What is the cause of the pain associated with lumbar degenerative disc disease

The answer to this question remains elusive. The outer layers of the annulus fibrosis are innervated by sympathetic pain fibers via the sinuvertebral nerve. Theories that have evolved to explain the painful symptoms associated with disc degeneration include:

• Chemical: The disc releases inflammatory mediators, which irritate the annular nerve fibers

• Disc nocioception: Motion and loading of a degenerated disc becomes painful following nerve fiber ingrowth into the outer annular region

• Instability: The degenerative process leads to excessive and abnormal painful motion of the degenerative lumbar segment

• Neutral zone: The neutral zone is conceptualized as a region of intervertebral motion around the neutral posture where little or no resistance to motion exists due to the passive structures of the spinal motion segment. Although the overall flexion-extension arc of motion may decrease with DDD, the types of motion and force required to produce motion may change. In early DDD, disc dehydration and nuclear resorption cause the peripheral annulus to become lax. This laxity increases translatory motion in the motion segment's neutral zone. Abnormal motion or laxity may cause pain by abnormally loading the annulus or by inducing lumbar extensor muscle spasticity in an effort to control abnormal motion.

• Stone in the shoe hypothesis: Focal abnormal loads (the stone in the shoe) cause areas of focal endplate overloading resulting in pain

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