5 Repair , regenerative and supportive therapies of the annulus fibrosus : achievements and challenges

Lumbar discectomy is a very effective therapy for neurological decompression in patients suffering from sciatica due to a hernia nuclei pulposus. However, high recurrence rates and persisting post-operative low back pain in these patients require serious attention. In the past decade, tissue engineering strategies have been developed mainly targeted to the regeneration of the nucleus pulposus (NP) of the intervertebral disc. Accompanying techniques that deal with the damaged annulus fibrous are now increasingly recognised as mandatory in order to prevent re-herniation to increase the potential of NP repair and to confine NP replacement therapies. In this chapter, the requirements, achievements and challenges in this quickly emerging field of research are discussed. Annulus fibrosus repair 81 Introduction Lumbar discectomy is an effective therapy for neurological decompression in patients suffering from an herniated nucleus pulposus (HNP), which can be safely performed via minimal invasive procedures [44, 128]. Current discectomy procedures, however, are not directed to treat the damaged intervertebral disc (IVD) and may even further aggravate existing damage [16, 22, 45]. It is therefore not surprising that successful neurological decompression is often followed by periods of persisting low back pain, severely affecting the quality of life [7, 8, 45]. Another serious problem in these patients is the high recurrence rates after discectomy, affecting up Since discectomy is still the most performed spinal surgical procedure worldwide and mainly affects the employed population, the resulting socio-economical consequences are dramatic [61].