Date Published: April 2, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Fadi Taher, David Essig, Darren R. Lebl, Alexander P. Hughes, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi.
Low back pain as a result of degenerative disc disease imparts a large socioeconomic impact on the health care system. Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by limiting motion in the lumbar spine, but novel treatment strategies involving stem cells, growth factors, and gene therapy have the theoretical potential to prevent, slow, or even reverse disc degeneration. Understanding the pathophysiological basis of disc degeneration is essential for the development of treatment strategies that target the underlying mechanisms of disc degeneration rather than the downstream symptom of pain. Such strategies ideally aim to induce disc regeneration or to replace the degenerated disc. However, at present, treatment options for degenerative disc disease remain suboptimal, and development and outcomes of novel treatment options currently have to be considered unpredictable.
Low back pain (LBP) is the single most common cause for disability in individuals aged 45 years or younger and as a result carries tremendous weight in socioeconomic considerations. National economic losses resulting from LBP are estimated to exceed $100 billion per year and are mainly indirect due to reduced productivity . Even though radiographic signs of degenerative disc disease (DDD) have been shown in asymptomatic individuals  and the degree of degeneration is by no means a marker for duration or severity of symptoms associated to DDD, ways of limiting disc degeneration or even inducing disc regeneration are still desirable goals in its treatment.
Patients with lumbar disc disease often present with a myriad of symptoms including pain, radicular symptoms, and weakness. LBP may be exacerbated by position and movement. Flexion often worsens the symptoms, while extension will relieve them. An increase in pain with extension may indicate facet arthropathy.
Upright plain radiographs in two planes are the initial imaging study of choice. They aid in ruling out pathologies such as deformity, fractures, or metastatic cancer as underlying causes of back pain and, often supplemented by other imaging modalities, are evaluated for signs of degeneration. Findings in degenerative discs include disc space narrowing, endplate sclerosis, “vacuum” phenomenon within the disc, and osteophytes. Flexion and extension views may be helpful if instability is suspected.