The Lumbar Disc and Low Back Pain

Bogduk, Nikolai

doi:10.1016/s1042-3680(18)30701-0

Cited by 108 publications

(60 citation statements)

References 93 publications

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“…This may improve precision in the evaluation of degenerative disc condition. Additionally, it would provide further three-dimensional information in a non-destructive manner to support the findings of authors who performed histological investigations [17][18][19][20][21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 67%

Intervertebral disc lesions: visualisation with ultra-high field MRI at 11.7 T

Berger-Roscher¹,

Galbusera

Rasche³

et al. 2015

Eur Spine J

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Section: Discussionmentioning

confidence: 67%

Intervertebral disc lesions: visualisation with ultra-high field MRI at 11.7 T

Berger-Roscher¹,

Galbusera

Rasche³

et al. 2015

Eur Spine J

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“…Back pain is closely associated with intervertebral disc (IVD) degeneration (Bogduk, 1991;Freemont, 2009). It afflicts nearly 85 % of the population during their lifetime (Loreto et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Mechanism of parathyroid hormone-mediated suppression of calcification markers in human intervertebral disc cells

Madiraju

Gawri²,

Wang³

et al. 2013

eCM

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In degenerative intervertebral discs (IVD), type X collagen (COL X) expression (associated with hypertrophic differentiation) and calcification has been demonstrated. Suppression of COL X expression and calcification during disc degeneration can be therapeutic. In the present study we investigated the potential of human parathyroid hormone 1-34 (PTH) in suppressing indicators of calcification potential (alkaline phosphatase (ALP), Ca 2+ , inorganic phosphate (Pi)), and COL X expression. Further, we sought to elucidate the mechanism of PTH action in annulus fibrosus (AF) and nucleus pulposus (NP) cells from human lumbar IVDs with moderate to advanced degeneration. Mitogen activated protein kinase (MAPK) signalling and alterations in the markers of calcification potential were analysed. PTH increased type II collagen (COL II) expression in AF (~200 %) and NP cells (~163 %) and decreased COL X levels both in AF and NP cells (~75 %). These changes in the expression of collagens were preceded by MAPK phosphorylation, which was increased in both AF and NP cells by PTH after 30 min. MAPK signalling inhibitor U0126 and protein kinase-A inhibitor H-89 DCH attenuated PTH stimulated COL II expression in both cell types. PTH decreased ALP activity and increased Ca 2+ release only in NP cells. The present study demonstrates that PTH can potentially retard IVD degeneration by stimulating matrix synthesis and suppressing markers of calcification potential in degenerated disc cells via both MAPK and PKA signalling pathways. Inhibition of further mineral deposition may therefore be a viable therapeutic option for improving the status of degenerating discs.

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“…3 Among a variety of etiologies, internal disc disruption (IDD) has been postulated as an important cause of low back pain. 4 It has been estimated that IDD could be present in 28% to 43% of the patients with low back pain. [5][6][7] The term IDD was first coined by Crock in 1970 on the basis of a large group of patients whose disabling back and leg pain became worse after operation for suspected disc prolapse.…”

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confidence: 99%

Diagnosis and Minimally Invasive Treatment of Lumbar Discogenic Pain – A Review of the Literature

Zhou

Abdi

2006

The Clinical Journal of Pain

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Diagnosis and treatment of lumbar discogenic pain due to internal disc disruption (IDD) remains a challenge. It accounts for 39% of patients with low back pain. The mechanism of discogenic pain remains unclear and its clinical presentation is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of IDD. However, relative low sensitivity (26.7% to 59%) and high false-positive (24%) and false-negative (38%) rates reduce the value of MRI in screening for the existence of painful IDD. Provocative discography can provide unique information about the pain source and the morphology of the disc. It may also provide information for selecting appropriate treatment for the painful annular tear. Adjunctive therapies, including nonsteroidal anti-inflammatory drugs, physical therapy, rehabilitation, antidepressants, antiepileptics, and acupuncture, have been used for low back pain. The value of these treatments for discogenic pain is yet to be established. Intradiscal steroid injection has not been proved to provide long-term benefits. Intradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. A block in the ramus communicans may interfere with the transition of painful information from the discs to the central nervous system. Disc cell transplantation is in the experimental stage. It has the potential to become a useful tool for the prevention and treatment of discogenic pain. Minimally invasive treatments provide alternatives for discogenic pain with the appeal of cost-effectiveness and, possibly, less long-term side effects. However, the value of most of these therapies is yet to be established. More basic science and clinical studies are needed to improve the clinical efficacy of minimally invasive treatments.

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The Lumbar Disc and Low Back Pain

Cited by 108 publications

References 93 publications

Intervertebral disc lesions: visualisation with ultra-high field MRI at 11.7 T

Intervertebral disc lesions: visualisation with ultra-high field MRI at 11.7 T

Mechanism of parathyroid hormone-mediated suppression of calcification markers in human intervertebral disc cells

Diagnosis and Minimally Invasive Treatment of Lumbar Discogenic Pain – A Review of the Literature

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