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    New Treatments and Imaging Strategies in Degenerative Disease of the Intervertebral Disks

    Jeffrey C. Lotz, PhD,
    Victor Haughton, MD,
    Scott D. Boden, MD,
    Howard S. An, MD,
    James D. Kang, MD,
    Koichi Masuda, MD,
    Anthony Freemont, BSc, MD,
    Sigurd Berven, MD,
    Dilip K. Sengupta, PhD,
    Lawrence Tanenbaum, MD,
    Philip Maurer, MD,
    Arun Ranganathan, DM,
    Abass Alavi, MD and
    Nicholas L. Marinelli, MD

    + Author Affiliations

    From the Orthopaedic Bioengineering Laboratory, University of California–San Francisco, San Francisco, Calif (J.C.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (V.H.); Department of Orthopedic Surgery, Emory University, Atlanta, Ga (S.D.B.); Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ill (H.S.A.); Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.D.K.); Department of Orthopaedic Surgery, University of California–San Diego, San Diego, Calif (K.M.); School of Biomedicine, University of Manchester, Manchester, England (A.F.); Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, Calif (S.B.); Department of Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (D.K.S.); Magnetic Resonance Imaging and Computed Tomography, New Jersey Neuroscience Institute at JFK Medical Center, Edison, NJ (L.T.); Department of Orthopedics, University of Pennsylvania Hospital, Philadelphia, Pa (P.M.); Department of Orthopedica Engineering, Northern Deanery, Newcastle-upon-Tyne, England (A.R.); Division of Nuclear Medicine, University of Pennsylvania, Philadelphia, Pa (A.A.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (N.L.M.).

    Address correspondence to
    V.H. (e-mail:


    Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, “functional” imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.

    © RSNA, 2012


    Received March 23, 2011; revision requested April 26; revision received May 18; final version accepted June 6; final review by V.H. March 13, 2012.

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