An ultrastructural study on the ligamentum flavum of the cervical spine in patients with ossification of the posterior longitudinal ligament

Some histological analyses of the ossification of the posterior longitudinal ligament (OPLL) have been reported, but no ultrastructural studies of the ligamentum flavum (LF) in patients with OPLL have been published to date. To understand the pathology of the ossification of the spinal ligament, we examined, by electron microscopy, ultrastructural changes in the LF in cases of OPLL and made a comparison with the LF in cervical spondylotic myelopathy (CSM). Subjects were three men and two women with cervical OPLL who underwent longitudinal spinous process-splitting laminoplasty. During surgery, a small piece of the LF was collected from C2–C3 to C7–T1 and was then analyzed by light and electron microscopy. We observed atrophic elastic bundles with a two-layer structure and disarrangement, a partially torn area, the disappearance of microfibrils, and an enlarged interstitium with an irregular alignment of collagen fibrils. We observed some properties of a cell preceding its death: the initial phase may be the disappearance of the plasma-membrane, followed by the scattering of many organellae around its degenerated nucleus. Finally, many extracellular plasma membrane-invested particles that resemble matrix vesicles remain there without phagocytosis. These results suggest that ultrastructural abnormalities exist in the spinal ligament in cases of ossification of the spinal ligament.     

Ultrastructural changes of the patellar tendon as a cruciate ligament substitute (one year and two year results)

In four black-faced sheep, the posterior cruciate ligament was replaced with a free autogenous patellar tendon transplant. Tissue samples from the transplants were investigated by light and electron microscopy 1 year and 2 years after surgery. The normal contralateral posterior cruciate ligament and the normal contralateral patellar tendon were used as controls. The structural differences concerned cells, collagen fibrils, elastic tissue and proteoglycans. Most of the cells of the contralateral patellar tendon were spindle-shaped, whereas those of the transplant were frequently chondroid. In the central region of the transplant as well as in the area far from the bone, cell degenerations, and occasionally hypo- or even acellular zones were found. Measurements of the diameter of collagen fibrils in both contralateral patellar tendon and posterior cruciate ligament showed a more or less pronounced bimodal distribution. A unimodal distribution with mainly thin fibrils (20-60 nm) was demonstrated in the transplant tissue which also revealed some morphological alterations of the collagen fibrils. Thin elastic fibers (microfibrils and amorphous material) were randomly scattered among the collagen fibrils of the control samples, bundles of microfibrils (without amorphous material) characterized the transplant. Staining with Alcian blue in the presence of 0.3 M MgCl2 demonstrated a close relationship between proteoglycans and collagen fibrils as well as elastic components in patellar tendon. This arrangement was lost in the transplant where abundant proteoglycans were revealed which, however, composed a tight irregular network between the collagen fibrils. The results serve as a baseline for understanding the impaired biochemical properties of a free autogenous patellar tendon transplant.     

The site of collagen resorption in the periodontal ligament of the rodent molar

In an attempt to determine the pattern of collagen phagocy-tosis by fibroblasts in the periodontal ligament, a stereologic investigation of the mesial root of the maxillary first molar of the rat was undertaken. The distribution of fibroblasts containing intracellular collagen fibrils was studied at the electron microscope level in the periodontal ligament along resorbing and non-resorbing surfaces of the alveolar wall. It appeared that fibroblasts with collagen-containing vacuoles were more or less randomly distributed across the width of the periodontal ligament. No major differences were observed among the alveolar, cemental and intermediate zones of the ligament. However, local variations in the occurrence of cells containing intracellular collagen fibrils may occur. A relatively high concentration of ingested collagen fibrils was seen in fibroblasts located in the direct vicinity of osteoclasts, but not in the vicinity of osteoblasts. These observations suggest that remodelling of collagen is even-ly distributed throughout the ligament, but may be influenced by local circumstances, such as the occurrence of bone resorption.     

