Neovascularization of the outermost area of herniated lumbar intervertebral discs

In 64 surgically treated herniated lumbar intervertebral discs, we performed histopathological studies of neovascularization in the outermost layer of the herniated mass in various types of hernia. We obtained specimens separately from the capsule tissue covering the herniated mass and the inner tip tissue of the herniated mass for comparison. Histologically, in most cases, the capsule tissue was the outermost layer of the annulus fibrosus or posterior longitudinal ligament, and the inner tip tissue was the nucleus pulposus. In the capsule tissue, newly formed small blood vessels were present in 73.4% of the total cases examined, regardless of the hernia type. However, the frequency and degree of such vessels in the tip tissue were significantly higher in hernias that perforated the posterior longitudinal ligament than in those that did not. When the intervertebral disc herniates, new blood vessels proliferate in the capsule of the hernial tissue. At the stage when the hernial capsule tissue is still present, these vessels were observed to have difficulty reaching the inner tip portion. These findings suggest that when the nucleus pulposus portion of the herniated mass perforates the posterior longitudinal ligament, it may be subject to a stronger neovascularization reaction. Received for publication on May 18, 1998; accepted on Jan. 19, 1999     

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.     

颈椎病突出椎间盘组织炎性反应特性的研究

目的：探讨颈椎病发生中突出颈椎间盘组织的炎症反应特性。方法：取31例脊髓型颈椎病患者的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的含量。结果：35个突出颈椎间盘中，18个（51．4％）在边缘区域有大量炎细胞浸润，其余17个（48．6％）未见炎细胞浸润，对照组未见炎细胞浸润；35个突出颈椎间盘组织中IL－1α、IL－6和NTF－α含量明显高于正常椎间盘。结论：颈椎病患者突出椎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。     

Lower-extremity sensibility testing in patients with herniated lumbar intervertebral discs

The significance of sensory changes determined by pinprick and light touch in individuals with a herniated lumbar disc has been questioned. Discrepancies may be related to the subjectiveness of the test, failure to use dermatome-specific testing sites, overlap of areas that are innervated by different nerve roots, anatomical variations, or lack of sensitivity of the testing technique. For this study, we assessed the results of sensory examinations of twenty-five patients with documented herniation of a lumbar disc. The examinations were done using Semmes-Weinstein monofilaments, vibrometry, pinprick, and light touch in the autonomous skin areas supplied by the fourth and fifth lumbar and first sacral-nerve roots. Right-left differences in Semmes-Weinstein pressure thresholds of more than fifteen milligrams per square millimeter enabled us to localize disc lesions to a specific root in 100 per cent of patients and differences in vibratory thresholds of more than 3.5 micrometers, to localize the correct level in 88 per cent. Lesser differences in thresholds did not help to identify the involved root. The mean sensory threshold on the side of the disc lesion was found to be significantly greater than that on the opposite side by both vibrometry and pressure aesthesiometry (p less than 0.005). These findings were not duplicated using light touch or pinprick testing. Even with the most sophisticated sensibility-testing techniques, correct identification of the nerve root that was compressed by a herniated lumbar disc was accurate in only 50 per cent of patients.     

Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs

Purpose

Lumbar disc degeneration may be associated with intensity of neovascularization in disc herniations. Our study was designed to evaluate how much the severity of histodegeneration is related to the development of neovascularization and to the level of pleiotrophin in the herniated lumbar discs.

Methods

Surgically excised lumbar disc specimens were obtained from 29 patients with noncontained (i.e., extruding through the posterior longitudinal ligament) and 21 patients with contained disc herniations. The histodegeneration scores and levels of neovascularization were estimated according to semiquantitative analysis in lumbar disc and endplate samples. Immunohistochemical staining were performed to identify the newly formed blood vessels and to detect the presence of pleiotrophin in the specimens.

Results

Higher levels of disc and endplate neovascularity were registered in noncontained herniations. The level of neovascularization was significantly related to the score of histodegeneration in the herniated disc tissues but not in the endplate specimens. Both contained and noncontained herniations had the highest values of histodegeneration in conjunction with the highest level of neovascularization but the relations between neovascularity and degenerative changes remained to be significant only in the group of noncontained herniations. Registration or frequency of pleiotrophin positive cells did not correlate significantly with histodegeneration or level of neovascularization in the disc samples.

