Mechanical initiation of intervertebral disc degeneration
Mechanical initiation of intervertebral disc degeneration
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DOI：
10.1097/00007632-200007010-00005
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发表时间：
2000-07-01
期刊：
影响因子：
3
通讯作者：
Dolan, P
中科院分区：
文献类型：
--
作者：
Adams, MA;Freeman, BJC;Dolan, P
研究设计.尸体腰部运动节段的力学测试。目的。目的：验证椎体轻微损伤可导致相邻椎间盘进行性破坏的假设。背景资料概要。椎间盘退变包括大体结构破坏以及细胞介导的基质成分变化，但几乎没有证据表明哪一个先发生。已知对椎体的相对较小的损伤会破坏相邻的椎间盘，并且这可能对椎间盘中的结构和细胞功能产生不利影响。在这项研究中，38具尸体腰椎运动节段（平均年龄，51岁）进行了复杂的机械负荷，以模拟典型的活动在体内，而在椎间盘基质的压缩应力分布进行了测量，使用压力传感器安装在一个针直径为1.3毫米。“应力分布”重复后，控制压缩过载损伤减少运动节段高度约1%。然后对受损样本施加适合模拟轻体力劳动的适度重复载荷约4小时，并重复第三次应力轮廓测量。然后将椎间盘切片并拍照。终板损伤使相邻髓核的压力降低25% +/- 27%，并在髓环中产生压应力峰值，通常在髓核后方。50至70岁的椎间盘受到的影响最大。重复加载进一步减压核和加强应力集中的环，特别是在模拟脊柱前凸姿势。15个椎间盘的X线平片显示9个椎间盘纤维环向内塌陷，11个椎间盘纤维环极度向外膨出，2个椎间盘完全放射状裂隙，其中1个椎间盘允许髓核向后移位。与组织培养实验结果的比较表明，所观察到的基质压应力的变化将抑制整个椎间盘的椎间盘细胞代谢，并可能导致基质的进行性退化。椎体终板的轻微损伤会导致相邻椎间盘的渐进性结构变化。
Study Design. Mechanical testing of cadaveric lumbar motion segments.Objectives. To test the hypothesis that minor damage to a vertebral body can lead to progressive disruption of the adjacent intervertebral disc.Summary of Background Data. Disc degeneration involves gross structural disruption as well as cell-mediated changes in matrix composition, but there is little evidence concerning which comes first. Comparatively minor damage to a vertebral body is known to decompress the adjacent discs, and this may adversely affect both structure and cell function in the disc.Methods. In this study, 38 cadaveric lumbar motion segments (mean age, 51 years) were subjected to complex mechanical loading to simulate typical activities in vivo while the distribution of compressive stress in the disc matrix was measured using a pressure transducer mounted in a needle 1.3 mm in diameter. "Stress profiles" were repeated after a controlled compressive overload injury had reduced motion segment height by approximately 1%. Moderate repetitive loading, appropriate for the simulation of light manual labor, then was applied to the damaged specimens for approximately 4 hours, and stress profilometry was repeated a third time. Discs then were sectioned and photographed.Results. Endplate damage reduced pressure in the adjacent nucleus pulposus by 25% +/- 27% and generated peaks of compressive stress in the anulus, usually posteriorly to the nucleus. Discs 50 to 70 years of age were affected the most. Repetitive loading further decompressed the nucleus and intensified stress concentrations in the anulus, especially in simulated lordotic postures. Sagittal plane sections of 15 of the discs showed an inwardly collapsing anulus in 9 discs, extreme outward bulging of the anulus in 11 discs, and complete radial fissures in 2 discs, 1 of which allowed posterior migration of nucleus pulposus. Comparisons with the results from tissue culture experiments indicated that the observed changes in matrix compressive stress would inhibit disc cell metabolism throughout the disc and could lead to progressive deterioration of the matrix.Conclusions. Minor damage to a vertebral body endplate leads to progressive structural changes in the adjacent intervertebral discs.