白细胞介素-17在退变腰椎间盘中的表达及意义

[目的]观察白细胞介素-17(IL-17)在退变腰椎间盘组织中的表达水平,并探讨其与椎间盘退变发生发展的关系.[方法]实时荧光相对定量PCR(RQ-PCR)方法检测42例退变椎间盘组织(26例来自腰椎间盘突出症患者,16例来自腰椎管狭窄症患者)及8例正常对照椎间盘组织(来自4具新鲜尸体)中IL-17和孤独受体(retinoid-relatedorphanreceptor,RORγT)mRNA的表达水平;免疫组织化学EnVision法检测入选标本CD4表面抗原、IL-17表达水平.[结果]退变组椎间盘组织IL-17、RORγTmRNA的相对表达量显著高于正常对照组相对表达量(P＜0.05),且腰椎间盘突出组和腰椎管狭窄组IL-17、RORγrmRNA表达量差异无统计学意义(t=0.669,P=0.507,T=421,p=0.38);IL-17mRNA和RORγTmRNA相对表达水平呈线性关系(r=0.381,P=0.013);退变组椎间盘组织IL-17、CD4细胞表面抗原阳性率显著高于正常对照组(P＜0.001),且腰椎间盘突出组和腰椎管狭窄组IL-17、CD4细胞表面抗原阳性率差异无统计学意义(t=1.13,P=0.265,t＝1.459,P=0.152).[结论]IL-17mRNA和蛋白表达水平在退变椎间盘组织中显著升高,说明IL-17参与椎间盘退变的病理过程,Th17细胞介导的免疫炎症反应可能在腰椎间盘退变的发生发展中起重要作用.     

细胞因子IL-1a、IL -6、TNF-a、MMP3与颈椎间盘退变机制的相关性研究

[目的]探讨细胞因子在颈椎间盘退变机制中的作用及其与神经功能的相关性.[方法]实验组椎间盘组织取自46例颈椎病患者,根据术前颈椎MRI及术中椎间盘突出情况分为两组:退变组(24例)和突出组(22例).对照组椎间盘组织取自15例无颈椎病病史的颈椎外伤患者.根据颈椎病患者术前JOA评分分为三组:轻度组(17例),中度组(15例)和重度组(14例).采用酶联免疫吸附法(ELISA法)分别检测不同退变程度颈椎间盘中IL-1a、IL -6、TNF -a和MMP3的表达水平.[结果]对照组、退变组和突出组三组之间比较,IL -1a、IL -6、TNF-a和MMP3的表达有统计学意义(P＜0.05),其表达水平与颈椎间盘退变呈正相关趋势;轻度组、中度组和重度组三组之间比较,MMP3、TNF -a的表达有统计学意义(P＜0.05),其表达水平与JOA评分呈负相关趋势.[结论]IL -1、IL -6、TNF -a和MMP3与颈椎间盘退变密切相关,其表达水平与椎间盘退变呈正相关趋势;TNF -a与神经功能有关,可能在神经损伤中起主导作用;MMP3与椎间盘突出有关,对TNF -a的神经功能损伤可能起促进作用.     

突出颈椎间盘组织炎症反应机制的研究

目的:研究颈椎病发生中突出颈椎间盘组织的炎症反应机制,探讨炎症反应在颈椎间盘退变和颈椎病发病中的作用.方法:临床收集了31个脊髓型颈椎病病人的35个突出的颈椎间盘标本和3个成年人的7个正常颈椎间盘标本.将每个标本分为2份,1份作组织学检查,观察有无炎细胞浸润,1份用生物化学方法测定其中IL-1α,IL-6和TNF-α三种细胞因子含量.结果:35例突出颈间盘中,18例(51.4%)在边缘区域有大量炎细胞浸润,其余17例(48.6%)未见炎细胞浸润,对照组也未见炎细胞浸润.生物化学测定结果表明,突出颈间盘组织中IL-1α,IL-6和TNF-α三种细胞因子含量明显高于正常对照组.炎细胞浸润组与无炎细胞浸润组三种细胞因子含量相当,在统计学上无任何差异.结论:突出颈间盘组织具有炎症反应特性,炎症反应可能在颈椎间盘退变和颈椎病的发生发展中起重要作用.     

