ISSLS Prize Winner: The Innervation of the Intervertebral Disc: A Quantitative Analysis

Fagan, Andrew B.; Moore, Robert J.; Roberts, Barrie Vernon; Blumbergs, Peter; Fraser, Robert D.

doi:10.1097/01.brs.0000096942.29660.b1

Cited by 147 publications

(90 citation statements)

References 20 publications

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“…16,34,35 In the normal IVD the sensory nerve fibers 16,35,88 and their accompanying blood vessels 112 are most dense posteriorly and anterior-laterally but are generally observed only to a depth of 3.5 mm from the periphery of the annulus. Interestingly, sensory information from these nerves travels in the sinuvertebral nerve to the spinal cord via 2 possible routes: segmentally through the adjacent dorsal root or extrasegmentally through the paravertebral sympathetic chain.…”

Section: The 4 Tissue Layersmentioning

confidence: 99%

“…86,87 Because these tears occur in a region that contains pain receptors, it is conceivable that they may act to generate symptoms. 35 High-intensity T 2 signals near the outer margins of the annulus have been described as representing hemorrhage or edema that may be associated with these tears. 68, 91 The meaningfulness of this "high-intensity zone" (HIZ) (FIG-URE 7) has been extensively investigated and, while it is highly correlated with pain production during discography, 68,91 it is also commonly observed in asymptomatic individuals.…”

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confidence: 99%

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Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

Beattie¹

2008

J Orthop Sports Phys Ther

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The lumbar intervertebral discs (IVDs) are of critical importance for the support and mobility of the spine. 16,54,71 These remarkable tissues have the capacity to maintain stability under a wide variety of loading conditions, while still permitting intersegmental motion. 7,16 Unfortunately, the lumbar IVDs undergo more destructive changes over a lifetime than do any other musculoskeletal tissues 53 and often contribute directly, or indirectly, to the symptoms of low back pain and sciatica. 61,62,90,91 decades. 18,44,51,53 Not surprisingly, DD is the most common condition affecting the adult spine and is the reason for over 90% of all adult spinal surgeries. 8Although exact data are lacking, it is quite likely that a high percentage of adults seeking physical therapy care for low back pain and/or sciatica will have imaging evidence of lumbar DD at 1 or more spinal levels. The exact role that these findings play in symptom generation is, however, often unknown. For example, several population-based or case control studies have also reported a high prevalence of DD in asymptomatic people. 19,57,97 This has led to a lack of consensus regarding the importance of the presence of DD relative to determining patient prognosis and treatment.Over the past several years, a growing body of evidence has provided valuable information regarding the etiology of lumbar DD 6,13,50,105,116 and the pathophysiology of the degenerative lumbar IVD. 5,27,58,70,94,99,101 This information will assist clinicians and researchers in understanding the development and clinical course of lumbar DD and its potential impact upon patients seeking physical therapy care for back pain. Although abnormalities of the lumbar IVD can manifest in many different ways, such as bulging or herniation, the common central feature to most disc pathology is the process of specific degenerative changes that occurs within the nucleus, annulus, and adjacent bony tissue. 5,8,98 This complex process of cell-mediated structural changes occurs over a lifespan, with signs of disc degeneration (DD) often present by the third decade of life, and almost universal by the seventh and eighth SYNOPSIS: Degeneration of the lumbar intervertebral discs (IVDs) is highly prevalent in adults and nearly universal in the elderly population. Degenerative changes within, and adjacent to, the IVDs are likely to contribute to a variety of pain syndromes; however, the exact association between these findings and symptoms remains speculative. Recent research has provided new information regarding the etiology, pathophysiology, and clinical relevance of degeneration of the IVD. This information will assist clinicians and researchers in understanding the development and clinical course of lumbar disc degeneration, as well as its potential impact upon patients seeking physical therapy care for back pain. The purposes of this clinical commentary are to review the structure and metabolic capacity of the normal and degenerative lumbar IVD, and to discuss factors that influence the onset and progr...

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Section: The 4 Tissue Layersmentioning

confidence: 99%

mentioning

confidence: 99%

Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

Beattie¹

2008

J Orthop Sports Phys Ther

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“…67 The bony vertebral endplate has a similar density of innervation. 69 Pain provocation studies associate severe back pain with relatively innocuous mechanical stimulation of the outer posterior anulus and endplate. 70 Painful discs are always structurally disrupted 67 and show irregular stress concentrations.…”

Section: Discogenic Painmentioning

confidence: 99%

What is Intervertebral Disc Degeneration, and What Causes It?

Adams¹,

Roughley²

2006

Spine

1,457

1,288

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“…Additional studies have identified nerve fibres and blood vessels in the endplates and subchondral bone in degenerate discs suggesting that tissue repair may be associated with back pain [11,17].…”

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confidence: 99%

The vertebral endplate: disc degeneration, disc regeneration

2006

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The vertebral endplates are critical for maintaining disc function yet like other components of the disc are vulnerable to degeneration. This paper provides an overview of the development and normal function of the endplates as well as an impression of what happens when they undergo progressive degeneration. Recent research suggests that the degenerative process can be retarded or reversed.Keywords Disc AE Endplate AE Degeneration AE Regeneration ManuscriptDespite all that is known from decades of research the intervertebral disc remains an enigma. It is a unique and remarkable entity and perhaps the one aspect that is responsible for much of its mystery is that such a large structure is able to survive and function under the most difficult physiological conditions. The discs of the human spine are the largest non-vascularised structures in the body, and in the largest of them (in the lumbar spine) some cells can be 20 mm from the nearest direct blood supply. Despite their apparent resilience however, the resident cells are not immortal. It is not unusual for discs to show signs of deterioration by the age of 25 years and it is in this regard that the vertebral endplate plays an important role.Discs are roughly cylindrical structures that vary in size and shape progressively from the cervical to the lumbar region. They all comprise a well-hydrated central nucleus pulposus that is surrounded by the firm but flexible collagenous lamellae of the annulus fibrosus [40]. At the cranial and caudal ends of each disc are the endplates that separate the vertebral bone from the disc itself and prevent the highly hydrated nucleus from bulging into the adjacent vertebrae. The endplates also absorb the considerable hydrostatic pressure that results from mechanical loading of the spine [10]. The endplates are typically less than 1 mm thick, and while this varies considerably across the width of any single disc, they tend to be thinnest in the central region adjacent to the nucleus [16,44].The endplates are identifiable from an early embryological stage and have an osseous as well as a hyaline cartilage component [50]. The cartilaginous component appears to generate great interest since it persists throughout normal maturation while the adjacent vertebrae undergo ossification. It comprises a gel of hydrated proteoglycan molecules reinforced by a network of collagen fibrils. Unlike the articular cartilage of the synovial joints the collagen fibrils do not connect the endplate directly to the vertebral bone [22], although the endplate does have intimate contact with the disc through the lamellae of the inner annulus [21]. A network of microscopic blood vessels penetrates the endplates during development of the growing spine, principally to provide nutrition for the disc, before disappearing around the time of skeletal maturity [50]. Apart from a sparse vascular supply in the outer

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ISSLS Prize Winner: The Innervation of the Intervertebral Disc: A Quantitative Analysis

Cited by 147 publications

References 20 publications

Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

What is Intervertebral Disc Degeneration, and What Causes It?

The vertebral endplate: disc degeneration, disc regeneration

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