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PubMed2006

Imaging intervertebral disc degeneration.

Magnetic resonance imaging provides excellent anatomic detail of spinal tissues, but fails to provide the type of information that permits a definitive diagnosis in many patients with back pain. New imaging strategies that can be applied to the study of intervertebral disc degeneration include diffusion-weighted imaging, magnetic resonance imaging, diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, dynamic computed tomography and magnetic resonance imaging, and T2 relaxometry. With dynamic imaging, the relative motions of normal and degenerated lumbar motion segments can be evaluated noninvasively. With further evaluation of the technique, hypermobile segments may be distinguishable from those with normal relative motion. T2 measurements obtained by T2 relaxometry appear to have important advantages with regard to spinal imaging because this modality provides a continuous and objective measure of the content of free water in the disc, which decreases with aging and degeneration. Anatomic imaging of the spine is highly accurate in the evaluation of nonmechanical causes of back pain and less beneficial in the evaluation of back pain that is due to mechanical causes. The development of functional imaging strategies of the spine will likely improve the management of patients with back pain. This article outlines the current magnetic resonance imaging protocols for intervertebral disc degeneration, indicates deficiencies in current imaging, and describes functional imaging strategies for the spine that will likely improve the evaluation of patients with back pain. It also reviews recent published articles on magnetic resonance imaging and computed tomographic imaging of the spine and details the results of studies that have explored the future potential of spine imaging.

Diagnostic Imaging↗
PubMedDate not supplied

[Role of proteoglycans and glycosaminoglycans in the intervertebral disc degeneration].

Proteoglycans and glycosaminoglycans are the main components of the extracellular matrix of the nucleus pulposus. Intervertebral disc degeneration due to aging and excessive mechanical loads results in adverse quantitative and structural changes to the macromolecules. Metalloproteinases induced by inflammatory mediators play a key role in degrading proteoglycans. Progressive matrix breakdown decreases water content in the disc. Dehydration compromises disc cells function and impairs resistance to compression. Biochemical changes may result in disc prolapse. Modifying the metabolism of proteoglycans and glycosaminoglycans might be an effective therapeutic strategy.

Disease Progression↗
PubMed2001

Fine-needle aspiration biopsy of vertebral and intervertebral disc lesions: specimen adequacy, diagnostic utility, and pitfalls.

BACKGROUND AND OBJECTIVES: Fine-needle aspiration biopsy (FNAB) is used extensively in the clinical workup of radiologically detected bony lesions. The aims of this study were to evaluate the diagnostic utility of FNAB of such radiologically detected vertebral and intervertebral disc lesions in patients with and without a known primary malignancy, to establish criteria for specimen adequacy, and to evaluate the diagnostic pitfalls. DESIGN: The cytologic material obtained by FNAB performed under computed tomographic guidance of 78 cases comprising 66 vertebral and 12 intervertebral disc lesions was reviewed and analyzed. The initial cytologic diagnosis was compared with the diagnosis after review in all 78 cases. RESULTS: Thirty-five cases (45%) were positive for malignancy, 1 case (1.3%) was suspicious for malignancy, 9 (11.5%) consisted of normal cellular elements with no evidence of malignancy, 21 (27%) were unsatisfactory/inadequate for diagnosis, and 12 (15.2%) were benign nonneoplastic lesions. Nonneoplastic lesions diagnosed included fracture callus, discitis/osteomyelitis, degenerative disc disease, and Paget disease. In 11 cases, FNAB gave the initial diagnosis of malignancy (8 occult carcinomas and 3 plasmacytomas). In 23 out of 36 cases with a clinical history of a known primary tumor, FNAB established the diagnosis of metastases, and in 1 case, a second primary was detected. CONCLUSIONS: Fine-needle aspiration biopsy of radiologically suspected vertebral and intervertebral disc lesions in patients with a history of a known malignancy is useful to confirm the presence of metastases. In cases without any history of malignancy, FNAB can provide additional clues to aid in the subsequent workup and treatment of cases diagnosed with an unsuspected malignancy and other nonneoplastic lesions. Through assessment of the specimen adequacy, correct interpretation of the cytologic material available, and correlating with the clinical and radiologic findings, a definitive diagnosis can be made in most cases.

