摘要:

Study Design.A retrospective chart review.Objectives.To report the correlation between the side of a concordantly painful, post-discography computer tomography (CT) visualized, annular tear, and the side of a patients’ low back pain.Summary of Background Data.An annular fissure extending from the nucleus to the outer one-third of the annulus is thought to be the nociceptive source stimulated during provocative lumbar discography. To our knowledge, there are no studies that have attempted to delineate whether the side of the annular tear correlates with the side of the patient pain.Methods.One hundred and one post-discography CT scans, performed on patients with single level, concordantly painful, and fissured discs identified during lumbar discography, were randomly obtained from the archived and current files of the Penn Spine Center’s film library. These were reviewed by both the lead author and a spine radiologist, both of who were blinded to the side of the patients pain, to determine which scans demonstrated clearly definable tears extending to the outer one-third of the annulus. Statistical analysis via the exact method was used to determine the correlation between the side of the patients tear and the side of the patients pain.Results.Forty post-discography CT scans met the inclusion criteria. There was a random correlation between the side of the patients concordantly painful annular tear and the side of the patients pain.Conclusions.The results of this study raise several questions regarding the embryologic development of the intervertebral disc and its somite, neurologic transmission of discogenic pain, distribution of chemical inflammagens, validity of discography, technique of ESI, and technique and validity of IDET.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Design.During prospective morphologic studies of the human intervertebral disc, specimens from a 79-year-old woman whose tissues were donated for study were found to contain birefringent crystals in multiple disc sites. This case report describes the histopathologic features of hard gritty (tophaceous) deposits and reviews the literature on gout in the spine.Objectives.Light and transmission electron microscopic studies were carried out to describe the microscopic features of disc tissue surrounding the deposits; histochemical procedures were carried out to determine whether crystals were nodular deposits of urate crystals or pyrophosphate crystals.Summary of the Background Data.Previous case studies of spines involved with gout are rare. Many past cases have not involved the disc tissue itself but rather have identified masses of crystals in spinal joints and intradural sites.Methods.Histopathologic studies included examination of disc tissue with routine light microscopy, polarized light microscopy, and transmission electron microscopy.Results.Autopsy findings reported severe osteoarthritic changes, including scoliosis of the spine and ulnar deviation of both hands and extensive cystic disease of both kidneys. Gross dissection of the spine revealed discrete nodular areas of tophaceous deposits in the inner and outer annulus at multiple disc sites (C6–7, C7–T1, T4–5, T6–7, T9–10, L1–2, L2–3). Microscopically these regions were seen to contain birefringent crystals that were determined to be pyrophosphate crystals (not urate crystals) by the histochemical lithium carbonate extraction–hexamine silver technique. Nodular crystal masses were not surrounded by a fibrous capsule or by giant cells or inflammatory cells. Ultrastructural studies showed the presence of intermediate filaments within annulus cells, the presence of cells in clusters, fibrous long-spacing collagen in the lacunar space, wide-banded collagen fibrils, matrix condensations encircling the cells, and sparse interterritorial matrix.Conclusions.This case study increases the small number of reports on findings of crystal deposits within the disc itself; the affected individual also showed scoliosis, severe osteoarthritic changes, extensive cystic disease of both kidneys, and systemic sarcoidosis. Histochemical analyses showed that the birefringent crystals in the disc were pyrophosphate crystals and not urate crystals. These findings are also of interest because they indicate that considerable movement of tissue fluid was present in these discs, as reflected by the subsequent foci of crystal deposition.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

It is always gratifying to be acknowledged by a colleague and asked to give a talk in a faraway land about a topic of one’s particular interest. To be invited, however, to give the Harry Farfan Presidential Lecture at the 27th Meeting of the International Society for the Study of the Lumbar Spine is, for me, a special honor and privilege. Too many years ago, when I was a very junior faculty member at the School of Physical and Occupational Therapy at McGill University in Montreal, Canada, we offered our students a course in Orthopedic Conditions. This course was primarily taught by orthopedic surgeons, rheumatologists, and other members of the medical profession with special interest in disorders of the musculoskeletal system. Teaching in this course was considered to be a professional obligation at McGill, and, while most individuals accepted the invitation, they did so with varying degrees of enthusiasm. Each year, Dr. Harry Farfan graciously agreed and provided several lectures for our students. He told them about the surgical management of problems of the lumbar spine and the necessity of treating the “whole” patient, as well as about his theory as to the cause of low back pain. At that point in time, we were not talking about quality of life as an outcome of care for our patients, but I cannot help but believe that he would keenly approve of the subject of this presentation.