The effect of laser irradiation for nucleus pulposus: an experimental study

BACKGROUND: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra-disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study. METHODS: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation. RESULTS: NCV in the laser-irradiated group was significantly faster than in the non-laser-irradiated group. The levels of chemical factors were significantly reduced after laser irradiation. CONCLUSIONS: One of the mechanisms thought to be responsible for PLDD's effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.     

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng’s Spinal Manipulation, hot fomentation, and bed rest (treatment group). The remaining 46 patients were treated with hot fomentation and bed rest only (control group). After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng’s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.     

模拟人后路髓核摘除构建椎间盘退行性变动物模型

背景：髓核摘除术是治疗椎间盘突出的经典方法,但存在较高的复发率。 目的：验证模拟人后路髓核摘除进行后外侧穿刺抽吸髓核,建立椎间盘退行性变动物模型的可行性。 设计、时间及地点：观察对照实验,于2006-10/2007-02在解放军南京军区福州总医院动物实验室完成。 材料：选用日本大耳白兔20只,行椎间盘退行性变动物模型制备。 方法：用持针器夹持21G穿刺针,行L1~2及L3~4椎间盘右后外侧穿刺髓核抽吸法摘除部分髓核组织,术后2,4,8,12周分别对造模后椎间盘行组织学观察,并将L2~3椎间盘作为对照。 主要观察指标：通过苏木精-伊红染色观察椎间盘组织学结构。 结果：苏木精-伊红染色可见对照椎间盘大多髓核完整,髓核与纤维环分界清晰,纤维环结构接近正常,髓核组织中有大量髓核细胞。造模后第4周髓核细胞数量不断减少,第12周时髓核中主要为纤维组织,伴有极少量髓核细胞。 结论：模拟人后路髓核摘除术建立后外侧纤维环穿刺髓核抽吸的椎间盘退行性变动物模型成功建立,可为应用组织工程修复重建退行性变椎间盘提供有效的动物模型。     

Collagenase-I and stromelysin distribution in fresh human herniated intervertebral disc: A possible link to the in vivo inflammatory reactions

Abstract

Chondrocytes may play an Important role in the inflammatory reactions involving intervertebral discs: the role of metalloproteases (MMP.) and the imbalance between proteases and their inhibitors seems to play a crucial role in the disc degenerative process. In the present study we have analysed the production of collagenase-1 and stromelysin in different parts of herniated intervertebral discs. Ten samples of herniated lumbar discs were obtained from adult patients operated on for primary microdiscectomy because of persistent radicular symptoms and subdivided into three samples: 1. The nearest to the nerve root in close contact with it, 2. the sample obtained from the intervertebral space, and 3. the sample obtained from the vertebral plates. The DNA content of each specimen was measured in order to obtain the best estimate of the cell content as well as to normalise the content of collagenase-1 and stromelysin found in the same tissues with respect to the number of cells. In 9 out of the 7 0 cases the DNA content was significantly higher in samples obtained from the intervertebral plates than in samples obtained near the nerve root or the intervertebral space. DNA content did not show any significant difference considering disc samples contiguous to the nerve root and samples obtained from the intervertebral space. The production of collagenase-1 did not show a specific pattern, being produced in similar quantities in the three disc compartments. The production of stromelysin was significantly lower in disc samples obtained from the intervertebral plates. In conclusion the results of the present study suggest firstly that in the herniated lumbar disc the reactivity and the production of pro-inflammatory agents is independent of DNA content, i.e. the cellularity of the sample, and secondly that activated cells in the intervertebral space and in the part of the disc in contact with the nerve root, even if scarce in number, are able to synthesise a proportionally higher quantity of MMP than the high-cellular disc fragments from the intervertebral plates, potentially playing a specific role in the inflammatory reactions. [Neurol Res 1999; 21: 677-681]     

