Intervertebral disc degeneration (IVDD) is a prevalent condition that contributes significantly to the global burden of lower back pain. While not directly life-threatening, IVDD can have a profound impact on an individual’s quality of life, causing pain, psychological distress, and economic hardship. Current conservative treatments for IVDD, such as pain medication and physical therapy, can provide symptomatic relief but do not address the underlying pathology or reverse the degenerative process.
For patients with severe, intractable pain, surgical intervention, such as discectomy or spinal fusion, may be considered. However, these procedures are not without risks and limitations. The removal of a degenerated disc can compromise the stability of adjacent segments, potentially leading to accelerated degeneration and the need for additional surgeries. Moreover, the risk of herniation after discectomy is significant, with reported rates as high as 21.2%.
Considering these challenges, there is a growing interest in regenerative strategies for treating IVDD, particularly those involving orthobiologics and exercise. Orthobiologics, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), harness the body’s natural healing processes to promote tissue repair and regeneration. These biological agents contain growth factors, cytokines, and other bioactive molecules that can modulate inflammation, stimulate matrix synthesis, and enhance cell survival and proliferation.
In the context of IVDD, orthobiologics can be delivered directly into the degenerated disc, targeting the nucleus pulposus (NP) and annulus fibrosus (AF) for regeneration. In preclinical studies, PRP, derived from a patient’s own blood, has been shown to promote NP cell proliferation, increase collagen and proteoglycan synthesis, and reduce inflammatory cytokine levels. Similarly, MSCs, obtained from various sources such as bone marrow or adipose tissue, have demonstrated the ability to differentiate into NP-like cells, produce extracellular matrix components, and modulate the inflammatory microenvironment within the disc.
While orthobiologics offer a promising approach to disc regeneration, their efficacy may be further enhanced when combined with exercise. Exercise has been shown to positively impact disc health by improving nutrient diffusion, reducing inflammation, and stimulating matrix production. Moderate-intensity aerobic exercise and targeted strengthening of the core and lumbar musculature can help to offload the spine, reduce mechanical stress on the discs, and promote the maintenance of a healthy disc phenotype.
The combination of orthobiologics and exercise may provide a synergistic effect in the treatment of IVDD. This multimodal approach could slow or reverse the degenerative process, alleviate pain, and improve function by addressing the biological and mechanical factors contributing to disc degeneration. As our understanding of the complex pathophysiology of IVDD continues to evolve, integrating orthobiologics and exercise into personalized treatment plans may revolutionize the management of this debilitating condition.
