From the Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
From the Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Vitam Horm. 2021;115:571-583. doi: 10.1016/bs.vh.2020.12.022. Epub 2021 Feb 5.
Lumbar back pain during aging is a major clinical problem, the origins and underlying mechanisms of which are challenging to study. Degenerative changes occur in various parts of the functional spinal unit, such the vertebral endplate and intervertebral disc. The homeostasis of these structural components is regulated by signaling molecules, such as transforming growth factor-β and parathyroid hormone. Previous efforts to understand sources of lumbar back pain focused on sensory innervation in the degenerative intervertebral disc, but intervertebral disc degeneration is frequently asymptomatic. An in vivo mouse model of lumbar spine aging and degeneration, combined with genetic technology, has identified endplate innervation as a major source of lumbar back pain and a potential therapeutic target. In this review, we consider how each structural component of the functional spinal unit contributes to lumbar back pain, how the homeostasis of each component is regulated, and how these findings can be used to develop potential therapies.
随着年龄的增长，腰部背部疼痛是一个主要的临床问题，其起源和潜在机制难以研究。在功能脊柱单元的各个部位都会发生退行性变化，例如椎体终板和椎间盘。这些结构成分的动态平衡受转化生长因子-β和甲状旁腺激素等信号分子的调节。先前对腰痛来源的研究主要集中在退行性椎间盘的感觉神经支配上，但椎间盘退变通常是无症状的。腰椎老化和退变的体内小鼠模型结合遗传技术，确定了终板神经支配是腰痛的主要来源和潜在的治疗靶点。在这篇综述中，我们考虑了功能脊柱单元的每个结构成分如何导致腰痛，每个成分的动态平衡如何受到调节，以及如何利用这些发现来开发潜在的治疗方法。
