Fundamentals of intervertebral disc degeneration and related discogenic pain

Abstract

Lumbar intervertebral disc degeneration is thought to be the main cause of low back pain, although the mechanisms by which it occurs and leads to pain remain unclear. In healthy adult discs, vessels and nerves are present only in the outer layer of the annulus fibrosus and in the bony endplate. Animal models, and histological and biomechanical studies have shown that annulus tear or endplate injury is the initiating factor for painful disc degeneration. Injury to the disc triggers a local inflammatory repair response that activates nociceptors and promotes the synthesis of neuropeptides such as substance P and calcitonin gene-related peptide, by dorsal root ganglion neurons. These neuropeptides are transported to injured discs and act as pro-inflammatory molecules, promoting the production of an “inflammatory soup” by inducing vasodilatation and plasma extravasation as well as by promoting the release of chemical mediators from disc cells and infiltrating immune cells, causing neurogenic inflammation that leads to progressive disc degeneration and discogenic pain.

Keywords: Intervertebral disc degeneration; Discogenic low back pain; Neurogenic inflammation; Neuropeptides; Substance P; Calcitonin gene-related peptide

Core Tip: Animal models, as well as histological and biomechanical studies, have shown that annular tear or endplate injury is the initiating factor for painful disc degeneration. Neurogenic inflammation of the disc involves the release of neuropeptides such as substance P and calcitonin gene-related peptide from nociceptive nerves that innervate the disc in response to disc injury, leading to progressive disc degeneration and discogenic pain.