Menopause causes vertebral endplate degeneration and decrease in nutrient diffusion to the intervertebral discs
Menopause causes vertebral endplate degeneration and decrease in nutrient diffusion to the intervertebral discs
复制标题
DOI：
10.1016/j.mehy.2011.03.014
复制
发表时间：
2011-07-01
影响因子：
4.7
通讯作者：
Griffith, James F.
中科院分区：
文献类型：
--
作者：
Wang, Yi-Xiang J.;Griffith, James F.
外环中的脉管系统仅供应椎间盘的外周，使得椎间盘的大部分（包括所有内环和髓核）的营养来源于脊椎骨骺端动脉，在脊椎骨骺端动脉处营养物扩散穿过软骨终板到达椎间盘。在这方面，椎体终板在椎间盘营养中起着重要作用。营养物质扩散到椎间盘细胞的损害可能在椎间盘退变的进展甚至开始中起很大作用。越来越多的证据表明，雌激素缺乏也会影响绝经后女性椎间盘退变的严重程度。椎体终板的结构紊乱发生在椎间盘退变，临床上观察到的最常见的终板变化是Schmorl结。Schmorl结在绝经后妇女中比年轻妇女更常见。与Schmorl结相关的骨质疏松、骨坏死和纤维化可阻碍营养物质扩散到椎间盘中以及从椎间盘中清除代谢物。我们假设绝经对椎体终板质量产生负面影响，并导致终板退变。这种终板退变减少了营养物质从椎体向椎间盘的扩散，也阻碍了代谢物的清除，导致椎间盘进一步退变。为了证实我们的假设，可以对绝经前和绝经后女性进行横断面对比后MRI研究。如果这一假设得到证实，那么低剂量激素替代治疗可能会延缓绝经后妇女的椎间盘退变，从而限制与椎间盘退变相关的后果，如腰痛。(C)2011爱思唯尔有限公司保留所有权利。
The vasculature in the outer annulus supplies only the periphery of the disc so that nutrition to the bulk of the disc, including all the inner annulus and nucleus pulposus, is derived from the vertebral epiphyseal end arteries where nutrients diffuse across the cartilaginous endplate to reach the disc. In this regard the vertebral endplate plays an important role in disc nutrition. Compromise of diffusion of nutrients to the disc cells may play a large part in the progression or even initiation of disc degeneration. Increasing evidence suggests that estrogen deficiency also influence the severity of disc degeneration in post-menopausal females. Structural disorganization of the vertebral endplate occurs with disc degeneration, with the most common endplate changes observed clinically being Schmorl's node. Schmorl's node is more commonly seen in post-menopausal women than younger women. Osteosclerosis, osteonecrosis and fibrosis associated with Schmorl's nodes can impede nutrient diffusion into the disc as well as removal of metabolites from the disc. We hypothesize that menopause negatively affects vertebral endplate quality and induces endplate degeneration. This endplate degeneration decreases nutrients diffusion from vertebral body into discs, and also impedes removal of metabolites, leads to further disc degeneration. To confirm our hypothesis, a cross-sectional post-contrast MRI study can be performed in pre-menopausal and post-menopausal women. If the hypothesis is confirmed, then low dose hormone replacement treatment may retard disc degeneration in post menopausal women and thereby limit the consequences associated with disc degeneration such as low back pain. (C) 2011 Elsevier Ltd. All rights reserved.