Type VI collagen in mouse masseter tendon,from osseous attachment to myotendinous junction

Background and Methods: The association of masseter tendon type VI collagen with other extracellular matrix (ECM) components was examined from osseous attachment to myotendinous junction by immunohistochemistry and transmission electron microscopy with ATP treatment and enzyme digestion. Results: In the tendon proper, fibrocytes extended their processes among bundles of striated collagen fibrils and associated with adjacent cells through amorphous materials, thus forming a three-dimensional network. The amorphous or filamentous material was observed around the fibrocyte cell body and along the cell processes, where the localization of type VI collagen was confirmed by immunohistochemistry using anti-type VI collagen antibody. After treatment with 20 mM adenosine 5′-triphosphate (ATP), 100 nm periodic fibrils, an aggregated form of type VI collagen, were formed in the place where amorphous or filamentous material was present before the treatment. In myotendinous junction, the ATP-aggregated periodic fibrils were observed to associate with the external lamina of the muscle cells as well as among junctional tendon collagen fibrils. In the tendonbone boundary, ATP-aggregated periodic fibrils were observed around fibrocartilage-like cells in the uncalcifying area but not in the calcification front. Prolonged ATP treatment or hyaluronidase predigestion caused the formation of type VI collagen periodic fibrils in the area near the calcified matrix. Conclusions: The distribution of type VI collagen in mouse masseter tendon is different in different anatomical position. This may reflect the different functional demand for this collagen. © 1995 Wiley-Liss, Inc.     

Microstructural Morphology in the Transition Region Between Scar and Intact Residual Segments of a Healing Rat Medial Collateral Ligament

This study used a rat model to investigate the microstructural organization of collagen through the transition from scar to intact residual segments of a healing medial collateral ligament (MCL). Twenty-two male retired breeder Sprague-Dawley rats were randomly separated into two groups. Eleven underwent surgical transections of both MCLs and were allowed unrestricted cage activity until euthanized two weeks post surgery. The remaining eleven rats were used as normal controls. All 44 MCLs were harvested including intact femoral and tibial insertions and prepared for scanning electron microscopy (SEM) imaging. At harvest the scar region in the healing ligaments was more translucent than the normal tissue. Ligaments were viewed from femoral to tibial insertions at magnifications of 100X through 20,000X. Tissue away from the scar region in the transected MCLs was indistinguishable from normal tissue in uninjured ligaments. Collagen fibers and fibrils in these tissues were more aligned along the longitudinal axis of the ligament than in the scar tissue. Continuity of collagen fibers and fibrils were consistently observed from the residual portions of the transected ligament through the scar region. Bifurcations/fusions, but no anastomoses, in fibers and fibrils were observed in both normal and scar tissues of ligaments. Qualitatively, bifurcations were encountered more frequently in scar tissue. In the transition region, larger diameter fibers from the residual tissue bifurcated into smaller diameter fibrils in the scar. This connection between larger diameter and smaller diameter fibers and fibrils indicates that bifurcations/fusions are likely to be the dominant way in which force is transmitted from a region with larger fibrils (residual ligament) into and through a region with smaller fibrils (scar).     

Microstructural morphology in the transition region between scar and intact residual segments of a healing rat medial collateral ligament.

This study used a rat model to investigate the microstructural organization of collagen through the transition from scar to intact residual segments of a healing medial collateral ligament (MCL). Twenty-two male retired breeder Sprague-Dawley rats were randomly separated into two groups. Eleven underwent surgical transections of both MCLs and were allowed unrestricted cage activity until euthanized two weeks post surgery. The remaining eleven rats were used as normal controls. All 44 MCLs were harvested including intact femoral and tibial insertions and prepared for scanning electron microscopy (SEM) imaging. At harvest the scar region in the healing ligaments was more translucent than the normal tissue. Ligaments were viewed from femoral to tibial insertions at magnifications of 100X through 20,000X. Tissue away from the scar region in the transected MCLs was indistinguishable from normal tissue in uninjured ligaments. Collagen fibers and fibrils in these tissues were more aligned along the longitudinal axis of the ligament than in the scar tissue. Continuity of collagen fibers and fibrils were consistently observed from the residual portions of the transected ligament through the scar region. Bifurcations/fusions, but no anastomoses, in fibers and fibrils were observed in both normal and scar tissues of ligaments. Qualitatively, bifurcations were encountered more frequently in scar tissue. In the transition region, larger diameter fibers from the residual tissue bifurcated into smaller diameter fibrils in the scar. This connection between larger diameter and smaller diameter fibers and fibrils indicates that bifurcations/fusions are likely to be the dominant way in which force is transmitted from a region with larger fibrils (residual ligament) into and through a region with smaller fibrils (scar).     

