Shared genetic factors underlie chronic pain syndromes

Chronic pain syndromes (CPS) are highly prevalent in the general population, and increasingly the evidence points to a common etiological pathway. Using a large cohort of twins (n = 8564) characterized for chronic widespread musculoskeletal pain (CWP), chronic pelvic pain (PP), migraine (MIG), dry eye disease, and irritable bowel syndrome (IBS), we explored the underlying genetic and environmental factors contributing to CPS and the correlation between them. The sample was predominantly female (87.3%), with a mean age of 54.7 (±14.7) years. Prevalence of the different CPS ranged from 7.4% (PP) to 15.7% (MIG). For all CPS the within-twin correlation in monozygotic twin pairs was higher than in dizygotic pairs, suggesting a heritable component. Estimated heritability ranged from 19% (IBS) to 46% (PP). Except for MIG, we found significant pairwise phenotypic correlations between the CPS. The phenotypic correlation was highest between CWP and IBS (0.40; 95% confidence interval: 0.27 to 0.46). Excluding MIG from further analyses, cross-twin cross-trait correlations were higher in monozygotic compared with dizygotic twin pairs, suggestive of shared genetic factors between CWP, PP, IBS, and dry eye disease. Twin modeling analysis revealed the common pathway model as the model best explaining the observed pattern of correlation between the traits, with an estimated heritability of 66% of the underlying latent variable. These results are evidence of shared genetic factors in conditions manifesting chronic pain and justify the search for underlying genetic variants.     

Shared rearing environment in migraine: results from twins reared apart and twins reared together

BACKGROUND: Studies of twins who are separated from each other early in life and are reared in different environments offer the opportunity to resolve variation in liability to disease. OBJECTIVE: To evaluate the importance of genetic and environmental influences in migraine; in particular, addressing the role of the shared rearing environment. METHODS: A population-based cohort of twins, including a subsample of 314 pairs reared apart and 364 matched control pairs reared together, was drawn from the Swedish Twin Registry. Data on lifetime migraine was collected via self-administered questionnaires mailed to twins aged 42 to 81 years. Quantitative genetic models and regression models were used to analyze sources of twin similarity. RESULTS: We found nonsignificant shared rearing environmental influences on migraine for men (17%) and no rearing effects at all for women. The heritability of migraine was estimated at 38% (95% confidence interval, 0 to 73) for men and 48% (95% confidence interval, 27 to 65) for women. Among monozygotic twins reared apart, those separated at 3 years of age or earlier were more similar for lifetime migraine than those separated later, and this was especially true for women. CONCLUSION: In agreement with previous twin data, family resistance in migraine is mainly due to genetic factors, whereas environmental influences make family members different, not similar.     

Genetic and environmental influences on the size of specific brain regions in midlife: The VETSA MRI study

The impact of genetic and environmental factors on human brain structure is of great importance for understanding normative cognitive and brain aging as well as neuropsychiatric disorders. However, most studies of genetic and environmental influences on human brain structure have either focused on global measures or have had samples that were too small for reliable estimates. Using the classical twin design, we assessed genetic, shared environmental, and individual-specific environmental influences on individual differences in the size of 96 brain regions of interest (ROIs). Participants were 474 middle-aged male twins (202 pairs; 70 unpaired) in the Vietnam Era Twin Study of Aging (VETSA). They were 51–59 years old, and were similar to U.S. men in their age range in terms of sociodemographic and health characteristics. We measured thickness of cortical ROIs and volume of other ROIs. On average, genetic influences accounted for approximately 70% of the variance in the volume of global, subcortical, and ventricular ROIs and approximately 45% of the variance in the thickness of cortical ROIs. There was greater variability in the heritability of cortical ROIs (0.00–0.75) as compared with subcortical and ventricular ROIs (0.48–0.85). The results did not indicate lateralized heritability differences or greater genetic influences on the size of regions underlying higher cognitive functions. The findings provide key information for imaging genetic studies and other studies of brain phenotypes and endophenotypes. Longitudinal analysis will be needed to determine whether the degree of genetic and environmental influences changes for different ROIs from midlife to later life.     

Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples

Twin studies are becoming popular to investigate risk factors for low back pain (LBP) because they consider the genetic factor and allow for more precise estimates of risks. We aimed to identify and summarize the results of studies based on twin samples investigating risk factors for LBP. The MEDLINE, CINAHL, LILACS, Web of Science and EMBASE databases were searched. Prospective and cross‐sectional observational studies of LBP involving twins were included. The exposure factors could be genetics (heritability) or environmental such as smoking, alcohol consumption, body mass index and medical history. Pooling was attempted using an inverse variance weighting and fixed effects model. Twenty‐seven studies were included. Estimates of heritability effects ranged from 21% to 67%. The genetic component was higher for more chronic and disabling LBP than acute and less disabling LBP. Smoking was significantly associated with LBP [pooled odds ratio (OR) = 3.0; 95% confidence interval (CI) 2.8–3.3] with a longitudinal and a cross‐sectional study also identifying a dose–response relationship in people with chronic LBP. Obesity was associated with LBP (pooled OR = 1.9; 95% CI 1.6–2.2) with a cross‐sectional study identifying a dose–response relationship. No association between alcohol consumption and LBP was identified. Co‐morbidities such as asthma, diabetes and osteoarthritis were associated with LBP (pooled OR ranging from 1.6 to 4.2). The contribution of genetics to LBP appears to be dependent on the severity of the condition. Twin studies could be better used to explore possible causation paths between lifestyle factors, co‐morbidities and LBP.     

Treatment of the degenerated intervertebral disc; closure,repair and regeneration of the annulus fibrosus

Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causing disc degeneration. Symptomatic disc herniation mainly causes radicular pain. Current treatments of intervertebral disc degeneration and low back pain are based on alleviating the symptoms and comprise administration of painkillers or surgical methods such as spinal fusion. None of these methods is completely successful. Current research focuses on regeneration of the IVD and particularly on regeneration of the nucleus pulposus. Less attention has been directed to the repair or regeneration of the annulus fibrosus, although this is the key to successful nucleus pulposus, and therewith IVD, repair. This review focuses on the importance of restoring the function of the annulus fibrosus, as well as on the repair, replacement or regeneration of the annulus fibrosus in combination with restoration of the function of the nucleus pulposus, to treat low back pain. Copyright © 2014 John Wiley & Sons, Ltd.     

Low back pain: a radiographic enigma

Ninety-nine anteroposterior and lateral lumbar radiographs taken of males ages 18-55 were independently analyzed by three chiropractors who assessed 56 variables, including determinations of disc space height, vertebral malalignments and subluxations, spondylosis, postural disturbances, relationships between pelvis and spine, and other congenital or acquired abnormalities. The distribution of low back complaints in this study included 31% with no low back pain, 44% with previous or present mild low back pain and 24% with previous or current severe, and often disabling, low back pain. Determinations were made of interobserver reliability between the three chiropractors and a medical radiologist. Of the 56 radiographic variables assessed by the chiropractors, six demonstrated a high interobserver reliability. In general, the best reliability was for variables that were actual measurements, rather than subjective observations. Sixteen additional variables demonstrated a fair interobserver reliability. Comparison of the observations between a radiologist and the chiropractors showed correlations in their assessments of disc space height at L3-4 and L4-5; otherwise, there was poor interobserver reliability. Few of the radiographic variables were found to be reliable predictors of present or prior history of low back and leg complaints. A few variables (most notably disc space narrowing) were statistically associated with back or leg complaints (P = 0.025). We conclude that spinal radiographs, whether analyzed by measurements, by a radiologist or by chiropractors, have minimal value in predicting the presence or absence of low back complaints and, in particular, have no value in epidemiological studies.     

