Molecular pathogenic factors in symptomatic disc degeneration

Abstract

Background context Although symptomatic disc degeneration is thought to be the leading cause of chronic low back pain, no available biologic therapy is yet available to treat this highly prevalent condition. Purpose In this article, the cellular, biomechanical and molecular alterations that occur during disc degeneration are reviewed to provide a better understanding of this pathologic process. Study design The cellular and molecular aspects of disc degeneration are reviewed. Methods The available studies detailing the molecular and cellular changes during disc degeneration are reviewed in an effort to provide a basis for understanding the biologic strategies for disc repair. Results Disc degeneration begins early in life and involves a cascade of changes at the cellular and molecular level that results in degradation of the extracellular matrix of the disc, leading to biomechanical failure of this complex structure. Conclusion With a thorough understanding of the cellular and molecular events causing degeneration of the intervertebral disc, rational strategies for disc repair can be understood and evaluated. It appears that biologic disc repair will be feasible in the future although challenges remain in this blossoming field.