Challenges in the treatment of degenerative intervertebral disc disorders: from fusion to traction

Abstract

Low back pain is one of the most common health problems in the world. Degenerative disorders of the intervertebral disc can cause low back pain. The combined work in this thesis aims to improve the clinical outcome of treatment for patients with symptomatic degenerative disc disorders. Unfortunately, there is still a large variation in treatment options for patients with degenerative disc disorders (H2). A spondylodesis surgery (bony fusion of the degenerated vertebrae with an implant) can be a sufficient treatment option. A PEEK implant is commonly used to facilitate fusion, but complications such as non-union (no bony fusion of the vertebrae) are still seen (H3). Direct bone ingrowth on the implant could reduce this risk. With an animal study and a randomized controlled trial among patients (follow-up two years), the SNAP study has investigated if a new implant (silicon nitride) leads to similar histological, radiological and clinical outcomes compared to PEEK (H4-6). However, although theoretically expected due to favorable osteointegrative properties, the results were not comparable with PEEK. Next to implants, other treatment options to improve low back pain were investigated. Temporarily distraction of the degenerated vertebrae, as already in use for degenerated knees, could be a viable option (H7). In addition, a literature review has shown that improving the sagittal balance of the spine (by reducing pelvic tilt) leads to better results after a spondylodesis (H8). Lastly, patient reported outcome measures (PROMs) are an important tool to measure the outcome of treatment. There are several PROMs in use. However, the two most commonly used PROMs for low back pain are not interchangeable (H9), which makes comparison between treatments difficult. This underlines the importance of clear guidelines for the use of specific PROMs, in order improve comparison between different treatments.