Password reminder
Spinal News
Contact the editor Visit Spinal News Twitter feed Visit Spinal News Facebook page

Understanding the pathology behind disc degeneration

Friday, 25 May 2012 12:59
Sally Roberts
Sally Roberts

Sally Roberts, Centre for Spinal Studies & ISMA (Keele University), Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK, talked to Spinal News International about the current understanding of the pathology behind disc degeneration. She spoke about “Disc biology and tissue engineering” at The Annual Imperial Spine Course (7–9 March 2012, London, UK) and will be speaking about disc degeneration at Spineweek (28 May–1 June 2012, Amsterdam, The Netherlands)

What is the pathology behind disc degeneration?

In disc degeneration, the matrix of the disc can no longer function normally because the extra cellular matrix (ECM) becomes degraded, losing some molecules, particularly proteoglycans and their constituent glycosaminoglycans. This process almost certainly involves the resident cells within the disc. While we know quite a lot about different enzymes and other molecules that can be involved, the exact sequence of events and trigger factors are not always clear. I suspect there may be many different pathways resulting in a similar endpoint. As with so many other things, our genes play a significant part in whether degeneration will happen or not.

What are the ways that cell therapy is being proposed as a treatment for disc regeneration?

It has not just been proposed—it has already been used in patients! For example, autologous cells from herniated discs cultured in vitro and injected back into the disc has been performed for some years in Germany, and mesenchymal stem cells from the patient’s bone marrow have been injected into discs in the USA and Japan.

Meantime, there are many aspects of cell therapy that are being researched, such as: attempting to identify the best cell type to use and whether this should be autologous or allogeneic; whether cells should be from the annulus fibrosus or nucleus pulposus; or whether they should be stem cells and if so from where—bone marrow or adipose tissue or somewhere else?; and should a carrier or scaffold be used?

What questions do we need to answer before we can routinely use cell therapy to treat disc degeneration?

A very important question is “which patients would benefit most from such treatment?” For example, should you select only very degenerate discs to treat? If so, the rest of the spinal structure, nutrient pathways, vascularisation etc. may not be able to support the implanted cells. But then would surgeons be happy to treat, and would patients want to have cells implanted into discs, if the degeneration (or more importantly, the pain) was not too bad?

More recently another big question has been raised and this is about how the cells should be introduced to the disc. I believe most people imagined, until a couple of years ago, that cells could be injected (minimally invasively) into the discs, but there are now several studies indicating that a needle hole, however small, may be very bad news for the disc long term and such a “puncture” can actually contribute to degeneration of the disc.

What role can spinal surgeons play in helping to answer these questions?

They can help researchers by providing clear grouping of (or characterising) patients in terms of diagnoses and phenotyping. They can work with scientists and other researchers in providing:

  • Ideas and hypotheses to test
  • Surgical samples for scientific investigations
  • Being active in collaborative studies

These factors are really important to progressing the field of research in disc degeneration.

Add New Comment

Most popular

Shilla growth guidance system cleared
Thursday, 28 Aug 2014
Medtronic has announced the 510(k) clearance and launch of the Shilla growth guidance system, designed for treatment of skeletally immature paediatric patients less than 10 years of age diagnosed ... Shilla growth guidance system cleared

More than half of spinal cord injury patients use inappropriate wheelchairs
Wednesday, 27 Aug 2014
A new study has found that, overall, 55% of patients with a spinal cord injury use an inappropriate wheelchair, including 66.7% of patients with inappropriate seat height—which could lead to pressure ... More than half of spinal cord injury patients use inappropriate wheelchairs

First surgery performed with Expanding Orthopedics’ FLXfit 3D expandable interbody cage
Wednesday, 03 Sep 2014
Expanding Orthopedics has announced that the first surgery ever, using its FLXfit, the world’s first 3D expandable interbody cage, has been performed by Jean-Charles Le Huec in France. First surgery performed with Expanding Orthopedics’ FLXfit 3D expandable interbody cage


Intraspinal pressure monitoring improves management of patients with spinal cord injury
Thursday, 09 Oct 2014
Traumatic spinal cord injury is a devastating condition that mostly affects young men (about a third of whom will remain paralysed or wheelchair bound for the rest of their lives). In the USA, the ... Intraspinal pressure monitoring improves management of patients with spinal cord injury

Probing, tapping, toggling: Are we inserting pedicle screws correctly?
Tuesday, 30 Sep 2014
Robert Lee and John Schmidt write about pedicle screw insertion and their study which challenges the standard technique. Probing, tapping, toggling: Are we inserting pedicle screws correctly?


Lori Karol
Wednesday, 13 Aug 2014
Lori Karol, Texas Scottish Rite Hospital, Dallas, USA, talks to Spinal News International about the ... Lori Karol

Luiz Pimenta
Thursday, 12 Jun 2014
Luiz Pimenta, immediate past president of the International Society for the Advancement of Spinal S... Luiz Pimenta

Cardiac Rhythm News Vascular News Cardiovascular News Interventional News Spinal News NeuroNews
BIBA Medical BIBA MedTech Insights CX Symposium ilegx
Password Reminder

BIBA Medical, 526 Fulham Road, Fulham, London, SW6 5NR.
TEL: +44 (0)20 7736 8788 FAX: +44 (0)20 7736 8283 EMAIL: 
© BIBA Medical Ltd is a company registered in England and Wales with company number 2944429.
VAT registration number 730 6811 50.
Site Map | Terms and Conditions