Tissue engineering and the intervertebral disc: the challenges

Abstract

Disc degeneration is a common disorder. Although the back pain that can develop in association with this is rarely life-threatening, the annual cost in terms of morbidity, lost productivity, medical expenses and workers' compensation benefits is significant. Surgical intervention as practised currently is directed towards removing the damaged or altered tissue. Development of new treatment modalities is critical as there is a growing consensus that the strategies used currently for symptomatic degenerative disc disease may not be effective. Accordingly, there is a need to develop an entirely new way to treat this disorder; regenerative medicine and tissue engineering approaches appear particularly promising in this regard. This paper reviews some of the challenges that currently are limiting the clinical application of this approach to the treatment of disc degeneration.

Fig. 1

Annulus fibrosus tissue engineering: a Scanning electron micrograph showing aligned electrospun polyurethane nanofibrous scaffold. b Annulus fibrosus tissue formation (asterisk) in vitro on aligned silk fibrous scaffolds (filled triangle). (Photographs courtesy of G. Chang, R. Kandel et al.)

Fig. 2

Challenges for disc tissue engineering. Schematic showing some areas requiring development before this technique can be applied to the disc as a routine clinical treatment. CPP indicates substrate used as a bone substitute (e.g. calcium polyphosphate)