Ultrastructural Analysis on Lumbar Disc Herniation Using Surgical Specimens Role of Neovascularization and Macrophages in Hernias
Ultrastructural Analysis on Lumbar Disc Herniation Using Surgical Specimens Role of Neovascularization and Macrophages in Hernias
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DOI：
10.1097/brs.0b013e31819c9d5b
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发表时间：
2009-04-01
期刊：
影响因子：
3
通讯作者：
Baba, Hisatoshi
中科院分区：
文献类型：
--
作者：
Kobayashi, Shigeru;Meir, Adam;Baba, Hisatoshi
研究设计。通过检查腰椎间盘突出症患者手术时收集的腰椎间盘突出症组织，探讨腰椎间盘突出症自发消退的机制。本研究的目的是探讨当LDH自发消退时，新生血管和巨噬细胞在疝中的作用。背景资料摘要。磁共振成像等诊断成像工具已经证实了ldh的自发消退。然而，基于病理检查的疝组织自发消退机制的研究很少。特别是，巨噬细胞的作用还没有详细的研究，巨噬细胞被认为与自发退化密切相关。本文对73例手术患者的磁共振成像和手术表现进行了研究，并对术中收集的标本进行了光镜和透射电镜检查。侵入疝的毛细血管和从这些毛细血管中迁移出来的单核细胞衍生的巨噬细胞被认为是椎间盘突出症消退的重要因素。巨噬细胞含有充满胶原降解酶的溶酶体，这些酶体在吞噬后分解物质，而原代溶酶体由这些细胞分泌，分解细胞间物质，如胶原。这两种机制都与疝的恢复密切相关。硬膜外间隙疝组织周围发生的炎症反应被认为在椎间盘突出吸收中起重要作用，尽管它也可能对邻近的神经根产生有害影响。因此，控制炎症反应是治疗椎间盘突出患者的一个重要挑战。
Study Design. The mechanisms responsible for the spontaneous regression of lumbar disc herniation (LDH) were studied by examining herniated tissue collected at operation from patients with LDH.Objective. The aim of the present study was to investigate the role of neovascularization and macrophages in hernias when spontaneous regression of LDH occurred.Summary of Background Data. Spontaneous regression of LDHs has already been demonstrated by diagnostic imaging with tools such as magnetic resonance imaging. However, there have been few studies on the mechanisms of spontaneous regression based on pathologic examination of herniated tissue. In particular, there has been no detailed work on the role of macrophages, which are thought to be closely associated with spontaneous regression.Methods. The magnetic resonance imaging and operative findings of 73 patients who underwent surgery were investigated, and specimens collected during surgery were examined by light and transmission electron microscopy.Results. Capillaries that invade the hernia and macrophages derived from monocytes migrating out of these capillaries are considered to be important factors in the regression of the herniated disc. Macrophages contain lysosomes filled with collagen-degrading enzymes that break down substances after phagocytosis, whereas primary lysosomes are secreted by these cells and break down intercellular substances such as collagen. Both of these mechanisms are closely involved in the regression of herniation.Conclusion. The inflammatory response that occurs around hernia tissue in the epidural space is believed to play an important role in herniated disc resorption, although it may also have a harmful effect on the adjacent nerve root. Therefore, control of the inflammatory reaction is an important challenge when treating patients with disc herniation.