Intervertebral disc regeneration - Is it possible?

Objective: The aim of this study was to evaluate disc metabolism after decreasing the axial load through surgery by assessing the glycosaminoglycan content through a non-invasive method-delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).

Methods: Sixteen patients with mono-segmental disc degeneration (L4-L5 or L5-S1) who underwent posterior lumbar spine fixation with intervertebral distraction of 2 consecutive vertebrae using monoaxial transpedicular screws and lyophilized allograft to achieve segmental fusion, and who had a follow-up period of at least 2 years, were included in this study. The first lumbar disc was used as the control group. The dGEMRIC studies in degenerative and control discs, visual analogue scale (VAS), Oswestry disability index (ODI), lumbar lordosis, and disc thickness were reviewed before and after surgery.

Results: Visual analogue scale and ODI showed significant improvements (P=.003, P=.0004, respectively). The thickness of the operated discs was increased by an average of 2.41 mm (P=.0004) while maintaining lumbar lordosis (P=.35). In pre- and post-surgery dGEMRIC studies, the operated discs showed a significant di!erence (P=.0013), while the control groups remained approximately unchanged (P=.87).

Conclusion: We have demonstrated that by restoring the disc height and reducing the associated pressure, the glycosaminoglycan content can be increased in the discs, as indicated by a decrease in gadolinium binding. Our results suggest that eliminating pressure on intervertebral discs can prevent their degeneration and initiate the regeneration process.

Level Of Evidence: Level IV, Therapeutic study.