Anatomia e fisiopatologia dell'unità funzionale disco-somatica

This review highlights three points. The intervertebral disc should be thought of as a dynamically evolving anatomo-functional unit. The dynamics of this process were investigated by studying the histobiochemistry of the acellular matrix of the joint cartilage in general and that of the intervertebral disc in particular to understand the effects of this arrangement on the structural changes to the disc induced by biomechanical stress, especially during ageing. Root pain due to disc-root conflict should be deemed a symptom of multifactorial origin in which the neural and perineural inflammatory reaction and its biohumoral mediators play a major role flanked by venous stasis due to mass effect on the perineural circulation. Nerve compression appears to play an adjuvant role by generating nerve conduction abnormalities due to fibre demyelinization with a direct or indirect anoxic-ischaemic effect. Lastly, we focus on the disc's nutritional mechanisms in order to examine "disc degeneration" as a sign of metabolic impairment of the nucleus pulposus and "disc regeneration". This concept was unknown until recently and is currently monitored in percutaneous controls following treatment for disc disease.