title: The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain.
abstract: This article reviews the current knowledge of   the intervertebral disc (IVD) and its association with low back   pain (LBP). The normal IVD is a largely avascular and aneural structure   with a high water content, its nutrients mainly diffusing through   the end plates. IVD degeneration occurs when its cells die or become   dysfunctional, notably in an acidic environment. In the process   of degeneration, the IVD becomes dehydrated and vascularised, and   there is an ingrowth of nerves. Although not universally the case,   the altered physiology of the IVD is believed to precede or be associated   with many clinical symptoms or conditions including low back and/or   lower limb pain, paraesthesia, spinal stenosis and disc herniation. New treatment options have been developed in recent years. These   include biological therapies and novel surgical techniques (such   as total disc replacement), although many of these are still in   their experimental phase. Central to developing further methods   of treatment is the need for effective ways in which to assess patients   and measure their outcomes. However, significant difficulties remain   and it is therefore an appropriate time to be further investigating   the scientific basis of and treatment of LBP.
authors.affiliation: Imperial College London, South Kensington Campus, London SW7 2AZ, UK. seanfrancishughes@imperial.ac.uk
authors.forename: S P F
authors.initials: SP
authors.lastname: Hughes
authors.forename: A J
authors.initials: AJ
authors.lastname: Freemont
authors.forename: D W L
authors.initials: DW
authors.lastname: Hukins
authors.forename: A H
authors.initials: AH
authors.lastname: McGregor
authors.forename: S
authors.initials: S
authors.lastname: Roberts
mesh_terms: D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000502:physiology / Q000503:physiopathology*; D055959:Intervertebral Disc Degeneration / Q000209:etiology*; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*