The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain

Abstract

This article reviews the current knowledge of the intervertebral disc (IVD) and its association with low back pain (LBP). The normal IVD is a largely avascular and aneural structure with a high water content, its nutrients mainly diffusing through the end plates. IVD degeneration occurs when its cells die or become dysfunctional, notably in an acidic environment. In the process of degeneration, the IVD becomes dehydrated and vascularised, and there is an ingrowth of nerves. Although not universally the case, the altered physiology of the IVD is believed to precede or be associated with many clinical symptoms or conditions including low back and/or lower limb pain, paraesthesia, spinal stenosis and disc herniation. New treatment options have been developed in recent years. These include biological therapies and novel surgical techniques (such as total disc replacement), although many of these are still in their experimental phase. Central to developing further methods of treatment is the need for effective ways in which to assess patients and measure their outcomes. However, significant difficulties remain and it is therefore an appropriate time to be further investigating the scientific basis of and treatment of LBP.

'Cell or Not to Cell' that is the Question: For Intervertebral Disc Regeneration?

“…[74] Total Disc Replacement (TDR), which consists of polyethylene on metal, or metal on metal implants engineered to resemble a low friction ball and socket joint, is currently considered as an alternative treatment strategy to spinal fusion [113]. his method does not avoid invasive surgery since the excision of the degenerate disc is unavoidable, however does restore some mobility to the intervertebral joint which could reduce the risk of adjacent disc degeneration [114].…”

Expression of miR-625 and Fas in cervical vertebral cartilage endplate

“…This degeneration causes pain in different areas of the body, leading to serious health problems (3). It has been suggested that cervical disc disease is primarily caused by the breakdown of intervertebral discs (4). Intervertebral discs consist of a nucleus, annulus and endplate.…”

Quantification of continuous in vivo flexion–extension kinematics and intervertebral strains

“…Currently, there are numerous treatments for painful disc degeneration, ranging from physical therapy to disc arthroplasty [1,2]. These treatments are only partially effective, due in part to an incomplete mechanical understanding of the natural deformation of intervertebral disc during physiologic movement.…”