Roughley Peter J
Genetics Unit, Shriners Hospital for Children, Montreal, Quebec, Canada.
Spine (Phila Pa 1976). 2004 Dec 1;29(23):2691-9. doi: 10.1097/01.brs.0000146101.53784.b1.
A review of current knowledge and opinions concerning the biologic changes that take place during development, maturation and degeneration of the intervertebral disc.
To provide an overview of the changes that occur in structure and composition of the extracellular matrix of the intervertebral disc and to explain the origin of such changes and their functional consequences.
The structure of the intervertebral disc, and, in particular, the composition of its extracellular matrix, changes throughout life, ultimately resulting in tissue degeneration in the adult.
A review of the published scientific literature.
In the young disc, the outer anulus fibrosus and inner nucleus pulposus have clear physical and molecular properties, although these differences become less distinct in the adult. The age changes are due to variations in both the abundance and structure of the macromolecules, particularly aggrecan, and the structural variations may be due to changes in both synthesis and degradation. It is not clear how many of the changes are by design to adapt to the altered environment of the growing spine. However, it is commonly thought that the degradative changes are detrimental to disc function, a property that is exacerbated by the inability of the mature avascular disc to remove and replace accumulated degradation products. The rate at which these detrimental changes occur may vary between individuals because of genetic, biomechanical, and nutritional differences. Such changes are thought to form the basis of tissue loss associated with disc degeneration.
Changes in intervertebral disc structure throughout life ultimately result in tissue degeneration and the need for medical intervention. Current research is aimed at trying to restore the integrity of the degenerate disc matrix by biologic means, although at present it is not clear what the structure of the most appropriate repair tissue should be or how it can be achieved.
对椎间盘在发育、成熟和退变过程中发生的生物学变化的现有知识和观点进行综述。
概述椎间盘细胞外基质的结构和组成变化，并解释这些变化的起源及其功能后果。
椎间盘的结构，尤其是其细胞外基质的组成，在整个生命过程中都会发生变化，最终导致成人椎间盘组织退变。
对已发表的科学文献进行综述。
在年轻的椎间盘中，外层纤维环和内层髓核具有明显的物理和分子特性，尽管在成人中这些差异变得不那么明显。年龄变化是由于大分子尤其是聚集蛋白聚糖的丰度和结构的变化，而结构变化可能是由于合成和降解的改变。目前尚不清楚这些变化中有多少是为了适应生长脊柱不断变化的环境而设计的。然而，人们普遍认为，降解性变化对椎间盘功能有害，而成熟的无血管椎间盘无法清除和替换积累的降解产物会加剧这种有害性。由于遗传、生物力学和营养方面的差异，这些有害变化发生的速度在个体之间可能有所不同。这些变化被认为是与椎间盘退变相关的组织损失的基础。
椎间盘结构在整个生命过程中的变化最终导致组织退变以及医疗干预的必要性。目前的研究旨在通过生物学手段恢复退变椎间盘基质的完整性，尽管目前尚不清楚最合适的修复组织的结构应该是什么，以及如何实现这一目标。