Adult↗
PubMed1955

Herniation of intervertebral discs; an evaluation of the indirect signs.

The incidence of so-called indirect signs of posterior herniation of an intervertebral disc in a series of working men who had no symptoms referable to the back was compared with the incidence of those signs in a group of cases in which herniation of a disc was proved at operation. There was no significant difference in incidence. In the cases in which herniation was proved at operation, it occurred no more often at a level where there was a thin disc than at a level where the disc was of normal thickness.

Adult↗
PubMed2002

Osteogenic protein-1 enhances matrix replenishment by intervertebral disc cells previously exposed to interleukin-1.

STUDY DESIGN: A study of the mechanisms involved in matrix repair by intervertebral disc cells cultured in alginate gel was performed. OBJECTIVES: To determine the effects of osteogenic protein-1 on the extracellular matrix of intervertebral disc cells previously exposed to interleukin-1, which is an in vitro model for degraded extracellular matrix. SUMMARY OF BACKGROUND DATA: Disc degeneration is accompanied by a decrease in the content of negatively charged proteoglycans in the matrix. No previous attempt has been made to repair the degraded matrix of the disc. METHODS: Nucleus pulposus and anulus fibrosus cells were isolated from the lumbar discs of New Zealand white rabbits and were separately encapsulated in alginate beads. The alginate beads were cultured with or without osteogenic protein-1 after previous exposure to interleukin-1alpha in the presence of 10% fetal bovine serum. The total contents of proteoglycan, collagen, and DNA in the alginate beads were measured. The rate of proteoglycan synthesis by the encapsulated cells was also determined. RESULTS: Treatment with interleukin-1alpha resulted in a significant decrease in proteoglycan and collagen contents in the matrix formed by both the nucleus pulposus and anulus fibrosus. However, subsequent treatment with osteogenic protein-1 led in both cases to rapid recovery of proteoglycans and collagens, whose contents returned to the levels seen in cells not previously exposed to interleukin-1alpha. By the end of the culture period (day 21), those values reached levels higher than those found in beads containing cells never exposed to interleukin-1alpha. Further, the rate of proteoglycan synthesis by both cell types in beads treated with osteogenic protein-1 after previous exposure to interleukin-1alpha was significantly higher than in beads whose cells were not treated with osteogenic protein-1 after previous exposure to interleukin-1alpha. CONCLUSION: Disc cells that have been previously exposed to interleukin-1alpha have lost none of their potential to upregulate proteoglycan synthesis in response to stimulation with osteogenic protein-1. On stimulation with osteogenic protein-1, these disc cells not only replenished the matrix with proteoglycans that had been lost during interleukin-1alpha treatment but proceeded to reform a matrix that was richer in these resilient molecules than that formed by disc cells never exposed to interleukin-1alpha.

Animals↗
PubMedDate not supplied

[Idiopathic intervertebral disc calcification in children: the role of diagnostic imaging. A case report].

The idiopathic calcification of the intervertebral disc in childhood is a rare syndrome with unknown aetiology. This pathology is more frequent in males, with predominant localization to cervical spine. The natural evolution of the syndrome is the progressive and spontaneous resorption of the calcific deposit, with symptom regression. We report a case of an acute and worsening torticollis in a 10-year-old child, with reference to a recent minor cervical distortion, resistant to analgesic treatment. X-ray evaluation, executed after a week from the appearance of torticollis, showed an oval calcification in the nucleus pulposus of the C6-C7 intervertebral disc. The CT and especially the MRI concurred to recognize a disc hernia and an adjacent osteo-ligamentous pathologic participation. In particular, MRI showed the adjacent vertebral spongy bone edema and the active enthesiopathy of the posterior longitudinal ligament.

