- Email: [email protected]
Preface disc degeneration for The Spine Journal
The Spine Journal 13 (2013) 215–216
Editorial
Preface disc degeneration for The Spine Journal Dino Samartzis, DSca,*, Eugene J. Carragee, MDb a
Division of Spine Surgery, Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China b Department of Orthopedic Surgery, Stanford University Medical School, 450 Broadway St, Redwood City, CA 94063, USA Received 13 February 2013; accepted 13 February 2013
Dino Samartzis, DSc.
Eugene J. Carragee, MD.
Disc degeneration is a rather complex phenomenon that still manages to capture our attention, mobilize our interests, and divide our perspectives with the changing times.
Due to such an intriguing condition that has long captured the attention of the spine community, it has been our esteemed honor to serve as the Guest Editors for this focus issue on disc degeneration for The Spine Journal. Disc degeneration and secondary effects are associated with concurrent axial and radicular low back pain (LBP) syndromes: an increasingly important burden of global illness and disease. Our understanding of these processes is fundamentally incomplete. Although in epidemiologic terms LBP syndromes are associated with degeneration, the association is often weak or not fully explored and very often overwhelmed by parallel clinical issues: psychological and social distresses, legal disputes, altered pain sensitivity, drug dependency/abuse issues, and so on. Clinicians are confronted daily by the paradox of people with very similar apparent morphologic findings of disc degeneration present with virtually no symptoms and others reporting gravely disabling illness. It is clear we have no unifying theory connecting mild-to-moderate disc degeneration to the spectrum of subjectively reported illnesses.
FDA device/drug status: Not applicable. Author disclosures: DS: Other office: The Spine Journal (Editorial Board), Journal of Spinal Disorders and Techniques (Editorial Board), Journal of Orthopaedic Surgery (Editorial Board), Spine (Editorial Board); Global Spine Journal (Editorial Board); InSpine (Editorial Board); SpineLine (Editorial Board); Souther Medical Journal (Editorial Board); Grants: RGC (I, Paid directly to institution), AOSpine (I, Paid directly to institution); Trips/Travel: AOSpine (B). EJC: Stock Ownership: Intrinsic Spine (B), Bioassetts (B); Private Investments: Simpirica (D); Research Support (Investigator Salary): NIH (C, Paid directly to institution/employer); Trips/Travel: The Spine Journal (A); Other Office: NASS/The Spine Journal (E, Editor in Chief); Fellowship Support: OREF (E, Paid directly to institution/employer), AO Foundation (E, Paid directly to institution/employer). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Division of Spine Surgery, Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China. Tel.: (852) 2255-4813; fax: (852) 2817-4392. E-mail address: [email protected] (D. Samartzis). 1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.02.018
216
D. Samartzis and E.J. Carragee / The Spine Journal 13 (2013) 215–216
On the other hand, progressive severe disc degeneration does lead to cascading events, resulting in progressive deformity, instability, spinal arthritis, and neurologic dysfunction. Being able to understand the pathologic basis of progressive disc and spinal degeneration is an essential public health goal. Furthermore, the etiology of disc degeneration remains multifaceted and necessitates a multidisciplinary group of scientists and clinicians to push forward the imagination to comprehend it. This special focus issue includes articles that address risk factors, biological therapies, and treatment considerations related to disc degeneration as well as pain mechanisms associated with disc changes. More specifically, the contents of this issue focus on the below points: Jin et al., Tsai et al., Mayer et al., Kepler et al., and Vo et al., provide articles that address our current understanding of why the disc may degenerate. Samartzis et al., to raise awareness of the potential risk factors related to disc degeneration, have outlined for the first time a theory regarding possible effects of ionizing radiation on the development of disc degeneration. Moss et al. provided their technical insights in describing annular puncture to induce disc degeneration in an animal model via a retroperitoneal approach to the intervertebral disc. We also examine opportunities in an age where novel technologies for biological therapies may help regenerate or repair the disc. Iatridis et al. provide a unique perspective as to the role of biomechanics on regenerative therapies of the disc. Leckie et al. report on the use of human umbilical tissue -derived cells that alter the degenerative process. Chan et al. provide a description of their model to assess injectable nucleus pulposus disc therapy. Furthermore, Huang et al. provide an in-depth discussion regarding mesenchymal stem cell therapy for disc regeneration. With regards to the age-old question of what leads to adjacent segment degeneration and disease, Helgeson
