Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
Global Spine J. 2013 Jun;3(3):145-52. doi: 10.1055/s-0033-1347300. Epub 2013 May 21.
Degeneration of the intervertebral disk and its treatments are currently intensely investigated topics. Back pain is a condition whose chronic and debilitating nature combined with its prevalence make it a major health issue of substantial socioeconomic importance. Although researchers, and even sometimes clinicians, focus on the degenerated disk as the problem, to most patients, pain is the factor that limits their function and impacts their well-being. The purpose of this review is to delineate the changes associated with disk degeneration and to outline mechanisms by which they could be the source of back pain. Although the healthy disk is only innervated in the external layer of its annulus fibrosus, adjacent structures are plentiful with nociceptive receptors. Stimulation of such structures as a consequence of processes initiated by disk degeneration is explored. The concept of discogenic pain and possible mechanisms such as neoinnervation and solute transport are discussed. Finally, how such pain mechanisms may relate to current and proposed treatment strategies is discussed.
椎间盘退变及其治疗是目前研究的热点。腰痛是一种慢性和使人虚弱的疾病，其普遍性使其成为具有重大社会经济重要性的主要健康问题。尽管研究人员，甚至有时是临床医生，将退变的椎间盘作为问题的焦点，但对大多数患者来说，疼痛是限制其功能并影响其健康的因素。本文综述的目的是描述与椎间盘退变相关的变化，并概述其可能成为腰痛根源的机制。尽管健康的椎间盘仅在纤维环的外层有神经支配，但相邻的结构中存在大量的伤害感受器。探讨了由于椎间盘退变引发的过程刺激这些结构的可能性。讨论了椎间盘源性疼痛的概念以及新神经支配和溶质转运等可能的机制。最后，讨论了这种疼痛机制如何与当前和拟议的治疗策略相关。
