Herniated lumbar intervertebral disc; cutaneous hyperalgesia as an early sign.
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X-ray diffraction shows that the arrangement of collagenous fibres in the annulus fibrosus of the fetal intervertebral disc is essentially the same as in the adult tissue. Collagen fibrils, when first forming, are apparently laid down with the same orientation as in the adult. Mechanical stress is suggested as a possible morphogenic factor. Mean values for the fibre tilt and its angular spread are calculated for anterior, posterior and lateral regions of the annulus.
The morphological development of the epiphyseal growth plate and intervertebral discs of newborn and nine-month-old beagles, greyhounds and dachshunds have been studied. On the basis of the cellular and matrix development of these canine tissues together with the known characteristics associated with achondroplasia it is concluded that the beagle should be assigned to the chondrodystroid breed classification.
STUDY DESIGN: An animal model was used to examine the short-term tissue response to changes in the mechanical environment after the structure (disc) is mechanically injured. OBJECTIVES: To observe changes in an injured intervertebral disc and the corresponding motion segment when the mechanical demands of the disc were increased by fusion of the adjacent motion segments. SUMMARY OF BACKGROUND DATA: Disc degeneration has been modeled in animals by producing a tear in the anulus via laminectomy, laparotomy, or posterolaterally. Methods of altering and quantifying the mechanics of the intervertebral joint by use of internal fixation and fusion in the canine have been developed. METHODS: Eight dogs divided into two groups (a study and a control group) had anular stab wounds (L2-L3). The study group was surgically instrumented posteriorly from L3 to L7. Magnetic resonance imaging studies were conducted for all animals before and periodically after the surgical procedures. At the end of the study, the segments were processed histologically and biochemically. RESULTS: Anular bulging was seen on magnetic resonance imaging in all control animals 4 months after injury and did not progress out until 6 months after injury. Similar changes were seen in study animals, but 75% were herniated by 6 months. Histologic changes correlated with magnetic resonance imaging changes. No significant difference in water or proteoglycan content of the disc tissue between groups was found. CONCLUSIONS: Progression from the bulging of the anulus to herniation was not evident in damaged discs not subjected to adjacent fusions. No change in water or proteoglycan content as a function of altered mechanical state was found, suggesting the short-term effect of the altered mechanics is on the mechanical structure and not on the cells or extracellular matrix.
Herniation of the calcified nucleus pulposus is a rare complication of intervertebral disc calcification in children. Surgical intervention is rarely indicated in the majority of such cases. This paper reports a 12-year-old boy with a calcified nucleus pulposus at C7-T1 which had ruptured into the spinal canal, causing dissociated motor loss. Anterior discectomy and fusion were performed and the patient's muscle weakness markedly improved after surgery.
The author presents an evaluation of 72 patients given intradiscal chymopapain as the treatment for symptoms related to ruptured intervertebral disc. The rationale, criteria for patient selection, risks, and results are described. The author believes thatt this early follow-up suggests tha chymopapain may have a place in the treatment of symptomatic disc protrusions and extrusions.
This retrospective study was made to illustrate the rare occurrence of neurologic deficits resulting from intervertebral disc calcification (IDC) in a child. Most authors agree that juvenile IDC is usually a benign, self-limiting disease with excellent prognosis. The symptoms subside spontaneously in 95% of patients. Conservative treatment is therefore usually sufficient. Reviewing the English-speaking literature, only two further cases of operated juvenile IDC with myelopathy have been published. In the current report, we describe a case of permanent thoracic myelopathy resulting from juvenile IDC treated by urgent decompressive thoracic laminectomy. At the 3-year follow-up examination, the patient had not recovered fully. Persisting deficits in motor and sensory function were observed.
In a population sample comprising 48 standard wirehaired dachshunds, the occurrence of intervertebral disc calcification was determined by plain spinal radiography. Body dimensions of the dogs were measured and information obtained from owners about exercise patterns, including stair climbing, and the relation of these variables to the number of calcified discs was analysed by logistic regression. In the Danish population of wirehaired dachshunds, the prevalence of disc calcification was estimated at 77%. The spinal distribution of calcified discs is similar amongst different populations, while the prevalence varies significantly. Most types of exercise included in the variable 'duration of exercise' as well as moderate stair climbing seemed to reduce the rate of occurrence of disc calcification. The effects of moderate stair climbing (OR = 0.34) and duration of exercise (OR = 0.52) were statistically significant and the effects appear to be additive. Running next to a bicycle was the only type of exercise with a positive association with the number of calcified discs. This was, however, not significant. Effects of body conformation, including absolute and relative body measurements, were not found.
