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PubMed2001

Intervertebral disc calcification in childhood--a case report and review of the literature.

The authors report the case of a 10-year-old girl with intervertebral disc calcifications from the levels C6/C7 to Th1/Th2, presenting with a herniated calcified intervertebral disc at the C7/Th1 level, causing spinal cord compression with subsequent progressive paresis and sensory loss of her left leg. After anterior cervical discectomy and fusion the neurological deficits completely resolved within 2 weeks. It can be concluded that calcification of an intervertebral disc is a rare syndrome in childhood, causing progressive neurological deficit only in a few reported cases. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurological deficit.

Calcinosis↗
PubMedDate not supplied

Discitis following removal of intervertebral disc.

Thirty-three patients with discitis following removal of an intervertebral disc and treated at the Orthopaedic Hospital of the Invalid Foundation in Helsinki, Finland, are reported. The incidence of discitis in this series extending over a period of 16 years (1960-1975) was 0.75%. The appearance of the disease paralleled mainly the frequency of postoperative infections at the hospital in general. Two-thirds of the patients were treated conservatively, while additional surgical treatment was needed for the others. At average follow-up 7.5 years later, most patients showed advanced symptoms from the back, and increased degenerative changes were observed on roentgenograms. About one-half of the patients had retired from regular work. Preoperative prophylaxis, early diagnosis, and appropriate management of the disease is especially urgent to overcome and inhibit the consequences of postoperative discitis.

Adult↗
PubMed2006

[Therapeutic effect of acupuncture on postoperative recovery of prolapse of lumbar intervertebral disc].

OBJECTIVE: To evaluate therapeutic effect of comprehensive therapy of acupuncture as main in postoperative recovery of prolapse of lumbar intervertebral disc. METHODS: Seventy-seven cases were randomly divided into an observation group (n = 40) and a control group (n = 37). The observation group were treated with acupuncture at Shenshu (BL 23), Dachangshu (BL 25), Baliao (BL 31, BL32, BL33, BL 34), Zhibian (BL 54) combined with polarized light, and the control group with western medicine dikeleke 75 mg, once daily. They were treated for 1 month. RESULTS: The cure-markedly effective rate was 95.0% in the observation group and 75.7% in the control group with a significant difference between the two groups (P<0.05). The average VAS score was 2.28 +/- 0. 96 in the observation group and 3.49 +/- 1.45 in the control group with a significant difference between the two groups (P <0.01). CONCLUSION: The comprehensive therapy of acupuncture as main can obviously increase the therapeutic effect in the postoperative recovery of prolapse of lumbar intervertebral disc.

Acupuncture Therapy↗
PubMed2000

The superficial anulus fibrosus ligament. An incipient description of a separate ligament between the lumbar anterior longitudinal ligament and the intervertebral disc.

A previously unknown ligament, the superficial anulus fibrosus ligament (SAFL), situated on the ventral part of the L5 intervertebral disc (ID) was observed and described from autopsy material. Twenty-eight cadaveric specimens from 12 black and 16 white persons aged 17-30 years were studied during routine forensic autopsies. The anterior longitudinal ligament was separated from the ID and the ventral part of the SAFL was visualized. The SAFL samples were removed, measured and studied with both conventional histology and examination by transmission electron microscopy. The SAFL was a completely separate ligament at the level of the L5-S1 ID situated between the anterior longitudinal ligament and the anulus fibrosus of the ID. The fibers of the ligament were vertically oriented. A difference in distance between the L5-S1 vertebral bodies ventrally was noted in the two groups studied (18.7 +/- 1.2 mm in the black vs. 15.2 +/- 1.0 mm in the white, p < 0.001), indicating a difference in the ventral thickness of the intervertebral disc. Also, there was a difference in the length (black: 17.7 +/- 1.6 mm vs. white: 14.1 +/- 1.1), thickness (black: 3.3 +/- 0.3 mm vs. white: 2.1 +/- 1.9), and the cross-sectional area (black: 58.2 +/- 6.7 mm(2) vs. white: 26.5 +/- 2.7 mm(2), p < 0.001) of the SAFL. Conventional light microscopy revealed no obvious differences. However, transmission electron microscopy revealed notably larger collagen fibril diameter in black than white subjects. In conclusion, the interbody distances were greater in the black group, indicating a greater intervertebral disc thickness, compared to that of the white. Furthermore, the SAFL was significantly longer and thicker in the black than in the white group. Albeit unsubstantiated, these race-specific macroscopic findings may have implications for understanding the etiology of various low back stress problems.

