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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 10, 1261-1270.
doi: 10.1302/0301-620X.90B10.20910  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The pathophysiology of disc degeneration

A CRITICAL REVIEW

A. G. Hadjipavlou, MD, FACS, FRCS (C), Professor of Orthopaedics1; M. N. Tzermiadianos, MD, Spine Fellow2; N. Bogduk, MD, DSC, FFPM(ANZCA), Professor of Pain Medicine3; and M. R. Zindrick, MD, Orthopaedic spine surgeon4

1 Division of Spine Surgery University of Texas Medical Branch at Galveston, Texas, USA.
2 Loyola University Medical Center, Maywood, Illinois, USA.
3 University of Newcastle, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, New South Wales 2300, Australia.
4 Hinsdale Orthopaedic Associates, Hinsdale, Illinois, USA.

Correspondence should be sent to Professor A. G. Hadjipavlou; e-mail: ahadjipa{at}yahoo.com

The pathophysiology of intervertebral disc degeneration has been extensively studied. Various factors have been suggested as influencing its aetiology, including mechanical factors, such as compressive loading, shear stress and vibration, as well as ageing, genetic, systemic and toxic factors, which can lead to degeneration of the disc through biochemical reactions. How are these factors linked? What is their individual importance? There is no clear evidence indicating whether ageing in the presence of repetitive injury or repetitive injury in the absence of ageing plays a greater role in the degenerative process. Mechanical factors can trigger biochemical reactions which, in turn, may promote the normal biological changes of ageing, which can also be accelerated by genetic factors. Degradation of the molecular structure of the disc during ageing renders it more susceptible to superimposed mechanical injuries.

This review supports the theory that degeneration of the disc has a complex multifactorial aetiology. Which factors initiate the events in the degenerative cascade is a question that remains unanswered, but most evidence points to an age-related process influenced primarily by mechanical and genetic factors.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General