Age-related morphological changes of the vertebral column and their association with degenerative spinal disorders: A narrative review

Age-associated remodeling of the vertebral column is a heterogeneous biological process involving intervertebral discs, vertebral endplates, facet joints, ligaments, paraspinal muscles, and vertebral bone. Although structural degeneration is frequently identified by magnetic resonance imaging and computed tomography, imaging abnormalities do not invariably explain pain or neurological dysfunction. This narrative review synthesizes anatomical, biomechanical, and clinical literature to describe the principal morphological changes of the aging spine, the mechanisms linking them to degenerative disorders, and the limitations of radiological interpretation. Particular attention is paid to disc dehydration, endplate remodeling, facet arthropathy, ligamentum flavum thickening, vertebral osteophyte formation, sagittal alignment, and changes in spinal canal dimensions. Evidence indicates that age is a major determinant of degenerative imaging findings, while symptoms depend on the interaction of anatomy, inflammation, neural compression, individual susceptibility, and psychosocial context. An integrated anatomical approach is therefore necessary for appropriate diagnosis and interpretation of spinal imaging.