Lecturer: Disc preservation can reduce number of fusions (Helio)
With back pain becoming increasingly more common, the clinical implications of disc research are greater than ever before. Therefore, these efforts should focus on disc preservation, which is less invasive than fusions, according to a presenter, here.
Gunnar B.J. Andersson, MD, PhD, noted in his plenary lecture at the Philadelphia Spine Research Symposium that the disc can be preserved for a while. “But, the primary cause [of degeneration] is genetic,” he said.
The number of fusions performed in the United States and the procedure’s cost has increased, and since fusion is an invasive approach it is more urgent than ever to find a cure for degenerative disc disease (DDD).
In 2011, the cost for a fusion increased to $44,000, he said. This underscores why disc research should continue and focus more intently on the preservation of the spinal disc. Hopefully, such a strategy will affect the degenerative process early on, at the stage when it first starts to be visible on MRI and well before it is detected on radiographs of the spine, Andersson said.
“In 2011 there were about 450,000 fusion operations in the United States — an enormous number. If we could replace some of them by a biologic treatment method, obviously it would have a huge impact on society,” said Andersson, who is the Section Editor of Basic Science & Technology for Orthopedics Today, said.
But, “we are not even close” on a biologic solution to disc preservation, he noted.
Andersson discussed limitations in the diagnosis and treatment of DDD and the problems that researchers face in understanding its etiology. One possible approach to solving this dilemma, he said, is to alter the effect the modifying factors of age, mechanical issues, obesity and others have on a person’s discs.
Researchers should also keep in mind that compared to any of these disc modifying factors, genetics may play an even larger, unalterable role in DDD. Secondary conditions may also impact the disc’s health, Andersson said.
He reviewed the mechanical, biochemical and nutritional theories of DDD.
“Whether the disc is the primary source of back pain or not, to me, is not that important in terms of research into retaining the disc because I know for sure it is a secondary source of back pain.” Andersson said.
“We do need better diagnostic methods…and we need noninvasive solutions,” he said. – by Susan M. Rapp
Reference:
Andersson GBJ. Disc research: what are the clinical implications? Presented at: Philadelphia Spine Research Symposium. Nov. 6-8, 2013. Philadelphia.
Disclosure: Andersson has no relevant financial disclosures.
PERSPECTIVE
Irving M. Shapiro- In my opinion, the possibility that an infectious agent may be a cause of degenerative disc disease (DDD) requires serious investigation.Dr. Andersson mentioned the observation that stomach ulcers were due to bacteria. Indeed, this observation revolutionized our understanding of the pathogenesis of this common condition. I should point out that initially, the concept that ulcers may be due to an infectious agent was treated with humor and disbelief by many authorities. Now, of course, we know that the claims of the Australian scientists/physicians who researched the concept were totally valid and their work has revolutionized the treatment of this ubiquitous condition.
New studies have shown that many of the tissues of the body are contaminated with bacteria. Moreover, the bacteria co-exist with the host (mammalian) cells. Based on these new understandings, the possibility is that bacteria may reside in cartilage and the nucleus pulposus and co-exist there with the resident chondrocytes and notochordal cells. Just like stomach ulcers, which can be activated by stress, a change in local conditions may activate the bacteria to proliferate; bacteria which live in communities with each other and control their own numbers and species-type, now dramatically change. Aside from invoking an inflammatory response and tissue degeneration, a biofilm may form which would protect the organisms from invading white cells and allow the organisms to reside in the tissue protected from antibiotics. If any aspect of this concept is valid, it would completely change our approach to treatment of DDD and back pain.
- Irving M. Shapiro, BDS, PhD
- Department of Orthopaedics
Thomas Jefferson University
Philadelphia