Intervertebral Disk Degeneration and Repair

Abstract

Intervertebral disk (IVD) degeneration is a natural progression of the aging process. Degenerative disk disease (DDD) is a pathologic condition associated with IVD that has been associated with chronic back pain. There are a variety of different mechanisms of DDD (genetic, mechanical, exposure). Each of these pathways leads to a final common result of unbalancing the anabolic and catabolic environment of the extracellular matrix in favor of catabolism. Attempts have been made to gain an understanding of the process of IVD degeneration with in Vitro studies. These models help our understanding of the disease process, but are limited as they do not come close to replicating the complexities that exist with an in Vivo model. Animal models have been developed to help us gain further understanding of the degenerative cascade of IVD degeneration In Vivo and test experimental treatment modalities to either prevent or reverse the process of DDD. Many modalities for treatment of DDD have been developed including therapeutic protein injections, stem cell injections, gene therapy, and tissue engineering. These interventions have had promising outcomes in animal models. Several of these modalities have been attempted in human trials, with early outcomes having promising results. Further, increasing our understanding of the degenerative process is essential to the development of new therapeutic interventions and the optimization of existing treatment protocols. Despite limited data, biological therapies are a promising treatment modality for DDD that could impact our future management of low back pain.

N-Cadherin Attenuates High Glucose-Induced Nucleus Pulposus Cell Senescence Through Regulation of the ROS/NF-κB Pathway

“…Aggrecan and collagen II are two primary NP matrix macromolecules [19]. We analyzed the matrix homeostatic phenotype in the high glucose group.…”

Serum miRNAs are potential biomarkers for the detection of disc degeneration, among which miR‐26a‐5p suppresses Smad1 to regulate disc homeostasis

“…In the United States, LBP is the second most common reason for patients to visit a physician, and the costs related to LBP are estimated to range from $84.1 billion to $624.8 billion . Being part of the general degeneration process of human beings in ageing, intervertebral disc degeneration (IVDD) is considered as a major cause for LBP, responsible for about 40% LBP in humans . The intervertebral disc is located between two vertebral bodies and is an avascular cartilaginous structure composed of endplate, annulus fibrosus (AF) and nucleus pulposus (NP).…”

“…The intervertebral disc is located between two vertebral bodies and is an avascular cartilaginous structure composed of endplate, annulus fibrosus (AF) and nucleus pulposus (NP). A number of risk factors are associated with the early onset of disc degeneration, such as genetic predisposition, environmental exposure, strenuous activities and smoking . At present, the diagnosis of disc degeneration mainly depends on imaging studies like MRI .…”

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

“…Late IVD degeneration has features that can create painful responses; it is identifiable in clinical radiographic evaluation in humans and in animal models of degeneration. Late IVD degeneration includes disc height loss (disc space narrowing), osteophyte formation, internuclear calcification, endplate sclerosis as seen in plain radiographs and via signal decrease in T2‐weighted (T2W) MRI, a loss of AF/NP boundary, an irregular cartilage layer, and a selective loss of horizontal trabeculae in MRI …”