The surgical approach to canine intervertebral disc disease.
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Young domestic pigs were incised with a scalpel blade into the anterior part of annulus fibrosus of lumbar discs in order to study the reparative processes in the annulus fibrosus and the secondary reactions in the nucleus pulposus. Northern and slot-blot hybridizations were used to investigate type I, III, and VI collagen gene expression in the disc tissue. For this purpose a method for RNA isolation was modified so as to be applicable to the intervertebral disc, which has a low cell density and a high proteoglycan content in its extracellular matrix. The amount of total RNA was found to be very low, particularly in the nucleus pulposus. Intact RNA could be isolated from most parts of the injured discs, but only from the outer annulus of the control discs. Hybridizations showed that healing of the wound in the annulus fibrosus involves an increase in the synthesis of particularly type I and type III collagens. However, no changes in the collagen gene expression were detectable in the nucleus pulposus two weeks after the injury.
An epidemiologic case-control study to identify risk factors for acute prolapsed lumbar intervertebral disc was undertaken in Connecticut during 1979-1981. This paper focuses on nonoccupational factors of possible etiologic significance. Persons in their 30s were affected most frequently. Among surgical cases, the ratio of men to women was 1.5 to 1, while among probable and possible cases not undergoing surgery, the male to female ratio was about 1 to 1. Cigarette smoking in the past year was associated with an increased risk for prolapsed disc. The greater the number of hours spent in a motor vehicle, the higher the risk. Use of Swedish and Japanese cars was associated with a lower-than-average risk, while use of other cars was associated with a higher-than-average risk. For each type of car, older cars were associated with higher risks than newer cars. Variables that did not affect the risk for prolapsed lumbar disc in this study included height, weight, number of pregnancies, number of children, frequency of wearing shoes with high heels, smoking cigars or pipes, and participation in baseball or softball, golf, bowling, swimming, diving from a board, tennis, bicycling or jogging.
The nerve supply to the posterior longitudinal ligament (PLL) and the intervertebral disc (IVD) of the lumbar vertebra was investigated by acetylcholinesterase (AchE) enzyme histochemistry in the rat. The meningeal branch of the spinal nerve (the sinuvertebral nerve) enters the vertebral canal and divides into ascending and descending branches which fuse with those from adjacent vertebrae. They give off transverse branches, connecting with those from the opposite side to form the superficial nerve fibre network in the intervertebral segment, which spreads to the vertebral segment of the PLL. Apart from this superficial nervous network, many nerve fibres enter through the posterolateral portion of the annulus fibrosus (AF) and form a dense, fine nerve fibre network in the deep layer of the intervertebral portion of the PLL and the superficial layer of the AF. Nerve fibres and terminals cannot be found in the deep layer of the AF or the nucleus pulposus. In the central part of the deeper nerve network there are few nerve terminals whereas there are abundant free nerve endings in the peripheral zones. It is suggested that these abundant nerve fibres may be correlated with various functions characteristic of this region and that they may be important in the regulation of movement and posture in the vertebral column.
We have assessed the utility of an intracellular fluorochrome, 5-(and-6)-carboxyfluorescein diacetate succinimidyl ester (CFSE), as a tracking label for human intervertebral disc cells in vitro. Although 5 microM provides adequate intracellular labeling for whole cell fluorescent microscopic identification of labeled cells, 20 microM was preferable for immunocytochemical localization of paraffin embedded labeled cells. Electron dense vesicles are seen at the ultrastructural level in labeled cells. Discrete vesicular labeling can also be observed in whole cell mounts viewed with fluorescence microscopy. Whole cells retain good label for 6 weeks. CFSE labeling is relatively easy, nontoxic to cells and nonradiocactive. Initial optimization of dose with specific cells types is recommended when confirmation of positive immunocytochemistry is needed for tissue engineering studies.
The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.