Adolescent↗
PubMed1994

Proteoglycans in the intervertebral disc of young dogs following strenuous running exercise.

The proteoglycans (PGs) of intervertebral disc were studied in ten beagles which ran on a treadmill for one year (up to 40 km/day) and in ten non-running control dogs. Nucleus pulposus and annulus fibrosus from cervical (C5) and thoracic (T6 and T12) discs were labeled in vitro with 35SO4. The extractability, concentration and synthesis of PGs, and the electrophoretic subpopulations, aggregation and glycosaminoglycan chain lengths of newly-synthesized and total PGs were measured. Sulfate incorporation was significantly elevated by running in the C5 disc and reduced in the annulus of T6 discs. In the annulus of the T6 discs the concentration of total PGs was significantly lower although that of dermatan sulfate PGs was actually higher than in the controls. The results show that enhanced loading of the spine exerts significant alterations in the intervertebral disc PGs in a spine-level specific manner. In the most strained area of the spine (upper thoracic), the alterations in the runners suggest compromised biomechanical properties of the disc.

Animals↗
PubMed2004

[Clinical characteristic and surgical treatments for the fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures].

OBJECTIVE: To analyze the clinical characteristics of fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures and to discuss the surgical procedure for the fracture. METHODS: The clinical materials of 15 patients who suffered from the disease mentioned above were retrospectively analyzed. RESULTS: The common physical examination findings were local bump in the dorsal or lumbar spine area and palpation of rupture ends of paraspinal muscles and ligaments. The common MRI manifestations were ruptures of anterior longitudinal ligament, intervertebral disc, paraspinal muscles, and spinous process ligaments. The common operative findings were similar to MRI findings. The fractured vertebrae in 5 patients who underwent posterior reduction and fixation with two-segments pedicle screw did not restore their shape, but 10 patients who underwent posterior three-segments pedicle screw reduction and fixation restored the shape of fractured vertebrae. CONCLUSION: The fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures is a severe spine injury. Clinical physical examination and MRI appearance and intraoperative observation are important for the selection of operation procedure. The open reduction and internal fixation with pedicle screw-rod system, and intervertebral resection and fusion via posterior approach is a good procedure for the special thoracolumbar fracture.

Adult↗
PubMed2006

Intervertebral disc recovery after dynamic or static loading in vitro: is there a role for the endplate?

In vivo studies on disc mechanics show loss of fluid from the intervertebral disc (IVD) during loading and full recovery during rest. Previous work indicated that in vitro recovery is hampered after static loading. The aim of the present study was to investigate the role of the endplate after dynamic and static loading on mechanical recovery in vitro. Lumbar spines (caprine) were obtained from the local slaughterhouse and stored frozen. Twenty-four intervertebral discs were thawed and subjected to a compression test in a saline bath (37 degrees C). The discs were pre-loaded at 20 N for 15 min. Three 15-min loading cycles (static: 2.0 MPa or dynamic: average load 2.0 MPa at 0.5 Hz) were applied, each followed by a 30-min period of unloading (20 N). After this protocol, the endplates of half of the discs were blocked with silicone paste and the long-term recovery protocol was applied; the discs were subjected to a single loading cycle (15 min of static or dynamic loading) followed by 10h of unloading at 20 N. All specimens showed a net loss of height and a gain in stiffness during the first part of the test. Eventually, height and stiffness were restored during a long-term recovery test. The difference in recovery between blocked and free endplates was marginal. If fluid flow plays a role during recovery in vitro, the role of the endplate appears to be limited. Our findings show no influence of loading type on recovery in vitro.

Animals↗
PubMed2003

Changes in vascularity of cartilage endplate of degenerated intervertebral discs in response to melatonin administration in rats.

