The intervertebral disc, a cartilaginous structure, undergoes degenerative changes earlier than any other connective tissue in the body. These changes are clinically significant as they are associated with back pain. Current treatments are primarily conservative or surgical, but many cases lack a clear diagnosis and effective therapy. New approaches, such as genetic and biological methods, may improve diagnosis and treatment in the future. The disc degeneration process involves morphological and biochemical changes, including loss of proteoglycans, disorganization of collagen and elastin networks, and increased cell proliferation and death. Nutritional pathways and mechanical loads are key factors in disc degeneration, with nutrient supply and abnormal mechanical forces contributing to the condition. Genetic factors also play a role, with several studies showing a strong familial predisposition and associations between specific gene polymorphisms and disc degeneration. New therapies, including cell-based therapies and gene therapy, aim to repair the degenerated disc matrix, but face challenges in delivery and selection of appropriate patients. Despite advancements, more research is needed to fully understand and treat intervertebral disc degeneration.The intervertebral disc, a cartilaginous structure, undergoes degenerative changes earlier than any other connective tissue in the body. These changes are clinically significant as they are associated with back pain. Current treatments are primarily conservative or surgical, but many cases lack a clear diagnosis and effective therapy. New approaches, such as genetic and biological methods, may improve diagnosis and treatment in the future. The disc degeneration process involves morphological and biochemical changes, including loss of proteoglycans, disorganization of collagen and elastin networks, and increased cell proliferation and death. Nutritional pathways and mechanical loads are key factors in disc degeneration, with nutrient supply and abnormal mechanical forces contributing to the condition. Genetic factors also play a role, with several studies showing a strong familial predisposition and associations between specific gene polymorphisms and disc degeneration. New therapies, including cell-based therapies and gene therapy, aim to repair the degenerated disc matrix, but face challenges in delivery and selection of appropriate patients. Despite advancements, more research is needed to fully understand and treat intervertebral disc degeneration.