Application of an asymmetric finite element model of the C2-T1 cervical spine for evaluating the role of soft tissues in stability

Different finite element models of the cervical spine have been suggested for evaluating the roles of ligaments, facet joints, and disks in the stability of cervical spine under sagittal moments. However, no comprehensive study on the response of the full cervical spine that has used a detailed finite element (FE) model (C2-T1) that considers the asymmetry about the mid-sagittal plane has been reported. The aims of this study were to consider asymmetry in a FE model of the full cervical spine and to investigate the influences of ligaments, facet joints, and disk nucleus on the stability of the asymmetric model during flexion and extension. The model was validated against various published in vitro studies and FE studies for the three main loading planes. Next, the C4-C5 level was modified to simulate different cases to investigate the role of the soft tissues in segmental stability. The FE model predicted that excluding the interspinous ligament (ISL) from the index level would cause excessive instability during flexion and that excluding the posterior longitudinal ligament (PLL) or the ligamentum flavum (LF) would not affect segmental rotation. During extension, motion increased when the facet joints were excluded. The model without disk nucleus was unstable compared to the intact model at lower loads and exhibited a similar rotation response at higher loads.     

Collagenase degradation decreases collagen fibril diameters--an in vitro study of the rabbit medial collateral ligament

Based on the similarity of fibril diameters in healing and grafted ligaments, it has been speculated that all small fibrils represent newly synthesized collagen. Alternatively, small fibrils in grafts could be due to enzymatic degradation of endogenous large fibrils. This study examined the effect of collagenase on collagen fibril diameters in normal NZW rabbit MCLs. Midsubstance MCL slivers were incubated in buffer for 72 or 144 h for comparison with slivers incubated in buffer containing 4 units/ml bacterial collagenase. The samples were examined under TEM for fibril diameter analysis. Mean fibril diameters of 3-day and 6-day collagenase-treated MCLs were significantly reduced, resembling 40-week scar values. These results suggest that collagenase treatment can alter collagen fibril diameter and shape in normal rabbit MCL, thus it is possible that despite their similarity to ligament scars, that at least some small fibrils in ligament grafts may be enzymatically reduced endogenous fibrils.     

影响下颈椎骨折脱位在麻醉下手法复位失败的多因素分析

目的探讨影响下颈椎骨折脱位在麻醉下闭合复位失败的相关影响因素。方法通过回顾我科于2006年1月~2011年1月治疗下颈椎骨折脱位病例85例。分别记录患者的年龄、性别、颅骨牵引重量、颅骨牵引时间、骨折脱位节段、交锁、并发多颈椎骨折、关节突关节骨折、前纵韧带及椎间盘损伤、后方韧带复合体损伤等相关因素,观察患者麻醉下复位的情况,分析引起复位失败原因。结果影响复位失败的相关因素和顺序为关节突关节交锁;前纵韧带及椎间盘损伤;多发颈椎骨折。结论下颈椎骨折脱位伴双侧交锁是麻醉下手法复位的适应症;单侧交锁或多发颈椎骨折受伤是相对禁忌症,选择适当的病例,可以减少医源性损伤,简化手术。     

Structural and mechanical architecture of the intestinal villi and crypts in the rat intestine: integrative reevaluation from ultrastructural analysis

