Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Spine (Phila Pa 1976). 2013 Aug 1;38(17):1491-500. doi: 10.1097/BRS.0b013e31829a6fa6.
A prospective multimodal study including clinical, radiological, serial postcontrast magnetic resonance imaging, intraoperative findings, and histopathological study.
To document in vivo, the site of anatomical failure in lumbar disc herniation (LDH).
Although in vitro mechanical disruption studies have implicated both the endplate junction (EPJ) and the annulus fibrosus (AF) as the site of failure in LDH, there are no in vivo human studies to document the exact anatomy of failure.
One hundred eighty-one consecutive patients requiring microdiscectomy at a single level formed the study group. The status of the endplate and AF in the operated level (study discs) and the other discs (control) were evaluated by plain radiograph, thin slice computed tomographic scan, plain and contrast magnetic resonance imaging, intraoperative examination, and histopathological analysis.
LDH due to EPJ failure (EPJF- type I herniation) was more common (117; 65%) than annulus fibrosis rupture. Herniated discs had a significantly higher incidence of EPJF than control discs (P < 0.0001). The EPJF was evident radiologically as vertebral corner defect in 30 patients, rim avulsion in 46, frank bony avulsions in 24, and avulsion at both upper and lower EP in 4. Thirteen discs with normal EP radiologically had cartilage or bone avulsion intraoperatively. Sixty-four discs (35%) had intact EP of which annular high intensity zone was found in 21 (11%), suggesting a disruption of AF (type II herniation). Postcontrast magnetic resonance image of 20 patients showed dye leak at the EPJ proving EPJF as main cause of LDH.
Our study provides the first in vivo evidence that LDH in humans is more commonly the result of EPJF than AF rupture and offers clinical validation of previous in vitro mechanical disruption studies. Future research must focus on the EPJ as a primary area of interest in LDH.
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一项包括临床、影像学、连续对比磁共振成像、术中发现和组织病理学研究的前瞻性多模态研究。
记录腰椎间盘突出症（LDH）的解剖学失败部位。
尽管体外力学破坏研究表明终板交界处（EPJ）和纤维环（AF）都是 LDH 失败的部位，但没有关于记录失败的确切解剖结构的人体研究。
181 例连续患者在单一水平接受微创手术，形成研究组。通过平片、薄层 CT 扫描、平扫和对比磁共振成像、术中检查和组织病理学分析评估手术水平（研究椎间盘）和其他椎间盘（对照椎间盘）的终板和 AF 状况。
EPJ 失败导致的 LDH（EPJF- 型疝）比纤维环破裂更常见（117 例；65%）。疝出的椎间盘比对照椎间盘更常见 EPJF（P < 0.0001）。EPJF 在放射学上表现为 30 例椎体角缺损、46 例边缘撕脱、24 例真性骨撕脱和 4 例上下终板撕脱。13 个放射学上正常的椎间盘在术中发现软骨或骨撕脱。64 个椎间盘（35%）终板完整，其中 21 个（11%）发现环形高信号带，提示 AF 破裂（型疝）。20 例患者的对比磁共振图像显示 EPJ 处染料漏出，证明 EPJF 是 LDH 的主要原因。
我们的研究首次提供了人体 LDH 更常见的是 EPJF 而不是 AF 破裂的体内证据，并为之前的体外力学破坏研究提供了临床验证。未来的研究必须集中在 EPJ 作为 LDH 的主要研究领域。
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