Degeneration of the intervertebral disc as an interdisciplinary clinical problem in the context of neurosurgery - a summary of the state of knowledge - part I

Abstract

Background: Degeneration of the intervertebral disc (IVD), resulting from various factors including both genetic and environmental, is a significant musculoskeletal disorder. It is characterized by a gradual deterioration of the structure and weakening the function of IVD, leading to a decline in the quality of life (QOL) or disability.Aim of the study: The aim of the study was to perform the review of scientific reports and summary of current knowledge regarding IVD degeneration in terms of etiopathogenesis, clinical symptoms, and various diagnostic methods.Materials and Methods: The literature review was based on searching key medical databases such as PubMed, MEDLINE, Scopus. A search strategy was defined, encompassing keywords, synonyms, and controlled keywords (MeSH terms). The search covered the last 20 years and focused on aspects of etiopathogenesis, clinical symptoms, and diagnostic methods. Papers meeting the inclusion criteria underwent a full-text analysis. Data and information gathered from the literature analysis were synthesized to provide a comprehensive overview of the current state of knowledge on the researched subject. Results: The process of IVD degeneration is extremely complex, involving biochemical, metabolic, and morphological changes that impact its structure and function. It entails a gradual loss of water in the nucleus pulposus (dehydration), resulting in impaired shock-absorbing function and leading to the formation of breaks in the annulus fibrosus, where the nucleus pulposus herniates. For years, mechanical injuries, especially work-related, were considered the primary factors causing IVD degeneration. Recent findings emphasize the significant role of genetic factors, with several genes encoding structural proteins of the IVD identified. Mutations in these genes may accelerate degeneration. Current clinical research results indicate a correlation between aortic calcifications and episodes of low back pain (LBP) and between lumbar artery stenosis, IVD degeneration, and subsequent LBP.Conclusions: Understanding the complexity of IVD degeneration and their neurological consequences is a crucial in planning effective treatment. It is essential to monitor the results of the latest research for the systematic updating of knowledge and practical guidelines in the discussed area. Collaboration between an experienced neurosurgeon and an interdisciplinary team of medical specialists can lead to achieving the best therapeutic outcomes.