Lumbar nerve root "walled" by a calcified herniated mass in a young patient

INTRODUCTION: Discal calcification in childhood is rare. Calcifications are occasionally discovered during routine examinations, especially in the cervical spine. Generally, the calcification process is confined to the nucleus pulposus of the intervertebral disc. CASE REPORT: In this report, we describe the case of a 16-year-old girl who presented with acute low back pain, right S1 radiculopathy and a history of increasing paresthesia. The patient underwent a CT scan, which demonstrated a postero-lateral calcified disc hernia at the L5-S1 level. The surgical decompression of the lumbar nerve root was carried out; at the operation it was observed that the nerve root was "walled" into the calcified hernia. DISCUSSION: Only a few cases with evidence of calcification of the herniated portion of the disc have been previously described. In none of them was the phenomenon was so pronounced that it sealed the nerve root completely.     

人颈椎间盘退变与细胞凋亡及基质金属蛋白酶11的表达**☆

背景：前期研究发现基质金属蛋白酶11基因在人退变颈、腰椎间盘组织中明显上调。 目的：观察人退变颈椎间盘髓核组织中基质金属蛋白酶11的表达与细胞凋亡的关系。 方法：纳入30个经MRI确认的退变颈椎间盘髓核组织和20个因颈椎创伤治疗获得的正常颈椎间盘髓核组织。 结果与结论：苏木精-伊红染色显示退变的颈椎间盘髓核组织中髓核细胞较正常髓核组织明显减少(P < 0.01),而凋亡细胞较正常髓核组织明显增多(P < 0.01)。免疫组化染色显示退变的颈椎间盘髓核组织中基质金属蛋白酶11的表达明显高于正常髓核组织(P < 0.01),且基质金属蛋白酶11表达与TUNEL染色检测到的细胞凋亡正相关(r=0.44,P < 0.05)。说明高表达的基质金属蛋白酶11不仅可直接破坏细胞外基质尚可诱导髓核细胞凋亡,在椎间盘退变的过程中发挥重要作用。     

单侧椎弓根螺钉置入并椎间融合对邻近椎间盘节段退变的影响

背景：坚强内固定和良好融合存在严重缺陷和不足。目前还未见临床应用单侧椎弓根螺钉固定结合椎间cage植骨融合治疗腰椎退变性疾病对邻近节段退变影响的相关报道。 目的：回顾分析单侧椎弓根螺钉固定结合椎间cage植骨融合治疗部分腰椎退变性疾病后对固定融合邻近上下节段退变的影响。 方法：2006-03/2009-12对收治的部分腰椎管狭窄症、腰椎失稳及腰椎间盘脱出症患者22例,进行了单侧椎弓根螺钉固定加椎间cage植骨融合,术中不显露对侧。在固定融合后3,6,12,20个月及取出内固定钉棒后3,6个月,随访X射线片及MRI。针对X射线片运用角平分线法测量固定融合邻近上位椎间隙高度变化,MRI测量椎间盘髓核退变情况。 结果与结论：所有病例获得随访,患者椎管狭窄症状及神经根性症状消失,并且在随访期间内没有新的临床症状出现。固定融合前、固定融合后3,6,12,20个月邻近节段上位椎间隙高度分别为(7.420±0.035 4),(7.426 6±0.036 9),(7.453 3±0.036 9),(7.516 6±0.036 9),(7.430 8±0.036 9) mm,结果表明,腰椎单侧固定融合后邻近节段椎间隙高度无明显变化(P > 0.05)。MRI测量结果显示,固定融合邻近上位椎间盘髓核信号在T2加权像无明显退变。提示单侧椎弓根螺钉固定结合椎间融合治疗部分腰椎退变性疾病能有效预防固定融合邻近上下节段退变。     

