Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 changes on MRI
Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 changes on MRI
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DOI：
10.1097/01.brs.0000215027.87102.7c
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发表时间：
2006-04-20
期刊：
影响因子：
3
通讯作者：
Takahashi, K
中科院分区：
文献类型：
--
作者：
Ohtori, S;Inoue, G;Takahashi, K
研究设计.椎间盘源性下腰痛患者椎体终板中肿瘤坏死因子（TNF）和蛋白基因产物（PGP 9.5）的免疫组织化学研究，MRI显示Modic 1型或2型终板改变。研究椎间盘源性下腰痛是否与炎性细胞因子和神经长入椎体终板有关。椎间盘退变和终板异常可能是椎间盘源性腰痛的原因之一。然而，在椎间盘源性腰痛和MRI终板改变的患者中，TNF免疫反应细胞和PGP 9.5免疫反应神经纤维的存在还没有研究。在手术过程中，从椎间盘源性腰痛患者（n = 14）或因其他背部问题需要手术的对照组（n = 4;脊柱侧凸和椎骨创伤性损伤）中采集了18个终板，这些终板在MRI上显示正常强度信号（终板变化-），Modic 1型信号（T1加权自旋回波图像上的低强度）或Modic 2型信号（高强度）。用TNF和PGP 9.5抗体对终板进行免疫染色，并对终板中的免疫染色细胞和神经纤维进行计数。MRI显示Modic 1型和Modic 2型终板改变的患者，其终板PGP9.5阳性神经纤维和TNF阳性细胞数均明显多于MRI显示正常终板者（P < 0.01）。Modic 1型改变的终板中TNF阳性细胞数明显高于Modic 2型改变的终板（P < 0.05）。结果表明终板异常与TNF诱导的炎症和轴突生长有关。TNF表达和PGP9.5阳性神经在异常终板中的长入可能是引起腰痛的原因。
Study Design. Immunohistochemistry for tumor necrosis factor (TNF) and protein gene product (PGP) 9.5 in vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 endplate changes on MRI.Objectives. To examine whether inflammatory cytokines and nerve in-growth into the vertebral endplate are associated with discogenic low back pain.Summary and Background Data. Degenerated discs and endplate abnormalities can be a cause of discogenic low back pain. However, the presence of TNF-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers has not been studied in patients with discogenic low back pain and endplate changes on MRI.Methods. Eighteen endplates showing either normal intensity signals on MRI (endplate change -), Modic Type 1 signals (low intensity on T1-weighted spin-echo images), or Modic Type 2 signals (high intensity) from patients with discogenic low back pain (n = 14) or controls requiring surgery for other back problems (n = 4; scoliosis and traumatic injury of vertebra) were harvested during surgery. Endplates were immunostained using antibodies to TNF and PGP 9.5 and immunostained cells and nerve fibers in the endplates were counted.Results. Vertebral endplates from patients with Modic Type 1 or Type 2 endplate changes on MRI had significantly more PGP 9.5-immunoreactive nerve fibers and TNF-immunoreactive cells in comparison with patients with normal endplates on MRI (P < 0.01). The number of TNF-immunoreactive cells in endplates exhibiting Modic Type 1 changes was significantly higher than in endplates exhibiting Modic Type 2 changes (P < 0.05).Conclusions. The results suggest that endplate abnormalities are related to inflammation and axon growth induced by TNF. TNF expression and PGP 9.5-positive nerve in-growth in abnormal endplates may be a cause of low back pain.