Ikwuegbuenyi Chibuikem A, Fidai Alikhan B, Cardenas Ashley, Willett Noah, Robayo Anthony, Hamad Mousa, Hussain Ibrahim, Bonassar Lawrence J, Härtl Roger
Department of Neurological Surgery, Och Spine at New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.
Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.
World Neurosurg. 2025 Aug;200:124107. doi: 10.1016/j.wneu.2025.124107. Epub 2025 May 21.
Degenerative disc disease is a significant cause of chronic low back pain, often leading to disability and high health care costs. Current treatments, including physical therapy, pain management, and surgical interventions such as spinal fusion and total disc replacement, do not reverse degeneration. Bioactive therapies offer a potential alternative by targeting the underlying degenerative process. Cell-based therapies, including the use of mesenchymal stem cells and platelet-rich plasma, aim to restore disc structure and function by promoting extracellular matrix production and reducing inflammation. Early studies show potential benefits in pain relief and disc regeneration, but long-term efficacy remains unclear. Nucleus pulposus augmentation and replacement strategies, such as the use of hydrogel implants and in situ curing polymers, are aimed at restoring disc height and biomechanical function. While these strategies are promising, issues such as implant durability and migration require further study. Total disc replacement preserves motion and avoids adjacent-segment disease, but outcomes depend on patient selection and implant design. Despite encouraging results, bioactive therapies still require research to establish long-term safety and effectiveness. Advancements in biomaterials, patient selection criteria, and clinical trials will determine their role in the future management of degenerative disc disease.
椎间盘退变疾病是慢性下腰痛的重要原因，常导致残疾和高昂的医疗费用。目前的治疗方法，包括物理治疗、疼痛管理以及诸如脊柱融合和全椎间盘置换等手术干预，都无法逆转退变。生物活性疗法通过针对潜在的退变过程提供了一种潜在的替代方案。基于细胞的疗法，包括使用间充质干细胞和富血小板血浆，旨在通过促进细胞外基质产生和减轻炎症来恢复椎间盘结构和功能。早期研究显示在缓解疼痛和椎间盘再生方面有潜在益处，但长期疗效仍不明确。髓核增强和置换策略，如使用水凝胶植入物和原位固化聚合物，旨在恢复椎间盘高度和生物力学功能。虽然这些策略很有前景，但诸如植入物耐久性和移位等问题仍需进一步研究。全椎间盘置换保留了运动功能并避免了相邻节段疾病，但结果取决于患者选择和植入物设计。尽管有令人鼓舞的结果，生物活性疗法仍需要进行研究以确立长期安全性和有效性。生物材料、患者选择标准和临床试验的进展将决定它们在未来椎间盘退变疾病管理中的作用。
