Degenerative disc disease stands as the predominant etiological factor
behind low back pain. In recent years, the therapeutic modality of mesenchymal stem
cell (MSC) infusion directly into the nucleus pulposus of the deteriorating disc has
gained prominence. The intricacies of the intervertebral disc, a biomechanically robust
tissue, span its components - the annulus fibrosus, nucleus pulposus, and cartilaginous
endplates. Compromising the integrity of these elements can precipitate advanced disc
degeneration due to biomechanical disruption. Animal models have demonstrated the
therapeutic potential of MSCs. Particularly, adipose-derived stem cells (ASCs), a
subset of MSCs originating from adipose tissue, possess attributes akin to their bone
marrow-derived counterparts, metamorphosing into mesodermal structures,
encompassing bone, cartilage, muscle, and fat. Their abundance in the human system, coupled with minimally invasive extraction methods, makes them appealing for
regenerative medicine applications. A comprehensive literature assessment presented in
this chapter delineates the therapeutic paradigm of MSCs in addressing degenerative
disc disease (DDD) pain. To date, research predominantly centered on the nucleus
pulposus, while neglecting the annulus fibrosus and cartilaginous endplates. Notably,
clinical manifestations like annular ruptures, Modic alterations, or Schmorl's nodal
formations typically hint at pathologies within these overlooked structures. The
prospects of successful regenerative interventions within the annulus, endplates, or
nucleus pulposus remain controversial, considering the hostile, nutrient-deprived
milieu of the deteriorating intervertebral disc often culminating in the swift demise of
the introduced MSCs. Singularly targeting the compromised nucleus pulposus via
existing MSC-centric regenerative modalities may not achieve disc restoration.
Therefore, MSC-based theurapeutic strategies should not just include the nucleus
pulposus but also the affected annulus fibrosus and cartilaginous endplates.
Keywords: Intervertebral disc degeneration, Low back pain, Mesenchymal stem cells, Nucleus pulposus, Regenerative medicine.
