Degenerative disc disease remains a leading cause of disability worldwide and continues to challenge clinicians, researchers, and health systems due to its complex and multifactorial nature. These challenges were highlighted at the NASS 2026 Annual Meeting in Denver during the session titled, “Intervertebral Disc Therapies: Voodoo or the Future?” with presentations by Gregory K. Paschal, MS, Andres Bonilla, PhD, Harvey Smith, MD, and Ira L. Fedder, MD, explored emerging biologic and interventional strategies for disc degeneration.

Genetic predisposition, mechanical loading, inflammatory cascades, and age-related metabolic changes interact to drive a progressive decline in disc structure and function.1-3 Traditionally, treatment strategies focused primarily on symptom relief through analgesics, physical therapy, rehabilitation and reserving surgical interventions such as discectomy, disc replacement, or spinal fusion for advanced stages of disease.1,2

However, the intervertebral disc can’t be understood only as a mechanical spacer between two vertebrae. Intervertebral disc is a highly specialized tissue with its own biology, complex biomechanical behavior and a very limited capacity for adaptation due to its poor vascular supply. With advancing degeneration, the intradiscal environment undergoes profound biological changes, including reduced oxygen availability, acidification, compromised nutrient transport, progressive cell depletion, degradation of the extracellular matrix, and a gradual loss of functional capacity.3,4