[Diseases of cervical intervertebral discs].
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Cervical Vertebrae↗
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Human lumbar apophyseal joint damage and intervertebral disc degeneration.
OBJECTIVES: To record the extent and location of lumbar apophyseal cartilage damage, and to ascertain if the extent of damage is correlated with the grade of disc degeneration, age, or both. METHODS: The extent and location of fibrillated areas of the apophyseal cartilage of the joint surfaces of 29 lumbar motion segments were examined using computer aided image processing of Indian ink stained areas, and degeneration of the associated intervertebral discs graded using the method of Nachemson. RESULTS: It was found that these joints showed a greater extent and prevalence of cartilage fibrillation than the knee, hip or ankle, with significant damage in specimens younger than 30 years. Damage was predominantly located peripherally, superiorly, and posteriorly in the concave superior apophyseal surfaces, and was predominantly peripheral and posterior in the inferior surfaces, with a tendency to be located inferiorly. There was a weak correlation between apophyseal joint damage and the intervertebral disc degenerative grade, but this was inconclusive, as both increased with age. CONCLUSIONS: The pattern of damage exhibited by superior joint surfaces is most probably caused by tension on collagenous joint capsule fibres which insert into the surfaces posteriorly, so producing an area of fibrocartilage unsuited to loadbearing. Tension on such fibres would be greatest during spinal flexion. The pattern of damage of the inferior surfaces lends some support to the hypothesis that their apices impact the laminae of the lumbar vertebra inferior to them, consequent upon the degeneration and narrowing of the associated intervertebral disc. The predominantly peripheral location of fibrillation of both superior and inferior surfaces may be associated with inadequate mechanical conditioning of marginal joint areas. Disc degeneration cannot be the initial cause of apophyseal fibrillation in most specimens. The study indicates a need for regular spinal exercise, starting at a young age.
Adolescent↗
[Diagnostics and treatment of intervertebral disc herniation].
The paper reviews procedures for treatment of intervertebral disc herniation in our Department, evaluating modern scanning methods and surgical procedures. A total of 173 cases aged 13-73 years are presented. Discectomy was performed at surgery, with recent cases also embracing intervertebral spondylodesis with the use of cages to restore intervertebral distance. Short-term follow-up of patients after surgery have been very encouraging.
Adolescent↗
Materials and design concepts for an intervertebral disc spacer. I. fiber-reinforced composite design.
The intervertebral disc is a complex joint anatomically and functionally. It may be displaced or damaged due to trauma or a disease process. To alleviate this condition, it may be necessary to remove the involved disc surgically and fuse the two adjacent vertebrae. Fusion is one option; however, replacing the damaged disc (or part thereof) with a suitable synthetic equivalent to allow near normal joint motion is more desirable. Unfortunately, the complex mechanical properties of the lumbar disc cannot be duplicated with homogeneous synthetic materials (polymers). To overcome this fundamental problem we have developed rational designs utilizing biocompatible thermoplastic elastomers of various stiffnesses (durometers) with and without fiber reinforcements. Our design consisted of three components analogous to the natural end plates, annulus, and nucleus. In this study only the fiber-reinforced design is considered. The variables examined in the present study included orientation of the fiber layers, number of fiber layers, and order of the reinforcing layers. The results of mechanical testing of the fiber reinforced disc spacer indicate that the range of compressive and torsional properties can be achieved. The results further demonstrate that properly developed, this design results in properties similar to the natural disc. Designs developed provided adequate compression and compression torsion properties for a synthetic spine disc spacer.
Biocompatible Materials↗
An atelocollagen honeycomb-shaped scaffold with a membrane seal (ACHMS-scaffold) for the culture of annulus fibrosus cells from an intervertebral disc.
The aim of this study was to investigate the possibility of using the atelocollagen honeycomb-shaped scaffold with a membrane seal (ACHMS-scaffold) for the culture of annulus fibrosus (AF) cells in tissue engineering procedures of intervertebral disc repair. AF cells from the intervertebral discs of Japanese white rabbits were cultured for up to 3 weeks in the ACHMS-scaffold to allow a high density, three-dimensional culture. Although the DNA content in the scaffold increased at a lower rate than in the monolayer culture, scanning electron microscopy data showed that the scaffold was filled with the grown AF cells and produced extracellular matrix on day 21. The amount of type II collagen and its mRNA expression by the scaffold cultured cells were determined using Western blotting and Northern blotting analyses, respectively, and remained at a higher level than in the monolayer cultured cells. Furthermore, glycosaminoglycan (GAG) accumulation in the scaffold culture was at a higher level than in the monolayer culture. Western blot analysis for extracted proteoglycans from the scaffold culture also exhibited a much higher proteoglycan accumulation than the monolayer culture. These results indicate that the AF cells are able to grow and remain phenotypically stable in the scaffold.
Animals↗
Comparative development of thoracic intervertebral discs and intra-articular ligaments in the human, monkey, mouse, and cat.
