Abstract
With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.
Highlights
Lower back pain remains the most important musculoskeletal condition affecting the quality of life over the past few decades [1]
Degenerative disc disease patients typically present with mechanical lower back pain, which is worse on forward flexion and when carrying heavy load
Advanced degenerative disc disease can present with morphological changes in the spine, such as intervertebral disc bulge, disc herniation, facet hypertrophy, and thickening of the ligamentum flavum, which in turn can lead to spinal stenosis and neural compression
Summary
Lower back pain remains the most important musculoskeletal condition affecting the quality of life over the past few decades [1]. IVD can affect both the young and old population [3,4]. Treatment strategies need to consider age of presentation, comorbidities, severity of IVD, neural elements compression and stability of the spinal column. It is a complex algorithm of management, with confounding factors contributing to success in the management of symptoms. It is in the authors’ opinion that the general stepwise invasiveness ladder of management in the treatment of IVD diseases is the relief of pain by conservative management, restorative, reconstructive, replacement, and rigid fusion (Figure 1). Many of the restorative and reconstructive management strategies are still at the early stages of laboratory experimental and animal trials, with clinical efficacy
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