THE WHERE AND WHY OF LOCAL INTERVENTIONS IN INTERVERTEBRAL DISC DEGENERATION-ASSOCIATED BACK PAIN

Disc degeneration-associated chronic back pain has become a major headache in science and society. Most approaches have focussed on regeneration by intradiscal administration of cells and other substances and some on stable replacements, but other than in small animals, these have not been successful. Cell-based regeneration may not only be a challenge because of the low oxygen and pH of the IVD, but also because the local chemicophysical cues may have been altered. How to deal with a structure that has adapted rather than healed, may be suited to other approaches than de novo tissue formation.