Developmental features of thoracic intervertrebral discs and their association in the adult with other vertebral structures were investigated in four species. The human anulus fibrosus, nucleus pulposus, and intra-articular ligaments were compared to those of the fetal rhesus monkey, mouse, and kitten. Photomicrographs of transverse sections of intervertebral discs document the presence of intra-articular ligaments in fetuses of these four species. Both transverse and sagittal sections of kittens were used to identify the intercapital ligament as it differentiated from the dorsal part of the intra-articular ligament. Relatively frequent dorsal herniation of the thoracic nucleus pulposus in humans may be due to the vestigial nature of the human intra-articular ligament. Quadrupeds have well-developed intra-articular ligaments, which explains anatomically the paucity of dorsal protrusions of the nucleus pulposus into the vertebral canal in the thoracic region of the cat and mouse when compared to the human. The intra-articular ligament was closely associated with the developing prenatal mammalian intervertebral disc in the four species studied, and this relationship and its surgical importance are described.
Anatomy, Comparative↗
Computed tomography in the diagnosis of prolapsed intervertebral disc.
In thirty-nine out of forty-one patients with radicular pain in the lumbar region, prolapse of the intervertebral disc could be diagnosed by computed tomography without intrathecal administration of contrast medium. In one patient a paravertebral tumour (malignant neurilemmoma) was found. One case could not be diagnosed by computed tomography. Myelographic findings in the patients corresponded with those of computed tomography, and the findings in CT scans made immediately after myelography. The technical requirements for non-invasive CT of the intervertebral disc are discussed.
Humans↗
A finite element analysis of the influence of surgical herniation on the viscoelastic properties of the intervertebral disc.
The purpose of this paper was to study the influence of surgical herniation on the viscoelastic properties of the intervertebral disc. The work was broken down into two phases: experimentation and analysis. In the first step of experimentation, five specimens were excised from the L1-L2 level of young adult rhesus monkeys. The prepared specimen consisted of the intervertebral joint and the two adjacent vertebral centrums without either the posterior elements or associated soft tissue. The specimens were subjected to a constant compressive load for eight hours followed by a sixteen hour relaxation time. During all the load cycles, displacement of the specimens was measured with an LVDT. After the first compressive test, the specimens were herniated and then the compressive test repeated. In the second phase of the work, a viscoelastic axisymmetric finite element model was used to quantify the experimental data. A three parameter Kelvin solid was employed in the finite element model. The results of this paper will be used to construct a dynamic model for the vertebral column.
Animals↗
Sustained loading generates stress concentrations in lumbar intervertebral discs.
STUDY DESIGN: Cadaveric motion segment experiment. Measurements on each specimen were compared before and after creep loading. OBJECTIVES: To show how sustained "creep" loading affects stress distributions inside intervertebral discs. SUMMARY OF BACKGROUND DATA: The central region of an intervertebral disc acts like a hydrostatic "cushion" between adjacent vertebrae. However, this property depends on the water content of the tissues and may be lost or diminished after creep. METHODS: Twenty-seven lumbar motion segments consisting of two vertebrae and the intervening disc and ligaments were loaded to simulate erect standing postures in life. The distribution of compressive stress in the disc matrix was measured by pulling a miniature pressure transducer through the disc in the midsagittal plane. Profiles of vertical and horizontal compressive stress were repeated after each specimen had been creep loaded in compression for 2-6 hours. RESULTS: Creep reduced the hydrostatic pressure in the nucleus by 13-36%. Compressive stresses in the anulus were little affected when the profiles were measured at 1 kN, but at 2 kN, localized peaks of compressive stress appeared (or grew in size) in the posterior anulus after creep. CONCLUSIONS: Increased loading of the apophysial joints causes an overall reduction in intradiscal stresses after creep. In addition, water loss from the nucleus causes a transfer of load from nucleus to anulus. Stress concentrations may lead to pain, structural disruption, and alterations in chondrocyte metabolism. Disc mechanics depend on loading history as well as applied load.
Adult↗
Structural studies of collagen fibres from intervertebral disc.
A combined biochemical, X-ray and electron microscopic study is presented on the molecular structure of bovine and human intervertebral disc. Positively stained electron micrographs of Type I and Type II collagen are shown to have slightly but significantly different banding patterns. New low-angle meridional patterns from different anatomical parts of the intervertebral disc are reported from native and trypsin-extracted discs. Qualitative measurements of these intensities lead to the conclusion that in the nucleus pulposus of the disc, another molecule, probably proteoglycan, is ordered on the collagen fibrils at the axial level of the gap region.
Animals↗
Body mass index and height in patients requiring surgery for lumbar intervertebral disc herniation.
