Article Text
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.
- low back pain
- rehabilitation
- magnetic resonance imaging
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Footnotes
Contributors Conception and design of the study: MB, FR, CN. Drafting of the original protocol: MB, FR, CN. Coordination of the study: CN. Acquisition of data: MB, CN. Obtained funding: CN. Drafting of the present manuscript: MB, CN. Final approval: MB, MMLC, FR, CN.
Funding This study was funded by Assistance Public-Hôpitaux de Paris (Project No MERRI-AAP-2017-008).
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; externally peer reviewed.
Data sharing statement No additional data are available.