Promoting Regeneration in Degenerative Disc Disease.

Abstract

The degenerative disc disease has a multifactorial etiology and mechanical stress is one of the most important etiological factor. The purpose of this study was to evaluate the intervertebral disc (IVD) after axial stress diminution from the point of view of its proteoglycan (PG) content, with preoteoglicans (PGs) being very important in the normal function but also in the degenerative or regenerative processes. This is a single-center, prospective, non-randomized study of 38 degenerated intervertebral discs treated with monosegmental or polisegmental posterior lumbar spinal fixation in 27 patients. During surgery, a posterior intervertebral distraction at operated levels was applied. Patients' mean age was 50.77 years and the mean follow-up 28.74 months. Both clinical (visual analog pain scale, Oswestry disability index) and radiological (lumbar spine lordosis, disc thickness) analyses were made before and after surgery. A new method of cartilage analysis, which was also validated for the IVD, delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) was used to determine the PG content before and after surgery for both the intervertebral degenerative disc and control level L1-L2 disc. The clinical features improved significantly. The thickness of the operated discs increased by an average of 1.71 mm postoperatively and remained unchanged in the control group. The lumbar lordosis did not change significantly. In dGEMRIC studies, the discs accumulated in average 410.08 units /cm2 of gadolinium before surgery and 272.45 units/cm2 after surgery, without significant changes in the control group. Our study shows an improvement of PG quantity in degenerated IVD due to a decrease in gadolinium binding seen in dGEMRIC study. Thus, we can ameliorate IVD homeostasis by eliminating mechanical stress, which could be a step towards the process of disc regeneration.