Abstract
Intervertebral disc (IVD) degeneration is a common cause of low back pain and most spinal disorders. As IVD degeneration is a major obstacle to the healthy life of so many individuals, it is a major issue that needs to be overcome. Currently, there is no clinical treatment for the regeneration of degenerated IVDs. However, recent advances in regenerative medicine and tissue engineering suggest the potential of cell-based and/or biomaterial-based IVD regeneration therapies. These treatments may be indicated for patients with IVDs in the intermediate degenerative stage, a point where the number of viable cells decreases, and the structural integrity of the disc begins to collapse. However, there are many biological, biomechanical, and clinical challenges that must be overcome before the clinical application of these IVD regeneration therapies can be realized. This review summarizes the basic research and clinical trials literature on cell-based and biomaterial-based IVD regenerative therapies and outlines the important role of these strategies in regenerative treatment for IVD degenerative diseases, especially disc herniation.
Highlights
Intervertebral disc (IVD) degeneration is a common cause of low back pain that affects the daily life of afflicted individuals and is the cause of most spinal disorders [1–4]
Numerous in vitro and in vivo experiments on nucleus pulposus (NP) regeneration therapy based on using soft biomaterials have been performed, but very few human clinical trials have investigated the use of biomaterials alone or as a cell scaffold or delivery system for IVD regeneration. [24,113]
Candidate biomaterials for IVD repair should be evaluated in ex vivo studies for mechanical feasibility and the associated risk of herniation after in situ application (Figure 3)
Summary
Intervertebral disc (IVD) degeneration is a common cause of low back pain that affects the daily life of afflicted individuals and is the cause of most spinal disorders [1–4] Surgical treatments, such as discectomy, arthroplasty, and spinal fusion, have been widely used for the treatment of IVD diseases, including disc herniation, spinal canal stenosis, and spinal deformities. Biomaterial-based therapies that maintain the disc structure and activate the remaining cells are expected to be applicable to degenerative disc diseases, such as lumbar disc herniation, which typically affects relatively young people up to the age of 40 years (Figure 1). We review the strategies for disc regeneration/repair therapy for IVD degeneration, with a focus on cell-based therapy and soft biomaterial-based approaches. Additional papers were obtained by analyzing papers containing excellent reviews
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