Surgical management of lumbar intervertebral-disc disease.
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Humans↗
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Detection of lymph and blood vessels in the human intervertebral disc by histochemical and immunohistochemical methods.
Twenty-four intervertebral discs from the lumbar region of postmortem human subjects were investigated by immunohistochemical and histochemical methods to evaluate the pattern of blood and lymph vessels of the discus intervertebralis and surrounding tissue at different ages. Antibodies against the basement membrane component laminin, and the lectin Ulex europaeus agglutinin as a marker for L-fucose in endothelial cells, were used to make the blood vessels visible. The 5'-nucleotidase activity in lymph endothelium served as a marker for lymphatic vessels. The dorsolateral parts of the connective tissue adjacent to the discus intervertebralis were well vascularized in all age groups examined. Vessels in the outer anulus fibrosus were detected in young individuals up to 20 years of age. Vascular canals, i.e. blood vessels in the cartilage end plate, were seen up to 7 years of age. Lymph capillaries are first described here penetrating the disc and peridiscal tissue and accompanying most of the small blood vessels into the areas specified.
5'-Nucleotidase↗
Fifty-six cases of protrusion of lumbar intervertebral disc treated by penetration and oral administration of Chinese decoction plus traction.
Fifty-six cases of the protrusion of the lumbar intervertebral disc in the treatment group were treated by drug-penetration and oral administration of traditional Chinese decoction plus traction, and the other 35 cases in the control group by oral administration of Chinese decoction and traction. The results showed that the cure rate in the treatment group was 83.9%, and that in the control group was 57.1%, with a statistically significant difference between the two groups (P < 0.01), indicating that the former is a more effective therapy for protrusion of the lumbar intervertebral disc.
Adult↗
Elastic fibre organization in the intervertebral discs of the bovine tail.
Elastic fibres have been revealed by both elastin immunostaining and conventional histological orcein-staining in the intervertebral discs of the bovine tail. These fibres are distributed in all regions of the disc but their organization varies from region to region. In the centre of the nucleus, long (> 150 microm) elastic fibres are orientated radially. In the transitional region between nucleus and annulus, the orientation of the elastic fibres changes, producing a criss-cross pattern. In the annulus itself, elastic fibres appear densely distributed in the region between the lamellae and also in 'bridges' across the lamellae, particularly in the adult. Elastic fibres are apparent within the lamellae, orientated parallel to the collagen fibres of each lamella, particularly in the young (12-day-old) discs. In the region between the disc and the cartilaginous endplate, elastic fibres appear to anchor into the plate and terminate there. The results of this study suggest that elastic fibres contribute to the mechanical functioning of the intervertebral disc. The varying organization of the elastic fibres in the different regions of the disc is likely to relate to the different regional loading patterns.
Animals↗
Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus. Case report.
The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.
Adult↗
Collagenolytic enzyme systems in human intervertebral disc: their control, mechanism, and their possible role in the initiation of biomechanical failure.
Changes in the macromolecular matrix of the intervertebral disc may predispose to biomechanical failure of the disc. Such changes would involve extracellular enzymes capable of altering the collagen and proteoglycan of the disc matrix. In this study, extracts from homogenates of both annuli fibrosi and nuclei pulposi of human lumbar discs were found to contain neutral collagenolytic, gelatinolytic, and elastinolytic enzymes in all samples assayed. The specific activity of the collagenase was higher in extracts from nuclear than from annular tissue, a difference not seen with gelatinase or elastase. The collagenase was present as both a latent and active enzyme, the other enzymes being fully active. Human intervertebral discs therefore contain enzymes capable of degrading their extracellular macromolecular matrix.
Age Factors↗
Expression of type II procollagens during development of the human intervertebral disc.
Mice lacking type II collagen fail to develop intervertebral discs. The present study describes the distribution of the developmentally expressed type IIA procollagen molecule, as well as types I and III collagens, in human IV disc specimens ranging from 42 to 101 days gestation. Type IIA procollagen contains the alternatively spliced exon 2 which encodes a 69-amino-acid cysteine-rich domain. By radioactive in situ hybridization and fluorescence immunohistochemistry, we identified changes in the localization patterns of type IIA procollagen, particularly between days 54 and 101. At day 54, the developing disc was divided into the outer annulus containing types I and III collagens, the inner annulus containing type IIA procollagen and the notochord consisting of all three fibrillar collagens. Specifically, the IIA N-terminal propeptide was localized in the extracellular matrix at day 54 but, by day 101, was only observed in the cytoplasm of the inner annulus cells. A functional role for the IIA N-terminal propeptide during this specific stage of disc development seems apparent. This function may involve regulation of growth factors since the exon 2-encoded domain of type IIA procollagen has previously been shown to bind to bone morphogenetic protein-2 and transforming growth factor-beta. We aim to explore this mechanism further.
