Degeneration, repair, and regeneration of the intervertebral disc

Low back pain continues to be a major cause of morbidity. The intervertebral disc is a relatively avascular structure made of a small amount of cells interspersed in an extracellular matrix composed primarily of collagen, proteoglycan, and water. The disc undergoes characteristic biochemical, structural, and morphologic changes with aging, which some experts feel result in many of the negative clinical sequelae (e.g., stenosis and disc herniation/degeneration) associated with low back pain. The most dramatic effects are in the nucleus pulposus. As a result, many believe disc degeneration is initiated in the nucleus pulposus. Profound effects on cell viability and matrix composition have been seen. Gene therapy is a potential therapeutic tool that may repair or regenerate intervertebral disc degeneration. This review seeks provide an update on intervertebral disc degeneration and its potential repair and or regeneration using gene therapy.