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.The possibility to prevent nucleus pulposus-induced functional and structural nerve root injury by selective tumor necrosis factor-&agr; inhibition was assessed in an experimental model in the pig spine.Objective.The objective of the study was to evaluate the role of tumor necrosis factor-&agr; in the mediation of nucleus pulposus-induced nerve injury by using selective inhibition.Summary of Background Data.The cytokine tumor necrosis factor-&agr; has been suggested to play a key role in the nerve root injury induced by local application of nucleus pulposus. However, previous studies have not been able to distinguish the effects between tumor necrosis factor-&agr; and other disc-related cytokines because of the use of nonspecific cytokine inhibition.Methods.Autologous nucleus pulposus was harvested from a lumbar disc and applied to the porcine sacrococcygeal cauda equina. The pigs were simultaneously treated with two selective tumor necrosis factor-&agr; inhibitors (etanercept n = 8 and infliximab n = 5), a heparin analogue (enoxaparin n = 5) or saline for control (n = 5). After 7 days the nerve conduction velocity over the application zone was determined and samples of the exposed nerve roots were collected for light microscopic evaluation.Results.The two tumor necrosis factor-&agr; inhibitors prevented the reduction of nerve conduction velocity and also seemed to limit the nerve fiber injury, the intracapillary thrombus formation, and the intraneural edema formation. However, treatment with enoxaparin did not seem to be different from control regarding reduction of nerve conduction velocity or histologic changes.Conclusions.The data clearly indicate that tumor necrosis factor-&agr; is involved in the basic pathophysiologic events leading to nerve root structural and functional changes after local application of nucleus pulposus. The study therefore provides a basic scientific platform with potential clinical implications regarding the use of anti-tumor necrosis factor-&agr; medication as treatment in patients with disc herniation and sciatica.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.An experimental study to clarify the effects of pentoxifylline, as an anti-tumor necrosis factor-alpha therapy on endoneurial fluid pressure in the dorsal root ganglion using an animal model of herniated nucleus pulposus.Objectives.To investigate the effects of anti-tumor necrosis factor-alpha therapy to nucleus pulposus-induced nerve root/dorsal root ganglion changes.Summary of Background Data.It has been reported experimentally that application of nucleus pulposus into epidural space induces morphologic and functional changes in the nerve roots and induces compartment syndrome in the dorsal root ganglia. Tumor necrosis factor-alpha has been considered a key pathogenic factor in the initiation and maintenance of neuropathic pain states.Methods.A total of 11 adult, female Sprague-Dawley rats had their left L5 nerve roots and associated dorsal root ganglions exposed. Autologous nucleus pulposus was applied to the L5 nerve root just proximal to the dorsal root ganglion. A piece of Spongel (Yamanouchi Pharmaceutical Co., Tokyo) containing 20 &mgr;L of 1000 &mgr;g/mL pentoxifylline was applied with the nucleus pulposus (NP+PTX group). In control animals nucleus pulposus was applied with a piece of Spongel containing 20 &mgr;L of physiologic saline solution in a similar fashion (NP+PS group). Endoneurial fluid pressure was recorded with a servo-null micropipette system using glass micropipettes with tip diameters of 4 &mgr;m. Endoneurial fluid pressure in the dorsal root ganglion was measured before and 3 hours after application of test substances. After measurement of endoneurial fluid pressure, the nerve root and dorsal root ganglion were processed for histology and evaluated by light microscope.Results.Values of endoneurial fluid pressure before application of test substances were as follows: 2.4 ± 1.2 cmH2O in the NP+PS (control) group and 1.8 ± 0.4 cmH2O in the NP+PTX group. There was no statistically significant difference between these two pretreatment measurements. However, values of endoneurial fluid pressure after application were as follows: 8.6 ± 1.8 cmH2O in the NP+PS group and 2.9 ± 0.8 cmH2O in the NP+PTX group. Values of endoneurial fluid pressure in the NP+PTX group were significantly lower compared with the NP+PS group. Histologic examination consistently showed only a slight degree of edema evident in the NP+PTX group compared with the NP+PS group.Conclusion.Pentoxifylline, an anti-tumor necrosis factor-alpha drug, prevented the dorsal root ganglion compartment syndrome caused by topical application of nucleus pulposus. Anti-inflammatory cytokine therapy may become an effective treatment of sciatica due to disc herniation.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID