Histologic Evidence of Absorption of Sequestration-Type Herniated Disc

Ito, Takui; Yamada, Mitsunori; Ikuta, Fusahiro; Fukuda, Takahiro; Hoshi, Shinichi; Kawaji, Youichi; Uchiyama, Seiji; Homma, Takao; Takahashi, Hideaki

doi:10.1097/00007632-199601150-00014

Cited by 133 publications

(59 citation statements)

References 11 publications

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“…Slavin et al hypothesized [23] that cartilaginous tissue resorption results from enzymatic degradation and phagocytosis as a result of inflammation and neovascularization due to an autoimmune response [24,25]. Some studies have revealed neovascularization at the periphery of the sequestrated disc and the presence of macrophages and T cells in the vascularized areas [26][27][28]. In our study, all patients with reduced pseudotumors demonstrated contrast enhancement of their pseudotumor on MRI after Gd administration.…”

Section: Discussionsupporting

confidence: 57%

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

et al. 2013

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Purpose A retro-odontoid pseudotumor is usually a reactive fibrocartilaginous mass associated with atlantoaxial subluxation (AAS). However, a retro-odontoid pseudotumor not associated with AAS, which undergoes spontaneous regression following C1 laminoplasty, has been reported. The purpose of this study was to report surgical outcomes of C1 laminectomy for retro-odontoid pseudotumor without AAS. Materials and methods The cases of seven patients (mean age 75.6 ± 7.6 years-old) with retro-odontoid pseudotumor without AAS were reviewed. The mean follow up time was 52.3 ± 25.5 months. Each patient underwent a C1 laminectomy with an additional C3-6 expansion laminoplasty in three patients. The Japanese Orthopaedic Association score (JOA score) was used for neurological assessment. Pseudotumor size and additional AAS were analyzed using MRI and radiography. Results All patients exhibited neurological improvement following surgery, the JOA score improved from 7.2 ± 3.2 to 14.1 ± 2.6. The mean O-C2 and C2-7 angle decreased from -3.2 ± 2.1°to -3.9 ± 1.7°, showing a slight kyphotic change. Postoperative AAS was not observed. All pseudotumors spontaneously resolved, and recurrence and regrowth were not observed. Five patients had MRIs after gadolinium administration; four patients who showed enhancement of the pseudotumor had almost complete reduction within 1 year following surgery.Discussion Our study, assessing the outcome of C1 laminectomy for retro-odontoid pseudotumor, found neurological improvement in all cases. Since all pseudotumors were reduced and additional AAS was not observed, C1 laminectomy for retro-odontoid pseudotumor, in the absence of AAS, is recommended as a therapeutic strategy.

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Section: Discussionsupporting

confidence: 57%

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

et al. 2013

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“…These, however, are known to be infiltrated with macrophages and T-cells, which may contribute to the levels of production of mediators. 13,[19][20][21][22] The disc material in sequestrated herniations is also in a different anatomical location to the contained or semicontained specimens in the group with low back pain only. The reasons for increased production of inflammatory mediators by the nucleus pulposus in patients with discogenic low back pain are unknown.…”

Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

Watson

McCormack

et al. 2002

The Journal of Bone and Joint Surgery. British volume

332

248

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H erniated intervertebral disc tissue has been shownto produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain.We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively).The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc. [Br] 2002;84-B:196-201. J Bone Joint Surg Received 8 June 2001; Accepted 3 August 2001The pathophysiology of discogenic low back pain is incompletely understood. 1 The changes which occur as a disc degenerates are well documented, but are unhelpful in determining whether a degenerate disc will cause pain.2 It is known that disc tissue from patients undergoing discectomy for sciatica synthesises proinflammatory mediators and cytokines. 3-12 Sequestrated and extruded discs produce higher levels of these mediators than specimens in which the annulus is intact. 5,10,12,13 To date, there have been no studies of the production of inflammatory mediators in disc tissue from patients undergoing operations for discogenic low back pain. It has been shown, however, that degenerate discs in these patients contain more nociceptive nerve endings in the endplates of the disc and in the nucleus pulposus than do degenerate discs which do not cause low back pain. 14, 15 We have therefore compared levels of production of the proinflammatory mediators tumour necrosis factor alpha (TNF␣), interleukin-1beta (IL-1␤), interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ), in disc tissue from patients undergoing discectomy for sciatica with those from patients undergoing fusion for discogenic low back pain. Patients and MethodsWe obtained specimens of intervertebral disc from 63 patients undergoing primary lumbar discectomy for sciatica. Intraoperative assessment of the morphology of the disc herniation revealed 25 in which the annulus was intact (AI), 30 in which a nuclear extrusion was present (EXT) and eight in which the nucleus was sequestrated (SEQ). The mean ages were 42 years in the AI group, 39.5 years in the EXT group and 42 years in the SEQ group. The male: female ratio in the AI, EXT and SEQ groups was 17:8, 20:10 and 6:2, respectively. Three specimens were from the L3/L4 level, 28 from the L4/L5 level and 32 from the L5/ S1 level.We also obtained disc specimens from 20 patients undergoing primary lumbar interbody fusion for discogenic low back pain, which had been confirmed by discograph...

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“…When an intervertebral disc is herniated, nuclear material extrudes into the spinal canal. Within a short time, neocapillarisation begins in and around the extruded nucleus material [15][16][17][18][19] and inflammation occurs with an increased presence of macrophages [17][18][19]. As the avascular anaerobic disc provides an ideal environment for anaerobic bacteria, it is plausible that these low virulent anaerobic bacteria may enter the disc and give rise to a slowly developing infection.…”

Section: Introductionmentioning

confidence: 99%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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Purpose To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema) in vertebrae are observed in 6 % of the general population and in 35-40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated the presence of low virulent anaerobic microorganisms, predominantly Propionibacterium acnes, in 7-53 % of patients. At the time of a herniation these low virulent anaerobic bacteria may enter the disc and give rise to an insidious infection. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production. Methods Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent antiseptic sterile protocols were followed. Results Sixty-one patients were included, mean age 46.4 years (SD 9.7), 27 % female. All patients were immunocompetent. No patient had received a previous epidural steroid injection or undergone previous back surgery. In total, microbiological cultures were positive in 28 (46 %) patients. Anaerobic cultures were positive in 26 (43 %) patients, and of these 4 (7 %) had dual microbial infections, containing both one aerobic and one anaerobic culture. No tissue specimens had more than two types of bacteria identified. Two (3 %) cultures only had aerobic bacteria isolated. In the discs with a nucleus with anaerobic bacteria, 80 % developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of those with aerobic bacteria and only 44 % of patients with negative cultures developed new MC. The association between an anaerobic culture and new MCs is highly statistically significant (P = 0.0038), with an odds ratio of 5.60 (95 % CI 1.51-21.95). Conclusion These findings support the theory that the occurrence of MCs Type 1 in the vertebrae adjacent to a previously herniated disc may be due to oedema surrounding an infected disc. The discs infected with anaerobic bacteria were more likely (P \ 0.0038) to develop MCs in the adjacent vertebrae than those in which no bacteria were found or those in which aerobic bacteria were found.

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Histologic Evidence of Absorption of Sequestration-Type Herniated Disc

Abstract: These findings suggest that organization is not a main course for this type of herniated disc and that a kind of "absorption" process occurs predominantly in the healing stage.

Cited by 133 publications

References 11 publications

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

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