骨形态发生蛋白2基因转染软骨细胞注入腰椎间盘损伤模型：10周测量蛋白多糖和胶原含量

背景：研究表明骨形态发生蛋白2基因转染软骨细胞可促进体外培养的髓核细胞合成细胞外基质,但其对体内退变椎间盘组织代谢的影响却罕见报道。 目的：探讨骨形态发生蛋白2基因转染细胞移植治疗椎间盘退变的可行性。 方法：用新西兰大白兔建立腰椎间盘损伤动物模型,建模后随机分为细胞移植组和对照组。细胞移植组注入骨形态发生蛋白2基因转染的软骨细胞,对照组注入等剂量生理盐水,两组动物在注射后2,4,6,8和10周分别取出退变的椎间盘髓核组织,并测量其蛋白多糖及胶原含量。 结果与结论：与对照组比较,细胞移植组髓核蛋白多糖及胶原含量均有明显增高(P < 0.05)。结果提示椎间盘退变的标志之一可能为髓核内细胞外基质含量的减少,而骨形态发生蛋白2基因转染细胞移植的方法可促进细胞外基质合成,改善退变髓核的生物活性,延缓椎间盘的退变。     

In vitro cellular processes sprouting in cortex microexplants of adult rat brains induced by low power laser irradiation

Abstract

The effect of He-Ne low power laser irradiation on the growth of cellular processes of microexplants of the brain cortex of adult rats in tissue culture was studied. Two 8-min doses of direct laser irradiation, 3.6 J/cm² each given on two successive days, caused a significant amount of sprouting of cellular processes outgrowth in microexplants compared to small amounts produced by nonirradiated controls. This preliminary observation suggests that low power laser irradiation applied to the area of an experimentally injured nerve may induce neurite processes sprouting, thereby improving nerve tissue recovery. [Neural Res 1998; 20: 470–472]     

经皮纤维环穿刺法建立兔椎间盘退行性变动物模型

背景：合适的椎间盘退变动物模型是椎间盘组织工程研究的必要条件,但目前尚缺乏公认的模型制备方法。 目的：采用C形臂辅助下经皮纤维环穿刺法制备兔椎间盘退变动物模型,并评估其可行性。 方法：选定新西兰大白兔L2/3和L3/4椎间盘作为穿刺干预椎间盘,L1/2和L5/6椎间盘作为空白对照组,采用C形臂辅助下经皮穿刺法干预椎间盘。于术后2,4,8,12周各选择2只兔麻醉后拍摄兔腰椎核磁共振影像,处死动物采集椎间盘,进行椎间盘髓核蛋白多糖测定。核磁共振检查观察椎间盘退行性改变,二甲基亚甲蓝染色分光光度法测定髓核中蛋白多糖含量变化。 结果与结论：术后4周穿刺干预椎间盘髓核区域核磁共振信号强度及髓核内蛋白多糖含量同空白对照组相比均下降(P < 0.05),其后两者呈现逐渐下降趋势。结果证实,C形臂X射线机辅助下经皮纤维环穿刺法可用于椎间盘退变动物模型的制备。     

Inflamación en la hernia del disco intervertebral

Up until fairly recently, it was thought that sciatic pain in the lumbar herniated disc was caused by compression on the nerve root. However, the lumbar herniated disc shows mixed pictures which are difficult to explain by simple mechanical compromise. In recent years various immunology, immunohistochemistry and molecular biology studies have shown that the herniated tissue is not an inert material, but rather it Is biologically very active with the capability of expressing a series of inflammatory mediators: cytokines such as interleukin-1, interleukin-6, interleuquin-8 and tumor necrosis factor being the ones which stand out. The inflammation is not only induced by the chemical irritation of the bioactive substances released by the nucleus pulposus but also by an autoimmune response against itself. Thus, in addition to the mechanical factor, the biomechanical mediation plays an important role in the pathophysiology of sciatic pain and of radiculopathy. Through a review of a wide range of literature, we researched the cellular molecular mediators involved in this inflammatory process around the lumbar herniated disc and its involvement in sciatic pain.     

