Frick S L, Hanley E N, Meyer R A, Ramp W K, Chapman T M
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
Spine (Phila Pa 1976). 1994 Aug 15;19(16):1826-34; discussion 1834-5. doi: 10.1097/00007632-199408150-00006.
Degenerative lumbar disc disease has been implicated as a cause of low back pain. Current treatment options for low back pain involve nonphysiologic fusion of the involved segments and have variable success rates. This is an experimental study of lumbar intervertebral disc transplantation using a canine surgical model.
This study evaluated the feasibility of lumbar disc transplantation and its effects on disc metabolism and morphology.
Eight mature mongrel dogs underwent disc transfer surgeries, in which the L2-L3 and L4-L5 intervertebral discs, with a small segment of adjacent superior and inferior vertebral body, were removed and transposed. The transplanted disc were stabilized by plates or by a flexible cable wire construct using Songer cables (DANEK, Inc., Memphis, TN). Unrestricted activity was allowed postoperatively. At 4 months, the spines were harvested, and the transplanted discs were evaluated biochemically and histologically. Intervening nontransplanted discs served as viable controls and thrice-frozen discs served as nonviable controls. Cell viability was assessed by measuring proteoglycan synthesis and DNA content.
Proteoglycan synthesis (35S uptake normalized to DNA content) was maintained in transplanted anulus fibrosus tissue, but was decreased in nucleus pulposus samples (P < 0.05). DNA content was not altered significantly in the transplanted discs. Histologic analysis of the transplanted discs showed revascularization and remodeling of the bone adjacent to the disc and preservation of the lamellar architecture of the anulus fibrosus. The transplanted nucleus pulposus samples had chondrocyte-like cells present, but the staining characteristics of the nucleus material was variable. The contour of the transplanted disc endplates was irregular in all specimens.
The structure and function of autograft intervertebral discs were maintained after disc transfer surgery; the transplant discs, however, were not completely normal in either their morphology or their metabolic functioning.
退行性腰椎间盘疾病被认为是腰痛的一个原因。目前针对腰痛的治疗方法包括对受累节段进行非生理性融合，且成功率各不相同。这是一项使用犬类手术模型进行腰椎间盘移植的实验性研究。
本研究评估了腰椎间盘移植的可行性及其对椎间盘代谢和形态的影响。
八只成年杂种犬接受了椎间盘移植手术，其中L2-L3和L4-L5椎间盘连同相邻的一小段上位和下位椎体被切除并进行移植。移植的椎间盘通过钢板或使用松格钢丝（DANEK公司，田纳西州孟菲斯）的柔性缆线结构进行固定。术后允许犬自由活动。4个月后，取出脊柱，对移植的椎间盘进行生化和组织学评估。未移植的中间椎间盘作为活对照组，三次冷冻的椎间盘作为非活对照组。通过测量蛋白聚糖合成和DNA含量来评估细胞活力。
移植的纤维环组织中蛋白聚糖合成（以DNA含量标准化的35S摄取量）得以维持，但髓核样本中的蛋白聚糖合成减少（P < 0.05）。移植椎间盘的DNA含量没有显著改变。对移植椎间盘的组织学分析显示，椎间盘相邻部位的骨出现血管再生和重塑，纤维环的板层结构得以保留。移植的髓核样本中有类似软骨细胞的细胞存在，但髓核物质的染色特征各不相同。所有标本中移植椎间盘终板的轮廓均不规则。
椎间盘移植手术后自体移植椎间盘的结构和功能得以维持；然而，移植的椎间盘在形态或代谢功能上均未完全正常。
