Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK.
School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK.
Cartilage. 2020 Apr;11(2):143-151. doi: 10.1177/1947603520907665. Epub 2020 Feb 19.
The complex structure of the intervertebral disc within the spine is well suited to its mechanical function. However, it is also prone to degeneration, which is associated with various clinical symptoms and conditions, ranging from disc herniation to back pain to spinal stenosis. Most patients' conditions are managed conservatively but a small proportion progress to having surgery. This may be decompression (to remove tissue such as the disc, bone, or hypertrophic ligaments impinging on nerves) or fusion of the normally mobile intervertebral joint to immobilize it and so reduce pain. These used to involve fairly major surgical procedures, but in the past decade there has been much progress to make the surgery more refined and less invasive, for example using endoscopic approaches. Simultaneously, the research world has been studying and developing tissue engineering and cellular techniques for attempting to regenerate the intervertebral disc, whether simply the central nucleus pulposus or a complete intricate assembly to replicate the native structure of this and the surrounding annulus fibrosus, cartilage endplate, and bone. To date, none of the complex entities have been trialed, while cellular approaches are easier to utilize, have progressed to clinical trials, and may offer a better solution.
脊柱内椎间盘的复杂结构非常适合其机械功能。然而，它也容易发生退化，这与各种临床症状和病症有关，从椎间盘突出到背痛再到椎管狭窄。大多数患者的病情都采用保守治疗，但一小部分患者病情会进展到需要手术。这可能是减压（去除压迫神经的组织，如椎间盘、骨或肥厚的韧带）或融合正常活动的椎间关节以使其固定，从而减轻疼痛。这些手术过去需要相当大的手术程序，但在过去十年中，手术已经取得了很大进展，使其更加精细和微创，例如使用内窥镜方法。与此同时，研究界一直在研究和开发组织工程和细胞技术，试图再生椎间盘，无论是简单的中央核髓还是完整复杂的装配，以复制这种结构以及周围的纤维环、软骨终板和骨。到目前为止，还没有一种复杂的实体被试用，而细胞方法更容易利用，已经进展到临床试验，并可能提供更好的解决方案。
