Degeneration of the lumbar spine: Preclinical concepts for clinical questions

Degeneration of the lumbar spine is one of the known causes of low back pain. It is an ongoing, progressive process and starts with degeneration of the intervertebral discs which may eventually result in de novo degenerative lumbar scoliosis (DNDLS). Unfortunately, there are currently no therapies available that are able to slow down, halt or even reverse this process. Therefore, the aim of this thesis was to provide a pre-clinical foundation for a better understanding of the degeneration of the lumbar spine and for the development and implementation of therapies.
We found that DNDLS tends to result in a stiffer and less flexible lumbar spine compared to lumbar spines without degenerative scoliosis and that the current surgical treatment of lumbar spines with degenerative scoliosis is not optimal. While laminectomy at the apex level tends to increase the flexibility of the lumbar spine, the following posterior instrumentation results in much stiffer and less flexible lumbar spines, also compared to their native state and age-matched healthy controls. We also found that a clear definition and reliable grading system for intervertebral disc degeneration are missing in clinical and research practice, resulting in heterogeneity in study determinants. In order to test the effect and safety of intradiscal therapies, the injection of collagenase and cABC into caprine intervertebral discs has shown to be a reliable method to quickly reproduce ex vivo moderate degenerated intervertebral disc. To implement such therapies in clinical practice, a clinical algorithm for treatment for intervertebral disc degeneration might be adapted from osteoarthritis.