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PubMed1997

Intervertebral disc autografting in a bipedal animal model.

Fusion of the spine while restoring stability of the spinal segment, fails to preserve spinal mobility. Long term complications of accelerated degeneration in the neighboring segments have been reported. The present study explores the possibility of intervertebral disc autografting in a bipedal animal model by isolating a lumbar disc together with the adjacent end plates and repositioning it with minimal internal fixation. Fourteen Rhesus monkeys were sacrificed at 2, 4, 6, and 12 months after surgery and the grafted discs were examined radiologically, biochemically, pathologically, and biomechanically. Healing of the bony end plate was seen between 2 to 4 months postoperatively. There was early loss of disc height at 2 and 4 months but there was a suggestion of some reconstitution up to 12 months. There was minimal evidence of gross degeneration at all stages. Gradual loss of water content was found in the annulus and the nucleus. The nucleus pulposus seemed to be able to reaccumulate proteoglycan after an initial drop in the first 4 months. There was significant increase in hydroxyproline content in the annulus fibrosus and the nucleus pulposus. Biomechanically, the grafted disc showed hypermobility in the first 4 months but gradually became stabilized with time. Results from this study suggested that a fresh intervertebral disc autograft could survive a period of ischemia. Although the physiology of the disc was deranged, it was able to preserve a certain degree of segmental mobility without sacrificing stability. Further studies are required to validate these results and the field of disc allografting should be explored.

Animals↗
PubMed1993

Pathology of cervical intervertebral disc injuries.

Autopsy was performed on 31 patients with traumatic spinal cord injuries who were treated and expired at the Chugoku Rosai Hospital between 1957 and 1987. These patients could be divided into four groups: intervertebral disc injuries (7 patients); hyperextension injuries (9 patients); fracture and fracture-dislocation of the cervical spine (11 patients); and fracture-dislocation of the thoracic spine (4 patients). The sex, age, cause of injury, bone injuries seen on roentgenograms, the level and grade of neurological deficits, the survival time, and the findings of the postmortem studies of the 7 patients with intervertebral disc injuries are presented in Table I. This paper illustrates and discusses these 7 cases.

Accidental Falls↗
PubMed1994

Proteoglycan components of the intervertebral disc and cartilage endplate: an immunolocalization study of animal and human tissues.

Monoclonal antibodies have been used to study the presence and distribution of various components of the proteoglycan molecule in the intervertebral disc and cartilage endplate. Link protein, hyaluronic acid binding region, keratan sulphate and chondroitin 4- and 6-sulphate have been investigated in tissues from humans and other mammals. Exposure of the carbohydrate and protein epitopes was enhanced by chondroitinase and trypsin pretreatment respectively. The degree of immunoreactivity varied with location, being greater in the nucleus pulposus than the annulus fibrosus with least reactivity in the cartilage endplate. In addition, there was increased staining in the pericellular domains, particularly in adult tissues. Areas of ectopic calcification exhibited very different immunoreactivity, depending on the type of calcium salt present. Calcium hydroxyapatite deposits showed greater staining for 8A4 (link protein), while calcium pyrophosphate deposits demonstrated greater staining for 3B3(-), 7D4(-) and 3D5 than the surrounding non-calcified matrix. Staining for chondroitin sulphate isomer epitopes 3B3(-) and 7D4(-), indicative of modified chondroitin sulphate chains, was greater in human tissues of degenerate than non-degenerate appearance. This suggests that expression of these epitopes may be an indicator of disease and subsequent reparative procedures in intervertebral disc and cartilage endplate, similar to that seen in articular cartilage degeneration.

Adolescent↗
PubMed1990

Amyloid in intervertebral discs of surgery and autopsy material. A new class of amyloid?

Intervertebral discs from 82 consecutive operations on herniation and 59 autopsies (one case with generalized amyloidosis) were studied. Amyloid deposits observed in surgical and autopsy specimens increased with age in both series. Degenerative changes were related to age and to amyloid deposits in autopsy, but not in surgical cases. Calcium pyrophosphate dihydrate deposits (often in proximity to amyloid deposits) were found in autopsy discs of six patients and in surgical specimens of three patients with previous operations on herniated discs. Antisera against amyloid fibril proteins of different types including AA-, A lambda-, A kappa, AF- and AB-types showed no reaction with disc amyloid. In one case with generalized A lambda-amyloidosis the disc amyloid was not of the A lambda-type. Based on our results, we suppose that disc amyloid is a form of localized senile amyloidosis - possibly representing a new class of amyloid limited to cartilage tissue.

Adult↗
PubMed2003

Finite element study of nutrient diffusion in the human intervertebral disc.

