Intradiscal Therapies for Lumbar Degenerative Disk Disease

Jose A. Canseco, MD, PhD; Arun P. Kanhere, MD, MS; Gregory D. Schroeder, MD; Alexander R. Vaccaro, MD, PhD, MBA; Christopher K. Kepler, MD, MBA


J Am Acad Orthop Surg. 2022;30(17):e1084-e1094. 

In This Article

Abstract and Introduction


Discogenic low back pain is a common musculoskeletal complaint in patients presenting to orthopaedic surgeons. In addition to surgical options, there are several nonsurgical intradiscal treatments that have gained interest, ranging from biologic, nonbiologic, cell-based, and molecular therapies. However, there is limited evidence for many of these techniques, and some are still in the clinical trial stage. We describe a broad overview of these intradiscal therapies, the mechanism of action, and the evidence behind them.


Low back pain secondary to degenerative disk disease (DDD) is the most prevalent musculoskeletal complaint among the adult population, affecting up to 80% of people and costing the US healthcare system between $19.6 and $118.8 billion per year.[1] The intervertebral disk (IVD), composed of the inner nucleus pulposus (NP), the outer anulus fibrosus (AF), and the cartilaginous/boney end plates, is subject to age-related cellular, structural, and extracellular matrix (ECM) changes.[2] Because of cell senescence, inflammatory cytokines, and degradative enzymes, the degenerating disk can be a severe source of pain.[3]

Traditional medical management consists of conservative treatment, such as physical therapy and analgesics, or surgical treatment, such as arthrodesis or diskectomy. However, both options often result in poor outcomes and persistent pain. Subsequently, much effort has been made developing alternative intradiscal therapies to reduce pain and slow the progression of degeneration. Although accessing the disk normally requires fluoroscopy or CT guidance, newer techniques have demonstrated the feasibility of ultrasound guidance.[4]

In this article, we will review the current progress made in intradiscal therapies for lumbar DDD, including nonbiologics, cell-based, biologics, and molecular approaches (Table 1).