From the Research
The most effective treatment approach for intervertebral disc degeneration is a stepped approach, starting with conservative management, including physical therapy and pain management, before considering surgical options, as this approach prioritizes minimizing morbidity, mortality, and improving quality of life 1.
Overview of Intervertebral Disc Degeneration
Intervertebral disc degeneration (IDD) is a common condition associated with low back pain, intervertebral disc herniation, and spinal stenosis, resulting in significant social and economic costs 2. The pathological changes of IDD include the senescence and apoptosis of nucleus pulposus cells, the progressive degeneration of extracellular matrix, the fibrosis of annulus fibrosus, and the inflammatory response.
Conservative Management
Initial treatment includes:
- Physical therapy focusing on core strengthening exercises, stretching, and proper body mechanics to reduce stress on the affected discs
- Pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks
- Potential use of muscle relaxants like cyclobenzaprine for associated muscle spasms
- Activity modification, avoiding prolonged sitting, heavy lifting, and activities that exacerbate symptoms
- Weight management, as excess weight increases disc pressure
Surgical Options
Advanced cases with neurological deficits, severe pain unresponsive to conservative treatment, or significant functional limitations may require surgical intervention, such as:
- Discectomy
- Laminectomy
- Spinal fusion
Emerging Therapies
Recent research has focused on biotherapy, including the use of mesenchymal stem cells (MSCs) and non-coding RNAs (ncRNAs) to regulate vital processes in IDD 2. Platelet-rich plasma (PRP) therapy has also shown promise in promoting intervertebral disc healing 3. However, further high-quality trials are needed to fully understand the efficacy of these emerging therapies 4.
Current Therapeutic Options and Challenges
Current therapies for IDD mainly focus on relieving symptoms rather than addressing the underlying etiology or mechanical function of the disc 1. Therefore, it is essential to continue researching and developing new therapeutic modalities to enhance clinical outcomes and improve the quality of life for patients with IDD.