Disc Regenerative Therapy

Disc regenerative therapy (DRT) is a treatment option for low back pain that involves injecting specialised cells to assist in the regeneration of damaged intervertebral discs. The human spine consists of intervertebral discs which act as shock absorbers during compressive loading of the spinal column and provide load-bearing capacity. The aging process of the disc is characterized by degeneration and loss of function due to cellular dysfunction with reduced synthesis of extracellular matrix (ECM).

Can spinal discs be regenerated?

Although many conservative treatments including specialist physiotherapy, pain medication and specific back strengthening can improve symptoms, they may not reverse the degenerative state of the disc. Surgical methods can also provide relief from pain but do not replace decreased nucleus pulposus (NP) cells or reverse the pathological changes of the disc and can result in various intraoperative and postoperative complications.

In addition to a decrease in NP cell number, degenerative processes are accompanied by the dysregulation of anabolic and catabolic molecular pathways that regulate ECM production. The synthesis of key ECM proteins such as aggrecan and collagen is impaired in the degenerate disc while expression of metalloproteinases and tissue inhibitors of metalloproteinases with thrombospondin motifs is increased compared to normal tissue.

Recent advances in cellular and molecular biology have facilitated the development of innovative therapeutic strategies for the repair of the degenerate human disc. Multipotent adult mesenchymal stem cells (MSCs) have been shown to be able to differentiate into multiple specialized cell types, including NP-like cells. The unique physiology of the IVD provides a suitable environment for MSCs to regenerate the disc, and early clinical trials have shown that MSC injection can induce healing in the degenerative disc.