Peng Bao-Gan, Wu Wen-Wen, Hou Shu-Xun, Zhang Chun-Li, Yang Yi, Wang Xiao-Hong, Fu Xiao-Bing
Department of Orthopaedics, the 304th Hospital of People's Liberation Army, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2004 Jun 22;42(12):720-4.
To study the pathogenesis of the pain of discography and the discogenic low back pain.
19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, and 12 physiologically aging discs and 10 normal control discs were collected to investigate the morphologic features and innervation containing neuropeptides substance P (SP), neural filament (NF), and vasoactive-intestinal peptide (VIP).
The distinct morphologic characteristic of the disc from the patient with discogenic low back pain was the formation of the strip zone of vascularized granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus in which there was one or several fissures. The structure of annulus fibrosus beyond the strip zone of granulation tissue was basically normal. The structures of the aging discs and the control discs showed the age-related changes. The innervation of SP, NF and VIP immunoreactive nerve fibers in the painful discs was more extensive compared with the aging discs and the control discs. The nerve in growth deep into annulus fibrosus and nucleus pulposus was observed mainly along the strip zone of granulation tissue in the painful discs.
Findings indicate that the strip zone of granulation tissue with extensive innervation in the posterior part of the painful disc is the original site of the pain of discography and the discogenic low back pain. The strip zone of granulation tissue might originate from the injury and subsequent reparation of the margin of annulus fibrosus. The difference of the aging disc and painful disc which can not be differed each other on MRI is the formation of the strip zone of granulation tissue along tear histologically in posterior part of the painful disc.
研究椎间盘造影疼痛及椎间盘源性下腰痛的发病机制。
收集17例椎间盘源性下腰痛患者在腰椎后路椎间融合术中的19个腰椎间盘标本，以及12个生理性老化椎间盘和10个正常对照椎间盘，研究其形态学特征及含有神经肽P物质（SP）、神经丝（NF）和血管活性肠肽（VIP）的神经支配情况。
椎间盘源性下腰痛患者的椎间盘有明显的形态学特征，即从髓核至纤维环外部形成血管化肉芽组织条带区，其中有一条或多条裂隙。肉芽组织条带区以外的纤维环结构基本正常。老化椎间盘和对照椎间盘的结构呈现出与年龄相关的变化。与老化椎间盘和对照椎间盘相比，疼痛椎间盘内SP、NF和VIP免疫反应性神经纤维的神经支配更为广泛。在疼痛椎间盘中，主要沿肉芽组织条带区观察到神经长入纤维环和髓核深部。
研究结果表明，疼痛椎间盘后部具有广泛神经支配的肉芽组织条带区是椎间盘造影疼痛及椎间盘源性下腰痛的起源部位。肉芽组织条带区可能起源于纤维环边缘的损伤及随后的修复。老化椎间盘与疼痛椎间盘在MRI上无法区分，其差异在于疼痛椎间盘后部沿撕裂处组织学上形成肉芽组织条带区。