We carried out an experimental investigation of cartilage endplate vascularity of degenerated intervertebral discs produced by exogenous melatonin (MEL) treatment. Adult Swiss albino rats were divided into three groups: control, operated degeneration, and MEL treatment. There were five rats in each group and, using a posterior approach, cuts were made parallel to the endplates in the posterior annulus fibrosus in five consecutive intervertebral discs between the 5th and 10th vertebral segments of the rats' tails. At 8 weeks, five of these animals were treated with exogenous MEL (s.c. injection of 30 microg/100 g body weight daily for 4 weeks). In each experimental group, one animal was examined using CT scanner to study the density of the cartilage endplate of the disc. To evaluate the bone growth and vascularity of the cartilage endplate region, the animals were killed for subsequent histopathological evaluation. We found that the vascular channel counts and percentage areas from animals treated with MEL were significantly lower than from the operated degeneration animals. Accordingly, the density histogram in the MEL group showed a spike profile for both the vertebral body and the cartilage endplate, indicating an increase in the amount of higher density tissues in these regions. Our results demonstrate that the use of MEL reduces the cartilage endplate vascularity of degenerated intervertebral discs, suggesting that it may have an osteoinductive effect on bone formation. Further studies are needed to characterize fully the relevance of our findings for the treatment of disorders such as postmenopausal osteoporosis.

Animals↗
PubMed2006

Feasibility of using a human nucleus pulposus cell line as a cell source in cell transplantation therapy for intervertebral disc degeneration.

STUDY DESIGN: Assessment of the potential use of an immortalized human nucleus pulposus cell line as an alternative cell source in cell transplantation therapy for intervertebral disc degeneration. OBJECTIVES: To evaluate the effect of transplanting the human nucleus pulposus cell line into a disc degeneration model in rabbits and to define whether it is capable of becoming an alternative cell source for cell transplantation therapy for disc degeneration. SUMMARY OF BACKGROUND DATA: Interest in cell transplantation therapy for disc degeneration has been growing for several years, and a range of different cell types have been examined as possible donor cells. In addition, the establishment of a novel cell line that possesses some of the major characteristics of a normal human nucleus pulposus cells has been reported. METHODS: Human nucleus pulposus cell line was established, and cells were transplanted into a rabbit disc degeneration model. At 4, 8, and 24 weeks after transplantation, inhibition of intervertebral disc degeneration was assessed by examining the disc height, macroscopic appearance, histologic findings, and immunohistochemistry. In addition, aggrecan, versican, and Type II collagen gene expression in the nucleus pulposus were measured semiquantitatively at the mRNA level. Furthermore, the survival of transplanted cells was examined using immunohistochemistry for Simian Virus 40 T antigen, and the presence of graft-versus-host reaction was assessed by immunohistochemistry for CD4 and CD58. RESULTS: The disc height was significantly greater in the transplanted group than in the degenerative group's disc from 4 weeks' posttransplantation. Macroscopically, the nucleus pulposus was absent and there was loss of disc height in the degenerative group at 24 weeks after transplantation, whereas the nucleus pulposus was preserved in the transplanted group. Histologic examination showed that the structure of the inner anulus fibrosus was significantly preserved in the transplanted group, and the boundary between the nucleus and anulus could be clearly visualized. Expression of mRNAs of the nucleus pulposus matrix, aggrecan, and Type II collagen was significantly greater in the transplanted group than in the degenerative group. This indicates that transplantation of human nucleus pulposus cell line helped to preserve the matrix of the nucleus pulposus. Thus, transplantation of a human nucleus pulposus cell line was shown to delay disc degeneration in this rabbit model. CONCLUSION: The human nucleus pulposus cell line may become an alternative cell source for cell transplantation therapy of intervertebral disc degeneration.

Adult↗
PubMed1983

Aortoiliac arteriovenous fistula simulating iliac vein thrombosis following intervertebral disc surgery.

This report describes an unusual presentation of arteriovenous fistula secondary to intervertebral disc surgery. A 61-year-old obese woman underwent operation for a herniated intervertebral disc. One month later she was readmitted with painful swelling of the left calf. The condition progressed to include pigmentation of the whole extremity with varicosities and ulcerations. The femoral vein was found to be occluded and there were multiple collateral vessels in the thigh. Initially, phlebitis was diagnosed, then iliac vein thrombosis. Her symptoms improved slightly with rest and anticoagulant therapy. Finally, after 2 years, an arteriovenous fistula was suspected because of a bruit in the presacral region and oxygen saturation of venous blood in the thigh. The diagnosis was confirmed by aortography. The fistula was transected and the artery and vein individually sutured, producing immediate improvement. The patient was symptom-free 3 years later. When chronic venous obstruction, unusual distribution of collateral circulation and pigmentation of a lower extremity are found after disc surgery, an arteriovenous fistula should be suspected. The diagnostic procedures should include auscultation of the abdomen and back, venography, measurement of blood oxygen levels in the collateral venous circulation and aortography.

