Coppes M H, Marani E, Thomeer R T, Groen G J
Department of Neurosurgery, Groningen University, The Netherlands.
Spine (Phila Pa 1976). 1997 Oct 15;22(20):2342-9; discussion 2349-50. doi: 10.1097/00007632-199710150-00005.
The authors investigated the innervation of discographically confirmed degenerated and "painful" human intervertebral discs.
To determine the type and distribution patterns of nerve fibers present in degenerated human intervertebral discs.
The innervation of intervertebral discs has previously been extensively described in fetal and adult animals as well as humans. However, little is yet known about the innervation of severely degenerated human lumbar discs. The question may be posed whether a disc that has been removed for low back pain possesses an increased innervation compared with normal discs.
The presence of nerve fibers was investigated using acetylcholinesterase enzyme histochemistry, as well as neurofilament and substance P immunocytochemistry. From 10 degenerated and 2 control discs, the anterior segments were excised and their nerve distribution studied by examining sequential sections.
In all specimens, nerve fibers of different diameters were found in the anterior longitudinal ligament and in the outer region of the disc. In 8 of 10 degenerated discs, fibers were also found in the inner parts of the disc. Substance P-immunoreactive nerve fibers were sporadically observed in the anterior longitudinal ligament and the outer zone of the anulus fibrosus.
Findings indicate a more extensive disc innervation in the severely degenerated human lumbar disc compared with normal discs. The nociceptive properties of at least some of these nerves are highly suggested by their substance P immunoreactivity, which provides further evidence for the existence of a morphologic substrate of discogenic pain.
作者研究了经椎间盘造影证实退变且“疼痛”的人类椎间盘的神经支配情况。
确定退变的人类椎间盘中存在的神经纤维类型及分布模式。
此前已对胎儿、成年动物及人类椎间盘的神经支配进行了广泛描述。然而，对于严重退变的人类腰椎间盘的神经支配情况仍知之甚少。对于因下腰痛而被摘除的椎间盘与正常椎间盘相比是否具有更多神经支配这一问题，仍有待探讨。
采用乙酰胆碱酯酶组织化学、神经丝及P物质免疫细胞化学方法研究神经纤维的存在情况。从10个退变椎间盘和2个对照椎间盘中切取前部节段，通过检查连续切片研究其神经分布。
在所有标本中，均在前纵韧带及椎间盘外部区域发现了不同直径的神经纤维。在10个退变椎间盘中，有8个在椎间盘内部也发现了神经纤维。在前纵韧带及纤维环外层区域偶尔可观察到P物质免疫反应性神经纤维。
研究结果表明，与正常椎间盘相比，严重退变的人类腰椎间盘的神经支配更为广泛。这些神经中至少有一些具有伤害感受特性，这一点从其P物质免疫反应性中得到了有力提示，这为盘源性疼痛形态学基础的存在提供了进一步证据。