Biomechanics of back pain

This paper offers a mechanistic account of back pain which attempts to incorporate all of the most important recent advances in spinal research. Anatomical and pain-provocation studies show that severe and chronic back pain most often originates in the lumbar intervertebral discs, the apophyseal joints, and the sacroiliac joints. Psychosocial factors influence many aspects of back pain behaviour but they are not important determinants of who will experience back pain in the first place. Back pain is closely (but not invariably) associated with structural pathology such as intervertebral disc prolapse and endplate fractures, although age-related biochemical changes such as those revealed by a 'dark disc' on MRI have little clinical relevance. All features of structural pathology (including disc prolapse) can be re-created in cadaveric specimens by severe or repetitive mechanical loading, with a combination of bending and compression being particularly harmful to the spine. Structural disruption alters the mechanical environment of disc cells in a manner that leads to cell-mediated degenerative changes, and animal experiments confirm that surgical disruption of a disc is followed by widespread disc degeneration. Some people are more vulnerable to spinal degeneration than others, largely because of their genetic inheritance. Age-related biochemical changes and loading history can also affect tissue vulnerability. Finally the concept of 'functional pathology' is introduced, according to which, back pain can arise because postural habits generate painful stress concentrations within innervated tissues, even though the stresses are not high enough to cause physical disruption.     

Heritability of SF-36 among middle-age, middle-class, male-male twins

OBJECTIVE: We sought to examine the relative importance of genetic and environmental factors for the MOS SF-36; a widely used, valid, and reliable measure of health-related quality of life and to discuss incorporating genetic influences into health services research. DATA SOURCES: Data are from a nationally distributed, nonclinical cohort of 2928 middle age, middle-class, male-male twin members of the Vietnam Era Twin Registry. STUDY DESIGN: This was a secondary data analysis, classic twin heritability analysis. DATA COLLECTION: A telephone survey was used to collect information on alcohol-related problems and health services use, including the SF-36. PRINCIPAL FINDINGS: Variance component analyses indicated that additive genetic factors accounted for 17% to 33% of the variance for each of the 8 domains of the SF-36. Shared environment accounted for 0% to 12% of the variance for each domain, with the majority of variance for each domain accounted for by nonshared, or unique environment and error. Physical and mental health summary measures indicated that approximately one-third of the variance was accounted for by additive genetic factors and the remainder accounted for by nonshared environment and error. Clinical condition, history of alcohol dependence, had a small-but-significant influence for all domains. Including condition proved to be a better-fitting model. However, confidence intervals temper uniform statistical significance for genetic factors. CONCLUSIONS: This study assessed the heritability of the SF-36 in a nonclinical, community sample of middle age, middle-class all-male twins. The moderate genetic effects on SF-36 domain and summary measures are new findings and thus may affect interpretations of SF-36 as a measure of health-related quality of life. Ideally, trait-based measures should identify genetic sources of variation and thus help understand any bias of the true effects of SF-36. Still the majority of variance is accounted for by nonshared or unique environmental factors and error. By extension, increased understanding of the importance of genetic and environmental factors that influence either predictors or outcomes of interest will expand the level of scientific debate in health services research and improve predictability.     

年轻患者腰椎间盘Pfirrmann分级与椎间盘膨出及突出的相关性研究

目的通过磁共振成像,观察30岁以下腰痛患者腰椎间盘退行性改变的Pfirrmann分级特征以及相关的其他改变,并评价Pfirrmann分级与椎间盘膨出及突出的相关性。材料与方法回顾性分析83例30岁以下因腰痛行腰椎MRI检查的患者,其中男50例,女33例,平均年龄25岁。由2名影像科医师对MR图像进行分析,观察L1~S1椎间盘信号、椎间盘形态、纤维环撕裂、椎间盘膨出、椎间盘突出、椎体终板及许莫氏结节的改变。椎间盘退行性改变采用Pfirrmann分级。观察指标的相关性分析采用Pearson多元相关分析。结果纳入研究的椎间盘共415个,其中Pfirrmann分级Ⅰ~Ⅱ级退变322个(77.6%),Ⅲ级退变56个(13.5%),Ⅳ级退变33个(7.9%),Ⅴ级退变4个(1.0%);103个椎间盘出现膨出或突出;椎间盘膨出以L4~5椎间盘最多(42.2%),且多合并Ⅲ级退变(51.1%);椎间盘突出以L5~S1椎间盘最多(51.7%),且多合并Ⅳ级退变(46.6%);17例患者出现椎间盘后方高信号区(HIZ),且均位于L4~5、L5~S1椎间盘水平;3例患者出现终板退变。多元相关分析结果显示PfirrmannⅢ级退变与椎间盘膨出有明显相关性(r=0.972;P=0.006),与椎间盘突出无明显相关性(r=0.639;P=0.245);PfirrmannⅣ级退变与椎间盘突出(r=0.999,P=0.000)及HIZ(r=0.919,P=0.028)有明显相关性,与椎间盘膨出无明显相关性(r=0.769,P=0.128)。HIZ与椎间盘膨出(r=0.919,P=0.027)及突出(r=0.935,P=0.020)均有相关性。结论腰椎MRI成像能够清晰显示年轻患者椎间盘早期退行性改变的不同病理阶段;PfirrmannⅢ退变与PfirrmannⅣ级退变分别与椎间盘膨出和椎间盘突出有相关性;年轻患者应及早发现椎间盘早期退变,以对临床评价提供更有价值信息。     

