Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
Int Orthop. 2019 Apr;43(4):995-1002. doi: 10.1007/s00264-018-4254-7. Epub 2018 Nov 30.
Low back and neck pain are among the top contributors for years lived with disability, causing patients to seek substantial non-operative and operative care. Intervertebral disc herniation is one of the most common spinal pathologies leading to low back pain. Patient comorbidities and other risk factors contribute to the onset and magnitude of disc herniation. Spine fusions have been the treatment of choice for disc herniation, due to the conflicting evidence on conservative treatments. However, re-operation and costs have been among the main challenges. Novel technologies including cage surface modifications, biologics, and 3D printing hold a great promise. Artificial disc replacement has demonstrated reduced rates of adjacent segment degeneration, need for additional surgery, and better outcomes. Non-invasive biological approaches are focused on cell-based therapies, with data primarily from preclinical settings. High-quality comparative studies are needed to evaluate the efficacy and safety of novel technologies and biological therapies.
下腰痛和颈痛是导致伤残调整生命年（DALY）的主要原因之一，导致患者寻求大量的非手术和手术治疗。椎间盘突出症是导致下腰痛最常见的脊柱病变之一。患者的合并症和其他风险因素导致椎间盘突出症的发生和严重程度不同。由于保守治疗的证据相互矛盾，脊柱融合术一直是椎间盘突出症的治疗选择。然而，再次手术和费用一直是主要挑战。新型技术包括笼表面改性、生物制剂和 3D 打印，具有很大的应用前景。人工椎间盘置换术已显示出降低相邻节段退变、需要额外手术和更好结果的发生率。非侵入性的生物方法侧重于细胞疗法，主要数据来自临床前研究。需要高质量的比较研究来评估新型技术和生物疗法的疗效和安全性。
