Peng BG. Fundamentals of intervertebral disc degeneration and related discogenic pain. World J Orthop 2025; 16(1): 102119 [PMID: 39850042 DOI: 10.5312/wjo.v16.i1.102119]
Corresponding Author of This Article
Bao-Gan Peng, MD, PhD, Chief Physician, Professor, Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, No. 69 Yongding Road, Beijing 100039, China. pengbaogan@163.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jan 18, 2025; 16(1): 102119 Published online Jan 18, 2025. doi: 10.5312/wjo.v16.i1.102119
Fundamentals of intervertebral disc degeneration and related discogenic pain
Bao-Gan Peng
Bao-Gan Peng, Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
Author contributions: Peng BG analyzed the data and wrote the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest related to this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bao-Gan Peng, MD, PhD, Chief Physician, Professor, Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, No. 69 Yongding Road, Beijing 100039, China. pengbaogan@163.com
Received: October 9, 2024 Revised: December 12, 2024 Accepted: December 19, 2024 Published online: January 18, 2025 Processing time: 96 Days and 0.6 Hours
Abstract
Lumbar intervertebral disc degeneration is thought to be the main cause of low back pain, although the mechanisms by which it occurs and leads to pain remain unclear. In healthy adult discs, vessels and nerves are present only in the outer layer of the annulus fibrosus and in the bony endplate. Animal models, and histological and biomechanical studies have shown that annulus tear or endplate injury is the initiating factor for painful disc degeneration. Injury to the disc triggers a local inflammatory repair response that activates nociceptors and promotes the synthesis of neuropeptides such as substance P and calcitonin gene-related peptide, by dorsal root ganglion neurons. These neuropeptides are transported to injured discs and act as pro-inflammatory molecules, promoting the production of an “inflammatory soup” by inducing vasodilatation and plasma extravasation as well as by promoting the release of chemical mediators from disc cells and infiltrating immune cells, causing neurogenic inflammation that leads to progressive disc degeneration and discogenic pain.
Core Tip: Animal models, as well as histological and biomechanical studies, have shown that annular tear or endplate injury is the initiating factor for painful disc degeneration. Neurogenic inflammation of the disc involves the release of neuropeptides such as substance P and calcitonin gene-related peptide from nociceptive nerves that innervate the disc in response to disc injury, leading to progressive disc degeneration and discogenic pain.