Genetic Influence in Headaches: A Swedish Twin Study

The heritability of liability to self-reported migraine and nonmigrainous headaches was examined in two large cohorts from the Swedish Twin Registry consisting of 6448 (the older cohort) and 12 884 (the younger cohort) like-sexed twin pairs. Higher concordance rates were consistently found for lifetime migraine among the monozygotic twins than in the dizygotic twins, as well as for migraine headaches of the recurrent disabling type. In addition, a higher concordance rate was found among the monozygotic twins than in dizygotic twins in a "mixed" group of possible tension-type or mild migraine headaches (or both). The results of structural equation model-fitting analyses showed that genetic effects for migraine headaches were stronger for the females (estimates ranging from 49% to 58%) than for the males (39% to 44%) in the two cohorts. Unique nonshared environmental effects were greatest for the "mixed" group in both sexes (estimates ranging from 60% to 69%). The results are discussed in view of similar large-scale twin studies examining the heritability of liability to migraine.     

软骨终板形态与椎间盘退变的相关性

背景:以往研究证明多种内环境因素共同作用引发椎间盘退变,最重要的机制为椎间盘软骨终板的退变。目的:分析椎间盘退变与终板形态的关系。方法:回顾性分析62例因椎间盘源性慢性下腰痛和79例因髓核脱出致神经根性症状患者的腰椎MRI正中矢状位图像资料。根据腰椎MRI正中矢状位T1W1图像确定终板形态,T2W1图像确定椎间盘退变程度分级。结果与结论:平坦型和不规则型终板最常见于椎间盘退变人群下腰椎,L5/S1平坦型最多见。髓核脱出组与椎间盘源性慢性下腰痛组中凹陷型终板椎间盘退变程度均较平坦型、不规则型低,平坦型终板椎间盘退变程度较不规则型低(P<0.01)。两组间凹陷型与不规则型终板椎间盘退变程度差异无显著性意义,髓核脱出组平坦型椎间盘退变程度较椎间盘源性慢性下腰痛组高(P<0.05)。提示随着椎间盘退变程度的加重,软骨终板形态有由凹陷型向平坦型、不规则型依次转变的趋势。     

Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults

BackgroundPatients with back pain can show one or more features of spinal osteoarthritis (OA), such as morning stiffness, limited or painful range of motion (ROM), and lumbar disc degeneration (LDD). However, it has not been investigated whether these features are prognostic of long-term back pain.ObjectivesThis study assessed whether spinal morning stiffness, ROM and LDD are prognostic factors for back pain after 1 year in older adults with back pain.MethodsThis prospective observational study (BACE cohort) included patients aged > 55 years visiting a general practitioner for a back-pain episode. Baseline patient-reported morning stiffness, physical examined ROM and radiographic LDD features (i.e., multilevel osteophytes and disc space narrowing) were analysed as potential prognostic factors in unadjusted and adjusted regression models with the outcomes of persistent back pain (yes/no) and back pain severity after 1-year follow-up.ResultsThis study included 543 patients with mean (SD) age 67 (8) years, 59% female, and 62% reporting back pain at 1-year follow-up. When studied in separate adjusted models, persistent back pain was associated with morning stiffness > 30 min (OR 3.0, 95%CI 1.3; 5.5), restricted lateroflexion (OR 1.8, 95%CI 1.0; 3.2), pain during rotation (OR = 1.7, 95%CI 1.0; 2.9), multilevel osteophytes (OR 2.4, 95%CI 1.4; 4.1), and multilevel disc space narrowing (OR 1.5, 95%CI 0.9; 2.4). When investigated in the same adjusted model, persistent back pain remained associated with only morning stiffness > 30 min (OR 2.4, 95%CI 1.0; 3.9), pain during rotation (OR 1.6, 95%CI 0.9; 2.8), and multilevel osteophytes (OR 2.1, 95%CI 1.2; 3.7). The same spinal OA-related features were associated with back pain severity.ConclusionsSpinal morning stiffness, painful rotation, and multilevel osteophytes are prognostic factors for persistent back pain and back pain severity after 1 year. Evaluating these clinical and radiographic features of spinal OA could help clinicians identify older patients who will experience long-term back pain.     

