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PubMed2006

Topographical guidance of intervertebral disc cell growth in vitro: towards the development of tissue repair strategies for the anulus fibrosus.

The anulus fibrosus (AF) of the intervertebral disc consists of concentric sheets of collagenous matrix that is synthesised during embryogenesis by aligned disc cells. This highly organised structure may be severely disrupted during disc degeneration and/or herniation. Cell scaffolds that incorporate topographical cues as contact guidance have been used successfully to promote the healing of injured tendons. Therefore, we have investigated the effects of topography on disc cell growth. We show that disc cells from the AF and nucleus pulposus (NP) behaved differently in monolayer culture on micro-grooved membranes of polycaprolactone (PCL). Both cell types aligned to and migrated along the membrane's micro-grooves and ridges, but AF cells were smaller (or less spread), more bipolar and better aligned to the micro-grooves than NP cells. In addition, AF cells were markedly more immunopositive for type I collagen, but less immunopositive for chondroitin-6-sulphated proteoglycans than NP cells. There was no evidence of extracellular matrix (ECM) deposition. Disc cells cultured on non-grooved PCL did not show any preferential alignment at sub-confluence and did not differ in their pattern of immunopositivity to those on grooved PCL. We conclude that substratum topography is effective in aligning disc cell growth and may be useful in tissue engineering for the AF. However, there is a need to optimise cell sources and/or environmental conditions (e.g. mechanical influences) to promote the synthesis of an aligned ECM.

Animals↗
PubMed1999

Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients.

To study the functional outcomes of patients with cervical herniated intervertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectively identified by chart reviews. Inclusion criteria were (a) cervical radiculopathy with defined neurological disturbances (sensory disorder, reflex abnormalities, and motor weakness); (b) a spinal computed tomograph scan or magnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacological treatment. Of 119 consecutive patients who were treated at the Departments of Neurology and Neurosurgery, University of Erlangen-Nuremberg, between January 1, 1985, and December 31, 1995, 60 patients met the inclusion criteria and were prospectively assessed, with an average follow-up time of 5.5 years. The patients were interviewed with regard to their daily activities, ability to work, and the surgical treatment they had undergone. A complete neurological examination also was performed. In 88.3%, the onset of disease was acute and in 11.7% subacute or chronic. The most common signs and symptoms were brachialgia (98.3%), neck pain (93.3%), sensory disorders (88.3%), reflex abnormalities (61.7%), and motor weakness (51.7%). The neuroimaging procedures demonstrated a disc prolapse (soft disc) in approximately 90% and spondylotic osteophytes (hard disc) in approximately 10%. During an average follow-up time of 5.5 years (range, 4.6 months-10.6 years) 39 (65%) patients had been treated using only conservative methods (COG = conservatively treated group), and 21 (35%) patients had undergone surgery (ventral discectomy) (SUG = surgically treated group). Brachialgia was completely or essentially improved in 100% of the COG and 95.1% of the SUG. Sensory disorders remitted completely or markedly in 97% of the COG and 75% of the SUG. The reflex abnormalities normalized or improved in 59.2% of the COG and in 53.3% of the SUG. Motor weakness improved in 94.1% of the COG and in 50% of the SUG. Neck pain was difficult to treat. It improved in only 36.1% of the COG and in 20% of the SUG. Occupational capacity was lost in 10% of the COG and in 38.9% of the SUG. In a self-rating scale, 89.7% of patients in the COG did not feel disabled in their everyday activities, compared with 66.7% of the patients in the SUG. Patients with a herniated cervical intervertebral disc with radiculopathy can be treated conservatively with good results, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neurological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropriate conservative treatment for a reasonable time has failed.

Adult↗
PubMed1993

[An experimental study on the pathological changes of the intervertebral disc and its surrounding tissues after intradiscal injection of various chemical substances (the first report)].

