2 Strategies to Treat Spinal Degenerative Diseases

Key Points

• The United States has a high annual prevalence of spinal degenerative diseases (SDD) among its aging population, with SDD including a range of conditions caused by the degeneration of spinal structures.
• Key risk factors for SDD include aging, heavy labor, trauma, genetics, obesity, and metabolic syndrome, with these conditions significantly impacting patients’ lives and society in terms of quality of life and economic burden.
• Metabolic syndrome, characterized by insulin resistance, obesity, vascular pathology, and dyslipidemia, can lead to “meta-inflammation” and contribute to the development of SDD.
• Recent studies have highlighted the role of gut microbiota (GM) in various metabolic, immune, structural, and neurological functions, with disruptions in GM linked to inflammatory diseases, obesity, and metabolic syndrome, all of which can contribute to SDD.
• The future of SDD research looks promising, with the potential for innovative preventive and therapeutic interventions based on the relationship between GM, immunity, metabolism, and inflammation.

Introduction

The United States sees a 27.1% annual prevalence of spinal degenerative diseases (SDD) among its aging population ¹.

SDD is a collection of diseases caused by the degeneration of spinal structures, including bones, cartilages, intervertebral disks, ligaments, and muscles.

Examples include osteoporotic vertebral fractures, facet joint osteoarthritis, intervertebral disk degeneration, lumbar spinal canal stenosis, and spinal sarcopenia.

These conditions often coexist and worsen with age, leading to a cycle of negative health impacts.

Key Risk Factors and Impacts of SDD

Research has identified aging, heavy labor, trauma, genetics, obesity, and metabolic syndrome as primary risk factors for SDD ^{2 3}.

The pain and paralysis resulting from SDD have a significant impact on patients’ lives, families, and society at large, both in terms of quality of life and economic burden ⁴.

Understanding the causes of SDD, which range from biomechanical injury to biochemical stress, is crucial for developing preventive and therapeutic measures.

Metabolic Syndrome: A Key Factor in SDD

Metabolic syndrome encompasses insulin resistance, obesity, vascular pathology, and dyslipidemia ⁵.

This condition can lead to “meta-inflammation,” a low-grade systemic inflammation that adds biochemical stress to tissues and can contribute to the development of SDD.

Inflammaging, a chronic, low-level inflammation associated with aging, has also been linked to osteoporosis, intervertebral disk degeneration, and other degenerative conditions⁶.

The Gut Microbiota (GM) Connection with SDD

Recent studies have brought attention to the role of gut microbiota (GM) in metabolic, immune, structural, and neurological functions, with disruptions in GM linked to inflammatory diseases, obesity, and metabolic syndrome ⁷.

These disruptions can result in the production of inflammatory cytokines and bacterial metabolites involved in the pathophysiology of musculoskeletal diseases, including SDD.

Additionally, several axes, such as gut-bone, gut-joint, gut-disk, and gut-muscle, have been identified, showcasing the intricate relationship between GM and various spinal conditions ⁸.

A Look at the Future of SDD Research

The close relationship between GM, immunity, metabolism, and inflammation presents an opportunity for further research into the involvement of GM in the degeneration of spinal structures and SDD.

With the potential for GM to be a key mechanism in the development of SDD, future studies could pave the way for innovative preventive and therapeutic interventions.

SDD Treatments: Harnessing the Power of Gut Microbiota

The prevalence of spinal degenerative diseases (SDD) globally demands innovative treatment strategies.

Research shows that gut microbiota (GM) plays a pivotal role in SDD progression through various gut-spinal axes, impacting bones, cartilage, disks, ligaments, and muscles.

Dysbiosis in GM can lead to chronic inflammation, and worsening SDD symptoms including osteoporosis, intervertebral disk degeneration (IVDD), and osteoarthritis (OA).

On the flip side, therapeutic interventions that restore GM balance can prevent and mitigate SDD progression.

Lifestyle changes, like improved diet, regular exercise, and adequate sleep, alongside cutting-edge microbiome-targeted therapies and fecal transplants, are promising avenues for GM modulation in treating SDD ⁹.

Power of Gut Microbiota for Spinal Health: A Lifestyle Approach

Bridging the Gap between Lifestyle and Spinal Degenerative Diseases (SDD)

A healthy lifestyle, encompassing balanced nutrition, sufficient sleep, and regular exercise, has been shown to improve the composition of gut microbiota (GM) and consequently mitigate symptoms of SDD ¹⁰.

By fostering the growth of beneficial bacteria, these lifestyle changes can alleviate inflammation, thereby halting the degeneration of spinal structures and reducing pain through short-chain fatty acids (SCFAs) or neurotransmitter activity.

The dynamic interaction between lifestyle factors and GM highlights the importance of holistic wellness in preventing and treating SDD.