STUDY DESIGN: The diffusion of small nutrients in the intervertebral human disc was examined using a finite element model. OBJECTIVE: To investigate nutrient transport into the disc using a numerical approach. SUMMARY OF BACKGROUND DATA: The intervertebral disc is the largest avascular tissue in the body. Nutrients necessary for cellular survival diffuse from the blood supply around the disc margins to the cells. Limited analytical studies have been performed and compared with measurements. However, the studies have only considered supply through the center of the nucleus and have only examined single solutes. A more sophisticated model is required to investigate the solute supply. MATERIALS AND METHODS: An axisymmetric finite element model has been created to study the transport of three solutes, i.e., oxygen, glucose, and lactate, using nonlinear consumption-concentration and production-concentration rates. For each of them, data for the consumption/production rate, diffusivity, and concentration in the blood were taken from experimental measurements and used in the model. The effect of varying disc height, exchange area with the blood supply, solute consumption rates, and diffusivities was investigated. RESULTS: The model predicted that concentrations of oxygen and glucose, which are consumed by cells, fell towards the disc center. Concentration levels decreased with a decrease in fractional exchange area and diffusivity, or with an increase in disc height and consumption rate. In contrast, the concentration of lactate, produced by the cells, was highest in the center and fell towards the disc-blood vessel interface. The absolute values of concentrations were in agreement with available measurements in vivo and those computed by few available analytical models, indicating the reliability of the finite element simulations. CONCLUSIONS: Finite element methods can be used to predict concentration gradients of solutes throughout the disc in relation to changes in disc and endplate morphology, disc properties, and cellular activities. This study provides a foundation for investigating the effect of load-induced changes or effects of changes in cellular metabolism on disc nutritional supply.

Diffusion↗
PubMed2005

Nucleus implant parameters significantly change the compressive stiffness of the human lumbar intervertebral disc.

Nucleus replacement by a synthetic material is a recent trend for treatment of lower back pain. Hydrogel nucleus implants were prepared with variations in implant modulus, height, and diameter Human lumbar intervertebral discs (IVDs) were tested in compression for intact, denucleated, and implanted condition. Implantation of nucleus implants with different material and geometric parameters into a denucleated IVD significantly altered the IVD compressive stiffness. Variations in the nucleus implant parameters significantly change the compressive stiffness of the human lumbar IVD. Implant geometrical variations were more effective than those of implant modulus variations in the range examined.

Compressive Strength↗
PubMed1992

Human intervertebral disc acid glycosaminoglycans.

Alcian blue critical electrolyte concentration (CEC) staining of intervertebral discs (annulus and nucleus of cervical, thoracic and lumbar discs) distinguished 3 groups where CEC staining correlated with age (less than 3 months; from 3 months to 5 years; over 10 years). The CEC increased markedly (implying increased sulphation of the glycosaminoglycans) in the period of maturation (fetal life to 10 years) and then remained constant throughout adult life. This is at variance with accepted views which attribute such changes to degenerative changes in old age. The major part of the CEC increase occurred after the disappearance of blood vessels from the disc, which is almost complete by 4 years. Our results are compatible with the hypothesis that keratan sulphate replaces chondroitin sulphate, functionally, in conditions of oxygen lack.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging features of extradural hematomas associated with intervertebral disc herniation in a dog.

Myelography and magnetic resonance imaging (MRI) were performed on a 4-year-old neutered female Rottweiler with bilateral pelvic limb paresis. On the myelogram, there was extradural spinal cord compression at the level of the T11-12 intervertebral disc. Inadvertent placement of epidural contrast medium also allowed identification of a 1-cm circular filling defect in the epidural space dorsal to the compressed spinal cord. MRI showed partial loss of the nucleus pulposus signal of the T11-12 disc, a focal signal void within the vertebral canal at T11 compatible with a free disc fragment, and extradural masses compressing the spinal cord at T10-11 and T11-12. Hemorrhage within the masses was confirmed on T2*-weighted images. A mixture of hematoma and mineralized disc material was found at surgery, and there was no histopathologic evidence of neoplasia. In this article, the appearance on MRI of hemorrhage associated with intervertebral disc herniation is discussed.

Animals↗
PubMed2005

Comparison of disability duration of lumbar intervertebral disc disorders among types of insurance in Korea.

The incidence of work-related musculoskeletal disorder including low back pain sharply increased since 2000 in Korea. The objectives of the present study are to compare disability duration of lumbar intervertebral disc displacement among types of insurances, and to obtain its appropriate duration. The medical records of all patients whose final diagnosis in discharge summary of chart was lumber specified intervertebral disc displacement (LIVD) in 6 large general hospitals in Korea were reviewed to compare the length of admission and disability among different types of insurances. The information on age, gender, the length of admission, the length of follow-up for LIVD, occupation, operation, combined musculoskeletal diseases, and type of insurance was investigated. 552 cases were selected and analyzed to calculate arithmetic mean, median, mode, and geometric mean of disability duration. There was a significant difference in the length of admission and disability among types of insurance after controlling covariates such as age and combined diseases by the analysis of covariance. The length of admission in cases of IACI and AI was much longer than that of HI, and the length of disability in cases of IACI was much longer than that of HI. Prolonged duration of admission and disability was not assumed due to combined diseases, complication or other unexplainable personal factors in cases of those with industrial accidents compensation insurance and automobile insurance. This means that proper management of evidence-based disability duration guidelines is urgently needed in Korea.