椎间盘退变炎症因子表达水平与椎间盘退变程度相关性分析

目的探讨白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)以及神经生长因子(NGF)的表达水平与椎间盘退变程度相关性。方法采用酶联免疫吸附法测定154例腰椎病患的IVD样本中TNF-α,IL-6和NGF表达水平,评估椎间盘退变程度与IL-6、TNF-α、NGF表达水平的相关性。比较腰痛患者与腿痛患者IL-6、TNF-α、NGF表达水平。结果相关性分析结果显示,TNF-α表达水平与椎间盘变性程度呈正相关(r=0.411,P 0.05),IL-6水平与椎间盘变性程度呈正相关(r=0.392,P 0.05),NGF表达水平与椎间盘变性程度呈负相关(r=-0.164,P 0.05)。腰痛患者的TNF-α表达水平明显高于腿痛患者(P 0.05),但两者IL-6和NGF表达水平比较差异无统计学意义(P0.05)。结论 TNF-α、IL-6和NGF表达水平与椎间盘退变程度密切相关。腰痛患者的TNF-α表达水平较腿痛患者高,可能与腰痛症状的发生和进展有一定关系。     

促炎因子与抗炎因子在突出腰椎间盘组织中的表达及其意义

目的观察促炎因子白介素(IL)-6、肿瘤坏死因子(TNF)-α及抗炎因子白介素(IL)-4在退变椎间盘组织内的表达,并探讨其意义。方法收集30例单节段椎间盘突出症患者及10例经前路松解手术的特发性脊柱侧弯患者的髓核组织,术前患者临床症状严重程度均予Oswestry功能障碍指数(ODI)评定,23例行MRI检查的患者,根据Schneiderman分级评定椎间盘退变程度,术后应用酶联免疫吸附测定法(ELISA)测定髓核组织中IL-6、TNF-α和IL-4的含量。结果退变髓核中IL-6的含量(11.2±7.5)ng/L较对照组(6.4±0.8)ng/L高(P<0.01)、TNF-α的含量(186.8±86.0)ng/L亦较对照组(122.3±23.5)ng/L高(P<0.05);IL-4的表达仅存在于TNF-α表达较高的髓核组织中;IL-6及TNF-α的同时表达与ODI评分高低正相关(IL-6:B=0.481,β=0.229,P<0.05;TNF-α:B=6.945E-2,β=0.522,P<0.01);椎间盘退变MRI分级与促炎因子和抗炎因子的高低无明显相关。结论促炎因子TNF-α与IL-6的表达增高为椎间盘退变的重要原因,亦为临床症状加重的重要原因之一;促炎因子与抗炎因子表达的不平衡亦可能为椎间盘退变进展的重要因素。     

前炎症因子在脊髓型颈椎病发病早期的表达

目的探讨前炎症因子在脊髓型颈椎病发病的早期变化,探讨前炎症因子与颈椎间盘早期退变的关系。方法收集从2004年5月~2005年1月之间我科收治的20例发病时间<1个月的早期脊髓型颈椎病患者术中取出的32个部分椎间盘髓核组织,与同时期取自死亡时间<24h的新鲜尸体中15个颈部椎间盘组织,分别作为实验组和对照组。采用免疫组化的方法检测其中TNF-α、IL-1β、IL-6的表达阳性例数,采用小鼠抗人TNF-α、IL-1β、IL-6单克隆抗体来检测早期脊髓型颈椎病患者椎间盘组织中的前炎症因子的含量。结果实验组32个颈部突出椎间盘组织中,TNF-α、IL-1β、IL-6表达阳性分别为27例、21例、18例,其中12例为4种细胞因子均表达阳性。对照组15个正常椎间盘组织中表达的阳性细胞较少。应用SPSS11.5统计学软件对实验数据进行统计学分析结果有差异性(P<0.05)。结论突出的颈椎间盘可产生TNF-α、IL-1β、IL-6,阳性细胞主要以成纤维细胞、软骨细胞及淋巴细胞为主,这些细胞因子可能在颈椎椎间盘早期退变中发挥作用。     

