Atherosclerosis and Low Back Pain

Atherosclerosis is well-known for its role in the development of coronary heart disease and stroke. The vascular occlusion that it causes leads to the infarction of heart and brain tissue. But coronary and cerebral blood vessels are by no means the only vessels that become clogged by atheromatous plaques. In 1993, Kauppila et al., from the department of forensic medicine at Helsinki University, postulated that insufficient arterial blood flow may play a role in low back pain. Their post-mortem angiographic study found that, compared to controls, significantly more people with a history of low back pain had anomalies in the arteries that supplied the lumbar spine – the arteries were narrowed by atheromatous lesions and some were completely missing.

Since that landmark study, several cadaver and clinical studies have corroborated the link between stenosis (and occlusion) of the lumbar arteries and the presence of low back pain. In fact, many studies have found an association between the aforementioned lumbar vascular insufficiency and degeneration of the corresponding lumbar discs. This shouldn’t be a surprise because, as Kauppila states, “the disc is located at the end of the nutrient chain, making it one of the first structures to suffer during insufficient nutrient supply.”

In epidemiological studies, associations between cardiovascular risk factors and low back pain (or disc degeneration) are weaker and conflicting. Nevertheless, several studies have linked high blood cholesterol and smoking with low back pain and disc degeneration. It’s important to remember that correlation is different from causation and more research is needed to determine a cause and effect relationship. So, a healthy diet and abstinence from smoking may play a role in the prevention and treatment of low back pain. Further still, and this is pure conjecture on my part, they may have a role to play in maintaining the health of all poorly vascularised tissues (spinal discs, tendons, articular cartilage of joints, etc.).