Unloading of intervertebral disc to improve low back pain management: from organ models to clinics

Low back pain (LBP) is a major cause of long-term disability in adults worldwide and it is frequently attributed to intervertebral disc (IVD) degeneration. So far, no consensus has been reached regarding appropriate treatment and LBP management outcomes remain disappointing. Spine unloading or traction protocols are one of the non-surgical approaches to treat LBP. These treatments are widely used and result in pain relief, decreased disability or reduced need for surgery. However, the underlying mechanisms -namely, the IVD unloading mechanobiology (i.e. the biological response of the IVD to those protocols)- have not been studied yet. Hence, we believe that studying the biological response of the degenerative IVD to unloading is an important step towards a better understanding of this organ and ultimately towards improved LBP management. In the lab, we will first adapt the actual organ model mimicking disc degeneration, what means, we will create, in disc samples, different degeneration stages. As second step, we will characterize these samples via magnetic resonance imaging (MRI) and standard biological analyses in order to identify and correlate imaging and biological markers that represent the IVD biological state. Afterwards, we will assess the influence of unloading on the previously defined markers, in our tailored organ model. Finally, we aim to translate the results from the lab to the clinics. Therefore, we will look, in patients with IVD degeneration and suffering from LBP, to the modification of the MRI markers following spine unloading protocols. The comparison of MRI and biological markers will allow establishing clinical markers that reflect the biological state of the disc, which would be a breakthrough in the field. Furthermore, the study of disc unloading will help improving the clinical spine traction protocols and LBP management overall.