Calcinosis↗
PubMed1990

[A clinicopathological study of cervical intervertebral discs--Part 2: On morphological and roentgenologic findings].

One hundred and eleven cervical vertebral bodies and 153 cervical intervertebral discs obtained in 35 autopsy cases were studied first by plain roentgenograms, discography and CT discography (CTD), and then histologically. In addition to the above studies, morphological measurements of various parts of the disc were made. Following results were obtained: 1) The anterior portion of the disc tended to become thinner with aging than the middle and posterior portions, 2) The nucleus pulposus initially located slightly anterior to the middle portion of the disc tended to move gradually to the posterior portion of the disc with aging, 3) The antero-posterior diameter of the cartilaginous plate showed a gradual decrease with aging, 4) False-negative discography+ was observed more frequently in the anterior protrusion than in the posterior protrusion, 5) The false-positive discography+ was apparently often caused by the penetration of the contrast medium into the Luschka's joint, and 6) The osteophyte of the vertebral body may be formed by enchondral ossification triggered by disc degeneration according to the histological studies.

Adult↗
PubMed2005

A three-dimensional nonlinear finite element analysis of the mechanical behavior of tissue engineered intervertebral discs under complex loads.

The use of tissue-engineering method holds great promise for treating degenerative disc disease [Gan JC, Ducheyne P, Vresilovic E, Shapiro IM. J Biomed Mater Res 2000; 51(4): 596-604]. This concept typically implies that nucleus pulposus (NP) cells are seeded on a scaffold, while the NP tissue is regenerated. Such hybrid implant is inserted into the host intervertebral disc. Because the success of a tissue engineering approach depends on maintenance or restoration of the mechanical function of the intervertebral disc, it is useful to study the initial mechanical performance of the disc after implantation of the hybrid. A three-dimensional finite element model (FEM) of the L2-L3 disc-vertebrae unit has been analyzed. The model took into account the material nonlinearities and it imposed different and complex loading conditions. In this study, we validated the model by comparison of its predictions with several sets of experimental data; we determined the optimal Young's modulus as well as the failure strength for the tissue-engineered scaffold under different loading conditions; and we analyzed the effects of implanted scaffold on the mechanical behavior of the intervertebral disc. The results of this study suggest that a well-designed tissue-engineered scaffold preferably has a modulus in the range of 5-10 MPa and a compressive strength exceeding 1.67 MPa. Implanted scaffolds with such properties can then achieve the goal of restoring the disc height and distributing stress under different loading conditions.

Biomechanical Phenomena↗
PubMed2004

An immunohistochemical evaluation of extracellular matrix components in the spinal posterior longitudinal ligament and intervertebral disc of the tiptoe walking mouse.

Ossification of the posterior longitudinal ligament (OPLL) in the spine is caused by systemic and/or regional factors affecting the regulation of osteocartilaginous formation and maintenance. The aims of this study were to elucidate the relationship between the degeneration of the intervertebral discs and changes in the posterior longitudinal ligament (PLL) in the tiptoe walking (ttw) mouse, an animal model of OPLL, and to analyze the sequential changes of the cells producing extracellular matrix components using immunohistochemical methods. At 6 weeks of age, the discs degenerated and the chondrocytes in the nucleus pulposus were positive for chondroitin-6-sulfate in the ttw mice. The fibroblasts in the PLL at the disc level were positively stained with type II and XI collagens. At 14 weeks, the discs herniated into the thickened PLL, and chondrocyte-like cells appeared in the PLL at vertebral endplate level. At 18 and 22 weeks, the number of chondrocyte-like cells increased in the PLL and expressed type I collagen. A potent regional factor causing OPLL in the ttw mice appears to be the initial degeneration and subsequent herniation of the nucleus pulposus. These sequential changes in the ttw mice were accelerated by administration of etidronate. It was suggested that etidronate stimulated the cartilaginous hyperplasia in the PLL of the ttw mice. It appeared as if the PLL transformed itself into cartilaginous tissue to repair the degeneration of the intervertebral disc.

