Lumbar intervertebral disc herniation clinical symptoms and signs are very complicated, lumbocrural pain is the most characteristic clinical symptoms,and show the site (range or area), intensity, nature, evolution, influence factors and adjoint symptoms and so on has certain characteristics and rules. Among them, the dermatomal pain, kinesthetic dysesthesia, dynamic changing pain and lesions segment vertebral side deep tenderness are the most impotent characteristics and rules of pain, therefore, can be regarded as the main basis of clinical diagnosis of the disease, and also the core content of this article.
Back Pain ; diagnosis ; etiology ; pathology ; Humans ; Intervertebral Disc Displacement ; diagnosis ; pathology ; Lumbar Vertebrae ; injuries ; pathology

OBJECTIVE: To evaluate T2 relaxation time change using axial T2 mapping in a rabbit degenerated disc model and determine the most correlated variable with histologic score among T2 relaxation time, disc height index, and Pfirrmann grade. MATERIALS AND METHODS: Degenerated disc model was made in 4 lumbar discs of 11 rabbits (n = 44) by percutaneous annular puncture with various severities of an injury. Lumbar spine lateral radiograph, MR T2 sagittal scan and MR axial T2 mapping were obtained at baseline and 2 weeks and 4 weeks after the injury in 7 rabbits and at baseline and 2 weeks, 4 weeks, and 6 weeks after the injury in 4 rabbits. Generalized estimating equations were used for a longitudinal analysis of changes in T2 relaxation time in degenerated disc model. T2 relaxation time, disc height index and Pfirrmann grade were correlated with the histologic scoring of disc degeneration using Spearman's rho test. RESULTS: There was a significant difference in T2 relaxation time between uninjured and injured discs after annular puncture. Progressive decrease in T2 relaxation time was observed in injured discs throughout the study period. Lower T2 relaxation time was observed in the more severely injured discs. T2 relaxation time showed the strongest inverse correlation with the histologic score among the variables investigated (r = -0.811, p < 0.001). CONCLUSION: T2 relaxation time measured with axial T2 mapping in degenerated discs is a potential method to assess disc degeneration.
Animals ; Disease Models, Animal ; Intervertebral Disc/injuries/*pathology ; Intervertebral Disc Degeneration/*pathology ; Lumbar Vertebrae/*pathology ; Magnetic Resonance Imaging/*methods ; Male ; Punctures ; Rabbits

OBJECTIVETo observe degenerative intervertebral disc and to examine innervation of degenerative discs in the rabbit anular-injury model.

METHODSTwo different magnitudes of anular injury at 5 mm depth were performed by 11 blade or 16 gauge needle at the L3-L4 or L5-L6 discs in New Zealand white rabbits (n=48, 2.5-3.0 kg). Disc degeneration was evaluated by radiographic, MRI and histological examination at different time points after surgery. To identify nerve ingrowth into disc, two general markers PGP 9.5 and GAP 43, for nerve fibers were examined by immunohistochemistry.

RESULTSignificant decreases in disc height and signal intensity in magnetic resonance imaging were observed in 11 blade group and 16 G puncture group (P<0.01). 16 G puncture group induced slower and more progressive disc degeneration companed with the stab group and control group. At the 12-week time point, nucleus pulposus tissues were extruded and scar tissues formed outside the disc. In stab discs, nerve ingrowth was scattered on the surface of injury site and in the deeper part of the scar tissues, more than 1 mm from the surface. However, in punctured discs, PGP 9.5 and GAP 43-immunoreative fibers were only observed in the outmost part of the scar tissues and superficial area. More nerve fibers were observed in stab group.

CONCLUSIONInnervation may act as a source of discogenic pain which is associated with intervertebral disc degeneration caused by disc anular injury.

Animals ; GAP-43 Protein ; metabolism ; Intervertebral Disc ; injuries ; innervation ; pathology ; Intervertebral Disc Degeneration ; diagnosis ; diagnostic imaging ; etiology ; Low Back Pain ; etiology ; Lumbar Vertebrae ; Male ; Nerve Fibers ; pathology ; Rabbits ; Radiography ; Random Allocation ; Ubiquitin Thiolesterase ; metabolism

Adult ; Cauda Equina ; injuries ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; complications ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Recovery of Function

OBJECTIVETo study the correlation between intrusion of nucleus gelatinosus into vertebral body and low back pain after thoracolumbar fractures.