颈椎前路手术对脊髓型颈椎病患者椎间盘组织中炎性细胞因子的影响

目的 探讨颈椎前路手术对脊髓型颈椎病(CSM)患者椎间盘组织中炎性细胞因子的影响.方法 35例脊髓型颈椎病患者(CSM组)和30例颈椎外伤患者(对照组)均行颈椎前路手术治疗,观察治疗效果.采用固相分离放射免疫分析法(SPRIA)测定两组颈椎间盘组织中白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)－α水平.结果病程≤6个月组优良率为81.8％,病程＞6个月组优良率为38.5％,两组优良率比较差异有统计学意义(P＜0.05);CSM患者术前JOA评分为(9.73±2.12)分,术后JOA评分为(14.21±2.52)分,术后JOA评分显著高于术前(P＜0.05);CSM组颈椎间盘中IL-6、IL-8、TNF-α水平均显著高于对照组(P＜0.05).结论 颈椎前路手术是治疗CSM的一种较有效手术方法;IL-6、IL-8、TNF-α在颈椎间盘退变和CSM发病中起重要作用.     

人退变腰椎间盘中HIF-1α和COX-2的表达相关性及其意义

目的研究在人类退变的腰椎间盘中缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)和环氧化酶-2(cyclooxygenase-2 COX-2)的表达相关性以及两者在腰椎间盘退变过程中的意义。方法取40例手术摘除的退变腰椎间盘组织与6例正常椎间盘组织,通过免疫组化染色方法,测定各组中HIF-1a和COX-2的表达量,统计学分别描述退变椎间盘中COX-2因子与HIF-1α因子之间的关系。结果HIF-1α因子、COX-2因子在正常椎间盘中表达很少或几乎不表达,退变椎间盘内阳性表达分别为45%,42.5%。HIF-1α因子和COX-2因子在退变的髓核内表达程度正相关(P0.01,r=0.406)。结论人类退变腰椎间盘中HIF-1α因子、COX-2因子表达存在相关性,且在腰椎间盘退变过程中发挥重要作用。     

间隙连接蛋白37在腰椎椎间盘突出症炎性反应中的意义

目的探索间隙连接蛋白37(CX37)在腰椎椎间盘突出症炎性反应中的意义。方法观察10例腰椎椎间盘突出症患者(观察组)及8例腰椎爆裂骨折患者(椎间盘部分损坏无明显退变,对照组)CT与MRI表现差异,采用Pfirrmann分级评估椎间盘退行性变程度。利用PCR方法检测患者椎间盘组织中CX37、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的表达,并分析CX37与IL-6、TNF-α表达的相关性。结果对照组影像学资料主要表现为不同程度的椎间盘损伤,观察组主要表现为椎间盘突出、髓核脱垂、髓核突出。对照组Pfirrmann分级Ⅰ级6例,Ⅱ级2例;观察组Ⅲ级3例,Ⅳ级3例,Ⅴ级4例。PCR结果显示观察组CX37、IL-6和TNF-α的m RNA表达水平均高于对照组,差异有统计学意义(P 0.05)。Pearson相关性分析显示,炎症因子IL-6,TNF-α的表达与CX37均呈正相关。结论腰椎椎间盘突出症患者髓核中CX37表达显著高于无椎间盘退行性变病例,且与炎症因子IL-6,TNF-α的表达均呈正相关,CX37可能通过调控炎症因子的表达参与椎间盘突出症的发生、发展。     

炎性因子TNF—α及IL-18与椎间盘退变的相关性研究

[目的]通过测定TNF-α及IL-18在正常组与实验组椎间盘组织中的表达,探讨在椎间盘退变中的作用,进一步了解椎间盘退变的发生机制.[方法]收集新疆石河子大学医学院第一附属医院骨科椎间盘突出症患者术后椎间盘病理组织34例用于实验组,年龄27～69岁,平均年龄46.24±11.25岁;取脊柱骨折外伤术后椎间盘组织标本7例,并取石河子大学医学院病理科尸检椎间盘标本8例,共15例用于对照组,年龄25～52岁,平均年龄40.07±8.43岁.采用免疫组化法和ELISA两种方法进行检测.[结果]光镜下观察,免疫组化检测TNF-α、IL-18蛋白表达阳性细胞表现为细胞浆中出现棕黄色、褐色或浅棕黄色染色,结果判定及统计学分析后表明:实验组TNF-α蛋白表达高于对照组,差异有统计学意义(P＜0.01),实验组IL-18蛋白表达高于对照组,差异有统计学意义(P＜0.01).Elisa法证实实验组中TNF-α含量为82.18±21.91 ng/ml,IL-18的含量为45.39±21.23 ng/ml;对照组中TNF-α含量为8.68±0.78 ng/ml、IL-18含量为3.58±2.84 ng/ml.两者差异均有统计学意义(P<0.01),且两种细胞因子的表达均与患者年龄及病程呈正相关.[结论]椎间盘组织中细胞因子TNF-α及IL-18表达与椎间盘退变有关,推测可能是导致椎间盘组织退变的重要原因之一.     