Force of femoral abductors in patients with lumbar nucleus pulposus prolapse]

In 50 patients with lumbar nucleus pulposus prolapse the force of femoral abductors was determined by the test of Lovett and by means of dynamometric measurements. In 90% of patients paresis of these muscles was found. A comparison of the incidence of other signs of nerve root damage such as paresis of plantar and dorsal flexion of the foot and toes, sensory impairment on the foot and lack or weakness of ankle jerk showed that paresis of fermoral abductors was most frequent among them. This fact is explained by a particular predisposition for development of uncleus pulposus prolapse at the level of 4th and 5th intervertebral discs with resulting injury to the nerve roots L4, L5, and S1 innervating femoral abductors. The authors think that paresis of femoral abductors may be a pathognomonic sign in the diagnosis of nerve root lesions caused by nucleus prolapse at the levels L4-L5 or L5-S1. The frequency of paresis and the degree of weakness indicate the necessity of motor rehabilitation of this music group in comprehensive treatment of patients with lumbar disc prolapse.     

兔不同程度椎体切除相邻椎间盘的组织学变化

背景：切除部分椎体是否可能会导致椎间盘营养通道的破坏,从而导致椎间盘的退行性变,目前很少有研究涉及。 目的：评估兔椎体不同程度切除对相邻椎间盘退行性变的影响。 方法：将10只新西兰兔分为2组,根据椎体不同程度切除植骨内固定,分为切除1/2椎体组和切除3/4椎体组。在造模后6个月处死动物,获取伤椎下位椎间盘及正常椎间盘组织(设为正常对照组);并进行苏木精-伊红染色,观察椎间盘组织学改变,检测椎体软骨终板血管芽数量;通过阿新蓝染色测量图像阳性吸光度以评价椎间盘髓核组织中蛋白多糖的变化。 结果与结论：兔椎体切除小于1/2时,相邻椎间盘营养状况不会有明显改变;如果前路减压需切除椎体不超过1/2时应考虑单节段植骨融合双节段固定。椎体切除大于3/4时,相邻椎间盘营养状况会有明显改变,并导致椎间盘退行性变;如果前路减压需切除椎体超过3/4时应考虑切除相邻间盘行两节段植骨融合。     

细胞移植及髓核组织工程重建修复椎间盘退变

背景：通过细胞组织工程将细胞或细胞支架复合体植入退变缺损的椎间盘内,使退变的椎间盘再生可能是治疗椎间盘退变性疾病最为理想的方法。 目的：评价组织工程髓核体内移植抑制腰椎间盘退变的临床疗效及应用前景。 方法：由第一作者检索1990/2010 PubMed数据、中国知网及万方数据库有关组织工程髓核、组织工程材料及骨髓间充质干细胞治疗腰椎间盘退变方面的文献。 结果与结论：目前常用的细胞支架主要包括胶原支架、琼脂糖支架、藻酸盐支架、聚乙醇酸支架与壳聚糖支架以及复合材料等。通过自体椎间盘细胞或间充质干细胞结合基因技术筛选种子细胞,进行细胞和/或细胞支架复合体移植恢复或再生相关细胞外基质的合成,通过逆转和修复椎间盘细胞病理性改变,为退变的椎间盘组织和功能恢复提供了全新的治疗策略。     

多效生长因子及血小板源性生长因子在增龄鼠椎间盘中的表达*

背景：在组织缺氧状态下,多效生长因子能够直接参与新生血管的生成,在人类腰椎间盘退变方面起重要的作用。 目的：观察增龄鼠椎间盘中多效生长因子和血小板源性生长因子的表达,及其与椎间盘退变的关系。 方法：取1,3,6,12,18月龄Wistar大鼠各10只。采用免疫组织化学染色方法检测椎间盘组织中多效生长因子及血小板源性生长因子的表达情况。采用Spearman相关分析方法对多效生长因子和血小板源性生长因子的相关性进行分析。 结果与结论：随着大鼠月龄的增加,椎间盘细胞中多效生长因子及血小板源性生长因子的表达有逐渐减低的趋势,但至18月龄又有所增加。同月龄组椎间盘细胞中,多效生长因子及血小板源性生长因子在终板的表达高于髓核和纤维环(P < 0.05)。多效生长因子及血小板源性生长因子在椎间盘组织中的表达有一定的相关性(P < 0.01)。提示大鼠椎间盘结构随月龄增加发生退行性变,多效生长因子及血小板源性生长因子参与了大鼠椎间盘的退变。     

