Intervertebral discs undergo dramatic changes with increasing age. Since stiffness and pain in the back and neck are among the most common physical complaints of the middle-aged and older people, alterations and degenerative changes of the intervertebral disc are of high relevance for clinical routine.
However, the intervertebral disc cannot be compared to a synovial joint, explaining why most of its pathologic features are quite different from those of a joint of the appendicular skeleton (Grignon et al., 2000). Considering this fact, the changes of the intervertebral discs should not be dealt with in detail.
Briefly, with increasing age, fissures and cracks appear in the disc extending from the periphery to the central regions. Morphological studies showed a decrease in proteoglycan and water content as well as a dramatic decline in cell types and cell viability in the central region of the disc (Buckwalter, 1982). Ultrastructurally, disc matrix proteoglycan concentration decreases in the central regions (Buckwalter, 1982; Buckwalter et al., 1985; Buckwalter et al., 1989). In particular a reduction in aggregating proteoglycans and in the size of these aggregates can be observed. A decline in the concentration of a functional link protein, responsible for stabilizing proteoglycan aggregates, may cause changes in proteo-glycan structure.
The most critical age-related changes in intervertebral discs are a loss of blood vessels supplying the region of the disc (Hassler, 1969). The consecutive decline in nutrition may lead to a decrease in cell viability and biosynthetic function.
Although the apparent severity of age-dependent changes in the intervertebral discs, regeneration of disc tissue seems to be possible, as shown by in vitro studies of enzymatically compromised tissue of the central disc regions (Nitobe et al., 1988).
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