Towards new treatment strategies for intervertebral disc degeneration: Pathophysiology, histological and biochemical changes in IVD degeneration

Abstract

Approximately 70% to 80% of all people worldwide will experience low back at any moment in their life. Intervertebral disc degeneration is an important cause of chronic low back pain. In most cases chronic low back pain can be treated conservatively with physiotherapy and analgesia. However, in some cases conservative treatment is not sufficient and surgical treatment, spinal fusion or placement of an intervertebral disc prosthesis, is indicated. Unfortunately the outcome of these surgical interventions is rather disappointing and there is a substantial risk of devastating complications. In the past decade several new regenerative treatment strategies for intervertebral disc degeneration have been developed. These new strategies focus on restoring the biomechanical function of the degenerative disc instead of replacing or removing the intervertebral disc. For the further development of regenerative treatment strategies, thorough understanding of the pathophysiology of the degenerative process is essential. Therefore, the main aim of this thesis is to contribute to a better understanding of the pathophysiology of IVD degeneration. In this thesis we’ll describe new therapeutic targets, evaluate which animal model is most suitable to simulate human intervertebral degeneration and we investigate if it possible to prevent intervertebral disc degeneration by local injection of growth factors and enzyme inhibitors.