[Intervertebral disc pathologies from an immunological perspective]

The back pain associated to intervertebral prolapsed disc is a frequent pathology, that produces in many cases severe work-disability. The mechanisms of pain generation are controversial, the mechanical theories of nerve compression have been weak for explaining severe pain in patients with low protrusion grades.

In the last years several studies have been accomplished in order to determinate the contribution of inflammatory phenomena into the intervertebral disc disease's evolution. Abnormal values of cytokines like TNF-alpha, IL-1 beta, IL-6, and other molecules related with the immune system have been found, although the available studies are inconsistent. The analysis of immune cells in the intervertebral disc is in the same way contradictory, but the presence of macrophages appears constantly. The variability might be originated by the self-heterogeneity of the immune system in a disease with repeated episodes of injury-reparation that could conduce to deregulation and progressive tissular damage.

Until now it seems clear the association of macrophages in the pathologic degeneration of the intervertebral disc, but the interaction of these in this microenvironment not totally. The understand of the cellular and molecular networks is fundamental for explaining the poor correlation between clinical and radiological findings, in addition to the potential impact on the actual management applied.