METHODSOne hundred and two patients who were treated in Peking university third hospital from January 2005 to September 2007 were evaluated retrospectively and included into this study. They were followed up for an average of 18 months and complete data were kept. Fifty-four patients were treated operatively and forty-eight patients were treated conservatively. VAS questionnaire was applied to evaluate the low back pain. Spearman Correlation Coefficients module and Wilcoxon 2-Sample Test module of SAS software were used to analyze the relation between intrusion of nucleus gelatinosus, different treatments, kyphotic Cobb angles and VAS.

RESULTSThere were strong correlations between intrusion of nucleus gelatinosus and VAS in both operative group, P < 0.01 and non-operative group, P < 0.01; there were poor correlations between different treatments and VAS in both intrusion group, P > 0.05 and non-intrusion group, P > 0.05; and there were also poor correlations between Cobb angles and VAS, gamma = 0.2584, P > 0.05.

CONCLUSIONThere is correlation between the intrusion of nucleus gelatinosus into vertebral body and the low back pain after thoracolumbar fractures.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Back Pain ; etiology ; Female ; Humans ; Intervertebral Disc ; pathology ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Fractures ; complications ; pathology ; Thoracic Vertebrae ; injuries ; Young Adult

Adult ; Aged ; Cervical Vertebrae ; pathology ; physiopathology ; surgery ; Female ; Fracture Fixation, Internal ; adverse effects ; Humans ; Intervertebral Disc Displacement ; pathology ; Male ; Middle Aged ; Radiculopathy ; Spinal Cord Diseases ; etiology ; Spinal Cord Injuries ; pathology ; Spinal Diseases ; pathology ; Spinal Osteophytosis ; etiology ; Transplants ; adverse effects

OBJECTIVETo evaluate the feature of experimental endplate fracture in lumbar spine and its related factors.

METHODSNineteen cadaveric lumbar motion segments aged 48 - 77 years were compressed by overload to fracture the endplate and dissected into isolated vertebrae to evaluate feature of their endplate failure. Before and after failure of endplate, radiographic tests were taken on every motion segment. The bone mineral density (BMD), bone mineral content (BMC) of the vertebral body and endplate were tested respectively before endplate fracture.

RESULTSAmong 19 motion segments, 16 were fractured and accounted for 84.2% of all and fracture featured as stellate, step, depression and intrusion. Fracture concentrated on the center or anterior of superior endplate of the inferior vertebrae in one motion segment. Failure load of endplate was positively correlated with BMD, BMC of vertebral endplate. Within one vertebral body, the BMD and BMC of its superior endplate was markedly less than that of inferior endplate, on the other hand, the difference of BMD and BMC of endplate around one disc was opposite.

CONCLUSIONSFractures usually concentrate on the center or anterior part of superior endplate of one vertebrae and are hard to be identified by conventional radiographic examination. Failure load of endplate is positively correlated with BMD, BMC of vertebral body and endplate. There might be certain relationship between feature of fracture and severity of disc degeneration.

Aged ; Bone Density ; Cadaver ; Female ; Fractures, Stress ; diagnostic imaging ; pathology ; Humans ; Intervertebral Disc ; diagnostic imaging ; pathology ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; pathology ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; pathology

OBJECTIVETo observe the pinching action to the nerve root by the lumbar disc herniation and facet or lamina (ligamentum flavum) and evaluate its clinical meaning.

METHODSSeventy-one patients were divided into 3 groups according to the size of distance between protrusion of nuclear and facet or lamina (ligamentum flavum). The degree of the straight leg raising of the affected side (SLR) and the sagittal index (SI) of lumbar disk herniation were measured and analyzed among them.

RESULTSThere was no corelation between the affected degree of SLR and sex, age and SI of patient (P > 0.05). The coefficient between distance group and the affected degree of SLR is-0.878 7 (P < 0.01).

CONCLUSIONThe degree of the surrounding compression by the protrusion of nuclear and facet or lamina (ligamentum flavum) reflects the injuried severity of the nerve root.

Adolescent ; Adult ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; diagnostic imaging ; pathology ; Ligamentum Flavum ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Compression Syndromes ; etiology ; Spinal Nerve Roots ; injuries ; Tomography, X-Ray Computed