The author has investigated the possible clinical application of new suitable and reliable substances for intradiscal therapy. MATERIALS AND METHODS; Several concentrations of various chemical substances (HCl, NaOH, etc.) were injected into the lumbar intervertebral discs of 165 Japanese white rabbits. These animals were sacrificed periodically and the obtained disc specimens were submitted to histological examinations with light and electron microscopes. Effects of these substances on the dura mater and the spinal cord of 87 guinea pigs were also investigated histologically. RESULTS; Acids, bases and ethanol, especially in high concentration, caused intense necrosis of nucleus pulposus cells and degeneration of the matrix as well as destruction of the annulus fibrosus occasionally with necrosis of endplate cells. Narrowing of disc height was frequently observed. Hemorrhage and inflammatory changes of surrounding tissues including the dura mater and the spinal cord were not rare. While low concentration acids and bases as well as other chemical substances such as osmic acid and phenol showed somewhat confined changes to the nucleus pulposus with minimal changes to peridiscal tissues including the neural structures. In other words, changes induced by these chemical substances were circumscribed to the nucleus pulposus, provided the concentration of the substances were adjusted to an appropriate level. DISCUSSIONS; Recently, chemonucleolysis and percutaneous discectomy have been recognized as alternatives to surgical treatments for lumbar disc herniation and seemed to have established a new concept "intermediate therapy". However, each method has certain disadvantages as well. The purpose of the present study is to find out safer and reliable agents that can dissolve the nucleus pulposus without adverse side effects such as anaphylaxis or transverse myelitis that occurs with some nucleolytic enzymes. In this perspective, the results of this study have provided evidences that certain chemical substances have possible clinical application in intradiscal therapy.

Animals↗
PubMed2002

Insertion of PCB to treat traumatic cervical intervertebral disc herniation.

OBJECTIVE: To evaluate the clinical effect of PCB (a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate) in treating traumatic cervical intervertebral disc herniation. METHODS: Anterior decompression and PCB internal fixation were used in 22 patients with traumatic cervical intervertebral disc herniation. They were followed up from 3 to 16 months and analyzed by symptom and image data. Among them, 16 patients underwent fixation at one level and 6 patients at two levels. RESULTS: This technique did not cause intraoperative complications. After surgery no screw backout or device failure was found. Based on the JOA grade, 20 patients improved clinically and 2 gently because of serious cervical stenosis. The general excellent rate was 90.9%. CONCLUSIONS: PCB internal fixation is stable. Morbidity of donor and acceptor sites is less. No collars are needed after surgery.

Adult↗
PubMed2006

Auto fluorescence of intervertebral disc tissue: a new diagnostic tool.

The paper reports on auto fluorescence phenomena of inter-vertebral human discs. It systematically investigates the auto fluorescence effects of ex vivo disc specimen and reports on surgical cases to demonstrate the potential value of the new method. The paper offers biologic explanations of the phenomenon and discusses the potential value of the UV auto fluorescence technique as a diagnostic tool. Intra- and postoperative observations are made by a surgical microscope with an integrated UV light source. Quantitative measurements were carried out using a photon counter and a spectrometer ex vivo. The auto fluorescence phenomenon allows the differentiation of traumatized and degenerated disc tissue intraoperatively in some cases, it allows the differentiation of bony and collagen endplate in cervical disc surgery. The source of the auto fluorescent light emission are amino acids of the collagen molecules. The proteoglycan components and the liquid components of the disc do not show relevant auto fluorescence. Emission wavelength of disc material is equivalent to color perception. It differs due to different collagen composition of the intervertebral disc components from yellow-green to blue-green and can be visualized in situ by naked eye.UV-auto fluorescence of inter-vertebral discs is a new clinical tool that has the potential to differentiate disc material from the anatomical surrounding, to distinguish between different fractions of the disc and to give information on the quality and status of the disc material. Since the technology has just emerged, it needs further investigations to quantify the clinical observations reported in this paper.

Amino Acids↗
PubMedDate not supplied

Correlation of clinical, radiographic, and surgical localization of intervertebral disc extrusion in small-breed dogs: a prospective study of 50 cases.

