Raj P Prithvi
Department of Anesthesiology and Pain Management, Texas Tech University, Lubbock, Texas, USA.
Pain Pract. 2008 Jan-Feb;8(1):18-44. doi: 10.1111/j.1533-2500.2007.00171.x.
This review article describes anatomy, physiology, pathophysiology and treatment of intervertebral disc. The intervertebral discs lie between the vertebral bodies, linking them together. The components of the disc are nucleus pulposus, annulus fibrosus and cartilagenous end-plates. The blood supply to the disc is only to the cartilagenous end-plates. The nerve supply is basically through the sinovertebral nerve. Biochemically, the important constituents of the disc are collagen fibers, elastin fibers and aggrecan. As the disc ages, degeneration occurs, osmotic pressure is lost in the nucleus, dehydration occurs, and the disc loses its height. During these changes, nociceptive nuclear material tracks and leaks through the outer rim of the annulus. This is the main source of discogenic pain. While this is occurring, the degenerative disc, having lost its height, effects the structures close by, such as ligamentum flavum, facet joints, and the shape of the neural foramina. This is the main cause of spinal stenosis and radicular pain due to the disc degeneration in the aged populations. Diagnosis is done by a strict protocol and treatment options are described in this review. The rationale for new therapies are to substitute the biochemical constituents, or augment nucleus pulposus or regenerate cartilaginous end-plate or finally artificial disc implantation..
这篇综述文章描述了椎间盘的解剖学、生理学、病理生理学及治疗方法。椎间盘位于椎体之间，将它们连接在一起。椎间盘的组成部分包括髓核、纤维环和软骨终板。椎间盘的血液供应仅至软骨终板。神经供应主要通过窦椎神经。从生化角度来看，椎间盘的重要成分是胶原纤维、弹性纤维和聚集蛋白聚糖。随着椎间盘老化，会发生退变，髓核渗透压丧失，出现脱水，椎间盘高度降低。在这些变化过程中，伤害性核物质沿纤维环外层追踪并渗漏。这是椎间盘源性疼痛的主要来源。在此过程中，退变的椎间盘因高度降低，会影响附近结构，如黄韧带、小关节及神经孔的形态。这是老年人群中因椎间盘退变导致椎管狭窄和神经根性疼痛的主要原因。诊断需遵循严格方案，本文综述了治疗选择。新疗法的基本原理是替代生化成分、补充髓核、再生软骨终板或最终进行人工椎间盘植入。
