Tissue Engineering of the Intervertebral Disc

  • Rita Kandel
  • Paul Santerre
  • Eric Massicotte
  • Mark Hurtig


In an autopsy study, 97 % of individuals 50 years or older had histological evidence of intervertebral disc degeneration, a disease process that involves the annulus fibrosus, nucleus pulposus, and cartilaginous endplate (Miller et al. 1988). The back pain that can develop as a result of this disease has a lifetime prevalence of up to 80 % (Manchikanti et al. 2009; Takatalo et al. 2011, 2012). Approximately 1 in 50 Canadians becomes disabled by back pain which is responsible for 40 % of all workplace absences (Iron et al. 2004; Lee 1994; Rapoport et al. 2004). Although rarely life threatening, the annual total costs in 2002 in the USA as a result of back pain were over $100 billion (Asche et al. 2007; Dagenais et al. 2008; Iron et al. 2004; Lee 1994) (for a detailed discussion, see  Chap. 9). It has been estimated that in the USA alone, there are up to four million adults with chronic back pain who have failed conservative therapy (Masuda and Lotz 2010) and although there are a number of surgical options for these individuals, they all have limitations (Chou et al. 2009; Kishen and Diwan 2010; Raj 2008). Discectomy which relieves pain (325,000 operations performed in 2004 in the USA) (2008) does not restore disc height or its original load-bearing capacity (Putzier et al. 2005). Spinal fusion (375,000 surgeries in 2004 in the USA) (2008) is another commonly performed treatment; as has been discussed earlier, this is not always successful, often leading to pseudoarthrosis and limited flexibility (Kishen and Diwan 2010; Mirza and Deyo 2007). Although controversial, some studies suggest that this type of treatment may induce degenerative changes in adjacent vertebrae (Huang et al. 2006; Javedan and Dickman 1999; Kim and Branch 2006; Lee et al. 2012a, b; Schulte et al. 2007). Disc replacement with a motion-preserving prosthesis, such as partial or total disc replacement, is another option (Fekete and Porchet 2010; Kishen and Diwan 2010; Shim et al. 2007; So et al. 2007; Vernengo et al. 2008). However, there are numerous clinical contraindications to this treatment (Fekete and Porchet 2010; Shim et al. 2007), and these replacements do not fully restore kinematics (Fekete and Porchet 2010). This topic is discussed in considerable detail in  Chap. 14. As well, disc prostheses can generate wear debris (van Ooij et al. 2007) and the reaction that this incites has the potential to be catastrophic given its location near major vessels and nerves. The long-term exposure to ions, such as cobalt and chromium, which can be detected in the serum after disc replacement is unknown (Zeh et al. 2009). Given all these issues, there has been great interest in developing new therapeutic options such as biological approaches for the treatment of chronic symptomatic disc disease (Bron et al. 2009; Kandel et al. 2008; Masuda and Lotz 2010; O’Halloran and Pandit 2007; Richardson et al. 2007). Cell-based therapies that regenerate the disc avoid the functional impact on the disc and/or adjacent tissues as well as the consequences of metal fatigue and the reaction to wear debris (Guyer et al. 2011; Tumialan and Gluf 2011). Importantly the regenerated tissue can remodel and respond to load in a way synthetic prostheses or fused discs cannot.


Intervertebral Disc Nucleus Pulposus Disc Degeneration Annulus Fibrosus Nucleus Pulposus Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Canadian Institutes of Health Research (CIHR) Grant MOP114991


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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Rita Kandel
    • 1
  • Paul Santerre
    • 2
  • Eric Massicotte
    • 3
    • 4
  • Mark Hurtig
    • 5
  1. 1.Department of Pathology and Laboratory Medicine, Mount Sinai HospitalUniversity of TorontoTorontoCanada
  2. 2.Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoCanada
  3. 3.Department of NeurosurgeryToronto Western HospitalTorontoCanada
  4. 4.Department of SurgeryUniversity of TorontoTorontoCanada
  5. 5.Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphCanada

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