OBJECTIVE: To compare prospectively clinical, radiographic, and surgical findings of intervertebral disc extrusion (IDE) localization in small-breed dogs and to determine the best means of lesion localization for the purpose of hemilaminectomy. STUDY DESIGN: Clinical, radiographic, and surgical findings of small-breed dogs with thoracolumbar IDE were prospectively compared for agreement on lesion localization. SAMPLE POPULATION: 50 small-breed dogs with IDE treated at the three participating veterinary hospitals were included in the study if no other confounding diseases were identified and if the owner gave permission for diagnostic tests and surgery. METHODS: Clinical and surgical findings were recorded by the surgeon assigned to the case. Radiographic studies were evaluated independently by two radiologists blinded as to the clinical and surgical findings. kappa values and 95% confidence intervals were calculated for agreement on lesion localization by clinical, radiographic, and surgical means and for agreement between radiologists. RESULTS: kappa values for agreement of lesion localization were as follows: clinical versus surgical, 0.595; radiologist A versus radiologist B, 0.81; radiologist A versus surgical findings, 0.60; radiologist B versus surgical findings, 0.71. Both radiologists' interpretation of IDE localization agreed with surgical localization in 60% of cases. CONCLUSIONS: Clinical lateralization of IDE was found to be the least reliable factor of those studied for determining on which side the hemilaminectomy should be performed. Results of this study differ from those of previous studies examining the reliability of myelography to localize the site of IDE accurately. The results of this study further suggest that surgery may not be an absolute standard for determination of the localization of IDE in small-breed dogs. CLINICAL RELEVANCE: Intervertebral disc extrusion in small-breed dogs frequently results in bilateral distribution of extruded material. Computed tomography or magnetic resonance imaging may be necessary to delineate completely the distribution of extruded disc material in IDE.

Animals↗
PubMed1986

Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine.

Posterior and anterior heights, cross-sectional area and shape were measured for all the intervertebral discs in four spines from elderly human cadavers. Disc height was a minimum at the T4-5 level; thoracic discs were less wedge-shaped than those in the cervical and lumbar regions. Cross-sectional area increased from the cranial to caudal extremity; at the L5-S1 level the nucleus pulposus occupied a high proportion of this area. Cervical discs tended to have an elliptical cross-sectional shape, thoracic discs were more circular and lumbar discs tended to have an elliptical cross-section which was flattened or re-entrant posteriorly. This shape distribution was quantified by defining a shape index which had a maximum value of 1 for a circular cross-section. Orientations of the reinforcing fibres in the outer lamellae of the anterior annulus fibrosus were measured from 27 discs by X-ray diffraction. For these measurements, C3-4, T7-8 and L2-3 were chosen as representative of cervical, thoracic and lumbar discs. The fibre tilt, with respect to the axis of the spine, was significantly less in the cervical discs (at 65 degrees) than in the thoracic and lumbar discs (about 70 degrees). These findings are interpreted in relation to differing functional requirements and possible mechanisms of failure in the cervical, thoracic and lumbar regions of the spine in the light of current knowledge on the biomechanics of the intervertebral disc.

Humans↗
PubMed2006

Comparison of cellular response in bovine intervertebral disc cells and articular chondrocytes: effects .of lipopolysaccharide on proteoglycan metabolism.

Lipopolysaccharide (LPS) induces matrix degradation and markedly stimulates the production of several cytokines, i.e., interleukin-1beta, -6, and -10, by disc cells and chondrocytes. We performed a series of experiments to compare cellular responses of cells from the bovine intervertebral disc (nucleus pulposus and annulus fibrosus) and from bovine articular cartilage to LPS. Alginate beads containing cells isolated from bovine intervertebral discs and articular cartilage were cultured with or without LPS in the presence of 10% fetal bovine serum. The DNA content and the rate of proteoglycan synthesis and degradation were determined. In articular chondrocytes, LPS strongly suppressed cell proliferation and proteoglycan synthesis in a dose-dependent manner and stimulated proteoglycan degradation. Compared with articular chondrocytes, nucleus pulposus cells responded in a similar, although less pronounced manner. However, treatment of annulus fibrosus cells with LPS showed no significant effects on proteoglycan synthesis or degradation. A slight, but statistically significant, inhibition of cell proliferation was observed at high concentrations of LPS in annulus fibrosus cells. Thus, LPS suppressed proteoglycan synthesis and stimulated proteoglycan degradation by articular chondrocytes and nucleus pulposus cells. The effects of LPS on annulus fibrosus cells were minor compared with those on the other two cell types. The dissimilar effects of LPS on the various cell types suggest metabolic differences between these cells and may further indicate a divergence in pathways of LPS signaling and a differential sensitivity to exogenous stimuli such as LPS.

