作为一线口服降糖药，二甲双胍一直是治疗 2 型糖尿病 (T2DM) 的首选药物。肥胖、癌症和骨骼退化与 T2DM 相关，而 T2DM 被认为是一种代谢性疾病。许多与 T2DM 相关的疾病，如肿瘤、心血管疾病和骨质退化，都可以用二甲双胍治疗。椎间盘退变（IVDD）的特点是椎间盘退变，伴随着IVD髓核（NP）中的蛋白聚糖和水分逐渐耗尽，导致腰痛。二甲双胍对IVDD的治疗作用也备受关注。二甲双胍通过刺激 AMP 激活激酶，增强自噬，抑制细胞衰老、凋亡和炎症，从而有效延缓 IVDD。本文旨在系统阐述IVDD的发展历程以及二甲双胍治疗和预防IVDD的作用机制，为二甲双胍辅助治疗IVDD的临床应用提供参考。

Metformin has been the go‑to medical treatment for addressing type 2 diabetes mellitus (T2DM) as a frontline oral antidiabetic. Obesity, cancer and bone deterioration are linked to T2DM, which is considered a metabolic illness. Numerous diseases associated with T2DM, such as tumours, cardiovascular disease and bone deterioration, may be treated with metformin. Intervertebral disc degeneration (IVDD) is distinguished by degeneration of the spinal disc, accompanied by the gradual depletion of proteoglycans and water in the nucleus pulposus (NP) of the IVD, resulting in lower back pain. The therapeutic effect of metformin on IVDD has also attracted much attention. By stimulating AMP‑activated kinase, metformin could enhance autophagy and suppress cell senescence, apoptosis and inflammation, thus effectively delaying IVDD. The present review aimed to systematically explain the development of IVDD and mechanism of metformin in the treatment and prevention of IVDD to provide a reference for the clinical application of metformin as adjuvant therapy in the treatment of IVDD.