Animals↗
[Pathogenic factors of blood circulation disturbance in lumbar intervertebral disc herniation and mechanism of Tuina manipulation in promoting circulation].
Tuina manipulation has long been used in the treatment of lumbar intervertebral disc herniation, although its therapeutic mechanisms remain uncertain. The specific characteristic syndrome of this disease is lumbocrural pain in varying degrees, which is due to mechanical compression, aseptic inflammation, blood circulation disturbance and dystrophy. These factors can act on the involved nerve roots and give rise to nerve conduction disturbance. Since the blood circulation disturbance and nerve roots dystrophy are the most important pathogenic aspects of this disease, the therapeutic effect of Tuina manipulation on lumbar intervertebral disc herniation is related to them directly or indirectly.
Decompression, Surgical↗
Bone ingrowth fixation of artificial intervertebral disc consisting of bioceramic-coated three-dimensional fabric.
STUDY DESIGN: The bone-bonding characteristic of the new artificial intervertebral disc consisting of bioceramic-coated three-dimensional fabric was evaluated mechanically and histologically in an in vivo sheep model. OBJECTIVES: To investigate the mechanical properties and the histologic appearance of the interface between the three-dimensional fabric disc and the vertebral body, and to evaluate these alterations in vivo under a spinal segmentally mobile condition. SUMMARY OF BACKGROUND DATA: Bone ingrowth to the bioceramic-coated three-dimensional fabric surface had been demonstrated already under a stable environment in preliminary animal studies. METHODS: For this study, 20 sheep underwent two-level lumbar intervertebral disc replacement with three-dimensional fabric discs (Group I) or bioceramic spacers as a comparative material (Group II). All operative segments were stabilized temporarily with spinal instrumentation for the initial ingrown phase. Four animals each were killed at 4, 6, 15, and 24 months in Group I and at 6 months in Group II, and the operative segments were subjected to either a detachment test or histologic evaluation. RESULTS: The interfacial tensile strength at 6 months was significantly higher in Group I than in Group II. No significant decrease in tensile strength was detected until 24 months after surgery in Group I. Histologically, bone ingrowth to the three-dimensional fabric surface was observed 4 months after surgery, and no aseptic loosening occurred until 24 months after surgery. CONCLUSIONS: The findings show that the three-dimensional fabric disc was firmly fixed to the vertebral body by bone ingrowth, and that this biologic fixation was preserved even under the spinal segmentally mobile condition.
Animals↗
An epidemiological study of acute prolapsed cervical intervertebral disc.
In this epidemiological study of acute prolapsed cervical intervertebral disc, we found that people in the fourth decade of life were affected somewhat more frequently than individuals in other age groups, and men with a prolapsed cervical disc outnumbered women by a ratio of 1.4 to one. Factors that were associated relatively strongly with this diagnosis were frequent lifting of heavy objects on the job that was held around the time of the onset of symptoms, cigarette-smoking, and frequent diving from a board. Positive associations that were of borderline statistical significance or were not statistically significant were found with operating or driving vibrating equipment and time spent in motor vehicles. Variables that did not appear to affect the risk for a prolapsed cervical disc included participation in certain sports other than diving, frequent wearing of shoes with high heels, the number of pregnancies or live births, frequent twisting of the neck on the job, time spent sitting on the job, and smoking cigars or a pipe.
Acute Disease↗
Aspartic acid racemization in intervertebral discs as an aid to postmortem estimation of age at death.
We investigated whether measurement of aspartic acid racemization in intervertebral discs (IVD) could be used in the postmortem estimation of age at death. The extent of aspartic acid racemization in IVD tissues was found to increase with age. The rate of racemization turned out to be much higher in the nucleus pulposus than in the annulus fibrosus. The relation between age and the D-aspartic acid content in the anterior peripheral annulus fibrosus of IVD was close enough to allow postmortem estimation of age at death based on the extent of aspartic acid racemization in this tissue.
Adolescent↗
Mechanisms of age-related decline in insulin-like growth factor-I dependent proteoglycan synthesis in rat intervertebral disc cells.
