椎体增强术可导致邻近椎间盘早期退变：来自兔模型的证据。
Vertebral Augmentation can Induce Early Signs of Degeneration in the Adjacent Intervertebral Disc: Evidence from a Rabbit Model.
机构信息
Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
出版信息
Spine (Phila Pa 1976). 2018 Oct 15;43(20):E1195-E1203. doi: 10.1097/BRS.0000000000002666.
STUDY DESIGN
An experimental study.
OBJECTIVE
The aim of this study was to determine the effect of polymethylmethacrylate (PMMA) augmentation on the adjacent disc.
SUMMARY OF BACKGROUND DATA
Vertebral augmentation with PMMA reportedly may predispose the adjacent vertebra to fracture. The influence of PMMA augmentation on the adjacent disc, however, remains unclear.
METHODS
Using a retroperitoneal approach, PMMA augmentation was performed for 23 rabbits. For each animal, at least one vertebra was augmented with 0.2 to 0.3 mL PMMA. The disc adjacent to the augmented vertebra and a proximal control disc were studied using magnetic resonance (MR) imaging, histological and molecular level evaluation at 1, 3, and 6 months postoperatively. Marrow contact channels in the endplate were quantified in histological slices and number of invalid channels (those without erythrocytes inside) was rated. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) was performed to determine disc cell apoptosis.
RESULTS
On MR images, the signal and height of the adjacent disc did not change 6 months after vertebral augmentation. Histological scores of the adjacent disc increased over time, particularly for the nucleus pulposus. The adjacent disc had greater nucleus degeneration score than the control disc at 3 months (5.7 vs. 4.5, P < 0.01) and 6 months (6.9 vs. 4.4, P < 0.001). There were more invalid marrow contact channels in the endplate of augmented vertebra than the control (43.3% vs. 11.1%, P < 0.01). mRNA of ADAMTS-5, MMP-13, HIF-1α, and caspase-3 were significantly upregulated in the adjacent disc at 3 and 6 months (P < 0.05 for all). In addition, there were more TUNEL-positive cells in the adjacent disc than in the control disc (43.4% vs. 24.0%, P < 0.05) at 6 months postoperatively.
CONCLUSION
Vertebral augmentation can induce early degenerative signs in the adjacent disc, which may be due to impaired nutrient supply to the disc.
LEVEL OF EVIDENCE
N/A.
研究设计
实验研究。
目的
本研究旨在确定聚甲基丙烯酸甲酯（PMMA）增强对相邻椎间盘的影响。
背景资料概要
据报道，椎体增强用 PMMA 可能使相邻椎体易于骨折。然而，PMMA 增强对相邻椎间盘的影响尚不清楚。
方法
采用腹膜后入路，对 23 只兔子进行 PMMA 增强。对于每只动物，至少有一个椎体用 0.2 至 0.3 毫升 PMMA 增强。在术后 1、3 和 6 个月，使用磁共振成像（MR）、组织学和分子水平评估研究相邻椎间盘和近端对照椎间盘。在组织切片中量化终板中的骨髓接触通道，并对无红细胞的无效通道（无红细胞的通道）进行评分。采用末端脱氧核苷酸转移酶介导的 dUTP 缺口末端标记法（TUNEL）检测椎间盘细胞凋亡。
结果
在 MR 图像上，椎体增强后 6 个月，相邻椎间盘的信号和高度没有变化。随着时间的推移，相邻椎间盘的组织学评分增加，特别是核髓核。在 3 个月（5.7 对 4.5，P<0.01）和 6 个月（6.9 对 4.4，P<0.001）时，相邻椎间盘的核髓核退变评分高于对照组。增强椎体终板中的无效骨髓接触通道多于对照组（43.3%对 11.1%，P<0.01）。在 3 个月和 6 个月时，相邻椎间盘的 ADAMTS-5、MMP-13、HIF-1α 和 caspase-3 的 mRNA 均显著上调（P<0.05）。此外，在术后 6 个月时，相邻椎间盘的 TUNEL 阳性细胞多于对照组（43.4%对 24.0%，P<0.05）。
结论
椎体增强可引起相邻椎间盘的早期退行性改变，这可能是由于椎间盘营养供应受损所致。
证据水平
无。
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