Treatment of the degenerated intervertebral disc; closure, repair and regeneration of the annulus fibrosus

Abstract

Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causing disc degeneration. Symptomatic disc herniation mainly causes radicular pain. Current treatments of intervertebral disc degeneration and low back pain are based on alleviating the symptoms and comprise administration of painkillers or surgical methods such as spinal fusion. None of these methods is completely successful. Current research focuses on regeneration of the IVD and particularly on regeneration of the nucleus pulposus. Less attention has been directed to the repair or regeneration of the annulus fibrosus, although this is the key to successful nucleus pulposus, and therewith IVD, repair. This review focuses on the importance of restoring the function of the annulus fibrosus, as well as on the repair, replacement or regeneration of the annulus fibrosus in combination with restoration of the function of the nucleus pulposus, to treat low back pain.

Angle-ply biomaterial scaffold for annulus fibrosus repair replicates native tissue mechanical properties, restores spinal kinematics, and supports cell viability

“…This results in a loss of IVD height, impaired IVD mechanical function, patient pain, and disability [5–11]. Accordingly, discogenic low back pain (LBP) affects approximately 80% of the adult population during their lifetime resulting in a diminished quality of life [4,12–14], and estimated healthcare expenditures exceeding $85.9 billion [15,16]. Surgical treatments for late-stage IVDD include spinal fusion and total disc replacement, however these methods suffer from significant drawbacks [17].…”

Protective effects of resveratrol on autologous nucleus pulposus model of radiculopathy

“…Amongst a variety of etiologies, degenerative disc disease (leading to so-called discogenic back pain) that correlated with increased levels of proinflammatory cytokines has been postulated to be a crucial cause of lower back pain (21,29,30). Current treatments for lower back pain remain contested, indicating that current treatment options are not ideal, as current therapeutic strategies do affect the underlying biological mechanisms of pain development (5). For those reasons, injectable anti-inflammatory substances that specifically target the metabolism of IVD cells may serve as novel and useful minimally-invasive treatment options (31,32).…”

“…However, biochemical factors derived from the NP, such as TNF-α and IL-1, have subsequently been found to be an additional pathophysiologic mechanism for inducing pain (4). The current treatment options of NP-mediated pain are not ideal, as they target symptomatic relief but do not interfere with the biological mechanisms underlying pain development (5). In clinical practice, reducing the inflammation can notably ameliorate the clinical outcomes of some autoimmune diseases (6,7), suggesting that the reduction of proinflammatory cytokine production may serve as an efficient therapeutic target for NP-mediated pain.…”

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

“…Although an FDA panel confirmed its efficacy in preventing reherniations following discectomy, the presence of lytic endplate lesions and device subsidence raised safety concerns . AF repair and NP replacement biomaterials and devices remain an emergent area of research as described in multiple excellent recent studies and reviews . These biomaterials must show efficacy for improved spinal healing or pain reduction, while also avoiding reherniation and/or adjacent tissue damage.…”