The role of genetics and environment in lifting force and isometric trunk extensor endurance

BACKGROUND AND PURPOSE: Our understanding of what different back performance tests are measuring is limited. The purpose of this study was to investigate the relative contributions of genetics and unique and common environmental factors for 3 tests of back muscle performance in a classic twin analysis. SUBJECTS: The subjects were a population-based sample of 122 monozygotic and 131 dizygotic male twin pairs aged 35 to 69 years (mean=49.9, SD=7.7). METHODS: Variance component analysis was applied to estimate genetic and environmental influences on isokinetic and psychophysical lifting and isometric trunk extensor endurance test performance. The Cholesky decomposition genetic factor model was used to estimate genetic and environmental correlations of these variables. Path analysis was applied to study determinants of isokinetic and psychophysical lifting and isometric trunk extensor endurance test performance. RESULTS: Genetic effects accounted for 60%, 33%, and 5% of the total variance of isokinetic and psychophysical lifting forces and isometric trunk extensor endurance, respectively, and unique environmental factors accounted for 35%, 49%, and 61% of the variance. DISCUSSION AND CONCLUSION: Genetics had a dominant role in isokinetic lifting and unique environmental factors in isometric trunk extensor endurance. The relatively high role of genetics in lifting force suggests the potential to increase and sustain changes in back muscle force in the general population may be particularly challenging.     

Genetic risk factors for lumbar disc disease

Lumbar disc disease (LDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for LDD. Lifting heavy loads, torsional stress and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in LDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a vitamin D receptor and matrix metalloproteinase-3 gene alleles.     

慢性腰背痛病变的相关CT影像分析

目的探讨慢性腰背痛病变的相关CT影像的临床应用价值。方法对164例慢性腰背痛患者经CT诊断或手术证实或随访后查明病因者的CT资料进行回顾性分析。结果164例中椎间盘退变致椎间盘程度不等膨出148例,占90.24%:椎间盘突出129例,占78.66%;骨性椎管狭窄33例,占20.12%;退行性腰椎滑脱14例,占8.5%;后纵韧带骨化或钙化26例,占15.85%;黄韧带肥厚22例,占13.41%。结论腰椎间盘病变是引起慢性腰背痛的主要原因,具有典型的CT影像改变,椎管狭窄或侧隐窝狭窄,后纵韧带骨化或钙化也是引起慢性腰背痛的原因之一,正确分析其CT影像特征,对于指导临床治疗,具有重要的意义。     

Genetic risk factors for lumbar disc disease

Lumbar disc disease (LDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for LDD. Lifting heavy loads, torsional stress and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in LDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a vitamin D receptor and matrix metalloproteinase-3 gene alleles.     

Morphology and properties of intervertebral discs - selected issues (part I)

Back pain is a major public health problem in industrialized countries. Own experience and literature review confirms that back pain is strongly associated with degeneration of the intervertebral disc. Disc degeneration alters disc height and their physics and chemistry. Those changes alter mechanics of the rest of the spinal column, possibly adversely affecting the behaviour of other spinal structures such as muscles and ligaments.
Authors shortly review the morphology and selected properties of normal discs and the changes that arise during degeneration what may influence an understanding of the etiology of this disorder and its treatment.     