STUDY DESIGN: Age-related fluctuations in insulin-like growth factor-I dependent proteoglycan synthesis in rat intervertebral disc cells were investigated. OBJECTIVES: The purpose of this study was to determine whether synthetic responses to insulin-like growth factor-I decline with age and to explore the possibility that an age-related increase in the expression of insulin-like growth factor binding proteins suppresses matrix synthesis in intervertebral disc cells. SUMMARY AND BACKGROUND DATA: Several studies have reported that the responsiveness of chondrocytes to insulin-like growth factor-I decreases with age and furthermore that this phenomenon may be related to increased expression of insulin-like growth factor binding proteins by chondrocytes. MATERIALS AND METHODS: Nucleus pulposus tissue and cells were obtained from the coccygeal vertebrae of 8-week-old, 40-week-old, and 120-week-old rats. Age-related changes in the expression of insulin-like growth factor-I and its receptor were assessed together with insulin-like growth factor-I dependent proteoglycan synthesis by the cultured nucleus pulposus cells. Also, western blot analysis of insulin-like growth factor binding protein-1 was carried out, and further examination was performed of insulin-like growth factor-I signal transduction through tyrosine phosphorylation of insulin receptor substrate-1, which is a signal transducer of insulin-like growth factor-I. RESULTS: Semiquantitative reverse transcription polymerase chain reaction analysis indicated that the expression of insulin-like growth factor-I receptor in 120-week cells decreased clearly in comparison with the cells of younger animals. By contrast, insulin-like growth factor-I dependent proteoglycan synthesis decreased with age, and the sharpest decline of synthesis was found between 8-week and 40-week cells, although the level of insulin-like growth factor-I/insulin-like growth factor-I receptor gene expression was maintained in 40-week-old animals. Consistent with the results of proteoglycan synthesis, the expression of phosphorylated insulin receptor substrate-1 decreased with age. Thus, the expression of insulin-like growth factor binding protein-1 and proteoglycan synthesis was investigated by use of Long R3 insulin-like growth factor-I, which was not influenced by insulin-like growth factor binding proteins. Insulin-like growth factor binding protein-1 was strongly expressed in 40-week cells in comparison with the expression in 8-week cells. Furthermore, proteoglycan synthesis in 40-week cells supplemented with Long R3 insulin-like growth factor-I was upregulated in comparison with that in 40-week cells supplemented with insulin-like growth factor-I. CONCLUSION: The present findings indicate that the age-related decline in insulin-like growth factor-I dependent proteoglycan synthesis in nucleus pulposus is caused, at least in part, by the increase in insulin-like growth factor binding proteins at the early stages of aging, and further suggest that a loss of proteoglycan synthesis during the late stages of aging is caused by the downregulation of insulin-like growth factor-I receptor in addition to an increase in insulin-like growth factor binding proteins.
Aging↗
An epidemiological study of acute herniated lumbar intervertebral discs.
In an epidemiological study of acute herniated lumbar intervertebral discs in the New Haven, Connecticut (U.S.A.), area, it was found that this condition was most likely to be diagnosed among persons in the age group 30-39 years, and that the most important risk factors among the variable considered in this study were driving of motor vehicles at or away from work, sedentary occupations, suburban residence, and previous full-term pregnancies. Variables for which there was some suggestion of an association but for which the evidence was inconclusive were the male sex, high social class among females, chronic cough and chronic bronchitis, participation in baseball, golf and bowling, the spring and fall seasons, and possibly lack of physical activity other than at work. No increase in risk for this condition was related to race, social class in males, smoking habits, participation in sports other than baseball, golf and bowling, weight or body bulk, recent episodes of emotional stress, pregnancies which were not full-term, and jobs involving lifting, pushing, pulling, or carrying.
Adult↗
Effect of running exercise on proteoglycans and collagen content in the intervertebral disc of young dogs.
Collagen and proteoglycans in the intervertebral disc (LI-II) of young beagle dogs (age 55 weeks) were analyzed following a 15 weeks' daily 20 km running training on a treadmill with 15 degree uphill inclination. In nucleus pulposus no statistically significant alterations were found in the content of proteoglycans or collagen. In annulus fibrosus the total tissue wet weight and total amount of collagen (hydroxyproline) increased by 34-36% in the runners as compared to age-matched, untrained controls. Since the total amount of proteoglycans did not increase, the annulus fibrosus became relatively depleted of proteoglycans, as indicated by the 27% reduction in uronic acid concentration, expressed either per wet weight or hydroxyproline. The average molecular size of the remaining nonaggregating proteoglycans was larger, and there was also a trend towards increased proportion of proteoglycans aggregating with hyaluronan. Most of the chondroitin sulfate side chains were 6-sulfated (65-66%). Running did not alter the sulfation or length of the chondroitin sulfate chains. The decreased proteoglycan/collagen ratio in annulus fibrosus may result in altered mechanical properties of the tissue and reflects its adaptation to enhanced motion and stress.
Animals↗
The effect of age on intervertebral disc compression during running.