Animals↗
PubMed2001

Sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats.

STUDY DESIGN: The levels of dorsal root ganglions (DRGs) innervating the dorsal portion of the lumbar intervertebral discs from L1-L2 to L4-L5 were investigated in rats by the retrograde transport method. The pathways and functions of nerve fibers supplying the dorsal portion of the discs were investigated by denervation and immuno-histochemistry. OBJECTIVES: To investigate the sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats. SUMMARY OF BACKGROUND DATA: The dorsal portion of the L5-L6 disc has been reported to be innervated multisegmentally, and anesthetic blockade of the paravertebral sympathetic trunks and the L2 spinal nerve can relieve discogenic low back pain. However, sensory innervation of the dorsal portion of the lumbar discs at other levels has not been clarified. METHODS: A retrograde transport of Fluoro-Gold was used. We studied a nonsympathectomy group (n = 44) and a sympathectomy group (n = 50) in which paravertebral sympathetic trunks were resected from L1 to L5 levels. Using a ventral approach, Fluoro-Gold crystals were inserted into the dorsal portion of the L1-L2, L2-L3, L3-L4, and L4-L5 discs. Seven days after surgery, Fluoro-Gold-labeled neurons were counted in the bilateral dorsal root ganglions from T10 to L6. RESULTS: Fluoro-Gold-labeled neurons were distributed in dorsal root ganglions from T11 to L5 levels in the nonsympathectomy group. However, in the sympathectomy group the number of labeled neurons was less than that of the nonsympathectomy group in T11, T12, and T13 dorsal root ganglions of the L1-L2 disc group, in T12, T13, and L1 dorsal root ganglions of the L2-L3 disc group, in T12, T13, L1, and L2 dorsal root ganglions of the L3-L4 disc group, and in T12, T13, L1, and L2 dorsal root ganglions of the L4-L5 disc group. CONCLUSION: The dorsal portion of the lumbar discs from L1-L2 to L4-L5 is multisegmentally innervated by the T11 through L5 dorsal root ganglions. Sensory fibers from the upper dorsal root ganglions innervate the dorsal portion of the discs via the paravertebral sympathetic trunks, although those from the lower dorsal root ganglions innervate via the sinuvertebral nerves. Furthermore, sensory nerve fibers enter the paravertebral sympathetic trunks through the corresponding ramus communicans and reach the dorsal root ganglions via each ramus communicans at the L2 and/or more cranial levels.

Animals↗
PubMed2002

Cervical spinal cord compression attributable to a calcified intervertebral disc in a patient with X-linked hypophosphatemic rickets: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: X-linked hypophosphatemic rickets is a common inherited phosphate-wasting disorder, but it is a rare cause of spinal cord compression. We present the first reported case of a calcified intervertebral disc causing spinal canal stenosis in X-linked hypophosphatemic rickets. CLINICAL PRESENTATION: A 44-year-old woman presented with paresthesia of her left arm and a loss of grip in both hands. Magnetic resonance imaging revealed a calcified intervertebral disc, as well as a posterior osteophytic bar causing marked cervical cord compression at C6/C7. INTERVENTION: An anterior cervical discectomy at C6/C7 and fusion with autologous bone graft were performed. The patient then exhibited significant improvement. CONCLUSION: A review of the 16 published cases demonstrates that thickening of the vertebral laminae, facet joint hypertrophy, and ossification of the intervertebral discs, posterior longitudinal ligament, and/or ligamentum flavum contribute to spinal canal stenosis in X-linked hypophosphatemic rickets. Those changes are caused by the disease itself and are unlikely to be related to long-term vitamin D treatment. Eleven of 16 patients were reported to have experienced favorable outcomes after surgery.