The ultrastructure of the rat intestinal interstitium was analyzed from the viewpoint of mechanical dynamics to stabilize the intestinal villi, crypts and mucosal folds. In the rat, the small intestine lacks circular folds, but the large intestine possesses spiral folds. The intestinal villi, the largest in the duodenum, decreased in size in the jejunum and ileum successively, and were absent in the large intestine. The intestinal interstitium consisted of lamina propria mucosae (LPM) and tela submucosa (TSM) separated by muscularis mucosae (MM), the LPM was subdivided into an upper part within the villi and a lower part among the crypts in the small intestine. The light microscopic density of interstitium in the intestinal wall was lowest in the upper LPM, moderately dense in the lower LPM and highest in the TSM, and that among the intestinal region was highest in the duodenum and decreased successively in the jejunum and ileum. In the large intestine, the TSM bulged to form spiral folds with very low density. The intestinal epithelium in the villi possessed wide intercellular spaces and that in the crypts had closed intercellular spaces. At electron microscopic level, the upper and lower LPM contained subepithelial supportive meshwork that consisted of collagen fibrils and myofibroblast processes. The lower LPM and TSM contained conspicuous bundles of collagen fibrils and, in addition, TSM contained minor populations of scattered collagen fibrils near the smooth muscle layer (SML). The diameter of collagen fibrils was the largest in the bundles of TSM, and decreased from the duodenum through the jejunum and ileum to the large intestine. On the basis of these observations, we hypothesize that the intestinal villi are mechanically stabilized by the balance between the expansive interstitial pressure and inward pull by the subepithelial supportive meshwork. This hypothesis explains the hitherto neglected fact that the intestinal epithelium possesses wide intercellular spaces only in the villi, and accounts for the counterforce against the perpendicular smooth muscle cells, which are supposed to contract the intestinal villi.     

Proliferation, apoptosis and expression of non-collagenous proteins: differences between the upper and the lower jaw bone in vitro

One of the effects observed during several screening studies for osteocompatibility in vitro was that cells derived from the upper and lower jaw exhibited distinct differences regarding proliferation. Therefore, the aim of this study was to examine systematically whether a single osteoblast possesses abilities which are specific to the upper or lower jaw. Both human maxillary and mandibular bone samples without any clinical or radiographic evidence of pathology were obtained from 4 male donors aged between 40 and 45 years. Cells were cultured for up to 25 days to investigate in vitro development. Total and apoptotic cell numbers were estimated by image analysis. Cells were identified as bone-like cells using immunocytochemical determination of bone sialoprotein (BSP) and osteocalcin expression. The number of healthy cells was significantly higher for cells of the lower jaw compared to those of the upper jaw. The number of apoptotic cells showed an inverse pattern. The expression pattern of osseo-inductive BSP correlated with the proliferation rate of the cells. The pattern of osteocalcin expression was related to the number of apoptotic cells. Our findings are new but were anticipated regarding the well-known differences in the healing process around implants in the lower jaw versus the upper jaw. Additionally, a relationship between our results and some diseases of the lower/upper jaw seems obvious. Future work on cell responses to biomaterials should define the origin of the cells more precisely.     

Distribution of sensory receptors in joints of the upper cervical column in the laboratory marsupial monodelphis domestica.

In order to investigate the sensory innervation, the upper cervical spine of a small laboratory marsupial (monodelphis domestica) was examined with serial section light microscopy and re-embedding of selected sections for electron microscopy. Large numbers of free nerve endings supplied by A delta- and C-fibres were found in the longitudinal ligaments and facet joint capsules. Electron microscopically, areas of direct contact between axon and collagen fibres of the surrounding connective tissue separated only by the basal lamina were observed. Such structural adaptations suggest mechanoreceptive or polymodal nociceptive functions. In addition, about 100 small lamellated corpuscles were found in the longitudinal ligaments mainly concentrated around the first intervertebral disk. Electron microscopy shows finger-like processes extending from the axon terminal into the inner core lamellae. These are the likely sites of the mechanoelectric transduction process. Smaller numbers of lamellated corpuscles were seen in the lower intervertebral disks and facet joint capsules. Lamellated corpuscles are known to function as rapidly adapting mechanoreceptors supplementing information supplied by muscle spindles to the CNS about position and movement of the cervical spine.     

Morphological, biochemical and mechanical features of the cranial cruciate and lateral collateral ligaments in dogs

