Do intervertebral discs degenerate before they herniate, or after?

LAMA, P., LE MAITRE, Christine, DOLAN, P., TARLTON, J. F., HARDING, I. J. and ADAMS, M. A. (2013). Do intervertebral discs degenerate before they herniate, or after? The Bone & Joint Journal, 95-B (8), 1127-1133.

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Official URL: http://dx.doi.org/10.1302/0301-620X.95B8.31660
Link to published version:: 10.1302/0301-620X.95B8.31660

Abstract

The belief that an intervertebral disc must degenerate before it can herniate has clinical and medicolegal significance, but lacks scientific validity. We hypothesised that tissue changes in herniated discs differ from those in discs that degenerate without herniation. Tissues were obtained at surgery from 21 herniated discs and 11 non-herniated discs of similar degeneration as assessed by the Pfirrmann grade. Thin sections were graded histologically, and certain features were quantified using immunofluorescence combined with confocal microscopy and image analysis. Herniated and degenerated tissues were compared separately for each tissue type: nucleus, inner annulus and outer annulus. Herniated tissues showed significantly greater proteoglycan loss (outer annulus), neovascularisation (annulus), innervation (annulus), cellularity/inflammation (annulus) and expression of matrix-degrading enzymes (inner annulus) than degenerated discs. No significant differences were seen in the nucleus tissue from herniated and degenerated discs. Degenerative changes start in the nucleus, so it seems unlikely that advanced degeneration caused herniation in 21 of these 32 discs. On the contrary, specific changes in the annulus can be interpreted as the consequences of herniation, when disruption allows local swelling, proteoglycan loss, and the ingrowth of blood vessels, nerves and inflammatory cells. In conclusion, it should not be assumed that degenerative changes always precede disc herniation.

Item Type: Article
Research Institute, Centre or Group: Biomolecular Sciences Research Centre
Identification Number: 10.1302/0301-620X.95B8.31660
Depositing User: Marguerite Lyons
Date Deposited: 10 Dec 2013 17:12
Last Modified: 10 Dec 2013 17:12
URI: http://shura.shu.ac.uk/id/eprint/7497

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