Repanti M, Korovessis P G, Stamatakis M V, Spastris P, Kosti P
Orthopaedic Department and Institute of Pathology, General Hospital Agios Andreas, Patras, Greece.
J Spinal Disord. 1998 Feb;11(1):41-5.
This is a prospective comparative histological study on blood supply between lumbar herniated discs and postmortem retrieved ones. The aim of this study is to observe the evolution of disc degeneration in relation to its blood supply changes. Disc vascularization is present early in life, but the nucleus pulposus becomes avascular after adolescence. Vascularization of the annulus fibrosus (AF) probably also occurs late in life in association with degenerative changes and in response to trauma. Capillary neoformation and hypervascularity in degenerated discs have also been mentioned, based on animal cases. In the present study, intervertebral lumbar disc specimens were surgically removed from 84 patients with an average age of 41 years (range 24-60 years) operated on for disc herniation. In addition, control autopsy specimens were selected from 24 cadavera with an age of 39 years (range 24th gestation week to 80 years). The material was fixed in neutral buffered formalin, and 4-microm-thick sections were stained with hematoxylin-eosin and reticulin. In addition, with use of an immunohistochemical avidin-biotin complex technique, paraffin sections were stained for Ulex europaeus agglutinin receptors (UEA-1) after binding UEA-1 to the tissue. In surgical specimens, small blood vessels were identified in 45% of the disc cases. They were of the capillary-type vessels and were intermingled with proliferating endothelial cells, fibroblasts, and few mononuclear cells. All of them were located along the edges of the surgically retrieved fibrocartilage fragments. Sometimes thin bands of fibrin were attached to them and extravasated erythrocytes were occasionally seen. In autopsy specimens, blood vessels were identified in 78% of the retrieved discs. In contrast to the edge neovascularity observed in surgical specimens, capillaries were observed at the outer layer of AF surrounded by dense hyalinized and inactive-appearing collagen. From these results it is concluded that the blood vessels in extruded tissue from every type of herniation are newly formed, possibly through metaplasia of undifferentiated mesenchymal cells. It is also possible that they are derived from blood vessels that have invaded the AF as a result of disc degeneration. The finding of detection of progressive disc degeneration in both groups after 20-25 years seems to be of special interest because disc degeneration is a process that may not be directly correlated to disc herniation in these age groups.
这是一项关于腰椎间盘突出症患者手术摘除的椎间盘与尸检获取的椎间盘血液供应的前瞻性对比组织学研究。本研究的目的是观察椎间盘退变与其血液供应变化的关系。椎间盘血管化在生命早期就存在，但髓核在青春期后变为无血管状态。纤维环（AF）的血管化可能也在生命后期与退变改变相关并对创伤作出反应时发生。基于动物病例，也有人提到退变椎间盘中的毛细血管新生和血管增多现象。在本研究中，从84例平均年龄41岁（范围24 - 60岁）因椎间盘突出接受手术的患者中手术摘除腰椎间盘标本。此外，从24具年龄39岁（范围从妊娠第24周至80岁）的尸体中选取对照尸检标本。材料用中性缓冲福尔马林固定，4微米厚的切片用苏木精 - 伊红和网状纤维染色。此外，使用免疫组织化学抗生物素蛋白 - 生物素复合物技术，在将欧洲荆豆凝集素（UEA - 1）与组织结合后，对石蜡切片进行UEA - 1染色。在手术标本中，45%的椎间盘病例中发现了小血管。它们是毛细血管型血管，与增殖的内皮细胞、成纤维细胞和少量单核细胞混合在一起。所有这些血管都位于手术获取的纤维软骨碎片边缘。有时有细的纤维蛋白带附着在它们上面，偶尔可见外渗的红细胞。在尸检标本中，78%的获取椎间盘发现有血管。与手术标本中观察到的边缘新生血管不同，在AF外层观察到毛细血管，其周围是致密的透明化且外观不活跃的胶原。从这些结果可以得出结论，每种类型突出组织中的血管都是新形成的，可能是通过未分化间充质细胞的化生形成。也有可能它们源自因椎间盘退变而侵入AF的血管。两组在20 - 25年后均检测到进行性椎间盘退变这一发现似乎特别有意思，因为在这些年龄组中，椎间盘退变是一个可能与椎间盘突出没有直接关联的过程。
