Disc regeneration: a glimpse of the future.

Abstract

The normal IVD clinically acts to support and dissipate loads while permitting multiaxial motions of the spine. Its demanding mechanical function is provided by a well-defined microstructural organization and biochemical composition. IVD degeneration is a complex process that disrupts this well-defined organization and biochemical balance. One hallmark of IVD degeneration is the loss of proteoglycan and water in the NP. Because of the central role of proteoglycans in the function of the IVD, restoration of normal proteoglycan production may be critical. Many different biological strategies have been developed, including the use of cells, scaffolds, and molecules. The molecules used to treat disc degeneration include anticatabolics and growth factors, which may influence the cell proliferation rate and phenotypic expression of the cells. Delivery of the molecules may include direct injection into the disc and also in vivo and ex vivo gene therapy using a viral vector. Although many of the in vitro and in vivo studies have exhibited promise in reversing the observed changes of disc degeneration, the unanswered question is whether these efforts will translate to the relief of patients' symptoms, the most common of which is back pain.