Histological changes in intervertebral discs after smoking and cessation: experimental study using a rat passive smoking model

Background Passive smoking has been reported to induce intervertebral disc degeneration in rats, and the objective of the present study was to histologically investigate changes in smoking-induced intervertebral disc degeneration after cessation of smoking. Methods Four-week-old rats were subjected to passive smoking for 8 weeks in a smoking box [20 cigarettes a day: one cigarette an hour (inhaled over 3 minutes and followed by ventilation with room air for 5 minutes)] to induce intervertebral disc degeneration. Smoke-free periods of different lengths were then established, and intervertebral discs were histologically analyzed. Results Immediately after 8 weeks of passive smoking, intervertebral discs exhibited cracks, tears, and misalignment of the annulus fibrosus, and increased fibrous tissue was seen in the nucleus pulposus. In addition, the level of interleukin-1β in intervertebral discs was higher in the smoking group than in the non-smoking group. After cessation, progression of degeneration ceased, and the matrix of the nucleus pulposus and annulus fibrosus exhibited increased fibrous connective tissue and proteoglycan. However, there were no changes in annulus fibrosus misalignment. Interleukin-1β levels also remained significantly elevated after 8 weeks of cessation. Conclusions While the annulus fibrosus degeneration caused by smoking was partially irreversible after cessation of smoking, the amount of mucin (proteoglycan) in the nucleus pulposus and annulus fibrosus tended to increase after cessation, thus suggesting the possibility that smoking-induced intervertebral disc degeneration can be repaired to some degree by cessation of smoking.     

MMP-3在退变腰椎间盘组织中的表达及意义

目的研究MMP-3在退变腰椎间盘髓核和纤维环组织中的表达及其临床意义。方法用半定量RT—PCR和免疫组织化学法检测实验组1（30例退变腰椎间盘髓核）、实验组2（30例退变腰椎间盘纤维环）和对照组（10例创伤腰椎间盘髓核）中MMP3mRNA和蛋白表达。结果实验组1MMP-3mRNA和蛋白的表达均显著高于对照组（P均〈0．01）,实验组1与2之间MMP-3mRNA和蛋白的表达没有显著差异（P均〉0．05）。结论MMP-3的表达增加可能参与腰椎间盘退变的进程。     

兔髓核组织中BNIP3表达与椎间盘退变的关系

目的:探讨兔椎间盘髓核组织中BNIP3表达量与椎间盘退变的相关性。方法:健康1月龄新西兰白兔24只,随机分为4组,每组6只。在每只动物的L4/5、L5/6和L6/7椎间盘进行纤维环穿刺术,建立椎间盘退变模型,作为实验椎间盘;穿刺椎间盘近端3个椎间盘(L1/2、L2/3、L3/4)作为正常对照椎间盘。分别于术后即刻、2、4、8周对椎间盘进行MRI及组织学评分,应用Real-time PCR定量检测髓核组织BNIP3 mRNA表达,免疫组织化学染色半定量髓核组织BNIP3表达,同时分析同一椎间盘BNIP3表达与MRI评分、组织学评分之间的相关性,并与正常椎间盘进行对照。结果:正常及手术后即刻实验椎间盘在MRI T2加权像上呈高密度,评分为1.0±0.0;手术后2周实验椎间盘信号呈不均一的高密度,评分为2.9±0.4;手术后4周实验椎间盘信号呈不均一中低密度,评分4.2±0.3;手术后8周实验椎间盘信号呈低密度,评分4.9±0.1,各时间点MRI评分比较有显著性差异(P<0.05)。组织学染色显示正常及手术后即刻椎间盘结构整齐,髓核与纤维环交界清晰,组织学评分4.0±0.0;手术后2周实验椎间盘纤维环出现小裂隙,髓核与纤维环交界轻度不清,组织学评分7.5±0.2;手术后4周实验椎间盘纤维环出现较大裂隙,髓核与纤维环交界中度不清,组织学评分10.0±1.0;手术后8周实验椎间盘正常结构丧失,髓核组织纤维化,组织学评分11.8±0.2,各时间点间组织学评分比较有显著性差异(P<0.05)。手术后即刻、2周、4周及8周实验椎间盘BNIP3 mRNA表达是正常组的1.0±0.3倍、2.0±0.1倍、2.8±0.3倍和4.2±0.2倍,与椎间盘MRI退变评分呈显著性正相关(r=0.92,P<0.01)。正常及手术后即刻实验椎间盘髓核组织BNIP3灰度值分别为55.3±6.2和60.7±4.4;而手术后2周、4周及8周实验椎间盘分别为150.4±13.4、176.0±35.1和173.6±7.9,其灰度值与椎间盘组织学评分呈显著性正相关(r=0.92,P<0.01)。结论:兔椎间盘髓核组织中BNIP3 mRNA表达量与椎间盘退变相关,BNIP3表达上调可能在椎间盘退变过程中发挥了重要作用。     

