Translational research of herniated discs: current status of diagnosis and treatment

Abstract

Lumbar herniated discs commonly occur in patients 20–40 years of age, and result in acute symptoms of shooting and intractable pain in the low back and/or lower extremities. However, the prognosis of these patients is considered to be very good. Moreover, 70 % of these patients have been reported to be free from sciatica at approximately 6 months after the first onset. Magnetic resonance imaging (MRI) studies have described the spontaneous resorption process of herniated discs, which is a major cause of the reduction of symptoms in patients. New advancements in MRI have recently been developed that have facilitated the examination of nerve tract fibers and identification of symptomatic nerve tissue. Furthermore, the mechanism underlying the resorption process of a herniated disc has been determined. Inflammatory cytokines such as TNF (tumor necrosis factor)-α, angiogenic factors such as vascular endothelial growth factor, and enzymes such as matrix metalloproteinases are intricately related to each other. In our previous studies, matrix metalloproteinase-7 (MMP-7) has been shown to play a crucial role in the initiation of herniated disc resorption. Therefore, we developed recombinant human MMP-7 for intradiscal therapy through an industry–university joint research program. We have already performed in vitro and in vivo experiments to confirm its efficacy; this therapy avoids the side effects associated with surgery, such as nerve tissue damage. Moreover, the phase 1/2 studies of recombinant human (rh) MMP-7 are currently ongoing in the United States, and careful monitoring is required for these clinical trials. In conclusion, patients with lumbar herniated discs may benefit from the development of a less invasive treatment for disc herniation, which can be applied even immediately after the onset of disease symptoms.

TWEAK and TSLP in disc degeneration and spontaneous hernia resorption

“…To date, many studies have focused on the mechanism by which major inflammatory cytokines such as TNF-α and IL-1β cause disc degeneration. 8,[15][16][17] These inflammatory cytokines have many reported roles in acute phase inflammation such as infection, tumor, and trauma. 18 TWEAK, by contrast, appears to have a role in chronic inflammatory diseases such as rheumatoid arthritis.…”

General Practitioners’ Management of Patients With Back Pain

“…Важно отметить, что грыжа диска может клинически не прояв-ляться [12], ее наличие во многих случаях не объясняет БНЧС. Нередко происходит естественное уменьшение или даже полный регресс грыжи диска, что связывают с развитием аутоиммунного воспалительного ответа про-тив фрагментов вещества диска [13][14][15] …”

Nonspecific low back pain: Causes, clinical picture, diagnosis, and treatment

“…Активно обсуж-дается роль генетических факторов, особенно при возник-новении грыж диска в молодом возрасте у лиц с признака-ми мезенхимальной дисплазии и повышенной растяжимо-стью связок. Определены несколько потенциальных гене-тических маркеров поражения дисков, однако необходимы дальнейшие исследования [24]. Вопрос о роли поражения диска в формировании болевого синдрома в спине остается открытым.…”