{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:49:49Z","timestamp":1791186589986,"version":"4.1.0"},"reference-count":82,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"10","license":[{"start":{"date-parts":[[2012,10,1]],"date-time":"2012-10-01T00:00:00Z","timestamp":1349049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:p>This article reviews the current knowledge of the intervertebral disc (IVD) and its association with low back pain (LBP). The normal IVD is a largely avascular and aneural structure with a high water content, its nutrients mainly diffusing through the end plates. IVD degeneration occurs when its cells die or become dysfunctional, notably in an acidic environment. In the process of degeneration, the IVD becomes dehydrated and vascularised, and there is an ingrowth of nerves. Although not universally the case, the altered physiology of the IVD is believed to precede or be associated with many clinical symptoms or conditions including low back and\/or lower limb pain, paraesthesia, spinal stenosis and disc herniation.<\/jats:p><jats:p>New treatment options have been developed in recent years. These include biological therapies and novel surgical techniques (such as total disc replacement), although many of these are still in their experimental phase. Central to developing further methods of treatment is the need for effective ways in which to assess patients and measure their outcomes. However, significant difficulties remain and it is therefore an appropriate time to be further investigating the scientific basis of and treatment of LBP.<\/jats:p>","DOI":"10.1302\/0301-620x.94b10.28986","type":"journal-article","created":{"date-parts":[[2012,9,27]],"date-time":"2012-09-27T01:57:24Z","timestamp":1348711044000},"page":"1298-1304","source":"Crossref","is-referenced-by-count":114,"title":["The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain"],"prefix":"10.1302","volume":"94-B","author":[{"given":"S. P. F.","family":"Hughes","sequence":"first","affiliation":[{"name":"Imperial College London, South Kensington Campus, London SW7 2AZ, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Freemont","sequence":"additional","affiliation":[{"name":"University of Manchester, Oxford Road, Manchester M13 9PL, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. W. L.","family":"Hukins","sequence":"additional","affiliation":[{"name":"University of Birmingham, Edgbaston, Birmingham B15 2TT, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. H.","family":"McGregor","sequence":"additional","affiliation":[{"name":"Imperial College London, South Kensington Campus, London SW7 2AZ, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, and ISTM, Keele University, Oswestry, Shropshire SY10 7AG, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","unstructured":"No authors listed.Bone and Joint Decade\u2019s Musculoskeletal Portal. http:\/\/www.boneandjointdecade.org\/ (date last accessed 22 August 2012)."},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B5.14403"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00276"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000202558.86309.ea"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181f2a177"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.93B9.27002"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-003-0612-1"},{"key":"r8","first-page":"728","volume":"15","author":"Videman T","year":"1990","journal-title":"Spine (Phila Pa 1976)"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200212010-00002"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7580.2009.01102.x"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199904150-00005"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.1016\/0268-0890(94)90012-4"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1016\/1350-4533(95)00047-X"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1136\/aim.22.4.178"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199104000-00011"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-2009-0239"},{"key":"r17","unstructured":"Crock HV.An atlas of vascular anatomy of the skeleton and spinal cord. London: Martin Dunitz, 1996."},{"key":"r18","volume":"94","author":"Fick A","year":"1855","journal-title":"Poggendorff\u2019s Annalen der Physick und Chemie"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.73B5.1894674"},{"key":"r20","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199406000-00004"},{"key":"r21","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-003-0616-x"},{"key":"r22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1042\/BIO02505015","volume":"25","author":"Urban JP","year":"2003","journal-title":"Biochemist"},{"key":"r23","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-002-0472-0"},{"key":"r24","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012010-00007"},{"key":"r25","doi-asserted-by":"publisher","DOI":"10.1002\/art.24291"},{"key":"r26","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ken056"},{"key":"r27","unstructured":"Razaq MS.The effect of extracellular pH on cartilage tissue metabolism and turnover. Oxford: University of Oxford, 2002."