The cruciate ligament and the collateral ligament play key roles in stabilization of the knee joint. Cases of serious knee joint problems presented at the, the Veterinary Teaching Hospital of Rakuno Gakuen University, Japan mostly involved rupture of the cranial cruciate ligament (CCL). Disorders in structural and biochemical components of the CCL were thought to be the causes of the knee problems. Morphological, biochemical and biomechanical features of the CCL and the lateral collateral ligament (LCL) were therefore analyzed. In the CCL, fibroblasts with ovoid and enlarged nuclei were observed mainly at the periphery of collagen bundles. The array of collagen fibrils in the LCL was slightly disoriented, but that of the CCL was tight and regular. In the LCL, the major groups of collagen fibrils were those with diameters of 70-80 and 120-130 nm. Most collagen fibrils in the CCL had diameters of 70-80 nm. The mean collagen diameters were 90 nm in the CCL and 105 nm in the LCL. The ratios of the noncollagen area to the area occupied by collagen fibrils were 43% in the CCL and 55% in the LCL. There was no difference between the amounts of HA or between the amounts of DS in two ligaments. However, the amount of CS in the CCL was about 17-times greater than that in the LCL. The expansion of and the resistance to tension exerted onto the CCL were less than those of the LCL. A high concentration of CS and low tensile strength due to small-sized collagen fibrils cause the CCL to rupture easily, especially when overextension of the knee joint occurs.     

Scanning electron microscopic observations of the periodontal ligament fibers and cells in rat molar teeth.

The periodontal ligament of rat molar teeth was observed with scanning electron microscopy (SEM) using two different methods: NaOH maceration and KOH-collagenase treatments. Rat jaws with molar teeth were fixed, demineralized with 10% EDTA, and cut into several pieces. After maceration with 5% NaOH for 5 days at room temperature, the cellular elements were completely removed and the periodontal ligament fibers appeared as bundles of collagen fibrils. The fibers branched and anastomosed but did not spread fibrils randomly. In some regions near the alveolar bone, collagen fibrils circularly binding the fibers were found. When treated with 30% KOH for 7 to 10 minutes at 60 degrees C and with 0.1% collagenase, the periodontal ligament fibers were removed and the cells appeared as spindle and stellate shapes, and combined with the irregular cell processes of each other. Thus, the interaction between the periodontal ligament fibers and cells were three-dimensionally visualized by using the two different methods.     

Apoptosis in woman uterine cervix in pathologies associated with human papillomavirus

The level of apoptosis in uterine cervical tissue was evaluated in healthy women and in patients with various pathologies. No signs of apoptosis were found in unchanged stratified epithelium, condyloma latum, and condyloma acuminatum. The level of apoptosis decreased with progression of neoplastic epithelial transformations, usually no apoptosis was observed in samples of stage III cervical intraepithelial neoplasms. The development of preinvasive carcinoma was accompanied by activation of apoptotic processes most pronounced in the upper third of the epithelium. In some stage I and stage I-II cervical intraepithelial neoplasms, apoptosis and elimination of the basal layer cells caused rejection of the epithelium which can explain regression of this pathology at the initial stages. The prevalence of human papillomavirus infection directly correlated with neoplastic changes in the cervical epithelium.     

环椎后桥的X线观察及临床意义探讨

用在１５８２例颈椎侧位片中发现的７６例环椎后桥进行了Ｘ线观察。环椎后桥由环枕韧带钙化、骨化形成。后格在可为单侧或双侧,并把环椎后桥分为完全型和不完全型,后者又分为前突型、后型、双突型、中央型。７６例中,临床症状与后桥孔大小无明显关系。并指出,不完全型环椎后桥在Ｘ光片上须与骨折折及软组织异物相鉴别。     

Spinal balance failure: a potential cause of spinal ligament ossification

Ossification of the posterior longitudinal ligament (OPLL) and of the ligamentum flavum (OLF), as well as calcification of ligamentum nuchae in the cervical spine and ossification of ligamentum flavum in the thoracic spine, are common types of spinal ligament ossification. As is known, the pathogenesis of OPLL and OLF has been unclear until recently, and mechanical stress assumably plays an important role. In this paper, we try to make a hypothesis that spinal balance failure (characterized by the gravity line, spinal curvature and flexion/extension in the sagittal plane), may play more important roles than any other factors in the development of ligament ossified diseases. Moreover, different stress thresholds and flexion/extension frequency may induce various ossification regions. It is supported by the conclusions that drawn from literature review: (1) OPLL and OLF seldom occur in lumbar spine which is of stiffer and lower-frequency motion than cervical spine, although its range of motion (ROM) was relatively great. (2) Spinal ligament ossification often appears in the cervical spine, which is significantly flexible with a larger motion range. (3) OLF is often seen in the thoracic spine, which is farthest away from the gravity line for thoracic kyphosis. (4) Many OPLL or OLF patients are often found with a local kyphosis or high segmental ROM. (5) The prevalence of ossification is higher in the larger stress regions, as described above, indicating that there may be a stress threshold for the spinal ligaments.     

