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Rheumatology Advance Access originally published online on October 14, 2008
Rheumatology 2009 48(1):5-10; doi:10.1093/rheumatology/ken396
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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The cellular pathobiology of the degenerate intervertebral disc and discogenic back pain

A. J. Freemont1

1Tissue Injury and Repair Research Group, Research School of Clinical and Laboratory Sciences, University of Manchester, Manchester, UK.

Correspondence to: A. J. Freemont, Tissue Injury and Repair Research Group, Research School of Clinical and Laboratory Sciences, Stopford Building, University of Manchester, Manchester M13 9PT, UK. E-mail: tony.freemont{at}manchester.ac.uk


  Abstract

In 2007, three times as many peer reviewed publications covering the biology and biotherapeutics of intervertebral disc (IVD) disease appeared in the literature than in 1997. This is testimony to the upsurge in interest in the IVD, mainly driven by the openings that modern molecular pathology has generated to investigate mechanisms of human disease and the potential offered by novel therapeutic technologies to use data coming from these studies to positively influence chronic discogenic back pain and sciatica. Molecular pathology has shown IVD degeneration, a major cause of low back pain, to be a complex, active disorder in which disturbed cytokine biology, cellular dysfunction and altered load responses play key roles. This has translated into a search for target molecules and disease processes that might be the focus of future, evidence-based therapies for back pain. It is not possible to describe the totality of advances that have been made in understanding the biology of the IVD in recent years, but in this review those areas of biology that are currently influencing, or could conceivably soon impinge on, clinical thinking or practice around IVD degeneration and discogenic back pain are described and discussed.

KEY WORDS: Intervertebral disc, Back pain, Pathobiology, Degeneration

Submitted 14 July 2008; revised version accepted 10 September 2008.
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