Department of Anatomy, University of Health Sciences, Lahore, Pakistan.
Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
Nat Rev Rheumatol. 2022 Jun;18(6):352-362. doi: 10.1038/s41584-022-00783-7. Epub 2022 May 9.
Low back pain is a leading cause of disability worldwide. Intervertebral disc (IVD) degeneration is often associated with low back pain but is sometimes asymptomatic. IVD calcification is an often overlooked disc phenotype that might have considerable clinical impact. IVD calcification is not a rare finding in ageing or in degenerative and scoliotic spinal conditions, but is often ignored and under-reported. IVD calcification may lead to stiffer IVDs and altered segmental biomechanics, more severe IVD degeneration, inflammation and low back pain. Calcification is not restricted to the IVD but is also observed in the degeneration of other cartilaginous tissues, such as joint cartilage, and is involved in the tissue inflammatory process. Furthermore, IVD calcification may also affect the vertebral endplate, leading to Modic changes (non-neoplastic subchondral vertebral bone marrow lesions) and the generation of pain. Such effects in the spine might develop in similar ways to the development of subchondral marrow lesions of the knee, which are associated with osteoarthritis-related pain. We propose that IVD calcification is a phenotypic biomarker of clinically relevant disc degeneration and endplate changes. As IVD calcification has implications for the management and prognosis of degenerative spinal changes and could affect targeted therapeutics and regenerative approaches for the spine, awareness of IVD calcification should be raised in the spine community.
腰痛是全球导致残疾的主要原因。椎间盘(IVD)退变常与腰痛有关,但有时也无症状。IVD 钙化是一种常被忽视的椎间盘表型,可能具有相当大的临床影响。IVD 钙化在衰老或退行性和脊柱侧凸性脊柱疾病中并非罕见发现,但常被忽视和报告不足。IVD 钙化可导致椎间盘更僵硬和节段生物力学改变、更严重的 IVD 退变、炎症和腰痛。钙化不仅限于 IVD,也可见于其他软骨组织(如关节软骨)的退变,并参与组织炎症过程。此外,IVD 钙化还可能影响椎体终板,导致 Modic 改变(非肿瘤性软骨下椎体骨髓病变)和疼痛产生。脊柱中的这种影响可能以类似于膝关节软骨下骨髓病变发展的方式发展,后者与骨关节炎相关疼痛有关。我们提出,IVD 钙化是具有临床相关性的椎间盘退变和终板变化的表型生物标志物。由于 IVD 钙化对退行性脊柱变化的管理和预后有影响,并可能影响脊柱的靶向治疗和再生方法,因此应提高脊柱界对 IVD 钙化的认识。
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