The lumbar degenerative disc: confusion, mechanics, management.

INTRODUCTION The lumbar disc represents a complex biological ecosystem dependent on a homeostatic environment. Consistent with a natural ecosystem, demise and degeneration occurs as a consequence of one or a combination of environmental disruptions. With this understanding, we must move away from the general term “degenerative disc disease” (DDD) and move toward the determination of etiology-specific conditions and the development of etiology-specific preventative or therapeutic strategies. Our vision must be the optimization of treatment outcomes for specific conditions of the lumbar disc and the implementation of degeneration prevention strategies through genetic or tissue engineering or other biologic modalities.