Intradiscal injection for the management of low back pain

Abstract

Low back pain (LBP) is a common clinical problem and a major cause of physical disability, imposing a prominent socioeconomic burden. Intervertebral disc degeneration (IDD) has been considered the main cause of LBP. The current treatments have limited efficacy because they cannot address the underlying degeneration. With an increased understanding of the complex pathological mechanism of IDD, various medications and biological reagents have been used for intradiscal injection for the treatment of LBP. There is increasing clinical evidence showing the benefits of these therapies on symptomatic relief and their potential for disc repair and regeneration by targeting the disrupted pathways underlying the cause of the disease. A brief overview of the potential and limitations for these therapies are provided in this review, based on the recent and available data from clinical trials and systematic reviews.Finally, future perspectives are discussed.intervertebral disc degeneration, intradiscal injection, low back pain | INTRODUCTIONLow back pain (LBP) is a common symptom that occurs below the costal margin and above the inferior gluteal fold, which refers to pain, muscle tension, or stiffness. The global prevalence of LBP in 2017 was 7.83%, and 577 million people were affected at any time. 1 In 2019, a systematic review of 13 studies from northern Europe, North America, and Israel reported that the prevalence of LBP ranged between 14% and 20%. 2 A systematic review and meta-analysis revealed that the lifetime prevalence of LBP was 47% in low-, lower-Fu Zhang and Songjuan Wang (shared first authorship) and Zhiyu Zhou and Shaoyu Liu (shared last authorship) contributed equally to this study.

Harmonization and standardization of nucleus pulposus cell extraction and culture methods

“… 7 , 9 Treatment strategies are under development which target IDD, such as gene‐, cell‐, and biomaterial‐based approaches. 10 , 11 , 12 , 13 , 14 , 15 , 16 …”

“…7,9 Treatment strategies are under development which target IDD, such as gene-, cell-, and biomaterial-based approaches. [10][11][12][13][14][15][16] The IVD is situated between two vertebrae and consists of a soft, gelatinous central nucleus pulposus (NP), which is surrounded by the annulus fibrosus (AF), and cartilaginous endplates (CEPs), which provide permeable connections to the bony vertebrae allowing for nutrient supply to the IVD. Each region is populated by unique cell populations.…”

Clinical Development of Regenerative Medicine Targeted for Intervertebral Disc Disease

“…In addition, none of these interventions aim to resolve the degenerative cascade underlying the pathology, and furthermore, can trigger degenerative cascades in neighboring discs [16]. New strategies are being explored to limit, halt, and even reverse disc degeneration in an attempt to revitalize the disc`s composition and thus its biomechanical features, thereby resolving or preventing associated spinal disorders [17,18]. These include regenerative approaches, e.g., growth factor injection [19], gene therapy [20], tissue engineering [21,22], and biomaterial-applications [23], each being at different stages of development and presenting different levels of success in preclinical and/or clinical studies.…”

Homing of vertebral‐delivered mesenchymal stromal cells for degenerative intervertebral discs repair – an in vivo proof‐of‐concept study

“… 2 Upcoming regenerative therapeutic strategies, for example, gene therapy, 3 , 4 tissue engineering, 5 , 6 , 7 biomaterials, 8 and growth factor treatments, 9 are highly anticipated as methods to alleviate pain associated with intervertebral disc (IVD) degeneration. 10 Particularly, cell therapy has been proposed as a promising technique towards supporting IVD repair 11 and has shown rapid developmental progression 12 , 13 , 14 with multiple clinical trials highlighting the potential of cell injection to augment IVD imaging modalities. 15 The regenerative effects of the de novo cells are expected to be derived from either direct incorporation into the IVD and their local contribution to disc matrix reorganization.…”

“…Low back pain (LBP) stands as the primary cause of disability, 1 and contemporary treatment procedures remain inadequate for a large portion of LBP patients 2 . Upcoming regenerative therapeutic strategies, for example, gene therapy, 3,4 tissue engineering, 5–7 biomaterials, 8 and growth factor treatments, 9 are highly anticipated as methods to alleviate pain associated with intervertebral disc (IVD) degeneration 10 . Particularly, cell therapy has been proposed as a promising technique towards supporting IVD repair 11 and has shown rapid developmental progression 12–14 with multiple clinical trials highlighting the potential of cell injection to augment IVD imaging modalities 15 .…”