Lumbar spinal degeneration (LSD), also known as degenerative disc disease, is a common condition characterized by the breakdown of the intervertebral discs in the lower back. It's a multifactorial condition, meaning several risk factors and comorbidities contribute to its development. While pinpointing the top 3 is difficult due to varying studies and individual patient profiles, the following consistently emerge as prominent factors:

1. Aging: This is the most significant and unavoidable risk factor. With age, discs lose water content, become less flexible, and more prone to tears and herniation. One study found that age >50 years had an odds ratio (OR) of 1.7/year for disc degeneration and herniation. Another study showed that progression rates for anterior osteophytes and disc space narrowing were 4% and 3% per annum, respectively, with age being a strong predictor. Several other studies also highlighted increasing age as a primary risk factor for various spinal degenerative conditions, including LSD, stenosis, and deformity. Age-related changes like reduced bone density mass and more severe spinal degeneration further contribute to the risk.

2. Genetic Predisposition: Family history plays a crucial role. Individuals with a family history of LSD are significantly more likely to develop the condition themselves. One study reported an OR of 4.0 for individuals with a family disposition. Twin studies have shown that heredity accounts for up to 74% of the variance in disc degeneration. Specific gene forms associated with disc degeneration have also been identified, further confirming the genetic influence. While genetic factors are non-modifiable, understanding their contribution helps in early detection and personalized management.

3. Biomechanical Stress and Lifestyle Factors: This encompasses a range of factors that place stress on the spine.

4. Obesity (elevated BMI): Increased weight puts extra strain on the discs, accelerating their degeneration. One study found an OR of 2.77 for elevated BMI. Other studies also identified higher BMI as a risk factor for various complications, including ASD and cage subsidence after spinal surgery.

5. Smoking: Reduces blood supply to the discs, hindering their ability to repair themselves. One study reported an OR of 3.8 for smoking. Other studies also highlighted smoking as a major risk factor for LSD and other spinal pathologies, leading to increased pain, delayed recovery, and greater need for surgery.

6. Occupational factors: Certain occupations involving heavy lifting, bending, twisting, or prolonged sitting can contribute to LSD. One study found night shift work to be a significant predictor of disc degeneration (OR 23.01). Other studies also identified occupational and mechanical influences as major risk factors, although their impact may be less than genetic factors.

7. Physical inactivity: Lack of exercise weakens the muscles supporting the spine, increasing the load on the discs. One study found that lack of sports activities was a significant predictor for disc degeneration (OR 2.71). Other studies also highlighted physical inactivity as a risk factor, especially in older adults.

Comorbidities that are frequently associated with LSD and can exacerbate its progression include:

• Diabetes Mellitus: One study found an OR of 6.8 for diabetes. Another study showed that diabetes was associated with a six-fold higher risk of disc degeneration in the upper lumbar spine.
• Hypertension: One study found an OR of 1.25 for hypertension.
• Dyslipidemia: One study found an OR of 1.26 for dyslipidemia.
• Atherosclerosis: One study found an OR of 2.24 for atherosclerosis.
• Arthritis in other joints: One study found an OR of 3.1 for arthritis in other joints.

It's important to note that these are not the only risk factors and comorbidities associated with LSD. Others, such as previous back injuries, female gender, and certain spinal anatomical variations, can also play a role. A comprehensive assessment considering individual patient characteristics is crucial for accurate diagnosis and personalized management of LSD.

The provided text focuses on the TOPS™ System for lumbar spinal stenosis and degenerative spondylolisthesis, and does not mention trials for other indications. It also mentions a 2D imaged-based motion capture system called PEAK Motus used to study the effects of aging on spinal range of motion, but this is not an implant or surgical device like the TOPS™ System. Therefore, the question about other indications for the TOPS™ System cannot be answered from the given text.

Regarding the PEAK Motus system, the provided text describes its use in a study of age-related changes in spinal range of motion. The intervention models for this study involved:

• Comparison between age groups: Healthy young adults were compared to healthy older adults.
• Specific movements: Participants performed flexion and extension movements in the cervical, thoracic, and lumbar spine.
• Alternative movement tests: A "cat-stretch" movement in the all-fours position was used to assess thoracic extension, and a "toe-touch" movement in standing was used to assess lumbar flexion. These alternative movements were investigated to determine if they allowed a greater range of motion compared to standard flexion/extension tests.

The study used a revised model of skin marker placement with the 2D PEAK Motus system. Data was collected via video recordings of the participants performing the movements. The primary outcome measure was the range of motion in each spinal region. The study found that older adults had significantly decreased flexion/extension ranges in all spinal regions compared to younger adults. The alternative movement tests (cat-stretch and toe-touch) did allow for greater range of motion in the thoracic and lumbar spine, respectively.

It's important to note that this study used the Motus system as a measurement tool to assess range of motion, not as a therapeutic intervention. The text does not describe any clinical trials involving the Motus system as a treatment for any medical condition.