Spontaneous herniated disc resorption occurs via inflammatory reactions involving abundant neovascularization and macrophage phagocytotic activity. Nonthermal low-intensity pulsed ultrasound (LIPUS) treatment might be effective in shortening the duration of disc resorption. We developed a rat in vitro resorption model in which a coccygeal intervertebral disc and peritoneal macrophages were cocultured. Secretion of tumor necrosis factor-a (TNF-a) from macrophages was promoted by LIPUS, and the process of disc degeneration was thus accelerated. In this study, we further examined the effects of LIPUS using this in vitro model focusing on whether LIPUS affects cyclooxygenase-2 (COX-2) signaling pathways. We found that the levels of COX-2 and prostaglandin E2 (PGE2) secreted from macrophages were increased by LIPUS. However, these phenomena were not caused by LIPUS directly, as the levels of these substances were reduced by neutralizing TNF-a activity. Moreover, the wet weights of the disc samples were not changed by addition of PGE2, but were reduced by recombinant TNF-a. Our results suggest that the effects of LIPUS in enhancing the process of herniated disc resorption are caused mainly by TNF-a. Keywords: low-intensity pulsed ultrasound; herniated disc; TNF-a; COX-2; PGE2A herniated disc (HD) is defined as a degenerated intervertebral disc protruding toward the spinal canal. Mechanical compression by an HD and chemical stimulation with substances such as tumor necrosis factor-a (TNF-a) can be potential causes of radiculopathy. 1 Pain may be relieved by surgical removal of the ruptured disc. Recently, spontaneous resorption of exposed HDs was recognized by magnetic resonance imaging (MRI), 2 and conservative treatments are now often selected to relieve pain. 3 The mechanism of HD resorption may involve inflammatory reactions correlated with abundant neovascularization and macrophage (Mj) phagocytotic activity. 4,5 TNF-a stimulates matrix metalloproteinase (MMP)-3 in the disc in an autocrine/paracrine manner, causing further infiltration of Mj and degeneration of extracellular matrix. [4][5][6] However, the resorption mechanism has not been clarified.We previously revealed that nonthermal low-intensity pulsed ultrasound (LIPUS) stimulation was effective for enhancing resorption, and accelerating the rate of disc degeneration. 7 LIPUS therapy promotes bone fracture healing in human subjects, 8 modulates gene expression in osteoblasts or chondrocytes, 9,10 and influences second messenger activities related to angiogenesis. We hypothesized that LIPUS stimulation would promote inflammatory activity, and therefore we examined the effects of LIPUS on a rat HD resorption model involving coculture of coccygeal ID tissues and peritoneal Mj. The LIPUS exposure enhanced TNF-a secretion by Mj, and disc wet weights were decreased by stimulation after 4 days of culture. 7 These results suggested that LIPUS activates the infiltration of Mj into cocultured disc samples, thus accelerating resorption.Cyclooxygenase-2 (COX-2...