Disc Degeneration

Background

Clinical Trials SquareDegenerative disc disease (DDD) typically arises as a result of the normal aging process and may lead to acute or chronic low back or neck pain. The degenerative process may begin as early as the third decade of life, with aging, obesity, smoking, and excessive axial loads perpetuating the deterioration of the discs. For most people, DDD does not cause significant problems; however, in patients with chronic low back pain, studies have shown that disc degeneration was one of the main factors contributing to their pain. In addition to low back pain, symptomatic DDD may also result in pain radiating to the hips, buttocks or thighs while walking, and tingling/weakness in the legs. Chronic neck pain may also be evident, with pain radiating to the head, shoulders, arms, and hands.

Disc pain is thought to arise in those people who have nerve endings that penetrate more deeply into the annulus fibrosus (outer disc layer) than others. Degenerative discs typically show replacement of the normal gelatinous material of the disc with fibrocartilage, which is suggestive of an underlying repair process occurring. This change of disc histology can result in protrusion, spondylolysis, subluxation of the vertebrae (spondylolisthesis), and/or spinal stenosis. MRI is the test of choice in evaluating intervertebral disc pathology. 

Current Treatment

Degenerative disc disease can often be managed conservatively through physical therapy, chiropractic manipulative therapy, osteopathic manipulation, anti-inflammatory medications such as non-steroidal anti-inflammatory drugs, and/or spinal injections that can provide pain relief.

If these more moderate approaches fail to alleviate symptoms, surgery may be necessary. There are several surgical options for the treatment of DDD, with spinal fusion being the most common. Newer regenerative treatment strategies to reverse or inhibit degeneration are currently in clinical trials and include growth factor administration, stem cell therapy, gene therapy, and the introduction of biomaterials.

Focused Ultrasound Research

Focused ultrasound is currently being evaluated in clinical trials for the treatment of lumbar back pain of facet joint origin. A phase 1 observational pilot study of 18 patients has already been performed at St. Mary’s Hospital in London, where focused ultrasound reduced pain and improved quality of life in patients with facet arthritis. While the use of focused ultrasound for degenerative disc disease is still in an early stage, it may offer a non-invasive method of destroying the nerves that supply the region, and reduce the pain signals to the brain.  While this technique may be able to reduce the pain from the region, current therapies do not impact the structural causes for the discomfort. 

Notable Papers

Karakitsios I, Mihcin S, Saliev T, Melzer A. Feasibility study of pre-clinical Thiel embalmed human cadaver for MR-guided focused ultrasound of the spine. Minim Invasive Ther Allied Technol. 2016;25(3):154-61. doi: 10.3109/13645706.2016.1150297. Epub 2016 Feb 29.

Weeks EM, Platt MW, Gedroyc W. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain-case series of an innovative new technique. Eur Radiol. 2012 Dec;22(12):2822-35. Epub 2012 Aug 31.

Forslund C, Persson J, Strömqvist B, Lidgren L, McCarthy ID. Effects of high-intensity focused ultrasound on the intervertebral disc: a potential therapy for disc herniations. J Clin Ultrasound. 2006 Sep;34(7):330-8.

     

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