Novelties in etiopathogenesis, diagnosis and treatment of patients with lumbar intevrertebral disc degeneration

Autori:

Simeon Grazio , Lovorka Grgurević, Darko Perović, Tea Schnurrer Luke Vrbanić, Zdenko Kovač, Boris Božić, Karlo Houra, Igor Borić, Dražen Kvesić, Ruđer Novak, Lejla Ferhatović Hamzić, Frane Grubišić, Tomislav Sajko, Robert Saftić, Stjepan Dokuzović, Krešimir Rotim

Sažetak
Križobolja je jedan od najčešćih uzroka fizičke nesposobnosti, čije je najčešće izvorište degeneracija intervertebralnog diska. Nemogućnost točnog utvrđivanja potjecišta boli jest ograničavajući čimbenik u učinkovitijoj prevenciji i liječenju. Nova saznanja, napose u područjima genetike i analize proteina primjenom spektrometrije masa, bacaju novo svjetlo u razumijevanju etiopatogeneze degenerativne bolesti diska. Novim slikovnim metodama kao što je CEST magnetska rezonancija ili ADC magnetska rezonancija mogu se detektirati rane degenerativne promjene. Napredak je ostvaren glede razjašnjenja uloge fizičkog opterećenja, kao i tipa vježbi koje mogu imati utjecaj kako na razvoj tako i na liječenje bolesnika s degenerativnim promjenama diska. Na kraju, značajan napredak je ostvaren u kirurškom liječenju tih bolesnika, s naglaskom na minimalno invazivne tehnike. Ostali kirurški modaliteti liječenja su pokazali napredak koji ohrabruje, kao što su totalna zamjena diska i liječenje mezenhimalnim matičnim stanicama. Uz navedeno, i ostale novosti u dijagnostici i liječenju degenerativne bolesti vertebralnog diska raspravljene su u ovom članku.
Summary

Low-back pain is one of the most common causes of physical disability, most often originating from intervertebral disc degeneration. Lack of pinpointing the exact source of pain is the limiting factor in more efficient prevention and treatment. New findings, especially in the fields of genetics and mass spectometry based protein analysis, shed a new light to the understanding of etiopathogenesis of disc degenerative disease. New imaging methods like chemical exchange saturation transfer (CEST)MRI or apparent diffusion coefficient (ADC)MRI can detect early degenerative changes. Advances have been made regarding elucidating the role of physical load, as well as the type of exercise that can have an impact on the development and treatment of patients with degenerative disc disease. Finally, a significant progress has been made in the surgical treatment ecouraging of these patients, with an emphasis on minimally invasive techniques. Other surgical modalities have also shown improvement, like total disc replacement and mesenchymal stem cells treatments. These, and other novelties in the diagnosis and treatment of degenerative disc disease of lumbar spine are discussed in this article.

Volumen: 1-2, 2021

Liječ Vjesn 2021;143:63–77

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