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ABSTRACT
Introduction
Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease.
Areas covered
This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed.
Expert opinion
Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.
Article highlights
Chronic lower back pain is a leading cause of disability and healthcare spending worldwide.
Current treatments for cLBP are primarily aimed at pain reduction and include conservative therapy, invasive therapy, and surgical intervention.
Current treatments do not slow or stop the degenerative process underlying pain and spinal instability.
A Viable disc allograft supplementation termed VIADISC™ NP produced by VIVEX Biologics, Inc. has shown great promise in treating LBP associated with DDD.
List of abbreviations
| AF | = | Annulus fibrosus |
| ADC | = | Autologous Disc Chondrocyte |
| BMP4 | = | Bone morphogenic protein 4 |
| CEP | = | Cartilaginous end plates |
| cLBP | = | Chronic Lower Back Pain |
| DDD | = | Degenerative Disc Disease |
| GDF-5 | = | Growth Differentiation Factor-F |
| IVD | = | Intervertebral Disc |
| LBP | = | Lower Back Pain |
| MCID | = | minimal clinically important difference |
| NP | = | Nucleus pulposus |
| ODI | = | Oswestry disability index |
| PG | = | Proteoglycan |
| rhGDF-5 | = | recombinant human GDF-5 |
| TGF-b | = | Transforming growth factor-beta |
| VAS | = | Visual analog scale |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.