Pathomechanisms of discogenic low back pain in humans and animal models.

Abstract

BACKGROUND CONTEXT:

Although explored in humans and animal models, the pathomechanisms of discogenic low back pain (LBP) remain unknown.

PURPOSE:

The aim of this study was to review the literature about the pathomechanisms of discogenic LBP.

METHODS:

Animal models of discogenic pain and specimens from degenerated human intervertebral discs (IVDs) have provided clues about the pathomechanisms of discogenic LBP. Painful discs are characterized by a confluence of innervation, inflammation, and mechanical hypermobility. These three possible mechanisms are discussed in this review.

RESULTS:

Animal models and specimens from humans have revealed sensory innervation of lumbar IVDs and sensory nerve ingrowth into the inner layer of IVDs. Cytokines such as tumor necrosis factor-α and interleukins induce this ingrowth. Nerve growth factor has also been recently identified as an inducer of ingrowth. Finally, disc degeneration induces several collagenases; their action results in hypermobility and pain.

CONCLUSIONS:

To treat discogenic LBP, it is important to prevent sensitization of sensory nerve fibers innervating the IVD, to suppress pathogenic increases of cytokines, and to decrease disc hypermobility.

• Authors: Seiji Ohtori, Gen Inoue, Masayuki Miyagi, Kazuhisa Takahashi
• Journal: The spine journal : official journal of the North American Spine Society (Spine J) Vol. 15 Issue 6 Pg. 1347-55 (Jun 01 2015) ISSN: 1878-1632 [Electronic] United States
• PMID: 24657737 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Cytokines
• Nerve Growth Factor

Topics

• Animals
• Cytokines (metabolism)
• Disease Models, Animal
• Humans
• Intervertebral Disc (metabolism, pathology)
• Intervertebral Disc Degeneration (complications, pathology)
• Low Back Pain (etiology, pathology)
• Nerve Growth Factor (metabolism)