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Stress distributions inside intervertebral discs: the validity of experimental "stress profilometry'.

This paper evaluates a technique for measuring the distribution of compressive stress within cadaveric intervertebral discs. A strain-gauged pressure transducer, side-mounted near the tip of a 1.3 mm diameter needle, was inserted into cubes of disc tissue and into intact discs. Regardless of the position and orientation of the transducer within the tissue or disc, its output was found to be proportional to the compressive force applied to the specimen. The distribution of compressive stress was measured by pulling the instrumented needle through the specimen and the resulting stress profiles were reproducible to within 20 per cent. Profiles obtained at different applied loads showed a similar distribution of stress within the disc, suggesting that the compressive stress at any location and direction increased in proportion to the applied load. Since transducer output was also proportional to applied load, it was reasoned that it must be proportional to compressive stress within the disc. The average vertical compressive stresses acting on various regions within a disc were calculated from the stress profiles and multiplied by the cross-sectional area of each region: the resulting force was then compared with the known applied force in order to assess the calibration coefficient of the transducer. Agreement between the two forces was good, indicating that the calibration coefficient established in a saline bath was applicable to disc tissues also. However, artifactual stress peaks could be generated if the transducer was pulled across a bony asperity. It is concluded that the transducer measures the mean compressive stress acting upon it within disc tissues. Errors associated with the technique are small compared to differences in stress distributions which occur naturally, for example when intervertebral discs are loaded to simulate different postures in a living person.

Adult↗

Internal intervertebral disc mechanics as revealed by stress profilometry.

A technique was developed for measuring the distribution of stress within loaded cadaveric intervertebral discs. A strain-gauged membrane mounted on the side of a 1.3-mm diameter needle was pulled through the disc at constant speed. The orientation of the membrane was changed by rotating the needle, so that profiles of vertical and horizontal components of compressive stress could be obtained. The measurements were reproducible and did not perturb the tissue to any significant extent. Stress profiles varied considerably between discs and were highly dependent on the severity of degenerative changes. They also showed that the mechanical behavior of individual disc tissues was dependent not only on their location, but also on the loading and loading history of the disc. The new insight into internal disc mechanics revealed by stress profilometry may lead to a greater understanding of the mechanisms of disc function and failure.

Aging↗

Radiographic and histologic effects of chondroitinase ABC on normal canine lumbar intervertebral disc.

Twelve dogs were divided into two equal groups and given lumbar intradiscal injections of 10, 50, or 100 U/ml of chondroitinase ABC reconstituted in sodium acetate buffer. Radiographs of the lumbar spine were made before and after surgery in both groups. Additional films were made at 5 days after surgery in Group I and at 7, 14, and 21 days after surgery in Group II. All spaces injected with 50 or 100 U/ml chondroitinase ABC demonstrated significant radiographic narrowing in both groups compared with uninjected control and buffer injected discs (P less than 0.001). Discs injected with 10 U/ml of chondroitinase ABC showed increased narrowing over time from 7 to 21 days (P less than 0.05). A zone of safranin O depletion was present in the ventral anulus fibrosus adjacent to the nucleus pulposus in all treated discs, indicating proteoglycan loss. All histologic effects of chondroitinase ABC were confined to intervertebral disc tissues. Chondroitinase ABC appears to be effective for chemonucleolysis in dogs.

Animals↗

The effect of fluid loss on the viscoelastic behavior of the lumbar intervertebral disc in compression.

A viscoelastic finite element model of a L2-L3 motion segment was constructed and used to study: (1) the behavior of the intervertebral disc with different amounts of nucleus fluid loss; and (2) the effect of different rates of fluid loss on the viscoelastic behavior of the disc. The results indicate that: (1) The viscoelastic behavior of the intervertebral disc depends to a large extent on the rate of fluid loss from the disc; the intrinsic properties of disc tissue play a role only at the early stage of compressive loading; (2) the axial strain increases, whereas the intradiscal pressure and the posterior radial disc bulge decrease with increasing fluid loss; (3) a decreasing fluid loss rate with a total fluid loss of 10 to 20 percent (from the nucleus) during the first hour of compressive loading best predicts the overall viscoelastic behavior of a disc.

Biomechanical Phenomena↗

In vivo temperature profile of intervertebral discs and vertebral endplates during vertebroplasty: an experimental study in sheep.

STUDY DESIGN: Experimental study of temperature profiles during vertebroplasty. OBJECTIVES: To define accurate temperature profiles during vertebroplasty in an in vivo animal model. SUMMARY OF BACKGROUND DATA: Controversy still exists whether vertebroplasty achieves its analgesic effect by stabilizing fracture fragments or due to thermal damage of sensory nerves inside the vertebral body. Furthermore, the energy release during cement polymerization may cause thermal injury to the spinal cord or intervertebral discs. METHODS: A total of 4.0 mL PMMA was injected into three lumbar vertebrae of four skeletally mature mixed-bred ewes. Nine separate K-type thermocouples were placed into 12 vertebrae and their adjacent intervertebral discs. Temperature changes were recorded continuously before, during, and after the injection. RESULTS: The highest peak temperatures were measured at the cranial endplate (mean 42.4 +/- 8.8 C) and in the center of the vertebral body (mean 43.3 +/- 6.9 C). Temperatures stayed above 40 C for approximately 2.5 minutes. Peak temperatures in the discs and at the dorsal wall (closest to spinal cord) did not exceed 41 C and 47 C and stayed above 40 C for approximately 1.5 minutes. CONCLUSIONS: The intervertebral discs and the spinal cord do not seem to be in danger of thermal damage during vertebroplasty. The measured energy does not seem to be sufficient for the palliative effect achieved by vertebroplasty.