Conclusion

Severe histodegeneration of the lumbar disc herniations is associated with enhanced neovascularization and potentially also spontaneous regression of the herniated tissue.     

Effects of human midkine on spontaneous resorption of herniated intervertebral discs

This study was performed in 36 rabbits to investigate the role of midkine (MK) in the resorption of herniated intervertebral discs. The L_1-2 disc was excised and immersed in one of three kinds of solution for two hours before relocation into the L4 epidural space. In the MK-treated group, the weight of relocated intervertebral discs decreased more over time than in the control group. Newly formed vessels and inflammatory cells were more frequently observed in the MK-treated group than in the control group two weeks after surgery. The degradation of matrix was more significant in the MK-treated group than in the control group four weeks after surgery. Larger areas were replaced by fibrous tissues in the MK-treated group eight weeks after surgery. Thus, MK can accelerate the resorption of the intervertebral disc relocation to the epidural space. Epidural injection of MK may contribute to the therapy of lumber disc herniation.     

Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results

Fifty consecutive patients with intractable sciatic pain, positive root tension signs, correlative myelography, and neurological impairment were treated by percutaneous lateral discectomy (PLD). Under local anesthesia and C-arm fluoroscopy control, an 18-gauge needle, introduced into the intervertebral disc dorsolaterally, entered the skin at approximately 9 cm from the midline. A Kirschner wire replaced the stylet of the needle, and the needle was withdrawn. The introduction of a specially designed cannulated trocar over the K-wire facilitated precisional insertion of the instruments. This step was followed by the introduction of a sheath with an internal diameter of 4.9 mm over the trocar. The sheath was held against the annulus fibrosis, and the cannulated trocar was removed. The annulus was windowed and the herniated disc material evacuated by instruments and suction. Evaluations were made with Macnab's criteria. Excellent and good results were obtained in 88% of patients. The mean length of hospital stay after operation was 2.3 days. The operative time, blood loss, and morbidity were minimal, and no serious complications were encountered. In carefully selected patients, PLD appears to be safe, effective, and cost-efficient.     

Serial changes of herniated intervertebral discs after posterior lumbar discectomy: the relation between magnetic resonance imaging of the postoperative intervertebral discs and clinical outcome

To evaluate the relation between the morphologic changes of postoperative intervertebral discs and the clinical outcome after posterior lumbar discectomy, the size of the bulging disc was analyzed prospectively on serial follow-up magnetic resonance images in 26 randomly selected patients. The bulging of postoperative intervertebral discs involved three patterns of reduction: early reduction (n = 15), gradual reduction (n = 6), and late reduction (n = 5). There was a significant difference in the serial changes of subjective symptoms and neurologic function among the three patterns. A late reduction of postoperative disc bulging could cause late recovery of subjective symptoms and neurologic disturbance.     

腰椎间盘突出后重吸收

本文对腰椎间盘突出后重吸收进行综述。指出以往传统认为的需积极考虑手术治疗的腰椎间盘突出巨大型、破裂型和游离型重吸收的几率大,存在因重吸收而致症状缓解的可能。对于初发上述类型椎间盘突出,如患者症状不重,或者症状可耐受,且有充足休养时间,可尝试保守治疗。但保守治疗时间不宜过长,出现难以忍受的疼痛、神经症状加重或马尾神经综合征,则需积极考虑手术。腰椎间盘重吸收最短可在2个月内发生,作为手术依据的影像资料距离手术时间不宜超过这个期限。对重吸收的机理进行了总结。     

Antibiotics in the management of inflammatory lesions of the intervertebral discs in young children.

A review of 35 cases of inflammatory lesions of the intervertebral discs in young children has failed to establish a role for antibiotics in management. There is a tendency to overinvestigate and overtreat this benign, self-limiting malady, for which a period of six weeks of immobilization in a double hip spica is recommended.