Abstract
Degeneration of the intervertebral disc – triggered by ageing, mechanical stress, traumatic injury, infection, inflammation and other factors – has a significant role in the development of low back pain. Back pain not only has a high prevalence, but also a major socio-economic impact. With the ageing population, its occurrence and costs are expected to grow even more in the future. Disc degeneration is characterized by matrix breakdown, loss in proteoglycans and thus water content, disc height loss and an increase in inflammatory molecules. The accumulation of cytokines, such as interleukin (IL)-1β, IL-8 or tumor necrosis factor (TNF)-α, together with age-related immune deficiency, leads to the so-called inflammaging – low-grade, chronic inflammation with a crucial role in pain development. Despite the relevance of these molecular processes, current therapies target symptoms, but not underlying causes. This review describes the biological and biomechanical changes that occur in a degenerated disc, discuss...
Highlights
Degeneration of the intervertebral disc – triggered by ageing, mechanical stress, traumatic injury, infection, inflammation and other factors – has a significant role in the development of low back pain
Ageing intervertebral disc (IVD) are characterized by a shift from anabolism towards catabolism, with a consequent matrix breakdown, loss of hydration in the nucleus pulposus (NP) and reduction in disc height
Inflammation has been described as the major pathological contributor to the development of painful disc degeneration, termed degenerative disc disease (DDD; Figure 1)
Summary
During the course of life, humans are exposed to numerous internal and external damaging agents, including products of metabolic stress, UV light or pathogens. There are cumulative data indicating a decrease in the counteraction capacity with increasing age.[1] pathologyassociated ageing that is linked to an imbalance between inflammatory and anti-inflammatory networks occurs. This imbalance is further promoted by age-related immune deficiency termed immunosenescence, which entails a reduced capability of the body to effectively combat stressors.[2]. As the term inflammaging has recently emerged in the context of disc pathologies,[8] the subsequent chapters will provide an overview of the current state of the art
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