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Immunohistochemistry was used to study the presence and distribution of the core proteins of the small proteoglycans decorin and biglycan in the various compartments of human intervertebral discs. Both proteoglycans could be found in the outer tendon-like parts of the annulus fibrosus, indicating their potential role in collagen network formation and biomechanical stress resistance. The loss of both proteoglycans in the annulus of individuals older than 50 years reflects a normal age-related change. In the nucleus pulposus, decorin could be found in fibrillar areas of the interterritorial matrix, thereby indicating co-localization of decorin with fibrils containing type II collagen. Biglycan was present in the extracellular matrix of the nucleus pulposus of adults. The pericellular immunoreactive rims observed around nucleus pulposus cells and giant chondrones indicated local biosynthetic activity for these small proteoglycans. The staining patterns in cartilage endplates resembled those found in human hyaline articular cartilage.
A direct ultrastructural study was carried out with a view to determining the changes brought about in vitro by chymopapain on the intervertebral disc and the vertebral growth plate. The tissues studied were: (A) fragments of protruded nucleus pulposus and extruded disc tissue; (B) portions of human and rabbit annulus fibrous; (C) fragments of rabbit vertebral growth plate. The fragments of tissue were incubated with chymopapain for three, six and twenty-four hours and were then fixed. In the protruded nucleus pulposus and extruded disc tissue, chymopapain produced disappearance of the electron-dense granules (which are presumably proteoglycans) and of the electron-dense granular material of the intercellular matrix. The enzyme probably also has an injurious action on the chondrocytes, but does not affect the fibrils and collagen fibres. Its action is also conditioned by the dimensions of the fragment of tissue incubated. If this is large, only the peripheral portion is completely digested. The action of the enzyme on the annulus fibrosus and the vertebral growth plate is similar to that on the nucleus pulposus. The present study indicates that the clinical effects of chymopapain are due to digestion of the proteoglycan granules and the electron-dense granular material of the herniated nucleus pulposus. These effects appear to be correlated with the collagen fibre content of the tissue, in the sense that the greater the collagen content, the more tissue mass remains unaffected.
This study was carried out to describe a simple, accurate and practical technique for estimating the volume of intervertebral disc (ID) by the combination of the Cavalieri principle and computed tomography (CT) images. Total eight lumbar IDs from two cadavers were CT scanned in axial, sagittal and coronal sections. The consecutive sections with 5 and 3mm thickness were used to estimate the volume of the IDs by the Cavalieri principle. Three investigators estimated the volume of IDs independently to evaluate inter-observer differences. When the results were compared to the real volumes of IDs measured by the fluid displacement technique, there was no significant difference between the real volume measurements and the Cavalieri estimation results of ID volumes (P > 0.05). Moreover, findings of three investigators did not show significant variations (P > 0.05). Our results indicate that the section thickness and the section planes did not affect the accuracy of the disc volume estimation. Thus the combination of CT scanning with the Cavalieri principle may be used as a direct and reliable technique to estimate the volume of IDs with a mean of 4 min workload per ID.
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A 3D inhomogeneous finite-element model for charged hydrated soft tissues containing charged/uncharged solutes was developed and applied to analyze the mechanical, chemical, and electrical signals within the human intervertebral disc during an axial unconfined compression. The effects of tissue properties and boundary conditions on the physical signals and the transport of fluid and solute were investigated. The numerical simulation showed that, during disc compression, the fluid pressurization and the effective (von Misses) solid stress were more pronounced in the annulus fibrosus (AF) region near the interface between AF and nucleus pulposus (NP). In NP, the distributions of the fluid pressure, effective stress, and electrical potential were more uniform than those in AF. The electrical signals were very sensitive to fixed charge density. Changes in material properties of NP (water content, fixed charge density, and modulus) affected fluid pressure, electrical potential, effective stress, and solute transport in the disc. This study is important for understanding disc biomechanics, disc nutrition, and disc mechanobiology.
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