},{"key":"r28","first-page":"677","volume":"9","author":"Kletsas D","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"r29","doi-asserted-by":"publisher","DOI":"10.1186\/ar1732"},{"key":"r30","doi-asserted-by":"publisher","DOI":"10.1002\/art.24248"},{"key":"r31","doi-asserted-by":"publisher","DOI":"10.1038\/35065000"},{"key":"r32","doi-asserted-by":"publisher","DOI":"10.1002\/jor.21140"},{"key":"r33","doi-asserted-by":"publisher","DOI":"10.1080\/08977190802273814"},{"key":"r34","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/S0030-5898(20)31329-8","volume":"14","author":"Yong-Hing K","year":"1983","journal-title":"Orthop Clin North Am"},{"key":"r35","doi-asserted-by":"publisher","DOI":"10.1016\/0730-725X(94)92452-X"},{"key":"r36","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/00003086-199206000-00005","volume":"279","author":"Olmarker K","year":"1992","journal-title":"Clin Orthop Relat Res"},{"key":"r37","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B1.14344"},{"key":"r38","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100120206"},{"key":"r39","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.79B1.0790147"},{"key":"r40","doi-asserted-by":"publisher","DOI":"10.1002\/path.1108"},{"key":"r41","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200201150-00003"},{"key":"r42","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)02135-1"},{"key":"r43","doi-asserted-by":"publisher","DOI":"10.1002\/art.10585"},{"key":"r44","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31824da3ba"},{"key":"r45","first-page":"1","volume":"6","author":"Benzel EC","year":"2011","journal-title":"ASME J Med Dev"},{"key":"r46","doi-asserted-by":"publisher","DOI":"10.1586\/erd.10.60"},{"key":"r47","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0125-9"},{"key":"r48","first-page":"480","volume":"17","author":"Kandel R","year":"2008","journal-title":"Spine J"},{"key":"r49","doi-asserted-by":"publisher","DOI":"10.1038\/mt.2009.146"},{"key":"r50","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199410063311401"},{"key":"r51","doi-asserted-by":"publisher","DOI":"10.3171\/2010.10.SPINE10223"},{"key":"r52","doi-asserted-by":"publisher","DOI":"10.1006\/excr.1998.4287"},{"key":"r53","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01672"},{"key":"r54","doi-asserted-by":"publisher","DOI":"10.1634\/stemcells.2004-0107"},{"key":"r55","doi-asserted-by":"publisher","DOI":"10.1634\/stemcells.2005-0205"},{"key":"r56","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2005.06.038"},{"key":"r57","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2009.12.001"},{"key":"r58","doi-asserted-by":"publisher","DOI":"10.1002\/nbm.1651"},{"key":"r59","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60496-6"},{"key":"r60","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-008-0750-6"},{"key":"r61","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181cd2cf4"},{"key":"r62","doi-asserted-by":"publisher","DOI":"10.2174\/157488810790442796"},{"key":"r63","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"r64","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003"},{"key":"r65","unstructured":"Ware J, Kosinski M, Dewey J, Gandek B.How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Boston: Qualy Metric , 2001."},{"key":"r66","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200207010-00019"},{"key":"r67","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200003010-00005"},{"key":"r68","first-page":"271","volume":"66","author":"Fairbank JC","year":"1980","journal-title":"Physiotherapy"},{"key":"r69","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200011150-00017"},{"key":"r70","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198303000-00005"},{"key":"r71","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199201000-00006"},{"key":"r72","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198403000-00012"},{"key":"r73","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-0942-8"},{"key":"r74","first-page":"541","volume":"7","author":"Copay AG","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"key":"r75","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200207010-00018"},{"key":"r76","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31819fcd52"},{"key":"r77","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181a9e640"},{"key":"r78","doi-asserted-by":"publisher","DOI":"10.1002\/pri.225"},{"key":"r79","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38441.620417.8F"},{"key":"r80","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000207257.64215.03"},{"key":"r81","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-2004-17207"},{"key":"r82","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2009.10.001"}],"container-title":["The Journal of Bone and Joint Surgery. British volume"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.94B10.28986","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.94B10.28986","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.94B10.28986","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T17:23:46Z","timestamp":1643477026000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.94B10.28986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,10]]},"references-count":82,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2012,10]]}},"alternative-id":["10.1302\/0301-620X.94B10.28986"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.94b10.28986","relation":{},"ISSN":["0301-620X","2044-5377"],"issn-type":[{"value":"0301-620X","type":"print"},{"value":"2044-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,10]]}}}