Advances in biological techniques for treatment of lumbar discogenic pain

Treatment of lumbar discogenic pain is based upon restoration of mechanical function and suppression of nociception within the intervertebral disc. The biophysical and pathologic basis of disc injury is reviewed with discussion of treatment modalities. Ablative intradiscal ethanol and restorative intradiscal fibrin appear promising. Intradiscal platelet-rich plasma is tantalizing, but unproven. Biochemical modification of anabolic-catabolic balance by intradiscal administration of growth factors including BMP-7 and GDF-5 in clinical trials, as well as multiple investigational pharmacologic moieties, is discussed. Successful use of intradiscal autologous and mesenchymal stem cells has been demonstrated for in animal models, but human experience is limited. Clinical considerations and risks of these treatments are discussed.