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Issues concerning the biological repair of intervertebral disc degeneration

Nature Clinical Practice Rheumatology volume 4, pages 226–227 (2008)Cite this article

Low back pain affects most people at some point in their lives. Although the precise source of low back pain is difficult to identify, the most common cause of chronic, severe low back pain is thought to be related to lumbar intervertebral disc degeneration.1 Current treatment options range from pharmacological management of inflammation to invasive procedures, such as spine fusion and arthroplasty. Unfortunately, all current approaches are limited to treating the symptoms and not the underlying biological alterations of the disc. There has recently been a growing interest in developing strategies that aim to repair or regenerate, biologically, the degenerate disc.

Genetic predisposition, mechanical load and nutritional factors are widely regarded as important contributors to intervertebral disc degeneration;2 however, detailed characterization of this complex interplay remains elusive. Disc cells actively modulate their metabolic activities through a variety of substances, including cytokines, enzymes, enzyme inhibitors and growth factors, in a paracrine and/or autocrine manner. With progressive disc degeneration, there is a net loss of proteoglycans and water from the nucleus pulposus, which leads to poor hydrodynamic transfer of axial stresses to the outer annulus fibrosus. Alterations in both anabolic and catabolic processes are involved in the onset and progression of disc degeneration. The ability to maintain or reconstitute proteoglycans, by altering the balance between synthesis and degradation, might be a strategic means by which function can be improved and the natural progression of degeneration altered. Since the disc has only a limited intrinsic capacity for regeneration, such therapeutic approaches are generally geared toward inhibition of matrix degrading enzymes and the stimulation of matrix production using growth factors, gene therapy, transplantation of autologous/allogenic cells, or combinations thereof. Preliminary studies of these methods have confirmed their ability to replenish those essential disc matrix components known to decrease with disc degeneration.2

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  1. Department of Orthopaedics, General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China pengbaogan@163.com

Authors and Affiliations

  1. B Peng is Director and Professor of the Department of Orthopaedics, General Hospital of Armed Police Force, Beijing, China.,

    Baogan Peng

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Peng, B. Issues concerning the biological repair of intervertebral disc degeneration. Nat Rev Rheumatol 4, 226–227 (2008). https://doi.org/10.1038/ncprheum0771

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