When you receive an imaging report containing the phrase “multilevel degenerative changes,” this finding, often seen on X-rays or MRI scans of the spine, is a common medical observation, not a formal diagnosis. It essentially describes the expected age-related wear and tear occurring in several areas of the vertebral column. The term is a descriptive summary of physical changes, reflecting a cumulative process over many years. Understanding this phrase requires breaking down its components and examining the specific anatomical structures involved.
Deconstructing the Term
The phrase “degenerative changes” refers to the progressive breakdown and structural deterioration of tissues, which is a normal aspect of aging. In the spine, this process involves the loss of tissue integrity and function, leading to reduced flexibility and stability.
The descriptor “multilevel” indicates that these changes are present at more than one vertebral segment. The spine is divided into regions, such as the cervical (neck), thoracic (mid-back), and lumbar (lower back). A multilevel finding means the degeneration is affecting multiple adjacent or non-adjacent segments, such as the areas between the L4 and L5 vertebrae and the L5 and S1 vertebrae.
The spinal column is comprised of 33 bones, or vertebrae, stacked one upon the other, with an intervertebral disc acting as a cushion between most of them. Each functional unit includes a disc, two vertebrae, and a pair of facet joints. Therefore, “multilevel” signifies widespread changes across several of these motion segments.
Anatomy of Spinal Degeneration
The intervertebral discs are often the first structures to show signs of degeneration, a process called disc desiccation. As a person ages, these water-composed discs naturally lose fluid content, causing them to dry out and shrink. The loss of hydration reduces the disc’s elasticity and height, compromising its ability to act as a shock absorber between the vertebrae.
This reduction in disc height increases stress on the small joints located at the back of the vertebrae, known as the facet joints. These joints are covered in cartilage and allow for twisting and turning motions. Increased pressure and friction on these joints can cause the cartilage to wear down, resulting in facet joint arthropathy (a form of arthritis).
To compensate for the instability caused by thinning discs and worn joints, the body attempts to stabilize the area by growing excess bone. These bony outgrowths, called osteophytes or bone spurs, form along the edges of the vertebrae and on the facet joints. While intended to create stability, these spurs can sometimes impinge on the spinal cord or the nerve roots exiting the spine.
Symptoms and Clinical Significance
The presence of multilevel degenerative changes on an imaging scan does not automatically mean a person will experience pain. Many individuals, especially those over the age of 40, have evidence of spinal degeneration but remain completely asymptomatic.
When symptoms do occur, they are typically related to localized mechanical instability or the involvement of nearby nerves. Common complaints include persistent, localized pain in the neck or lower back, which may worsen with movements like bending or prolonged sitting. Stiffness, particularly noticeable in the morning or after periods of inactivity, is another frequent symptom.
If the degenerative changes lead to spinal stenosis (a narrowing of the spaces where nerves exit the spine), symptoms can include radiating pain, numbness, or tingling. This nerve involvement, often called radicular pain, can travel down into the arms or legs, depending on the affected spinal level. The clinical significance lies not in the mere existence of the changes but in whether they are structurally causing nerve compression or significant functional limitations.
Causes and Contributing Factors
The primary factor driving multilevel degenerative changes is the natural process of aging, which leads to unavoidable wear and tear on the spine’s structures. Spinal discs have a limited blood supply, making them susceptible to long-term breakdown because they cannot easily repair themselves. These degenerative changes often begin to appear as early as the third decade of life and progress throughout a person’s lifespan.
Mechanical stress also contributes to the acceleration of these changes through repetitive motion and sustained poor posture. Occupations involving heavy lifting, frequent twisting, or prolonged sitting can place undue strain on the discs and joints. Genetic predisposition also plays a role, with some individuals inheriting a tendency toward earlier or more pronounced spinal degeneration.