Lumbar disc herniation and tight hamstrings syndrome in adolescence

BACKGROUND: Lumbar intervertebral disc herniation is infrequently encountered in children and adolescents. Additional signs and symptoms such as postural deformities and abnormal gait accompany the classical findings of lumbar root irritation. These unusual signs have been described in the literature as "tight hamstrings syndrome". Waddling gait with flexed knees is considered as pathognomonic for this condition and may be masked by the signs of root irritation due to prolapsed intervertebral disc material. CASE REPORT AND DISCUSSION: We report an adolescent patient with lumbar disc herniation in whom gait abnormality and limitation of lumbar movements persisted after surgical intervention. A review of the literature on tight hamstrings is presented.     

模拟人后外侧入路髓核摘除构建的椎间盘退行性变动物模型

背景：椎间盘退变的病理生理学机制至今尚未明了,所以制作一种与自然椎间盘退行性病变过程相类似的、适用于这些治疗方法的动物模型有助于对椎间盘退行性变的诱因、病理生理变化及某些治疗方法的研究。 目的：模拟人后路髓核摘除术进行后外侧穿刺抽吸髓核建立椎间盘退行性变动物模型的可行性研究及其优点。 方法：随机选取日本大耳白兔20只,根据解剖结构观察结果,为防止纤维环后外侧穿刺损伤血管,采用右后外侧入路,行L1~2和L3~4椎间盘后外侧穿刺髓核抽吸法摘除部分髓核组织,将L2~3椎间盘纳入对照组。术后2,4,8,12周分别对造模后椎间盘及对照椎间盘(L2~3)行X射线及MRI影像学观察。 结果与结论：日本大耳白兔20只均进入结果分析,术后2,4,8,12周实验组椎间盘高度指数持续下降(P < 0.05),说明造模后椎间盘间隙高度会逐渐降低,并且各时间点椎间盘高度指数明显低于对照组(P < 0.05)。与对照组比较,造模后2,4,8,12周时实验组椎间盘MRI T2WI信号逐渐下降,并且随时间延长逐渐降低,呈低信号改变。通过影像学观察发现本模型退行性变的征象与人腰椎间盘退行性变的征象一致,提示模拟人后路髓核摘除术建立后外侧纤维环穿刺髓核抽吸的椎间盘退行性变动物模型成功建立,为运用组织工程修复重建退行性变椎间盘的研究提供有效的动物模型。     

雌激素影响去势雌兔腰椎间盘髓核中白细胞介素20和基质金属蛋白酶3的表达？

背景：雌激素缺乏可导致椎间盘发生一系列的物理化学变化,有研究报道基质金属蛋白酶3可降解蛋白多糖聚合体及椎间盘内多种基质成分,白细胞介素20在椎间盘发生退变的过程中也发挥着重要作用。 目的：探讨雌激素对去势雌兔腰椎间盘髓核中白细胞介素20和基质金属蛋白酶3表达的作用。 方法：将新西兰大白兔随机分为正常对照组、模型组、低剂量和高剂量雌激素组。除正常对照组外均切除双侧卵巢建立去势动物模型。正常对照组和模型组隔日肌注生理盐水2 mL,低、高剂量雌激素组分别隔日肌注0.2 和1.0 mg的苯甲酸雌二醇。3个月后所有动物于腰椎间盘髓核组织取材,采用苏木精-伊红染色、免疫组织化学染色和Western-blot方法检测白细胞介素20和基质金属蛋白酶3的表达。 结果与结论：模型组细胞密度明显降低,脊索细胞明显减少,软骨样细胞集簇成团,其余各组无明显变化。免疫组化结果显示模型组腰椎间盘髓核组织白细胞介素20和基质金属蛋白酶3阳性细胞表达明显高于正常对照组和高剂量雌激素组(P < 0.05)。Western-blot检测结果与免疫组化学染色结果相似。提示肌注雌激素能降低去卵巢新西兰大白兔腰椎间盘髓核中白细胞介素20和基质金属蛋白酶3的表达,进而防止腰椎间盘髓核基质的降解。     