Previous studies have shown that intervertebral discs compress under axial loading, yet few studies have examined the relationship between disc age and compressibility. The purpose of this study was to determine if the amount of vertebral column height (VCH) loss induced by running was significantly different between two age groups, 17 males ages 20-27 years and 14 males ages 50-57 years, who could comfortably run 6 miles. The subjects had no previous or current back pathologies. Within 1.5 hours of rising in the morning, each subject's VCH was measured from spinous processes C7 to S2. Immediately following the measurement, each subject ran a predetermined, paved, 6-mile course at a comfortable pace. Within minutes after completing the run, each subject was again measured for VCH. Paired t tests revealed significant decreases in VCH after the run in both groups. An independent t test showed no significant differences between the respective age groups in terms of postrun VCH decreases. Although no significant differences were noted between groups, this study has demonstrated that both age groups experienced significant decreases in VCH after a 6-mile run. These findings have implications for physical therapy for younger and older male patients who may have back pathologies and require an exercise program. Patients may be advised to limit running due to possible exacerbation of back symptoms.
Adult↗
Anatomy of intervertebral disc and pathophysiology of herniated disc disease.
This discussion reviews developments in normal and abnormal disc biology over the past decade. The anatomic and biochemical structure of the disc is reviewed. Emphasis is placed on recent neurochemical changes identified in disc degeneration and disc herniation. Biomechanical considerations for the normal disc are presented. Influence of mechanical factors on disc nutrition, disc degeneration and disc herniation is reviewed. Biologic events underlying the diagnostic methods used in evaluating disorders of the intervertebral disc are presented. The biologic consequences of iatrogenic disc injury in discectomy are also discussed.
Adolescent↗
Changes in proteoglycans of intervertebral disc in diabetic patients. A possible cause of increased back pain.
STUDY DESIGN: Characterization of the analytic profile of proteoglycans in the intervertebral discs at L4-L5 of nondiabetic (n = 5) and diabetic (n = 5) age-matched subjects. The discs used were discarded material from operations. OBJECTIVES: To clarify the reason for the higher risk of disc prolapse in diabetic patients. SUMMARY OF BACKGROUND DATA: The pathogenesis of diabetes results from a combination of neurologic dysfunctions and a yet undefined metabolic failure, which leads to an abnormal proteoglycan profile. METHODS: The following methods were used to determine the proteoglycan profile: the measurement of 35S-sulfate uptake per gram wet tissue into sulfated glycosaminoglycan using fresh tissue explants; extraction of proteoglycans by 4 M guanidinium chloride containing protease inhibitors, with further purification by ultracentrifugation on cesium chloride buoyant density gradient under dissociative conditions; total uronic acid and protein contents in the various gradient fractions; assessing the length of sugar side chains of isolated 35Sulfate-glycosaminoglycan molecules by separation of the glycosaminoglycan molecules on a Sepharose 6B-CL column; and paper chromatography of the final digest products of glycosaminoglycan molecules obtained by chondroitinase ABC, a glycosaminoglycan-degrading enzyme. RESULTS: The findings show that discs from normal nondiabetic subjects have 15 times the rate of 35Sulfate incorporation into glycosaminoglycan molecules than do discs of diabetic patients. The proteoglycans of diabetic patients are banded at a lower buoyant density, indicating a lowered glycosylation rate and a lower number of sugar side chains per core protein. In discs of diabetic patients, there is a slight increase in the chain length of chondroitin sulfate. Further analysis of the glycosaminoglycan chains showed a decreased amount of keratan sulfate, compared with that in nondiabetic subjects. However, the total uronic acid content of the disc tissues and the ratio of uronic acid to protein of each fraction were unchanged in diabetic patients versus that in control subjects. CONCLUSIONS: Discs in patients with diabetes have proteoglycans with lower buoyant density and substantially undersulfated glycosaminoglycan, which with the specific neurologic damage in these patients, might lead to increased susceptibility to disc prolapse.
Aged↗
Is atopic dermatitis a risk factor for intervertebral disc degeneration? A preliminary clinical and MRI study.
Atopic dermatitis (AD) is a common allergic disease that has recently been reported to be complicated with acute myelitis. To clinically evaluate the occurrence of myelitis in AD, 65 consecutive AD patients were neurologically examined. Of these, 37 underwent cervical MRI scans. Unexpectedly, the neurologic and MRI findings did not suggest myelitis, but rather, in most cases, cervical spondylosis. Therefore, we assessed the relationship between AD and cervical spondylosis. In addition, cervical MRI findings in 26 patients with multiple sclerosis (MS) and in 12 normal controls were also evaluated. The neurologic examinations in the AD patients frequently showed hyperreflexia in the legs, and sensory and motor disturbances were often present in the limbs. Cervical MRI findings suggestive of spondylosis, such as intervertebral disc degeneration and bulging/protrusion, were found more frequently in AD patients than in MS patients, with statistical significance. Posterior spondylolisthesis was observed with higher frequency in AD and MS patients than in normal controls. We concluded that AD might be a risk factor for intervertebral disc degeneration. As far as we know, this is the first paper describing the potential association between disc degeneration and AD.
Adolescent↗