et al. provide an informative review article that explores this curiosity further. Verlaan et al. have further addressed disc viability issues following burst fractures of the thoracic and lumbar spine, and their respective treatment options via pedicle screw fixation and direct endplate restoration. As noted, disc degeneration is not always synonymous with LBP syndromes, but our research is aimed to understand the patterns that separate well-tolerated changes from those that lead to chronic illness. In addition to the studies designed to understand the etiology of disc degeneration and the cutting-edge therapies aimed to regenerate/repair it, advances in imaging allowing for more quantitative assessment of the disc have made tremendous strides in the past decade. More recently, the ‘‘pain genetics’’ field provides a unique perspective on LBP syndromes and may potentially explain the large variance in the phenotype of apparent illness. Such platforms are essential and may lead to more personalized spine care when considering disc degeneration and the many potential biological therapies meant to either reconstitute the disc and possibly alleviate pain. Although imaging pain or pain genetics are not touched upon in this particular issue of the journal, it is with great hopes that this focus issue attempts to raise awareness of such developments and the new horizons ahead. We would like to acknowledge our families and colleagues for their support. More importantly, and this cannot be stressed enough, we want to thank all the authors who entrusted their creativity, insights, experience, and hard work to this focus issue with the pure altruistic intent to broaden our knowledge of disc degeneration. It is because of this pantheon of international and multidisciplinary experts addressing the disc that forms the basis of this focus issue. We hope that this issue will be informative, provide a unique perspective, and inspire many to address new and exciting platforms regarding disc degeneration in an effort to improve the management and outcomes of patients as well as their quality of life.
Editorial
Preface disc degeneration for The Spine Journal Dino Samartzis, DSca,*, Eugene J. Carragee, MDb a
Division of Spine Surgery, Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China b Department of Orthopedic Surgery, Stanford University Medical School, 450 Broadway St, Redwood City, CA 94063, USA Received 13 February 2013; accepted 13 February 2013
Dino Samartzis, DSc.
Eugene J. Carragee, MD.
Disc degeneration is a rather complex phenomenon that still manages to capture our attention, mobilize our interests, and divide our perspectives with the changing times.
Due to such an intriguing condition that has long captured the attention of the spine community, it has been our esteemed honor to serve as the Guest Editors for this focus issue on disc degeneration for The Spine Journal. Disc degeneration and secondary effects are associated with concurrent axial and radicular low back pain (LBP) syndromes: an increasingly important burden of global illness and disease. Our understanding of these processes is fundamentally incomplete. Although in epidemiologic terms LBP syndromes are associated with degeneration, the association is often weak or not fully explored and very often overwhelmed by parallel clinical issues: psychological and social distresses, legal disputes, altered pain sensitivity, drug dependency/abuse issues, and so on. Clinicians are confronted daily by the paradox of people with very similar apparent morphologic findings of disc degeneration present with virtually no symptoms and others reporting gravely disabling illness. It is clear we have no unifying theory connecting mild-to-moderate disc degeneration to the spectrum of subjectively reported illnesses.
