Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2022 Jan;157:264-273. doi: 10.1016/j.wneu.2021.09.066.
Lumbar disc degeneration is one of the leading causes of chronic low back pain. The degenerative cascade is often initiated by an imbalance between catabolic and anabolic processes in the intervertebral discs. As a consequence of extracellular matrix degradation, neoinnervation and neovascularization take place. Ultimately, this degenerative process results in disc bulging and loss of nucleus pulposus and water content and subsequent loss of disc height. Most patients respond to conservative management and surgical interventions well initially, yet a significant number of patients continue to suffer from chronic low back pain. Because of the high prevalence of long-term discogenic pain, regenerative biological therapies, including gene therapies, growth factors, cellular-based injections, and tissue-engineered constructs, have attracted significant attention in light of their potential to directly address the degenerative process. Understanding the pathophysiology of degenerative disc disease is important in both refining existing technologies and developing innovative techniques to reverse the degenerative processes in the discs. In this review, we aimed to cover the underlying pathophysiology of degenerative disc disease as well as its associated risk factors and give a comprehensive summary about the developmental, structural, radiological, and biomechanical properties of human intervertebral discs.
腰椎间盘退变是慢性下腰痛的主要原因之一。退变级联反应通常是由椎间盘内分解代谢和合成代谢过程之间的失衡引起的。由于细胞外基质降解，会发生新生神经支配和新生血管形成。最终，这个退行性过程会导致椎间盘膨出、髓核和水分丢失，进而导致椎间盘高度丢失。大多数患者最初对保守治疗和手术干预反应良好，但仍有相当数量的患者持续遭受慢性下腰痛的困扰。由于长期椎间盘源性疼痛的高患病率，再生生物疗法，包括基因疗法、生长因子、细胞注射和组织工程构建物，因其有可能直接解决退行性过程，引起了人们的极大关注。了解退行性椎间盘疾病的病理生理学对于改进现有技术和开发创新技术以逆转椎间盘的退行性过程非常重要。在这篇综述中，我们旨在涵盖退行性椎间盘疾病的潜在病理生理学及其相关危险因素，并全面总结人类椎间盘的发育、结构、影像学和生物力学特性。
