Working together to address disc degeneration and low back pain


By Dino Samartzis and Jaro Karppinen 

Low back pain is regarded as the most debilitating condition worldwide and represents a tremendous socioeconomic and healthcare burden. As a result of this burden, the medical and scientific communities have conducted, throughout the years, several studies to better understand the risk factors involved in the development, duration and recurrent nature of low back pain. Disc degeneration of the lumbar spine has been identified as one of those factors, and its cause is attributed to various determinants, such as genetics, environmental and lifestyle issues. However, we need to understand how disc degeneration is characterised if we are to properly understand its clinical relevance. Unfortunately, the “phenotype” and assessment of disc degeneration, as has been reported time and time again in the literature, is not standardised and is not fully representative of the overall breakdown of the disc and surrounding elements.  

The ISPC was established in June this year primarily as a vehicle to bring together a multidisciplinary group of spinal experts involved in large-scale cohorts focusing on disc degeneration and other spinal abnormalities as well as various pain profiles to address spine degeneration and pain. This initiative was initially supported by a 2013 MacNab/LaRocca prize bestowed upon by the International Society for the Study of the Lumbar Spine (ISSLS) to the authors of this commentary and their group of international collaborators.

The first ISPC meeting was held in Hong Kong on 28–29 June 2013 and it addressed large-scale population-based cohorts assessing genetic epidemiology of disc degeneration and pain. Investigators from Europe and Asia participated in the inaugural meeting, representing studies researching advanced imaging, lifestyle/environmental factors, clinical parameters, and genetic data of thousands of participants. 

Understanding and treating disc degeneration and patients with low back pain has taken centre stage at spinal conferences. Additionally, tremendous efforts and funds have been spent throughout the years to elaborate on such platforms, which have not been without challenges. In a large part, these efforts have focused on how disc degeneration and its severity, as well as pain parameters, should be defined. In short, the phenotype of disc degeneration needs to be re-visited, re-classified, and standardised. Due to the complexities of why the chemistry and morphology of the disc changes and since its clinical relevance has in the past been elusive, large-scale, collaborative and systematic studies are needed to address genetic epidemiology of the disc and pain profiles.

The standardisation of the phenotype of disc degeneration cannot be established by a single player, but through a collaborative approach. This is the first task of the ISPC, which enables us to make advances in the fields of genetic epidemiology and treatment of spinal disorders. If we have a better understanding of the phenotype of disc changes and its pain parameters, this may help improve the development of preventative measures, novel diagnostics, cutting-edge biological therapies, and improved prognostic outcomes in an effort to have a more “personalised” approach to the spine.

Overall, the aim of the ISPC is to bring together a multidisciplinary group of clinicians and scientists from around the world to address topical spine issues and cutting-edge research to advance the understanding of spinal disorders and improve patient care/outcomes. There are future plans to address other clinical and research platforms, such as pain genetics and its role in spinal conditions and therapeutic outcomes. With the international spine community coming together and working on platforms of common interest and clinical importance, much more can be achieved than by working alone. This consortium is one of the first of its kind in the world and promises to set a new standard of international collaboration and high-impact studies.


Additional information of the ISPC can be found here.


Dino Samartzis is from the Department of Orthopaedics and Traumatology at the University of Hong Kong, Hong Kong and Jaro Karppinen is from the Department of Physical and Rehabilitation Medicine at the University of Oulu, Finland