中老年腰腿痛患者腰椎终板Modic改变与腰椎不稳的相关性研究

目的 探讨中老年腰腿痛患者腰椎终板Modic改变的分布情况及其与腰椎不稳的相关性.方法 选择195例因腰腿痛在本院行腰椎MRI检查的中老年患者,统计各型Modic改变在中老年腰腿痛患者中的发生率及在椎间盘节段中的发生率,分析Modic改变与腰椎间盘退变、腰椎不稳定之间的关系.结果 中老年腰腿痛患者中Modic改变分型为Ⅱ型的患者所占比率最高,Modic改变发生率最高的腰椎间盘位置为L5 ～S1.腰椎间盘退变程度越高,Modic改变发生率越高.腰椎不稳定患者发生腰椎终板Modic改变发生率明显高于腰椎稳定患者.腰椎稳定者中腰椎曲度异常患者Modic发生率明显高于腰椎曲度正常患者.结论 中老年腰腿痛患者腰椎终板Modic改变以Ⅱ型多见,其与腰椎稳定性及腰椎曲度之间存在相关关系.     

Genetic and environmental influences of white and gray matter signal contrast: a new phenotype for imaging genetics?

The estimation of cortical thickness is in part dependent on the degree of contrast in T1 signal intensity between white matter and gray matter along the cortical mantle. The ratio of white matter to gray matter signal (WM/GM contrast) has been found to vary as a function of age and Alzheimer's disease status, suggesting a biological component to what might otherwise be labeled as a nuisance variable. The aim of the present study was to determine if measures of WM/GM contrast are genetically influenced, as well as the degree to which this phenotype may be related to the genetic and environment determinants of cortical thickness. Participants were 514 male twins (130 monozygotic, 97 dizygotic pairs, and 60 unpaired individuals) from the Vietnam Era Twin Study of Aging. Ages ranged from 51 to 59 years. Measures of WM/GM contrast and cortical thickness were derived for 66 cortical regions of interest (ROI) using FreeSurfer-based methods. Univariate and bivariate twin analyses were used in order to estimate the heritability of WM/GM contrast, as well as the degree of shared genetic and environmental variance between WM/GM contrast and cortical thickness. WM/GM contrast was found to be significantly heritable in the majority of ROIs. The average heritability across individual ROIs was highest in the occipital lobe (.50), and lowest in the cingulate cortex (.24). Significant phenotypic correlations between WM/GM contrast and cortical thickness were observed for most of the ROIs. The majority of the phenotypic correlations were negative, ranging from ?.11 to ?.54. Of the 66 associations, only 17 significant genetic correlations were found, ranging from ?.16 to ?.34, indicating small amounts of shared genetic variance. The majority of the phenotypic correlations were accounted for by small unique environmental effects common between WM/GM contrast and cortical thickness. These findings demonstrate that like cortical thickness, WM/GM contrast is a genetically influenced brain structure phenotype. The lack of significant genetic correlations with cortical thickness suggests that this measure potentially represents a unique source of genetic variance, one that has yet to be explored by the field of imaging genetics.     

Computational modeling of lumbar disc degeneration before and after spinal fusion

BackgroundAdvancing age and degeneration frequently lead to low back pain, which is the most prevalent musculoskeletal disorder worldwide. Degenerative changes in intervertebral discs and musculo-ligamentous incapacity to compensate sagittal imbalance are typically amongst the sources of instability, with spinal fusion techniques being the main treatment options to relieve pain. The aims of this work were to: (i) assess the link between ligament degeneration and spinal instability by determining the role of each ligament per movement, (ii) evaluate the impact of disc height reduction in degenerative changes, and (iii) unveil the most advantageous type of posterior fixation in Oblique Lumbar Interbody Fusion to prevent adjacent disc degeneration.MethodsTwo L3-L5 finite element models were developed, being the first in healthy condition and the second having reduced L4-L5 height. Different degrees of degeneration were tested, combined with different fixation configurations for Oblique Lumbar Interbody Fusion.FindingsFacet capsular ligament and anterior longitudinal ligament were the most influential ligaments for spinal stability, particularly with increasing degeneration and disc height reduction. Pre-existent degeneration had lower influence than the fusion procedure for the risk of adjacent disc degeneration, being the highest stability and minimal degeneration achieved with bilateral fixation. Right unilateral fixation was more suited to reduce disc stress than left unilateral fixation.InterpretationBilateral fixation is the best option to stabilize the spinal segment, but unilateral right fixation may suffice. This has direct implications for clinical practice, and the extension to a population-based study will allow for more efficient fusion surgeries.