Spinal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Eur Spine J. 1993 Mar;1(4):205-13. doi: 10.1007/BF00298361.
Disc degeneration in the human spine is a complex phenomenon characterised by biochemical change in the nucleus pulposus and inner annulus and the formation of clefts and fissures radiating from the central area of the disc towards the periphery. In addition, and probably independent of these phenomena, discrete defects in the outer annular attachement are seen which are likely to be due to mechanical stress and failure. The presence of stress tears in disc tissue and their failure to heal can initiate or accelerate the degeneration of the central component of the intervertebral disc. We postulate that discogenic pain may be linked to damage to the outer portion of the annulus fibrosus. Although it would seem logical to assume that discs with sustained high intradiscal pressure would be more prone to pain referred in the outer annular layers because of higher tensile strain, analysis of prospective studies has failed to confirm a relationship between typical pain reproduction at discography and high pressure values. It is concluded that, at present, the only consistent morphological changes present in patients with pain reproduction at discography are the presence of various annular defects involving the outer layers. Whether nerve ingrowth during attempts at repair of these defects is a consistent feature remains to be established.
人类脊柱的椎间盘退变是一种复杂的现象，其特征是核髓和内环发生生化变化，并形成从椎间盘中央区域向周围放射的裂隙和裂缝。此外，可能与这些现象无关，还可以看到外环附着处的离散缺陷，这可能是由于机械应力和失效所致。椎间盘组织中的应力撕裂及其未能愈合可能会引发或加速椎间盘中央成分的退变。我们推测，椎间盘源性疼痛可能与纤维环外层的损伤有关。尽管人们似乎有理由认为，由于拉伸应变较高，持续承受高椎间盘内压力的椎间盘更容易因外层的高张力而引起疼痛，但前瞻性研究的分析未能证实椎间盘造影术中典型疼痛再现与高压力值之间存在关系。结论是，目前，在椎间盘造影术中出现疼痛再现的患者中，唯一一致的形态学变化是存在涉及外环的各种环形缺陷。在这些缺陷的修复过程中是否存在神经内生长仍然有待确定。