纤维环穿刺法与纤维环切开法建立兔椎间盘退变模型

背景：椎间盘退行性变模型的建立,是研究椎间盘退行性变病理过程和尝试基因治疗等的基础,建立的动物模型要求与人类椎间盘退行性变具有相似性和可比拟性,但目前尚缺乏公认的最佳实验动物模型。 目的：比较纤维环穿刺法和纤维环切开法建立兔椎间盘退变动物模型的差异。 方法：将32只新西兰大白兔以数字表法随机分为纤维环穿刺组和纤维环切开组。经腹膜外入路暴露L3/4、L4/5、L5/6椎间隙,纤维环穿刺组采取针刺纤维环,纤维环切开组采取尖刀切开纤维环,控制穿刺或切开的深度及方向。术后2,4,12,20周通过MRI和组织病理学检查观察腰椎间盘髓核变性及组织病理情况。 结果与结论：术后4周,兔椎间盘髓核面积缩小,纤维环面积增大,髓核内T2加权像信号降低、变暗,椎间隙高度也开始下降,纤维环穿刺组T2信号强度评分较纤维环切开组低(P < 0.05);随着时间的进展,兔椎间盘T2信号强度评分逐步增高,椎间隙逐渐变窄,术后20周椎间盘T2信号强度评分达最高,两组比较差异无显著性意义。随着时间的进展,两组髓核内细胞含量逐渐减少,纤维软骨形成。提示纤维环穿刺法和纤维环切开法均可成功建立椎间盘退变模型,但纤维环切开法椎间盘的退变程度较纤维环穿刺法剧烈,建立的模型过程可能不是人体椎间盘自然退变的模拟过程,纤维环穿刺法比较真实地模拟了人类椎间盘损伤后的退变过程。     

抽吸法诱导兔椎间盘退变模型的病理及影像表现

背景：椎间盘退变的病理生理学机制至今尚未明了,需要构建更稳定和简便易得的椎间盘退变模型,观察其病理及影像表现,揭示其内在因素。 目的：实验希望通过病理学及影像学检测,来验证利用抽吸法构建兔椎间盘退变模型的可行性、以及造模的简便和稳定性。 材料：10月龄健康新西兰大耳白兔42只, 雌雄不拘,随机分为对照组和实验组各21只。速眠新由长春市军需大学兽医研究所提供。 方法：设两组兔椎间盘高度指数均为100%。利用21G皮肤穿刺针分别在实验组白兔L4~5单节段刺入,抽吸髓核8~12 mg造模;对照组不做处理。造模完毕,两组兔分别于4,12,20周各取7只进行指标检测。 主要观察指标：利用椎间盘高度指数百分比、X射线片、MRI及Alcian blue组织染色观察退变椎间盘的变化。 结果：4,12,20周实验组退变椎间盘高度指数百分比分别为(81.0±3.2)%,(75.0±2.5)%,(71.0±1.8)%,与对照组相比差异有显著性意义 ( P < 0.05)。退变椎间盘T2加权像信号明显降低,Alcian blue组织染色显示退变椎间盘组织中聚集蛋白多糖含量明显降低。 结论：抽吸法构建兔椎间盘退变模型简便可靠,其退变过程的病理及影像表现与人椎间盘退变过程的病理及影像表现十分相似。