Adult↗
PubMed1998

MRI of cervical intervertebral discs in asymptomatic subjects.

We studied degenerative changes in the cervical intervertebral discs of 497 asymptomatic subjects by MRI and evaluated disc degeneration by loss of signal intensity, posterior and anterior disc protrusion, narrowing of the disc space and foraminal stenosis. In each subject, five disc levels from C2-C3 to C6-C7 were evaluated. The frequency of all degenerative findings increased linearly with age. Disc degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age. We found significant differences in frequency between genders for posterior disc protrusion and foraminal stenosis. The former, with demonstrable compression of the spinal cord, was observed in 7.6% of subjects, mostly over 50 years of age. Our results should be taken into account when interpreting the MRI findings in patients with symptomatic disorders of the cervical spine.

Adolescent↗
PubMed1975

The treatment of thoracic intervertebral disc protrusions.

A series of seventeen patients with a protruded thoracic intervertebral disc is reported. In many cases a trauma, which was sometimes mild, seems to have played a role. This and signs and symptoms (of which pronounced numbness and obtrusive paraesthesiae are the most important) should suggest the diagnosis. In such patients myelography and tomography of the thoracic region is indicated. Twelve of the seventeen patients operated upon improved and nine of them made a good or excellent recovery.

Back Pain↗
PubMed1984

Biomechanical properties of human intervertebral discs subjected to axial dynamic compression. A comparison of lumbar and thoracic discs.

This investigation revealed biomechanical properties and some morphological parameters of isolated intervertebral discs at various disc levels. One hundred twenty-three specimens were subjected to axial dynamic compressive loads. The duration of testing was 5 minutes, the loads Fd1 = 650 N +/- 400 N (discs from T5-6 to L1-2) and Fd2 = 950 N +/- 540 N (discs from T9-10 to L5-S1). Down the spine, the mean disc heights and cross-sectional areas increased; the water content seemed to be nearly constant. Axial deformation and ventral bulging increased down the spine as well, which is mainly due to the increasing disc height. Creep showed different characteristics. It was smallest within the region T10-11 to L1-2 and increased above and below this level. The increase below L1-2 is mainly due to the increasing disc height; the increase above T10-11 occurs because the thoracic discs behave in a more viscous manner than the lumbar discs.

Adolescent↗
PubMed1994

The intervertebral disc: a biologically active tissue challenging therapy.

The primary role of intervertebral disc as the tissue related to low back pain was confirmed 60 years ago when disc prolapses were described. Recent studies are providing more information on what other types of changes in discs can cause low back pain and how pain and clinical findings are related to disc herniations. This differs greatly from what the scientific community has generally accepted in the past and so it is evident that the new knowledge will change both diagnostic and treatment procedures. These new studies give very little, if any, support to the old methods of physical medicine in treating back pain as being anything more than palliative. However, the increased understanding of how cartilaginous tissues maintain, lose, or even improve their loading capacity supports active, dynamic rehabilitation which has led to good clinical results.

Animals↗
PubMed1996

Can variations in intervertebral disc height affect the mechanical function of the disc?

STUDY DESIGN: The finite element method was used to investigate the effect of variations in disc height on the mechanical behavior of the intervertebral disc. OBJECTIVES: The effect of disc height on the mechanical behavior of a human lumbar spine segment in terms of axial displacement, intradiscal pressure, posterolateral disc bulge, tensile stress in the peripheral anulus fibers, and longitudinal stress distribution at the end plate-vertebra interface was evaluated. SUMMARY OF BACKGROUND DATA: Disc height varies with individuals, disc level, abnormal conditions, and clinical management. METHODS: A three-dimensional finite element model of L2-L3 disc body unit was developed. Parametric studies were undertaken by studying discs of three different heights: 8 mm, 10 mm, and 12 mm, whereas disc cross sectional area, finite element mesh density, and all other parameters were kept constant. The model accounted for geometric nonlinearity but assumed that the material properties were linear. RESULTS: Variations in disc height had a significant influence on the axial displacement, the posterolateral disc bulge, and the tensile stress in the peripheral anulus fibers, but the effect on the intradiscal pressure and the longitudinal stress distribution at the endplate vertebra interface was minimal. CONCLUSIONS: Variations in disc height may compromise the general conclusions reached from experimental work and analytic studies in which geometric parameters (especially disc height and disc cross-sectional area) are not taken into consideration.

Biomechanical Phenomena↗