(K. Barbee, M. Marcolongo, E. Vresilovic, and B. Schauer)

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Abstract: Degenerative disc disease of the spine causing lower back pain is one of the leading musculoskeletal disorders confronting our health system. Annually, 15%-20% of the population experiences lower back pain; 60% or more will experience back pain over a lifetime(2). The utilization of epidural injections for managing chronic back pain was shown to increase 121% over a 7 year period as reported by medicare. At the time of the steroid injection procedure, however, it would be possible to also inject the nucleus with a material that would augment the disc and restore normal mechanics, thus alleviating pain long term. We propose such a material that would serve as an injectable medical augmentation device. We believe that the treatment will be considered a device rather than drug by the FDA. The material system is philosophically based on the 3D brush-like structure of aggrecan, the primary proteoglycan of the nucleus. Aggrecan has two main mechanical functions in the disc: 1) it allows water uptake by the nucleus due to sulfated groups in the chondroitin and keratin sulfate rich regions which, in part, provide intradiscal pressure and 2) it provides electrostatic repulsion due to the 3D macromolecular structure, which contributes to intradiscal pressure and disc height. The applied engineering of the polymer structure using a biomimetic philosophy will enable the development of an effective early stage treatment to the spine.