Comparison of the histopathological differences between the disc material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis

Abstract

BACKGROUND: Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE: Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN: Descriptive, cross-sectional. SETTING: Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES: PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE: 50. RESULTS: MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades ( P =.002). CONCLUSION: Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS: Small sample, retrospective CONFLICT OF INTEREST: None.

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

“…The PLC runs along the dorsal plexus of the vertebral body down the sacrum which increases cervical stability by providing posterior support to the vertebral body and limiting flexion and lateral bending and rotation 19,20 . What's more, there are also many complications associated with PLC resection, including symptoms such as cerebrospinal fluid leakage and spinal cord compression 21,22 . Therefore, PLC is important in maintaining spinal stability and preventing complications, so the decision to perform surgical resection needs to be considered holistically.…”

“…19 , 20 What's more, there are also many complications associated with PLC resection, including symptoms such as cerebrospinal fluid leakage and spinal cord compression. 21 , 22 Therefore, PLC is important in maintaining spinal stability and preventing complications, so the decision to perform surgical resection needs to be considered holistically.…”

Posterior longitudinal ligament suturation after lumbar discectomy provides postoperative a large intradural area: First report

“…[ 11 ] The load-bearing forces in the lumbar spine are more important than the thoracic spine and the cervical spine. [ 3 ] The posterior longitudinal ligament (PLL) extends from the cervical spine to the sacrum[ 12 ] on the dorsal surface of the vertebral body and represents the anterior portion of the vertebral canal and adheres to the intervertebral discs and adjacent marginal strips. [ 13 ] The lumbar spine is stabilized by paraspinal muscles, including psoas muscles, erector spinae, and multifidus,[ 7 ] and this ligament also provides mobility, stability, and flexibility to the spine.…”

“…[ 13 ] The lumbar spine is stabilized by paraspinal muscles, including psoas muscles, erector spinae, and multifidus,[ 7 ] and this ligament also provides mobility, stability, and flexibility to the spine. [ 12 ] The PLL strongly attaches to the annulus and has been ruptured in patients with extruded and sequestrated disc herniations. The PLL prevents the disc from protruding and plays a key role in the pathogenesis of LDH.…”

“…The PLL prevents the disc from protruding and plays a key role in the pathogenesis of LDH. [ 12 ] The comparative effectiveness of this ligament may have a vital role in spinal surgery. Technologic development is important in neurosurgical practice;[ 14 ] however, the pathophysiology of changes after lumbar discectomy is still not fully understood.…”