Biochemistry of intervertebral disc degeneration and the potential for gene therapy applications

Background context: Low back pain continues to be a major cause of morbidity in the United States and the world. Although the exact cause has yet to be defined, the intervertebral disk and its age-related changes have been most frequently implicated. Purpose: This article represents a brief summary of intervertebral disk structure and function, both in the “normal” and degenerative states. Study design/setting: Review article. A Medline search from 1966 to present was performed to identify pertinent articles related to the topic of the intervertebral disc and degeneration. Methods: This review article describes the pertinent anatomy, as well as the biochemical and biomechanical changes that occur in the intervertebral disc over time. It presents many of the current theories implicated as causing these changes. Results: Recent studies have shown that gene therapy (the transfer of therapeutic gene[s] into a cell), may have promise as a method of slowing down, or preventing some of the changes seen in the intervertebral disc. Conclusion: Intervertebral disc degeneration is a complex phenomenon, likely the result of a combination of biochemical and biomechanical factors that are known to occur in the disk. Ongoing research efforts in the area of gene therapy show promise as a way to prevent, or even reverse, some of these changes.