Histological composition of lumbar disc herniations related to the type of herniation and to the age (original) (raw)
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Neurocirugía (English Edition), 2018
Background and objective: The use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Patients and method: Retrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa.
Neovascularization in Herniated Lumbar Disc: A Histological Study
2013
Background: Inter-vertebral disc is the largest avascular structure in human body, which is primarily a load bearing and stabilizing unit of the human spine. Degenerative disorders and disc herniation causes proliferation or in growth of new blood vessels in this structure. Lumbar disc herniated tissues were studied microscopically in comparison with the cadaveric lumbar disc tissue, to evaluate the changes particularly the formation of new blood vessels. Methods: It was a case control study in which 45 lumbar herniated disc tissues (L 4 – L5 and L 5 – S1) and 45 dissected, fresh cadaveric disc tissues of same level and almost of same age groups were collected and in reference to age were divided into groups. Both sets of tissues were processed, sectioned and stained with Hemotoxyllin / Eosin, to observe the architecture of annuli fibrosis and nuclei pulposus parts of disc and the micro-vessels under light microscope. Results: Cadaveric discs, group A, B and C compared with herniate...
Spine, 2007
Study Design. Basic scientific investigation using radiologic, histochemical, and microscopic dissection techniques.
The Spine Journal, 2014
BACKGROUND CONTEXT: Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system. PURPOSE: To report migration patterns of extruded lumbar disc fragments. STUDY DESIGN: A review of magnetic resonance (MR) images. PATIENT SAMPLE: A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation. OUTCOME MEASURES: Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation. METHODS: High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered ''migrated.'' The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. RESULTS: In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (p!.001 for both). Radiculopathy was significantly more frequent in caudal migrations than in rostral migrations (78.9% vs. 65.1%, p!.001). There was no significant association between gender or BMI and migration patterns in the vertical plane. In the horizontal plane, central, paracentral, subarticular, foraminal, and extraforaminal migrations were reported in 17.3%, 74.2%, 4.3%, 2.5%, and 1.8% of the patients, respectively. The youngest (median age 39 years, interquartile range [IQR] 13 years) and the oldest (median age 55 years, IQR 15 years) groups of patients (p!.001) had the most formainal and extraforaminal migrations, respectively. Radiculopathy was present in 66.5%, 76.8%, 88.6%, 96%, and 27.8% of the patients with central, paracentral, subarticular, foraminal, and extraforaminal migrations, respectively (p!.001). No significant association was found between gender, BMI, or the level of herniation and migration pattern in the horizontal plane. CONCLUSIONS: Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively.
Significance of cartilage endplate within herniated disc tissue
European Spine Journal, 2014
Purpose Disc herniations sometimes contain hyaline cartilage fragments, but their origins and significance are uncertain. Methods Herniations were removed surgically from 21 patients (aged 35-74 years) whose main symptom was sciatica (10 patients) or back pain (11 patients). Frozen sections, 5 lm thick, were examined histologically, and antibodies were used to label the matrix-degrading enzyme MMP 1, pro-inflammatory mediator TNFa, and cell proliferation marker Ki-67. Proportions of each tissue type were quantified by image analysis. Cartilage and bone components of the endplate were examined in 7-lm frozen sections from 16 cadaveric spines, aged 61-98 years.
Disc herniations in the young and end-plate vascularity
Clinical Anatomy, 1998
The objective of this study was to determine the nature of the persistence of remnants of the original nutritive vascular canals within the vertebral body and correlate their existence with end-plate ''weak spots.'' The body-disc region of 20 lumbar vertebrae between the ages of birth and 22 years was examined histologically to study the vascularity of the end-plate cartilage and its fate at the end of vertebral growth. Observations indicate a regression of the vascular canals in the end-plate commencing in the first decade, with ''scars'' left by these canals visible as nodular areas. By the beginning of the third decade, herniation of the disc material into the weak spots was observed. It is apparent that these weak spots represent a route for the early formation of intrabody nuclear herniations at this age (Schmorl's nodes).
Lomber Disk Hernisinin Radyolojik Evrelemesi Üzerine Mesleksel Faktörlerin Etkisi
Acibadem Universitesi Saglik Bilimleri Dergisi, 2020
Background: Lumbar disc herniation may cause back and/or leg pain, sensory deficits, loss of strength, and even urinary and fecal incontinence. The relationship between lumbar disc herniation (LDH) and occupation was tried to be revealed through various studies. In this study, the association between the radiological stage of LDH on magnetic resonance imaging (MRI) and occupational features of the patients was evaluated. Materials and methods: Sociodemographic and occupational features were collected from medical files of 895 patients with lumbar disc hernia. The occupational groups consisted of housewives, construction workers, health care workers and teachers. Patients were divided into three groups according to the years spent at work as follows: 0-5 years, 5-10 years, 10-15 years and over 15 years. On MRI, LDH was classified as bulging, protrusion, extrusion and sequestration according to Macnab classification. Results: There was no statistically significant relationship between the radiological staging of LDH and occupation (p=0.2) or gender (p=0.4). Increased(advanced) age and more working years had a significant association with the radiological staging of LDH (p <0.001). Conclusion: There is a significant relationship between the progression of the radiological staging of LDH and the increased(advanced) age and working years.
The Natural History of Patients with Acute Disc Herniation: A Series of 150 Cases
Coluna/Columna, 2020
Objective This study aims to analyze the characteristics of patients with acute lumbar/sciatic disc herniation who underwent conservative, pain block procedures and surgical treatment, in order to better understand the natural history of herniations and their surgical indications, as well as the impact of hernia volume. Methods We analyzed 150 patients with a diagnosis of acute lumbar disc herniation. The treatments considered were: conservative, infiltration/pain block procedures and microdiscectomy. For seven patients who were surgically treated, the lumbar sequestrectomy volume was submitted to pathological analysis. Results Of the 150 patients, 80% were treated conservatively; 15.31% were treated with pain block procedures and 4.66% underwent microdiscectomy. The mean age of the surgical group was 42.5 years, and 57.1% of the patients were men. Most of the hernias were at L5-S1 (55.5%), and 77.7% were on the left side. All patients had presented significant lumbar pain or sciati...
Disc degeneration after disc herniation: are we accelerating the process?
Evidence-Based Spine-Care Journal, 2013
Study design: Systematic review. Study rationale: Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear. Objectives: To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time. Methods: A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results: From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination. Conclusion: Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low.