Replicas of freeze-fractured collagen fibrils of peripheral and central parts of the annulus fibrosus of bovine intervertebral discs show microfibrils which run either arranged in parallel or in a helix with an inclination-angle ranging from 4 degrees to 8 degrees. According to results of freeze-fracutred tissues, thin sections of specimens treated with 4M guanidinium chloride show collagen fibrils with a parallel or a slightly wavy microfibrillar packing. Thin sections of specimens treated with alcian blue diluted in MgCl2 critical electrolyte solutions reveal interfibrillar proteoglycan particles with a filamentous shape in the peripheral zones of the annulus fibrosus and a predominant leaf-like appearance in the inner ones. These observations are discussed with reference to previous data concerning the variation in composition from the peripheral to the inner parts of the annulus fibrosus.
Intervertebral disc (IVD) proteoglycans (PGs) and trypsin inhibitory protein levels were assessed for groups of beagles and greyhounds aged between 4 and 80 months. A significant age-dependent decline in PGs and in trypsin inhibitory protein levels was evident in extracts of the beagle nucleus pulposus (NP). This was confirmed for the semi-purified trypsin inhibitor, using Western blotting. These age changes, however, were not evident in the greyhound NP. Furthermore, no significant ageing trends in PG or trypsin inhibitory protein levels were evident in extracts of the annulus fibrosus of either animal. The early onset of IVD degeneration in the beagle, a canine breed of the chondrodystrophoid (achondroplastic) classification, may be related to this decline in the anti-catabolic effects of the endogenous serine proteinase inhibitory proteins.
Magnetic resonance imaging was used to determine the T2 relaxation times of prepared proteoglycan solutions and of normal human intervertebral disc tissue from the annulus fibrosus (AF) and nucleus pulposus (NP). The collagen, proteoglycan, and water contents of the disc tissue samples were determined by biochemical assays after they were scanned. Correlations among 1/T2, collagen, proteoglycan, and water contents of the tissue samples and among 1/T2, water, and proteoglycan contents of the proteoglycan solutions were calculated. A moderate negative correlation between 1/T2 and water content was noted for the tissue samples, and a very high negative correlation was found between 1/T2 and water content for the proteoglycan solutions. The very high positive correlation between 1/T2 and proteoglycan content of the proteoglycan solutions is probably due to this negative correlation between 1/T2 and water content. There was no significant correlation between 1/T2 and proteoglycan content of the tissues. The moderate positive correlation between 1/T2 and collagen content is probably due to the high negative correlation between collagen content and water content. No significant correlation was found between the collagen and proteoglycan contents of the tissues. Thus it appears that the data confirm previous reports in the literature that the collagen of the disc tissue functions to control its water content.
The suitability of chitosan-based hydrogels as scaffolds for the encapsulation of intervertebral disc (IVD) cells and the accumulation of a functional extracellular matrix mimicking that of the nucleus pulposus (NP) was investigated. The specific hypothesis under study was that the cationic chitosan would form an ideal environment in which large quantities of newly synthesized anionic proteoglycan could be entrapped. Indeed, all the formulations of cell-seeded chitosan hydrogels, studied under in vitro culture conditions, showed that the majority of proteoglycan produced by encapsulated NP cells was retained within the gel rather than released into the culture medium. This was not always the case when annulus fibrosus cells were encapsulated, as unlike the nucleus cells the annulus cells often did not survive when cultured in chitosan. The results support the concept that chitosan may be a suitable scaffold for cell-based supplementation to help restore the function of the NP during the early stages of IVD degeneration.
A polarographic membrane-covered electrode has been used for measurements of oxygen tension in the intervertebral disc. In vitro studies showed that the method measured partial pressures of oxygen with good reproducibility. However, in long continuous experiments, disc matrix adhering to the membrane influenced the readings negatively. The results of in vivo measurements in canine nucleus pulposus showed tensions of the order of 0.53 - 1.06 KPa (4 - 8 mm Hg). No significant variations between different disc levels were found.
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A method has been established for analysing the glycosaminoglycan distribution pattern in small specimens from intervertebral discs and other connective tissue materials. The procedure is based on the consecutive digestion by the specific enzymes hyaluronate lyase, chondroitin sulfate lyase AC and ABC. The quantitative determination of the resulting disaccharides was achieved by high performance liquid chromatography with a detection limit of less than 0.1 nmmol. The undigested heparan- and keratansulfate were separated from each other by thin layer chromatography and quantified by the colorimetric determination of uronic acid and hexosamine, respectively. Correlation of distribution patterns obtained by this method with those obtained by ion exchange chromatography (Dowex 1 X 2) is not possible without the additional enzymatic characterization of the ion exchange chromatographic fractions. The method was applied to 9 discs of one human spine (anulus fibrosus and nucleus pulposus separately) with the following results: 1) there were no systematic changes to be seen in the distribution patterns with respect to the location of the discs in the spine, and 2) the galactosaminoglycan/keratansulfate ratio was higher in the anulus fibrosus than in the nucleus pulposus.