FDA device/drug status: Not applicable. Author disclosures: DS: Other office: The Spine Journal (Editorial Board), Journal of Spinal Disorders and Techniques (Editorial Board), Journal of Orthopaedic Surgery (Editorial Board), Spine (Editorial Board); Global Spine Journal (Editorial Board); InSpine (Editorial Board); SpineLine (Editorial Board); Souther Medical Journal (Editorial Board); Grants: RGC (I, Paid directly to institution), AOSpine (I, Paid directly to institution); Trips/Travel: AOSpine (B). EJC: Stock Ownership: Intrinsic Spine (B), Bioassetts (B); Private Investments: Simpirica (D); Research Support (Investigator Salary): NIH (C, Paid directly to institution/employer); Trips/Travel: The Spine Journal (A); Other Office: NASS/The Spine Journal (E, Editor in Chief); Fellowship Support: OREF (E, Paid directly to institution/employer), AO Foundation (E, Paid directly to institution/employer). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Division of Spine Surgery, Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China. Tel.: (852) 2255-4813; fax: (852) 2817-4392. E-mail address: [email protected] (D. Samartzis). 1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.02.018
216
D. Samartzis and E.J. Carragee / The Spine Journal 13 (2013) 215–216
On the other hand, progressive severe disc degeneration does lead to cascading events, resulting in progressive deformity, instability, spinal arthritis, and neurologic dysfunction. Being able to understand the pathologic basis of progressive disc and spinal degeneration is an essential public health goal. Furthermore, the etiology of disc degeneration remains multifaceted and necessitates a multidisciplinary group of scientists and clinicians to push forward the imagination to comprehend it. This special focus issue includes articles that address risk factors, biological therapies, and treatment considerations related to disc degeneration as well as pain mechanisms associated with disc changes. More specifically, the contents of this issue focus on the below points: Jin et al., Tsai et al., Mayer et al., Kepler et al., and Vo et al., provide articles that address our current understanding of why the disc may degenerate. Samartzis et al., to raise awareness of the potential risk factors related to disc degeneration, have outlined for the first time a theory regarding possible effects of ionizing radiation on the development of disc degeneration. Moss et al. provided their technical insights in describing annular puncture to induce disc degeneration in an animal model via a retroperitoneal approach to the intervertebral disc. We also examine opportunities in an age where novel technologies for biological therapies may help regenerate or repair the disc. Iatridis et al. provide a unique perspective as to the role of biomechanics on regenerative therapies of the disc. Leckie et al. report on the use of human umbilical tissue -derived cells that alter the degenerative process. Chan et al. provide a description of their model to assess injectable nucleus pulposus disc therapy. Furthermore, Huang et al. provide an in-depth discussion regarding mesenchymal stem cell therapy for disc regeneration. With regards to the age-old question of what leads to adjacent segment degeneration and disease, Helgeson
et al. provide an informative review article that explores this curiosity further. Verlaan et al. have further addressed disc viability issues following burst fractures of the thoracic and lumbar spine, and their respective treatment options via pedicle screw fixation and direct endplate restoration. As noted, disc degeneration is not always synonymous with LBP syndromes, but our research is aimed to understand the patterns that separate well-tolerated changes from those that lead to chronic illness. In addition to the studies designed to understand the etiology of disc degeneration and the cutting-edge therapies aimed to regenerate/repair it, advances in imaging allowing for more quantitative assessment of the disc have made tremendous strides in the past decade. More recently, the ‘‘pain genetics’’ field provides a unique perspective on LBP syndromes and may potentially explain the large variance in the phenotype of apparent illness. Such platforms are essential and may lead to more personalized spine care when considering disc degeneration and the many potential biological therapies meant to either reconstitute the disc and possibly alleviate pain. Although imaging pain or pain genetics are not touched upon in this particular issue of the journal, it is with great hopes that this focus issue attempts to raise awareness of such developments and the new horizons ahead. We would like to acknowledge our families and colleagues for their support. More importantly, and this cannot be stressed enough, we want to thank all the authors who entrusted their creativity, insights, experience, and hard work to this focus issue with the pure altruistic intent to broaden our knowledge of disc degeneration. It is because of this pantheon of international and multidisciplinary experts addressing the disc that forms the basis of this focus issue. We hope that this issue will be informative, provide a unique perspective, and inspire many to address new and exciting platforms regarding disc degeneration in an effort to improve the management and outcomes of patients as well as their quality of life.