Animals↗
PubMed1995

Materials and design concepts for an intervertebral disc spacer. II. Multidurometer composite design.

The main function of the intervertebral disc is to transmit and attenuate compressive and torsional forces, and stabilize the intervertebral joint. Unfortunately, the disc may be displaced or damaged due to trauma or disease causing the nucleus to herniate and protrude into the vertebral canal or intervertebral foramen. Pressure on the spinal nerve may cause pain or paralysis in the area of its distribution. At present, the surgical procedures used to alleviate this condition include disc excision, and/or spinal fusion. A more desirable situation would involve removing the nucleus pulposus and part or all of the annulus fibrosis and implanting a suitable biofunctional equivalent. Such a prosthesis should attenuate stresses and prevent abnormal stress at adjacent intervertebral joints. Maintenance of normal disc height would prevent impingement of the posterior facet joints and facet joint syndrome. In a previous companion paper (J. Applied Biomat. 5:125-132; 1994), the mechanical behavior of disc prostheses manufactured from fiber reinforced, elastomeric thermoset resins were examined. In order to develop devices which were more practical from a manufacturing standpoint and extremely reproducible, the fiber reinforced thermoset resins were replaced by multi-durometer thermoplastic elastomeric materials. In the present paper, the mechanical properties of thermoplastic multicomponent designs have been investigated.

Biocompatible Materials↗
PubMed1984

Degenerated annulus fibrosus of the intervertebral disc contains collagen type II.

Collagen has been isolated and purified from the pronase digest of the outer annulus fibrosus of degenerated and unaffected intervertebral discs obtained at necropsy. The mixture of different collagen types has been purified and fractionated by 2 subsequent DEAE-cellulose chromatographic procedures according to established methods. Collagen chain polymers were then isolated by molecular sieving. Their reduction with 2-mercaptoethanol followed by agarose chromatography resulted in the separation of 3 major peaks corresponding to gamma, beta, and alpha chains. Cyanogen bromide (CNBr) peptides and aminoacid analyses revealed the identity of the isolated alpha-chain as alpha 1(III). Further support for this finding was obtained by immunofluorescence. It is suggested that the presence of collagen type III in the outer annulus fibrosus may be related to intervertebral disc prolapse.

Aged↗
PubMed1995

Natural course and prognosis of intervertebral disc diseases. International Society for the Study of the Lumbar Spine Seattle, Washington, June 1994.

The disc is an osmotic system that lives from motion. Because of the human sedentary nonmoving lifestyle, disc degeneration is progressive. The morbidity curve does not follow the degeneration curve. In patients between 40 and 50 years old, discs have highlights in their clinical course because of the biomechanical constellation, with the presence of tears and fissures in the anulus and maintained expansion power of nucleus material. In old discs, the nucleus is not willing to move. This is the comfortable rigidity of the aging spine. Not only during lifetime also in case of acute back pain and sciatica natural course is benign. If patients and their doctors wait long enough, most pain curves drop, so that initially planned surgery can be cancelled. This is the waiting list phenomenon. Few patients need a disc operation because of hard disc fragments, which can be identified on magnetic resonance imaging. Open disc surgery is the most frequent and important spine operation. Proper patient selection and good technique with a small approach by microsurgery can help avoid PDS, the worst course and prognosis of intervertebral disc disease.

Humans↗
PubMed2002

Natural history of extruded lumbar intervertebral disc herniation.