Animals↗

Chymopapain for the treatment of intervertebral disc herniation. The final report of a double-blind study.

Sixty patients with unilateral sciatica resulting from lumbar intervertebral disc herniation were entered into a double-blind study. All patients had failed to respond to conservative management, and the diagnosis had been confirmed by metrizamide myelography. Following a randomized schedule, 30 patients had intradiscal injections of chymopapain, and 30 patients had intradiscal injections of an equivalent volume of normal saline solution. Two years after the injection, 77% of patients treated with chymopapain were assessed as moderately improved, compared with 47% of saline-injected patients. Fifty-seven percent of the chymopapain group were free of pain, compared with 23% in the saline group. Based on the late results of this study, chymopapain is recommended for the treatment of sciatica from intervertebral disc herniation when conservative measures have failed and before disc fragment excision is considered.

Analgesics↗

Factors influencing oxygen concentration gradients in the intervertebral disc. A theoretical analysis.

Oxygen concentration gradients in the intervertebral disc were calculated to examine the effects of exchange area and disc thickness on oxygen concentrations and oxygen flux into the disc. The concentration gradients were determined using the two-dimensional Poisson equation with experimental values for oxygen consumption rate and oxygen diffusion. The calculated gradients were steep, and the oxygen concentrations in the center of thick discs were low, in agreement with experimental gradients. The results support the hypothesis that maximum cell density in the disc is determined by nutrient supply and that exchange area and disc thickness are critical parameters.

Biological Transport↗

Mitochondrial dysfunction in the pathogenesis of intervertebral disc herniation: a mitochondrial related genome-wide Mendelian randomization analysis.

BACKGROUND: As a degenerative disease, the pathophysiology of intervertebral disc herniation (IDH) closely related to mitochondrial dysfunction. However, the specific molecular mechanisms involved have yet to be precisely established. METHODS: Here, we employed a two-sample, two-step Mendelian Randomization (MR) approach, along with summary-Data-Based MR, genetic colocalization, full phenomenon association analysis, and GO and KEGG enrichment analysis to investigate the genetical effects of mitochondrial dysfunction on IDH. RESULTS: From the intercross between mitochondrial-related genes and eQTLGen genes, we obtained seven genes (DMPK, EHHADH, SLC25A16, ME3, METTL17, TUFM, NDUFA13) with strong causal association with disc herniation. By SMR and genetic colocalization analysis, we further identify five key genes (EHHADH, METTL17, TUFM, NDUFA13, DMPK) as the direct causal tartgeted genes with no heterogeneity and pleiotropy in the SNPs of the genes. Full phenomenon Mendelian randomization was performed to determine possible side effects of the 5 targeting genes. Finally, we validated the expressions of key genes in the degenerative intervertebral discs tissues by qRT-PCR and double-immunofluorescence examinations, and the results were consistent with the MR analysis. CONCLUSIONS: Our study provided genetic support for the relationship between mitochondrial related genes and IDH, implicating potential therapeutic targets for future development. However, more basic experiments need to be finished to validate the role of key genes in the development of IDH.

Intervertebral Disc Displacement↗

Chymopapain for the treatment of intervertebral disc herniation. A preliminary report of a double-blind study.

Sixty patients with unilateral sciatica resulting from lumbar intervertebral disc herniation were entered into a double-blind study. All patients had failed to respond to conservative management, and the diagnosis had been confirmed by metrizamide myelography. Following a randomized schedule, 30 patients had intradiscal injections of chymopapain and 30 patients had intradiscal injections of an equivalent volume of normal saline solution. Complete relief of sciatica was obtained in 63% of patients treated with chymopapain, compared with 27% of saline-injected patients. Six weeks after the injection, 73% of patients treated with chymopapain and 37% of patients treated with saline solution considered that the treatment was successful. The success rate at six months was 80% for patients treated with chymopapain and 57% for saline-injected patients. From the preliminary results of this study, chymopapain is recommended for the treatment of sciatica from intervertebral disc herniation when conservative measures have failed and before disc fragment excision is considered.

Adult↗

Spontaneous regression of intervertebral disc calcifications in a child.

This article presents the case of a boy who complained of cervical and thoracic spine pain for the first time at the age of nine. Plain films of cervical and thoracic spine showed calcifications of intervertebral disc C4-C5, C5-C6, C6-C7 and D3-D4. The symptoms disappeared after conservative therapy. Plain films taken 16 months later showed spontaneous disappearance of all disc calcifications. This spontaneous regression of intervertebral disc calcifications in childhood has also been described in other cases reported in the medical literature. Except for the rare cases when disc calcifications are associated with disc herniation, the discovery of disc calcifications on a plain X-ray of a child corresponds to a benign abnormality.

Calcinosis↗

Accuracy of ultrasonic evaluation of lumbar intervertebral discs by an anterior approach.

The aim of this investigation was to evaluate the diagnostic accuracy of sonography of the lower lumbar intervertebral discs. The results in 50 patients were compared to lumbar myelography. A short description of the sonographic appearance of the normal and pathological lumbar disc is given. The sonographic examination was inconclusive in 18% of the patients because of obesity, meteorism or diminution of the intervertebral disc space. In nearly half of these patients a herniation was found at myelography and confirmed at surgery. The study revealed a sensitivity varying from 0.63 to 0.77. Compared to lumbar myelography and CT scanning we find this too low to support its addition in lumbar disc disease because of non-invasiveness or lack of radiation alone.

Humans↗