Moore R J, Vernon-Roberts B, Fraser R D, Osti O L, Schembri M
Division of Tissue Pathology, University of Adelaide, Australia.
Spine (Phila Pa 1976). 1996 Sep 15;21(18):2149-55. doi: 10.1097/00007632-199609150-00018.
In a clinicopathologic study, disc tissue collected from surgery and from cadaveric spines was examined to test an hypothesis about the pathogenesis of herniation.
To determine the origin and fate of herniated lumbar intervertebral disc tissue.
Previous studies have ascribed herniated disc tissue to the nucleus, anulus, or endplate, or combinations of the three. One study describes it as newly synthesized fibrocartilage. Regardless of its origin, peripheral neovascularization of disc fragments has been described and may be related to pain symptoms.
Disc tissue was collected after extrusion and was examined histologically to determine its origin and fate. To test the hypothesis that sequestration results from migration of isolated, degenerate fragments of nucleus pulposus through preexisting tears in the anulus fibrosus, cadaveric lumbar disc were examined in detail.
Ninety-eight percent of sequestrations contained some nuclear material indicating that nucleus pulposus is the principal substance extruded from the disc. None contained anulus alone. Although vascular repair was present in 89% of specimens, it did not correlate with several clinical parameters.
The autopsy study confirmed the model of nuclear fragmentation, migration, and extrusion along radiating anular clefts. Neovascularization of extruded fragments bore no relationship with duration of sciatic pain symptoms or clinical outcome.
在一项临床病理研究中，对从手术中及尸体脊柱采集的椎间盘组织进行检查，以验证关于椎间盘突出症发病机制的一个假设。
确定腰椎间盘突出组织的来源及转归。
以往研究认为椎间盘突出组织来源于髓核、纤维环或终板，或三者的组合。一项研究将其描述为新合成的纤维软骨。无论其来源如何，椎间盘碎片的外周新生血管形成已被描述，且可能与疼痛症状有关。
在椎间盘脱出后采集组织，并进行组织学检查以确定其来源及转归。为验证椎间盘游离是由于孤立的退变髓核碎片通过纤维环中已有的裂隙迁移所致这一假设，对尸体腰椎间盘进行了详细检查。
98%的游离组织含有一些髓核物质，表明髓核是从椎间盘中挤出的主要物质。无一例仅含纤维环组织。虽然89%的标本中存在血管修复，但它与几个临床参数并无关联。
尸检研究证实了髓核沿放射状纤维环裂隙碎裂、迁移和挤出的模型。突出碎片的新生血管形成与坐骨神经痛症状的持续时间或临床结局无关。
