucleus that is surrounded by concentric rings of fibrous tissue. It can undergo chronic changes, where the hydration status of the gelatinous nucleus progressively decreases leading to loss of disc height, but also to bulging of parts of the disc or the entire disc posteriorly. These anatomical changes can lead to back pain but also to pain caused by compression of the neurological structures that are located just behind the disc. The fibrous tissue surrounding the nucleus can also acutely rupture, leading to a herniated disc that can cause acute compression of the nerve and pain, decreased sensibility and even paralysis in the area that is innervated by this nerve.

The facet joints are located posteriorly and have similar characteristics to other joints in the body. Just like the other joints, they can undergo degenerative changes leading to loss of cartilage (and pain as a results) and hypertrophy of the surrounding bone. This hypertrophied bone can also compress the nerve.

Finally, the ligaments, especially the yellow ligament, can become heavily hypertrophied, leading to compression of the dural sack but sometimes also of the individual nerves.

Disc degeneration, artrhosis of the facet joints and hypertrophy of the yellow ligament often goes together, leading to significant pain but also multidirectional dompression of the neural structures.


Treatment of pain in the back or in the leg as a result of degenerative spine disease mostly depends on whether or not the pathology is acute or chronic and whether or not there is an isolated degenerative disease (for example an isolated herniated disc) or whether the degeneration of the spine is more universal (affecting multiple structures and levels of the vertebral spine)

Conservative treatment (rest, medication, physiotherapy) is often preferred in the first stage as long as pain can be controlled with medication and no signs of paralysis are seen.

If this conservative treatment fails, injections can be administered in order to decrease pain symptoms. These injections can be administered peridurally but also in the transforaminal area (the trajectory of the nerve) or of the nerves innervating the facet joints.

Surgical treatment is offered in case conservative treatment fails or in case the nerve shows signs of significant compression (indicated by persisting pain in the limb and/or signs of paralysis). The type of surgical treatment that is then chosen depends on where the source of the problem is located, and can go from minimally invasive resection of a disc hernia to an open fixation with removal of the entire disc and facet joints and complete decompression of the nerves. Our department is familiar with all different approaches to spine pathology; the type of surgery chosen will be the least invasive surgical approach that best addresses the patient’s pathology.