Intervertebral Disc Degeneration
Summary of an AAOS/NIH/ORS Workshop, September 2005
Gunnar B.J. Andersson, MD, PhD; Howard S. An, MD; Theodore R. Oegema Jr., PhD; Lori A. Setton, PhD

Degenerative changes of the intervertebral disc occur as a natural part of aging. What the initiating events are, what influences progression, and to what degree the degenerative process by itself is a source of pain remain unclear. From a clinical perspective, disc degeneration is considered one cause of chronic pain. Disc degeneration is also the source of important secondary clinical problems such as disc herniations, spinal stenosis, and degenerative spondylolisthesis.

In September 2005, a group of clinical, basic-science, and biomechanics experts gathered for a workshop on degenerative disc disease. The workshop was sponsored by the American Academy of Orthopaedic Surgeons, the National Institutes of Health, the Orthopaedic Research Society, and private industry. The presentations from the workshop, along with a research agenda outlined at the sessions, are published in the supplement to the current issue of The Journal of Bone and Joint Surgery. This article is a condensed report of the workshop. All references appear in the supplement.

The workshop began with an overview session moderated by Gunnar B. J. Andersson, MD, PhD. Tapio Videman, MD, presented information on the epidemiology and genetics of disc degeneration. Sally Roberts, PhD, reviewed the histologic and pathologic changes accompanying disc degeneration, while Victor Haughton, MD, talked about the rapidly emerging imaging methods. Finally, Jeffrey Katz, MD, MSc, reviewed the socioeconomic impact of this commonly presenting process.

Over the past decade, a great shift has occurred in the understanding of the etiology of disc degeneration from an epidemiologic perspective. Studies on twins have suggested that heredity has a dominant role in disc degeneration, while physical loading and environmental factors play a lesser role. Several gene forms have been associated with disc degeneration. It appears likely that disc degeneration can be characterized as a common, oligogenic, multifactorial genetic condition. Dr. Videman suggested that a standardized …

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