Advances in Lumbar Degenerative Disk Disease Pathophysiology Comprehension

Degenerative disc disease (DDD) is a chronic multifactorial disease with high socio-economic impact and still limited therapeutic options. Its current aetiological concepts suggest a strong genetic predisposition that paves the way for mechanical and metabolic stress to result in the loss of disc tissue repair capacity causing tissue disruption, cell necrosis and loss of disc tissue function. This is mediated by cellular transmitters, pro-inflammatory cytokines and growth factors and leads to the activation of matrix-degrading enzymes with loss of the tissue. Recent studies suggest that the beginning of this process takes place in infancy. In consequence, future research has to focus on early prevention – at least in individuals with high genetic risk – potentially by pharmacological substances.