Active discopathy: a clinical reality. Issue 1 (17th April 2018)

• Record Type: Journal Article
• Authors: Boisson, Margaux; Lefèvre-Colau, Marie-Martine; Rannou, François; Nguyen, Christelle
• Is Part Of: RMD open. Volume 4:Issue 1(2018)
• Publication Date: 2018-04-17
• Subjects: low back pain -- rehabilitation -- magnetic resonance imaging; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2018-000660
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : In the late 1980s, the description by Modic and colleagues of elementary discovertebral changes detected on MRI (Modic classification) suggested for the first time a possible correlation between anatomical and clinical features in a subgroup of patients with non-specific chronic low back pain. Degenerative disc disease is frequent and usually asymptomatic, but Modic 1 changes in the vertebral endplates adjacent to a degenerated disc are associated with inflammatory-like chronic low back pain and low-grade local and systemic inflammation, which led to the concept of 'active discopathy'. Active discopathy shares some similarities with acute flares of peripheral osteoarthritis. Likewise, what triggers disc activation and how it self-limits remain unknown. A better understanding of mechanisms underlying disc activation and its self-limitation is of clinical relevance because it may enable the design of more targeted pharmacological and non-pharmacological interventions for the subgroup of patients with chronic low back pain and active discopathy. Here, we narratively review current disc-centred biomechanical and biochemical hypotheses of disc activation and discuss evidence of interactions with adverse personal and environmental factors.