Tissue Collection for Understanding Intervertebral Disc Degeneration and Back Pain

Degenerative disc disease is the most prevalent indication for spine surgery and the major
source of back pain in afflicted patients. Age related degeneration of the intervertebral
discs is not the exception, but the rule. Degenerative changes are associated with weakening
of the disc and hypertrophy of the ligamentum flavum in the spine. The aim of this study is
to determine if there are any local or systemic biomarkers that correlate with the severity
of degeneration as indicated by radiological examination. To date, Imaging (XRay, MRI, CT
scans) are the most widely used diagnostic tools for identifying degenerated discs. Physical
changes in the disc are also associated with increased secretion and expression of
inflammatory mediators in the tissue. The investigators are interested in measuring both gene
and protein level changes of inflammatory mediators in degenerated discs in order to
correlate these levels with imaging based indicators of degeneration. Protein level changes
in the disc and ligamentum flavum have yet to be correlated with MRI-derived disc modic
changes classification system. The investigators hypothesize that as the image
characteristics of advancing degenerative disease increase, a corresponding change will be
present in the secretion (or expression) of specific markers related to inflammatory
processes in the disc. Cytokines found to be upregulated in disc tissue or ligamentum flavum
will also be measured in patient's serum levels to begin developing a systemic diagnostic
method for detecting disc degeneration.

Inclusion Criteria:

1. 18 years of age or older

2. Patients requiring surgery in lumbar spine region (L1-L2 to L5-S1)

3. Potential procedures: Spinal stenosis, discectomy, laminectomy, lumbar fusion, disc
herniation.

Exclusion Criteria:

1. Patients requiring revision surgery in lumbar spine

2. Patients who have had a discography procedure performed at the same disc level as the
one being operated on.

3. Known inflammatory conditions- Rheumatoid arthritis, Osteomyelitis, Discitis, Gout,
Ankylosing spondylitis, and other infections.

4. Oncologic conditions- any history of cancer of any type.