Latif Rabia, Imran Sumera, Ahmad Ijaz, Ilyas Muhammad Saad, Aziz Amer, Zehra Uruj
Department of Anatomy, University of Health Sciences Lahore, Lahore, Pakistan.
Department of Orthopedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
Asian Spine J. 2022 Apr;16(2):212-220. doi: 10.31616/asj.2021.0106. Epub 2021 Sep 1.
Cross-sectional comparative.
To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI).
Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported.
Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid-Schiff stain; examined for histological degeneration scores (HDS; 0-15), inflammation (0 [absence]-3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance.
VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02).
VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.
横断面比较研究。
描述椎间盘突出样本中椎间盘退变、炎症和神经密度的评分，并将研究结果与磁共振成像（MRI）上椎体终板（VEP）变化的存在情况相关联。
考虑到椎间盘成分在保守治疗期间疼痛的自发缓解和持续存在中的作用，识别影响因素很重要。VEP变化与椎间盘退变高度相关，但其与椎间盘突出成分的相关性尚未见报道。
从接受椎间盘突出手术的患者中获取51个椎间盘。患者年龄在19至65岁之间，51例中有31例为男性。分析术前腰椎T1和T2加权MRI，以观察受影响节段的Pfirrmann分级、VEP缺陷、突出类型、Modic改变和高强度区（HIZ）。将5微米厚的切片用苏木精和伊红、阿尔辛蓝过碘酸希夫染色；检查组织学退变评分（HDS；0 - 15）、炎症（0[无] - 3[严重]）以及软骨终板（CEP）的存在情况。将3微米厚的切片用蛋白基因产物9.5染色，并计算每平方毫米的表达量。对数据进行分析，p<0.05被认为具有统计学意义。
在51个样本中，分别有30/51、16/51和6/51观察到VEP缺陷、Modic改变和HIZ。在51个样本中有26个观察到CEP，在51个有终板缺陷的样本中有23个观察到CEP。伴有相邻VEP缺陷的椎间盘显示HDS增加（p<0.001）和炎症增加（p<0.001）。伴有相邻Modic改变的椎间盘也显示HDS增加（p = 0.01）。有CEP的组织学切片显示HDS增加（p<0.001）和炎症增加（p<0.001），并且神经密度与HDS显著正相关（r = 0.27，p = 0.02）。
VEP变化可调节椎间盘突出的退变和炎症。这些变化的存在高度预示着椎间盘突出中CEP的发生，这会导致吸收缓慢和临床症状持续存在。