Harnessing the Power of Prebiotics and Probiotics

Prebiotics, consisting of non-digestible food components like dietary fiber, fuel the growth of beneficial bacteria in the digestive tract.

They facilitate the synthesis of SCFAs, impacting cell growth and inflammation regulation¹¹.

Probiotics, live microorganisms often found in fermented foods, help maintain a balanced GM by enhancing epithelial barrier function and inhibiting the production of bacterial toxins.

This aids in promoting immune responses and anti-inflammatory pathways¹².

Both prebiotics and probiotics have been documented to foster calcium and vitamin D absorption, inhibit osteoclast differentiation, and protect bone and cartilage, thereby exhibiting beneficial effects on osteoporosis and OA.

The Role of Exercise in Promoting Spinal Health

Exercise has been identified as a crucial factor in improving skeletal muscle mass and GM composition.

Specifically, the ‘gut-muscle‘ axis is of interest, as it links improvements in spinal sarcopenia to regular physical activity ¹³.

In essence, regular exercise can foster a positive cycle, improving GM composition and, in turn, spinal structures.

Impact of Sleep on Spinal Health

While the relationship between sleep disturbances, GM dysbiosis, and SDD is yet to be thoroughly explored, existing studies suggest that healthy sleep patterns can contribute to mitigating symptoms of SDD.

Sleep disturbances have been linked to decreased bacterial diversity in the intestine, which can trigger systemic chronic inflammation, a known risk factor for SDD ¹⁴.

The Interplay between GM and Drug Metabolism

GM has a profound impact on the metabolism of drugs, which can, in turn, affect their efficacy.

By modulating GM through lifestyle interventions, the efficacy of analgesics can be enhanced, potentially leading to a reduction in drug dosage.

This is particularly relevant for older individuals with SDD, who often face the challenge of polypharmacy.

Fecal Microbiome Transplants (FMT) for Health Restoration

A Dynamic Solution for Gut Health

Fecal microbiome transplants (FMT) offer a revolutionary approach to rectify gut microbiota (GM) dysbiosis-related conditions.

By transferring healthy donor stool to the recipient, FMT re-establishes the balance of intestinal bacteria, addressing various inflammatory conditions such as acute inflammation (Clostridioides difficile infection), chronic inflammation (Crohn’s disease, ulcerative colitis), and chronic low-grade inflammation ¹⁵.

FMT: Beyond Probiotics and Prebiotics

Contrary to single-microorganism-targeting solutions like probiotics and prebiotics, FMT preserves the entirety of GM and its metabolites, thereby ensuring the optimal functioning of GM and swiftly restoring gut microenvironmental homeostasis¹⁶.

The Far-Reaching Impacts of FMT

FMT has demonstrated efficacy across a spectrum of diseases, encompassing gastrointestinal diseases (Clostridioides difficile infection, Crohn’s disease, ulcerative colitis), liver diseases (severe alcoholic hepatitis, primary sclerosing cholangitis, liver cirrhosis), brain disorders (autism, Parkinson’s, multiple sclerosis, Alzheimer’s, epilepsy), metabolic conditions (diabetes, obesity, metabolic syndrome, gout), and even cancer (melanoma, gastroesophageal cancer).

FMT’s Role in Spinal Health

Specifically for spinal health, FMT has proven beneficial for inflammatory, immune, or metabolic spinal disorders such as osteoporosis, psoriatic arthritis, and axial arthritis ¹⁷¹⁸.

While its impact on other spinal degenerative diseases (OA, IVDD, LSS, spinal sarcopenia) remains unexplored, the potential normalization of GM could play a pivotal role in preventing, treating, and ameliorating these conditions.

Discussion

• The high prevalence of SDD in the aging population of the United States highlights the need for comprehensive research and innovative treatment strategies.
• Key risk factors such as aging, genetics, heavy labor, obesity, and metabolic syndrome play a significant role in the development and progression of SDD.
• Metabolic syndrome and its associated “meta-inflammation” can significantly contribute to the development of SDD, further emphasizing the need for holistic approaches to treatment.
• The interconnected relationship between gut microbiota (GM) and various spinal conditions opens up new avenues for research and potential treatments.
• The impact of lifestyle factors such as diet, exercise, and sleep on GM composition and, consequently, on SDD symptoms should not be underestimated.

Conclusion

• There is a clear need for further research to fully understand the complexities of SDD and its various contributing factors.
• The relationship between GM and SDD offers promising potential for innovative preventive and therapeutic interventions.
• Holistic approaches that incorporate lifestyle changes and microbiome-targeted therapies could significantly improve the quality of life for individuals with SDD.
• The potential benefits of fecal microbiome transplants (FMT) in treating SDD are particularly intriguing and warrant further exploration.
• Overall, the future of SDD research and treatment is promising, with numerous opportunities for groundbreaking discoveries and advancements in patient care.