We studied the natural history of extruded lumbar intervertebral discs using MRI. Forty-nine patients with lumbar disc herniation were included in this study. Ages ranged from 19 to 57. On the T2-weighted sagittal MR image, the signal intensity in the herniated mass was measured and the ratio to that in the original nucleus (i.e., nucleus pulposus from which they extruded) was calculated (signal intensity ratio; SIR). The relationship with SIR and duration of illness was evaluated. In ten patients who were re-examined by MRI after conservative treatment, the size of the herniation measured by T1-weighted axial MR image was compared before and after treatment. The signal intensity of HNP became higher than that of the original nucleus immediately following herniation and thereafter decreased with time, suggesting that initial hydration of the HNP occurred shortly after herniation followed by dehydration of the HNP. The size of the HNP with a SIR value of 1.2 and higher on T2-weighted MR images decrease with time, however, the HNP with a SIR below 1.2 did not show any size reduction. The SIR of 1.2 and higher is a good indicator predicting spontaneous reduction of the HNP. Dehydration in the HNP may play an important role in the reduction of the lumbar disc herniation.

Adult↗
PubMed1990

Photonucleolysis of intervertebral disc and its herniation. Preparation to percutaneous laser discectomy.

Making use of a whole-body stereotactic device under model conditions a human intervertebral disc and its herniations could be targeted and removed with a laser by photocoagulation. The applicable cannulae are 3 mm in diameter and of a 6 to 12 W output power. The required effect is reached within one minute. The situation is now prepared for the clinical introduction of the new technique of discectomy, which is still performed with chemicals or mechanically section and suction.

Animals↗
PubMed2006

Correlation of serum trace elements and melatonin levels to radiological, biochemical, and histological assessment of degeneration in patients with intervertebral disc herniation.

The aim of our study was to assess the blood concentrations of some trace elements and melatonin (MLT) in patients with intervertebral disc herniation (IDH) and to investigate the interaction of histological and biochemical degeneration findings with aging. The present study was carried out on 13 subjects (8 women and 5 men) diagnosed with IDH. They were divided into three groups according to their ages. Nighttime serum MLT, zinc (Zn), and magnesium (Mg) levels were determined in all patients. In addition, computed tomography (CT) scan of the brain and magnetic resonance imaging examination of the lumbar spine were obtained in this study. The Zn level and Zn/Mg ratio showed a decline in patients with IDH with aging, whereas the serum Mg level and tissue hydroxyproline content increased. A positive correlation between serum Zn and MLT concentrations was found (r=0.104, p=0.734). In addition, there was a positive correlation between serum Zn level and Zn/Mg ratio (r=0.835 and p<0.01), and a negative correlation between serum Mg level and Zn/Mg ratio (r=-0.571, p<0.05). On CT study, both volume percentage of calcified pineal gland and density of calcification were found to increase progressively with advancing age. The results of semiquantitative evaluation of disc tissues of patients with IDH for histological degeneration findings showed that 66.7% of discs treated had slight degeneration in younger age group, but 75.0% and 100% of discs had moderate or marked degeneration in older age groups. Our data indicated that there is a close relationship between MLT and Zn or Mg levels in the serum samples of patients with IDH, and the levels of these elements might be affected by the presence of degeneration process and serum MLT level, or vice versa.

Adult↗
PubMed1995

Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera.

One hundred lumbar intervertebral foramina from eighteen spines of fresh cadavera were studied to assess the relationship between compression of the nerve root and the height of the intervertebral disc and the morphological characteristics of the intervertebral foramen as determined on cryomicrotome sections. The critical posterior disc height and the critical foraminal height that were associated with entrapment and compression of the nerve root were determined. Significant positive correlations were demonstrated between compression of the nerve root and the posterior disc height, the foraminal height, and the foraminal cross-sectional area for the four intervertebral levels between the second lumbar and first sacral vertebrae. Nerve-root compression was evident in twenty-one of the 100 foramina, in eight of the ten foramina in which the posterior disc height was four millimeters or less, and in four of the five foramina in which the foraminal height was fifteen millimeters or less. These critical dimensions may be indicators of foraminal stenosis in the lumbar spine. However, compression of a spinal nerve root does not always cause sciatica, and the clinical findings must always be taken into account when a diagnosis of stenosis is considered.

Adult↗