Endochondral calcification by hypertrophic chondrocytes in the Meckel's cartilage grafted into the isogenic mouse spleen

We found that when the midsection of Meckel's cartilage bars obtained from mice on the eighteenth day of gestation were grafted into isogenic mouse spleen, chondrocytes induced an endochondral calcification. Concurrent with the onset of calcification throughout Meckel's cartilage matrix, periodic banded thick collagen fibrils and matrix vesicles were observed around the chondrocytes. Although most of the chondrocytes prior to grafting were hypertrophic cells, they survived for seven days in the splenic tissue and had well-developed secretory organelles. The cells which were surrounded by calcified matrix were relatively small, spherical, and showed a morphology closely resembling that of osteocytes. These findings suggest that the life span of hypertrophic chondrocytes is influenced by the microenvironment of the spleen.     

An ultrastructural study on anterior cruciate ligament reconstruction using autogenous patellar tendon grafts in dogs

An ultrastructural study was undertaken concerning morphological changes within the autografted patellar tendon (PT) after being transplanted to the anterior cruciate ligament (ACL) in mongrel dogs. After 4 weeks, the arrangements of both large and small collagen fibrils in the PT graft became disordered, and the number of inflammatory cells increased. However, the same PT grafts revealed postsurgical signs of newly-produced collagen fibrils around activated fibroblasts at 12 to 24 weeks. At 52 weeks after the transplantation, small collagen fibrils increased in both number and density, showing a remarkable morphological similarity to the collagen fibrils of normal ACL. These data indicate that the characteristics of the PT graft eventually resemble those of a normal ACL. This paper was presented in part at the Combined Meeting of the Orthopedic Research Societies of the USA, Japan and Canada in Banff, Alberta, Canada, October, 1991.     

Fibroblasts are required for Schwann cell basal lamina deposition and ensheathment of unmyelinated sympathetic neurites in culture

Summary The ability to purify and recombine populations of peripheral neurons, Schwann cells and fibroblasts in tissue culture has enabled us to examine the contribution of fibroblasts to Schwann cell basal lamina assembly and ensheathment of unmyelinated rat superior cervical ganglion neuritesin vitro. Purified perinatal superior cervical ganglion neurons were grown in culture either with Schwann cells or with Schwann cells plus fibroblasts derived from either superior cervical ganglion capsule or cranial periosteum. The cultures were maintained for 2–8 weeks on a collagen substratum in a medium known to promote Schwann cell differentiation (myelin, basal lamina formation) in the presence of dorsal root ganglion neurons. The extent of Schwann cell differentiation (ensheathment, basal lamina formation) in the presence of superior cervical ganglion neurons was evaluated in this study using electron microscopy. In superior cervical ganglion neuron plus Schwann cell cultures (without fibroblasts), Schwann cells achieved only a moderate degree of ensheathment; also, Schwann cell basal lamina was discontinuous and extracellular collagen fibrils were sparse. Although only discontinuous basal lamina was demonstrable by electron microscopy in these cultures, surprisingly, Schwann cell/neurite fascicles were uniformly immunostained for laminin, type IV collagen, and heparan sulfate proteoglycan. The addition of fibroblasts to superior cervical ganglion neuron plus Schwann cell cultures increased the deposition of basal lamina around the Schwann cell/neurite units, the number of collagen fibrils, and the extent of neurite ensheathment. We propose that the presence of basal lamina increases the Schwann cell's ability to ensheathe superior cervical ganglion neurites, possibly through an augmentation of specific extracellular matrix components or by increasing in some way the capacity of these components to become organized into basal lamina. We conclude that, unlike dorsal root ganglion neurons, superior cervical ganglion neurons are unable to stimulate full Schwann cell extracellular matrix expression with the result that these Schwann cells require the extraneuronal influence of fibroblasts to deposit basal lamina and attain their mature phenotype in culture.