Aortic Diseases↗
PubMed2000

Immunohistochemistry of chondromodulin-I in the human intervertebral discs with special reference to the degenerative changes.

The expression of the matrix protein chondromodulin-I has been studied in human intervertebral discs of 101 people using immunohistochemical analyses. The purpose of this report is to present data on the metabolic changes that were found to occur in the chondrocytes of intervertebral discs during development and aging. Chondromodulin-I was highly expressed during the gestational period and gradually decreased after maturation. It was detected in both the extracellular matrix and chondrocytes in the zone of hypertrophic cartilage, the zone of proliferative cartilage and the zone of resting cartilage in fetal discs. It was also present in the annulus fibrosus, nucleus pulposus and end-plate cartilage in mature discs. In degenerative discs, chondromodulin-1 immunoreactivity tended to be elevated in the remaining chondrocytes. Our findings suggest that the expression of the protein is developmentally regulated and upregulated through a defense mechanism against the degenerative processes of the aged intervertebral disc.

Adolescent↗
PubMed2002

Expression of monocyte chemoattractant protein-1 in primary cultures of rabbit intervertebral disc cells.

Macrophages are considered essential for herniated disc resorption, and chemokines may play a role in their recruitment. Here we demonstrate that intervertebral disc cells are capable of producing monocyte chemoattractant protein-1 (MCP-1), a CC chemokine that is chemotactic for macrophages. Nucleus pulposus cells and anulus fibrosus cells were harvested from intervertebral discs of healthy rabbits, and the cells were stimulated with either interleukin (IL)-1beta or tumor necrosis factor (TNF)alpha. Reverse transcriptase polymerase chain reaction demonstrated that IL-1beta and TNFalpha induced mRNA expression for MCP-1 in nucleus pulposus and anulus fibrosus cells. Protein concentrations of MCP-1 in the culture supernatants were quantitated by fluoroimmunoassay, which showed that nucleus pulposus and anulus fibrosus cells dose- and time-dependently produced MCP-1 after IL-1beta- and TNFalpha-stimulation, an event that was completely abrogated by IL-1 receptor antagonist and anti-TNFalpha monoclonal antibody, respectively. Nucleus pulposus cells produced significantly higher levels of MCP-1 than did anulus fibrosus cells. Immunohistochemically, the intensity of MCP-1 positive cells in nucleus pulposus cells was stronger than that in anulus fibrosus cells. Altogether, our data clearly demonstrated the production of MCP-1 in intervertebral disc cells, suggesting the possible involvement of disc cells in an early stage of macrophage infiltration.

Animals↗
PubMed1996

Effect of sustained loading on the water content of intervertebral discs: implications for disc metabolism.

OBJECTIVE: To examine regional changes in the fluid content of human intervertebral discs by comparing sagittal plane "profiles" of hydration before and after mechanical loading. METHODS: Cadaveric lumbar intervertebral discs were loaded to simulate a typical day's loading in vivo. Ten motion segments were subjected to a 1500 N compressive load for a period of 6 h with the superior vertebrae inclined by 4-8 degrees to simulate a slightly flexed posture. Immediately after loading the discs were frozen at -80 degrees C. Subsequently they were cut into slices perpendicular to the sagittal midline of the disc, and each slice was weighed before and after freeze drying. This enabled a profile of fluid content across the disc to be constructed. Fluid loss due to loading was estimated by comparing the water content of each loaded disc with that of an adjacent unloaded disc from the same spine. RESULTS: After 6 h of creep loading, disc height approached, but did not quite reach, an equilibrium. The mean fluid loss from all discs was 18%. All regions except the outer 2 mm experienced a significant loss of fluid (P < 0.01). The posterior mid-annulus showed the greatest fluid loss (30%), while the nucleus lost 15%. CONCLUSIONS: A comparison with previously published work suggests that fluid exchange of this magnitude will have a considerable effect on disc cell metabolism and on metabolite transport.

Adult↗
PubMed2004

Distribution and immunocytochemical characterization of dorsal root ganglion neurons innervating the lumbar intervertebral disc in rats: a review.

