Hadjipavlou A G, Tzermiadianos M N, Bogduk N, Zindrick M R
Division of Spine Surgery, University of Texas Medical Branch at Galveston, Texas, USA.
J Bone Joint Surg Br. 2008 Oct;90(10):1261-70. doi: 10.1302/0301-620X.90B10.20910.
The pathophysiology of intervertebral disc degeneration has been extensively studied. Various factors have been suggested as influencing its aetiology, including mechanical factors, such as compressive loading, shear stress and vibration, as well as ageing, genetic, systemic and toxic factors, which can lead to degeneration of the disc through biochemical reactions. How are these factors linked? What is their individual importance? There is no clear evidence indicating whether ageing in the presence of repetitive injury or repetitive injury in the absence of ageing plays a greater role in the degenerative process. Mechanical factors can trigger biochemical reactions which, in turn, may promote the normal biological changes of ageing, which can also be accelerated by genetic factors. Degradation of the molecular structure of the disc during ageing renders it more susceptible to superimposed mechanical injuries. This review supports the theory that degeneration of the disc has a complex multifactorial aetiology. Which factors initiate the events in the degenerative cascade is a question that remains unanswered, but most evidence points to an age-related process influenced primarily by mechanical and genetic factors.
椎间盘退变的病理生理学已得到广泛研究。人们提出了多种影响其病因的因素，包括机械因素，如压缩负荷、剪切应力和振动，以及衰老、遗传、全身和毒性因素，这些因素可通过生化反应导致椎间盘退变。这些因素是如何联系的？它们各自的重要性是什么？没有明确证据表明在存在重复性损伤的情况下衰老还是在不存在衰老的情况下重复性损伤在退变过程中起更大作用。机械因素可引发生化反应，进而可能促进衰老的正常生物学变化，而遗传因素也可加速这种变化。衰老过程中椎间盘分子结构的降解使其更容易受到叠加的机械损伤。本综述支持椎间盘退变具有复杂多因素病因的理论。哪些因素引发退变级联反应中的事件仍是一个未解决的问题，但大多数证据表明这是一个主要受机械和遗传因素影响的与年龄相关的过程。
