Gradisnik L, Prestor B, Zele T, Kocivnik N, Maver U, Velnar T. Pathophysiology and current understanding of degenerative disc disease. World J Orthop 2026; 17(5): 117153 [DOI: 10.5312/wjo.v17.i5.117153]
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08393303
Submitted on:
May 21, 2026, 05:36
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Reader Comments:
This article is remarkable and stands out for its thorough synthesis of the multidimensional characteristics of degenerative disc disease (DDD). The authors proficiently unify molecular biology, biomechanics, genetics, and lifestyle influences into a logical explanation that reflects the true complexity of disc degeneration.
The in-depth analysis of cytokine-mediated pathways (IL 1β, TNF α, IL 6) and their subsequent signalling cascades (NF κB, MAPK, Wnt/β catenin) provides functional understanding into how inflammation and matrix breakdown the disc pathology. Equally compelling is the emphasis on the avascular and hypoxic microenvironment of the intervertebral disc, which helps explain its susceptibility to metabolic and oxidative stress.
The exploration of genetic predisposition adds significant depth to the discussion. The inclusion of heritability estimates of 50–70% and polymorphisms involving collagen, aggrecan, and inflammatory mediators clarifies why certain individuals may be more vulnerable to degeneration. Furthermore, the incorporation of epigenetic mechanisms, including DNA methylation, histone modifications, and microRNAs, highlights the dynamic interaction between environmental influences and gene regulation, making the article highly relevant to emerging precision medicine approaches.
I found the section addressing metabolic contributors particularly illuminating. The discussion of diabetes and obesity leading to advanced glycation end-product (AGE) accumulation and extracellular matrix stiffening effectively connects systemic metabolic dysfunction with localized disc degeneration.
Clinically, the article makes an important distinction between structural degeneration and symptomatic disease, emphasizing that radiographic abnormalities do not always correlate with pain. The discussion of aberrant nerve ingrowth, cytokine-driven sensitization, and biomechanical instability as mechanisms of pain successfully bridges the gap between imaging findings and patient experience. In addition, the diagnostic overview, highlighting MRI as the gold standard alongside emerging AI-driven radiomics, reflects both current clinical practice and future directions in the field.
The management section is balanced and comprehensive, covering conservative approaches such as physical therapy and lifestyle modification, as well as surgical interventions including spinal fusion and disc replacement. The inclusion of regenerative therapies, such as platelet-rich plasma (PRP), stem cell therapy, biomaterial scaffolds, and gene therapy adds considerable value for both clinicians and researchers. Particularly exciting is the forward-looking discussion of epigenetic modulation and senolytic therapies as potential disease-modifying strategies, which underscores the evolving future of DDD treatment.