The immediate preoperative body mass index and standing body height of 1128 patients who underwent surgery for lumbar intervertebral disc herniation were compared in a cross-sectional study with the corresponding values obtained from a general population sample. The material was divided into sex- and age-specific subgroups. To delineate possible differences, the 99% confidence intervals for the anthropometric mean values were constructed instead of hypothesis testing. With the exception of the oldest age group, from 50 to 59 years, the patients who underwent surgery for a disc herniation were more obese and taller than the population on average in all other sex- and age-specific subgroups. The major contrast emerged in women aged 20-29 years, in whom the 99% confidence interval for the mean body mass index of the patients undergoing surgery on was 25.1-27.3 kg/m2 versus 22.3-23.1 kg/m2 in the general population. In patients aged 20-39 years the mean body mass index was increased also when the body height of the patients was less than the mean value of the general population samples. Both an increased body mass index and a tall stature seem to have a clear association with those severe lumbar intervertebral disc herniations that require operative treatment.
Adult↗
MRI of the ageing and herniating intervertebral disc.
The role of diagnostic imaging from the patient's perspective is to provide answers to four basic questions:--what is wrong?, How bad is it?, Is it clinically relevant?, Can it be treated? In the assessment of spinal disorders, multiple modalities have evolved in an attempt to answer the questions poised. Without doubt, the advent of MRI has given this process significant benefits primarily because of the unparalleled way of depicting normal and abnormal tissues in a non-invasive manner. In particular, MRI is admirably suited to study the intervertebral disc and goes a long way in answering the first two questions, aiding in the accurate analysis of disc morphology, defining pathological states, and delineating the extent and effect of disease. This information however, needs to be equated with the clinical signs and symptoms before any decisions concerning treatment options can be made. At this point one needs to exercise some degree of prudence and remember that MRI as yet does not differentiate abnormal asymptomatic from symptomatic painful disc levels. Enhancement with gadolinium compounds may go some way in providing some answers by defining the tissue response at or around the damaged points within the disco-vertebral unit. Modern MRI scanners and techniques demonstrate exquisitely, the structural status of the disc but the functional impact of these structural alterations cannot as yet be fully determined by MRI--there lies the challenge for the future. This article reviews the current MRI knowledge concerning the ageing and herniating intervertebral disc in a clinical context, and critically appraises its present role in a practical fashion.
Aged↗
Neutral protease inhibitors from human intervertebral disc and femoral head articular cartilage.
Assays of several proteases, incorporating guanidinium chloride extracts of human femoral head cartilage and intervertebral disc, demonstrated that both tissues contain inhibitors of certain serine proteases. Trypsin, chymotrypsin and a granule extract of human polymorphonuclear leukocytes containing elastase and cathepsin G activities, were inhibited by low molecular weight fractions prepared by Sephadex G-75 chromatography. Using a radioassay, it was further shown that these fractions inhibit proteolysis of cartilage proteoglycan. The inhibitor in intervertebral disc is concentrated in the nucleus pulposus, with a decreasing gradient to the periphery of the annulus fibrosus. It is proposed that these inhibitors confer at least partial protection against pathological proteolysis of the proteoglycans in human articular cartilage and nucleus pulposus.
Animals↗
Antenatal differentiation of the human intervertebral disc.
To study the antenatal differentiation of the human intervertebral disc, the columns of forty eight embryos and fetuses were examined histologically. The primitive disc is composed of two structures: the notochord which shows a progressive expansion into the disc, and the fibro-cartilaginous perinotochordal disc. No histological sign of interaction between notochordal and perinotochordal cells, which may explain the notochordal expansion into the discs, was seen. On the other hand, the notochordal intervention in the cartilaginous differentiation of the inner zone is probable.
Gestational Age↗
Intervertebral disc biomechanical analysis using the finite element modeling based on medical images.
In this paper, a 3D geometric model of the intervertebral and lumbar disks has been presented, which integrated the spine CT and MRI data-based anatomical structure. Based on the geometric model, a 3D finite element model of an L1-L2 segment was created. Loads, which simulate the pressure from above were applied to the FEM, while a boundary condition describing the relative L1-L2 displacement is imposed on the FEM to account for 3D physiological states. The simulation calculation illustrates the stress and strain distribution and deformation of the spine. The method has two characteristics compared to previous studies: first, the finite element model of the lumbar are based on the data directly derived from medical images such as CTs and MRIs. Second, the result of analysis will be more accurate than using the data of geometric parameters. The FEM provides a promising tool in clinical diagnosis and for optimizing individual therapy in the intervertebral disc herniation.
Biomechanical Phenomena↗
Intradural herniation of lumbar intervertebral discs.
A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression.
Adult↗
Monitoring water content in deforming intervertebral disc tissue by finite element analysis of MRI data.
Mechanical loading, occurring during normal daily life, causes fluid to be expelled from intervertebral discs. Excessive fluid loss during heavy loading might make the disc more vulnerable to damage. In this study, fluid loss was investigated in vitro through monitoring the loss of MRI signal intensity in four bovine coccygeal intervertebral discs, compressed at 2000 N during 1.5 hr. The MRI signals were analyzed with the aid of finite element models to account for the deformation of the tissue. A gradual signal loss over time was found during loading, the most pronounced loss occurring in the central disc region. Initial patterns of signal distribution were quite variable between specimens but repeatable within specimens.
Animals↗