Histological study on chemonucleolysis with special reference to the relationship between the dose of chymopapain and disc regeneration

The present study on chemonucleolysis was conducted to determine the influence of chymopapain dose level and patient age on the degree and mode of the response and regeneration of the intervertebral disc. Chymopapain at various doses was injected into the intervertebral discs of young (8-week-old) and mature (20-week-old) rabbits respectively for a histological study. In rabbits undergoing high dose injection, not only the nucleus pulposus but also the inner layer of the annulus fibrosus was digested. Regeneration hardly occurred, and only a slight amount of scar tissue appeared in many animals. At lower dose, the annulus fibrosus remained intact and the posterior inner layer of the annulus fibrosus mainly proliferated toward the anterior portion of the disc, filled the space of digested nucleus pulposus, and restored disc height. This regeneration process was not thought to be specific to the damages caused by chymopapain but rather a common response of injured intervertebral discs.     

实验性脊柱内固定后相应区域椎间盘超微结构观察

目的　观察脊柱内固定后相应区域椎间盘的超微结构变化。　方法　日本大耳白兔2 4只,随机分成实验组和对照组,每组12只。实验组骨膜下游离T1 0 ～L3棘突和关节突,克氏针制成“L”形,将钢丝横行穿过T1 1、1 2 ,L1、2 的关节突关节,并与置于T1 1 ～L3棘突两旁的克氏针系紧,对相应区域的脊柱行内固定术。对照组未行手术,仅喂养至实验完成。术后6个月,对两组动物摄X线片观察1次,随后处死动物。取两组动物的L1 椎间盘组织(髓核、纤维环内侧及纤维环外侧)行透射电镜观察,对两组T1 2 、L2 椎间盘组织分别行水平面和矢状面透射电镜及扫描电镜观察。　结果　X线片显示,实验组与对照组椎体及椎间隙差别不明显;透射电镜与扫描电镜观察,实验组椎间盘的髓核、纤维环内层细胞的结构改变较纤维环外层早;对照组的髓核、纤维环内层细胞的结构改变与纤维环外层差别不明显。在退变的椎间盘基质中,蛋白多糖颗粒和特殊结构明显减少。髓核与纤维环基质内有蛋白多糖颗粒和一种特殊结构,而特殊结构在髓核与纤维环内层的形态不一致。　结论　脊柱内固定术后6个月,实验组在异常应力环境下发生椎间盘退变。髓核、纤维环内层基质内的特殊结构分布有特殊规律,与蛋白多糖颗粒在椎间盘退变中的生物学行为密切相关。     

T2* mapping of ovine intervertebral discs: Normative data for cervical and lumbar spine

To obtain T2* values in histologically evaluated healthy ovine intervertebral discs of the cervical and lumbar spine. Intervertebral discs of nine sheep and nine lambs underwent histological assessment with the modified Boos score for grading of disc degeneration. Discs with a score <10 points (maximum = 40 points) underwent T2* mapping (n = 64). Mid‐sagittal T2* values were obtained in five regions: Anterior annulus fibrosus, anterior nucleus pulposus, central nucleus pulposus, posterior nucleus pulposus, and posterior annulus fibrosus. We noted a zonal T2* distribution with high values in the central nucleus and low T2* values in the anterior and posterior annulus fibrosus. The T2* values were higher in lamb than in sheep IVDs for both cervical and lumbar spine (p < 0.001). The T2* values were also higher in the cervical than in the lumbar spine (p = 0.029 for sheep and p < 0.001 for lamb IVDs). The T2* values obtained in these ovine intervertebral discs can serve as baseline values for future T2* measurements both in health and disease. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:717–724, 2016.     

Histological development of intervertebral disc herniation

Sagittal and horizontal sections of 257 intervertebral discs obtained at autopsy and material obtained from 441 operations for herniation of a disc were examined histologically. In the material that was taken at autopsy, myxomatous degeneration of the annulus fibrosus increased in proportion to the age of the subject. The bundles in the internal layer of the annulus fibrosus reversed their usual direction and showed myxomatous degeneration, sometimes resulting in posterior and anterior convex bulging in the internal layer of the anterior and posterior parts of the annulus fibrosus, respectively. When material from a disc was surgically removed as a single free fragment (as in a complete extrusion or a sequestration type of herniation), annulus fibrosus with myxomatous degeneration was found in most material, while the nucleus pulposus rarely was. These results suggest that, from the standpoint of pathomechanism, a protrusion type of herniation of the annulus fibrosus exists in which only the annulus fibrosus is protruded due to reversal of the bundles of the annulus fibrosus, without involvement of the nucleus pulposus. This type of herniation would be a separate entity from the protrusion type of herniation of the nucleus pulposus that occurs when the nucleus pulposus is protruded through a fissure in the annulus fibrosus.     

两种骨水泥渗漏对椎间盘影响的实验研究

目的 探讨椎体成形术时骨水泥渗漏是否会引起椎间盘退变，以及椎间盘退变程度与骨水泥类型是否相关。方法 选用8只成年家犬，以每只犬L2-3、L3-4、L4-5椎间盘为实验对象，随机分为对照组、聚甲基丙烯酸甲酯（polymethylmethacrylate，PMMA）与磷酸钙骨水泥（calcium phosphate cement，CPC）3组。对照组仅行椎间盘穿刺，不注入任何物质，PMMA组及CPC组均各向椎间盘注入0．1ml骨水泥。术前及术后24周摄正、侧位X线片，计算椎间盘高度指数百分数（disc height index percentage，DHIP）。术后24周行MR检查，计算MRI指数。组织学检查参照Masuda标准对椎间盘退变程度评分并分析。结果 术后24周X线片显示对照组椎间隙无狭窄，病理学检查未见椎间盘退变。PMMA、CPC组椎间盘MRI显示：椎间隙有狭窄，R加权像髓核信号不同程度降低且不均一，其相对高信号区面积减小，髓核形态不规则，纤维环与髓核界限不清。组织学检查显示髓核细胞数量不同程度减少，空泡变小。髓核的细胞外基质不同程度压缩，纤维环断裂或扭转。3组DHIP、MRI指数、组织学评分的差异均有统计学意义（P〈0.01）。结论 PMMA、CPC注入椎间盘会导致椎间盘退变，PMMA所致椎间盘退变较CPC更为严重.     

Postmortem changes in ultrastructures of the mouse intervertebral disc

To elucidate the effects of nutrition and oxygen deficiencies on the intervertebral disc, cell components of mouse intervertebral discs and their postmortem changes were observed by electron microscopy. The annulus fibrosus could be divided into an inner and outer region. The main cell components of the annulus fibrosus were fibroblast-like cells in the outer region and chondrocytes in the inner region. The nucleus pulposus consisted of massively packed notochordal cells. The cartilage plates could also be divided into two zones: articular cartilage and growth cartilage containing chondrocytes. Postmortem degenerative changes proceeded from the peripheral to the central parts of the intervertebral disc, ie, showing degeneration of first the fibroblast-like cells, next the chondrocytes, and finally, the notochordal cells. The findings suggest that cells situated at the periphery predominantly depend on aerobic metabolism, whereas the cells situated more centrally depend on anaerobic metabolism. Furthermore, postmortem changes of the nucleus pulposus were similar to age-related changes. The age-related changes or degeneration in the intervertebral disc appear to be related to deficiencies of nutrition or oxygen caused by changes in structures of the disc and the surrounding tissues.