Adult↗
PubMed2002

Multiple independent, sequential, and spontaneously resolving lumbar intervertebral disc herniations: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: To highlight the potential for spontaneous resolution of large extruded intervertebral lumbar disc herniations in a patient with three independent herniations. SUMMARY OF BACKGROUND DATA: The most effective methods of treatment for lumbar intervertebral disc herniations remain in question. This is partly because the potential for intrinsic spontaneous resolution is not understood, and because many believe that large extruded lumbar intervertebral disc herniations require surgical intervention. This case report addresses both issues. METHODS: A case is reported and the literature is reviewed. RESULTS: In the patient described, multiple independent lumbar intervertebral disc herniations resolved spontaneously both clinically and radiographically with nonoperative treatment. CONCLUSIONS: Not only is the question concerning the cause of disc herniation unresolved, but the best methods of treatment also are generally unclear. This case report documents a patient with the intrinsic capability not only to herniate multiple lumbar intervertebral discs, but also to resolve them clinically and anatomically. Extruded lumbar intervertebral disc herniations may be treated without surgery, as highlighted by this case report. The immunohistologic pathomechanism for resorption remains unclear.

Adult↗
PubMed1996

Effects of strain distribution in the intervertebral discs on the progression of ossification of the posterior longitudinal ligaments.

STUDY DESIGN: Strain distribution in the intervertebral discs was evaluated biomechanically using an engineering true strain calculation formula. OBJECTIVES: This study was performed to clarify the involvement of dynamic factors in the progression of ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: In patients with ossification of the posterior longitudinal ligament of the cervical spine, ossification frequently progresses after laminectomy. This suggests the involvement of dynamic factors in the progression of ossification. However, these factors have not yet been clarified. METHODS: The analysis was performed on 101 patients with ossification of the posterior longitudinal ligament by employing dynamic lateral x-ray films of the cervical spine. The x-ray films were digitized and used as computer data for calculating the strain distribution. X-ray films were obtained again 5 years later, and the strain distribution and the presence or absence of progression of ossification were evaluated. RESULTS: The progression of ossification of the posterior longitudinal ligament was highly correlated with abnormal strain distribution in the intervertebral discs. Progression of ossification was frequently observed in areas having disc distortion in tension and extension on the posterior longitudinal ligament. CONCLUSIONS: In this study, the area of progression of ossification corresponded to the area showing uneven strain distribution and resultant concentration of dynamic stress. These results suggest an important role for dynamic factors in the progression of ossification of the posterior longitudinal ligament.

Adult↗
PubMed1992

Serial changes observed by magnetic resonance imaging in the intervertebral disc after chemonucleolysis. A consideration of the mechanism of chemonucleolysis.

Changes in the intervertebral disc after chemonucleolysis in 26 patients were observed by magnetic resonance imaging for 1 year, and from the results a mechanism for chemonucleolysis was considered. A reduction in size of the herniation was not recognized 2 weeks after treatment, when chymopapain had caused necrosis of the disc, but began after 4 weeks, when regeneration of the disc had occurred. The herniation was further reduced after 3 months, and the disc had become fibrocartilaginous in a cicatricial process. Marked decrease in disc signal was observed after 2 weeks, and never recovered. From these facts, it is considered that chymopapain might never cause primary diminution of disc herniation, and any reduction of herniation that occurs is due to the effects of a secondary cicatricial contraction.

Adolescent↗
PubMed1983

Long-term results of lumbar intervertebral disc prolapse.

A series of 40 patients is presented at least ten years following anterior spinal fusion for intervertebral disc prolapse. The proportion of patients who had complete relief or only isolated transient symptoms at the five-year review (67.5%) showed only a very slight fall over the years (65.0%). The union rate was shown to improve with time. There was no clear evidence that anterior spinal fusion led to accelerated degeneration of adjacent intervertebral discs. The significance of posterior extension of the fusion is discussed.

Adult↗