Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease
Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease
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DOI：
10.1302/0301-620x.79b1.6814
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发表时间：
1997-01-01
影响因子：
--
通讯作者：
Polak, JM
中科院分区：
文献类型：
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作者：
Brown, MF;Hukkanen, MVJ;Polak, JM
我们从退行性间盘疾病患者的手术中获得了带有软骨终板和下面的松质骨的椎间盘，然后使用免疫组织化学技术对标本中的神经和神经末梢进行了定位。我们使用了无处不在的神经元蛋白基因产物9.5(PGP9.5)的抗体。神经肽Y免疫反应性用于识别自主神经，降钙素基因相关肽(CGRP)和P物质用于识别感觉神经。血管通过血小板-内皮细胞-黏附分子(CD31；PECAM)免疫反应识别。在无慢性腰痛病史的对照组中，PGP 9.5和神经肽Y免疫反应阳性的神经纤维与血管关系最密切，偶见P物质和CGRP免疫反应。在腰痛和腰椎间盘高度显著降低的患者中，终板区域和椎体下可见血管和伴行神经纤维的增殖。其中许多神经对P物质或CGRP免疫反应阳性，此外，P物质和CGRP免疫反应阳性的伤害性感受器与血管无关。图像分析定量显示，与正常对照组相比，含有CGRP的感觉神经纤维明显增加。我们推测，对椎间盘破裂产物的趋化反应是导致终板区域和退变椎间盘邻近椎体的血管和含有CGRP的感觉神经增殖的原因。神经肽P物质和降钙素基因相关肽具有强大的血管扩张和疼痛传递作用。感觉神经末梢的增加表明血液的增加可能是为了增加退变的椎间盘的营养。感觉神经密度的增加和终板软骨缺陷的存在，强烈表明终板和椎体是疼痛的来源；这可能解释了一些退行性腰椎间盘疾病患者运动时的剧烈疼痛。
We obtained intervertebral discs with cartilage endplates and underlying cancellous bone at operation from patients with degenerative disc disease and then used immunohistochemical techniques to localise the nerves and nerve endings in the specimens. We used antibodies for the ubiquitous neuronal protein gene product 9.5 (PGP 9.5). Immunoreactivity to neuropeptide Y was used to identify autonomic nerves and calcitonin gene-related peptide (CGRP) and substance P to identify sensory nerves. Blood vessels were identified by immunoreactivity with platelet-endothelial cell-adhesion molecule (CD31; PECAM).In a control group with no known history of chronic back pain, nerve fibres immunoreactive to PGP 9.5 and neuropeptide Y were most closely related to blood vessels, with occasional substance P and CGRP immunoreactivity. In patients with severe back pain and markedly reduced disc height, proliferation of blood vessels and accompanying nerve fibres was observed in the endplate region and underlying vertebral bodies. Many of these nerves were immunoreactive to substance P or CGRP, and in addition, substance P- and CGRP-immunoreactive nociceptors were seen unrelated to blood vessels. Quantification by image analysis showed a marked increase in CGRP-containing sensory nerve fibres compared with normal control subjects.We speculate that a chemotactic response to products of disc breakdown is responsible for the proliferation of vascularity and CGRP-containing sensory nerves found in the endplate region and vertebral body adjacent to degenerate discs. The neuropeptides substance P and CGRP have potent vasodilatory as well as pain-transmitting effects. The increase in sensory nerve endings suggests increase in blood how perhaps as an attempt to augment the nutrition of the degenerate disc. The increase in the density of sensory nerves, and the presence of endplate cartilage defects, strongly suggest that the endplates and vertebral bodies are sources of pain; this may explain the severe pain on movement experienced by some patients with degenerative disc disease.