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Degenerative disc disease (DDD) is a condition that occurs as an intervertebral disc deteriorates from aging or as a result of a disc injury. DDD causes acute and chronic low back pain, sometimes associated with loss of neurologic function when the spinal cord, thecal sac, or nerve roots are affected. The incidence of DDD has increased significantly with the general population aging. DDD has a huge functional, financial, and quality of life on individual patients and society as a whole.
The main function of the intervertebral disc is to support the anterior spinal column, cushion the adjacent vertebral bodies, and facilitate normal spine motion. A healthy intervertebral disc consists of a nucleus pulposus (NP) center surrounded by an annulus fibrosus (AF) outer ring. The NP is made up of NP cells, notochord cells (NCs), extracellular matrix (ECM), and water. Normal ECM is composed of Type II collagen fibers, elastin, and proteoglycans and has a high water content [4]. The AF consists of numerous layers of Type I collagen fibers including an innervated outer layer [3]. The intervertebral disc has upper and lower cartilaginous endplates (CEPs) between the NP center and the adjacent superior and inferior vertebral bodies. The CEPs are involved with nutrient exchange between the avascular NP and the vascular vertebral bodies.
The DDD cascade generally begins when a mechanical force partially tears the AF (annular tear) and allows a portion of the NP to “herniate” into the AF causing discogenic back pain from irritation of the innervated outer AF fibers. The herniation may progress outside of the AF into the epidural space where the components of the herniated NP cause an inflammatory reaction which leads to acute or chronic back pain. This disruption of the intervertebral disc initiates the inflammatory response that triggers the DDD cascade. The inflammatory cell processes are mediated by interleukins (ILs) and matrix metalloproteinases (MMPs) that both degrade the existing NP cells and ECM and inhibit new proteoglycan synthesis in the ECM of the NP. This cycle causes further degeneration of the intervertebral disc. Varying degrees of discogenic pain are related to different conditions of the degenerative disc cascade cycle.