Previously, it was believed that the lumbar intervertebral disc was innervated segmentally by dorsal root ganglion (DRG) neurons via the sinuvertebral nerves. Recently, it was demonstrated using retrograde tracing methods that the lower disc (L5-L6) is innervated predominantly by upper (L1 and L2) DRG neurons via the sympathetic trunks. Furthermore, we investigated the expression of various pain-related molecules such as calcitonin gene-related peptide (CGRP), isolectin B4 (IB4), P2X(3) receptor and vanniloid receptor 1 (VR1) in DRG neurons innervating the disc using a combination of immunostaining with the retrograde tracing method. This review outlines the distribution and immunocytochemical characterization of DRG neurons innervating the disc. Small nociceptive DRG neurons are classified into nerve growth factor (NGF)-dependent neurons and glial cell line-derived neurotrophic factor (GDNF)-dependent neurons and they can be distinguished by their reactivity for CGRP and IB4, respectively. We found that about half of the neurons innervating the disc were CGRP-immunoreactive (-ir), whilst, only 0.6% of the DRG neurons were IB4-positive, thereby indicating that NGF-dependent neurons are the main subpopulation which transmits and modulates nociceptive information from the disc. In addition, we also demonstrated P2X(3)- and VR1-immunoreactivity in DRG neurons innervating the disc and noted that they were mainly localized in NGF-dependent neurons. It is well known that NGF has sensitizing effects on DRG neurons, with a recent study demonstratng the presence of NGF in the painful intervertebral disc. Therefore, it is suggested that NGF is involved in the generation of discogenic low back pain.

Animals↗
PubMed2001

Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production.

STUDY DESIGN: Surgically obtained cervical herniated intervertebral discs were examined histologically and immunohistochemically. The production of nitric oxide (NO) in the local tissue was examined using the electron spin resonance (ESR) method. OBJECTIVES: To investigate the local histologic and immunohistochemical changes in cervical disc herniation, including NO production, and to compare such changes with those in autopsy cases. SUMMARY OF BACKGROUND DATA: Very little is known about the histopathologic processes of cervical disc herniation. In addition, no information is available on the level of in vivo NO production in cervical disc herniation. METHODS: Thirty-six herniated cervical discs obtained from 31 patients were immunohistochemically examined for localization of blood vessels, matrix metalloproteinase (MMP)-3, and inducible NO synthetase (iNOS). We also compared the production of NO, measured by the ESR method, in eight specimens with that of five control discs obtained from fresh cadavers. RESULTS: The presence of herniated discs correlated with the degeneration of cartilaginous endplate and torn anulus fibrosus. Formation of new blood vessels around the herniated discs was detected, using von Willebrand factor antibody, in seven uncontained hernias and 20 contained hernias. Immunohistochemical studies showed the presence of cells positive for MMP-3 (chondrocytes), iNOS (chondrocytes and granulation tissue) in cervical disc hernias. ESR analysis showed a significantly higher NO production in herniated cervical discs than in disc samples of fresh cadavers. CONCLUSIONS: Herniated cervical intervertebral disc is characterized by the presence of an inflammatory process associated with neovascularization and increased expression of MMP-3. Production of NO was markedly high in both contained- and uncontained-type hernias.

Adult↗
PubMed2006

Projection field of primary afferent fibers innervating the ventral portion of the lumbar intervertebral disc in the spinal cord dorsal horn.

In the present study, we investigated the central projection of afferent fibers innervating the lumbar intervertebral disc using the fluorescent neurotracer 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (Dil). The tracer Dil was applied to the ventrolateral portion of the L5-L6 intervertebral disc in 11 adult rats. Fluorescent sites were observed microscopically on spinal cord transverse sections. Fluorescent spots in laminae I-III were plotted on the central projection map of cutaneous afferents. In six of 11 rats, Dil was restricted to the application site. Of these six rats, three showed no evident fluorescent sites. In the remaining three rats, small fluorescent spots were scattered in the dorsal horn. Fluorescent spots in dorsal horn lamina I were located in the central projection fields of the low back and groin skin. Fluorescent spots were observed, also sporadically, in Clarke's column in T12-L1 segments. The central projection of afferent fibers innervating the rat lumbar intervertebral disc was indistinct with Dil labeling. We presumed this was due to the scarcity of central terminal arbors of disc afferent fibers. Spotty projections in laminae I-IllIIere present near the central projection fields of the loin and groin, indicating that pain would be perceived in the groin.

Animals↗