OBJECTIVESTo analyze the correlation between intervertebral disc-endplate degeneration and bony construction parameter and to explore its roles in adult degenerative scoliosis.

METHODSThe imaging data of 79 patients with adult degenerative scoliosis from March 2005 to March 2010 were retrospectively reviewed as the study group. The imaging data of 41 patients with adolescent idiopathic scoliosis were selected as the control group. The vertebral body and intervertebral height in both sides on frontal X-ray, and the facet joint orientation in both sides on CT scan were measured respectively. The average vertebral body height, average intervertebral disc height and average facet orientation were regarded as bony structural parameters. The quantitative grading methods were used in the intervertebral disc and endplate degeneration. The relationship of bony construction parameter and intervertebral disc-endplate degeneration, and the relationship of bony construction parameter and Cobb's angle of scoliosis were analyzed by comparing all bony construction parameters in both groups.

RESULTSAnalyzed by paired-t test, the intervertebral height, vertebral body height and facet joint orientation between convex and concave sides of the study group were of significant difference (t = 3.411, 2.623 and 2.085, P < 0.05). The intervertebral height between convex and concave sides of the control group were of significant difference (t = 3.276, P < 0.01), while the vertebral body height and the facet joint orientation were of no statistical significance (t = 1.572 and 1.493, P > 0.05). By linear correlation and regression analysis, the asymmetric degree of bony construction parameter showed good correlation with the score of intervertebral disc-endplate degeneration (-1 < r < 1, P < 0.05), which was positively correlated with Cobb's angle of scoliosis (0 < r < 1, P < 0.05). Linear regression existed between asymmetric degree of bony construction parameter and Cobb's angle (F = 427.342, P < 0.01). The regression function was obtained: Cobb's angle = -8.904+8.136 × IAD + 3.274 × VAD-0.713 × FAD (IAD: intervertebral asymmetry degree, VAD: vertebral asymmetry degree, FAD: facet joint asymmetry degree).

CONCLUSIONSThe asymmetric change of bony construction exists in adult degenerative scoliosis, which significantly correlated with intervertebral disc-endplate degeneration and Cobb's angle of scoliosis. The asymmetric bony construction parameter probably plays a biomechanical role in the progression of scoliosis, which maybe the reason for the asymmetric degeneration of intervertebral disc-endplate.

Aged ; Female ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Displacement ; pathology ; Male ; Middle Aged ; Scoliosis ; pathology

As a self-protective mechanism of cells, autophagy of cells can maintain cell stability by degrading self-aging substances, and it can be highly induced. The ability of autophagy to degraded cells will decrease with age. The resorption phenomenon after lumbar disc herniation is one of the effective mechanisms in conservative treatment of lumbar disc herniation. The degenerative lesion of intervertebral disc is one of the main reasons of lumbar disc herniation. Cell autophagy is extensive participation in the degeneration of lumbar intervertebral disc, delaying the occurrence of degenerative disease. Futhermore, cell autophagy can potentially induce the occurrence of reabsorption. The study of cell autophagy has great significance to the degenerative disease of intervertebral disk and the reabsorption of lumbar disc herniation. And it is also of great significance for the clinical treatment of patients with lumbar disc herniation. For this reason, we should pay more attention to the study of cell autophagy in resorption.
Autophagy ; Humans ; Intervertebral Disc ; cytology ; pathology ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; pathology

This article reviews the literature about the etiology and pathology of intervertebral disc degeneration. The degeneration of intervertebral disc is associated with certain biomechanical factor. Stress can directly lead to the rupture of intervertebral disc and, more importantly, change its biological properties. And then, it can trigger the process of degeneration via inflammatory mechanism which may include autoimmunity.
Biomechanical Phenomena ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Displacement ; etiology ; pathology

OBJECTIVES: To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination. METHODS: Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively. RESULTS: Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively. CONCLUSIONS The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.
Adult ; Age Distribution ; Aged ; Cervical Vertebrae/pathology* ; Humans ; Intervertebral Disc Degeneration/pathology* ; Intervertebral Disc Displacement/pathology* ; Middle Aged

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

Lumbar intervertebral disc herniation is one of the most common causes of lumbocrural pain with its uncertain causes and varied clinical manifestations which marked by the specific symptoms and signs. Effective individualized therapy scheme depends on the correct and timely multi-level diagnosis of this disease. The paper systematically proposed the multilevel diagnosis, including qualitative diagnosis, level diagnosis, diagnosis by exclusion,combined diagnosis, classification diagnosis, syndrome differentitation in different stages, and disease severity grading diagnosis etc. The content and methods of the multi-level diagnosis on each individual case has great significance to formulate the individualized therapy scheme and to promote the clinical research of LIDH.
Diagnosis, Differential ; Humans ; Intervertebral Disc Displacement ; diagnosis ; pathology ; Lumbar Vertebrae ; pathology

It is generally agreed that spinal manipulation has been applied into the treatment of lumbar intervertebral disc herniation (LDH) for thousands of years according to historical reviews of the paper. The balance restore of spinal column had been always the main aim of spinal manipulation during the time. The situation has been changed after LDH was discovered pathomechanically about 70 years ago and the protruded nucleus pulposus has attracted the attention of whole world ever since and surgery become the major choice for LDH patients. Nevertheless, some latest reports of clinical observation in past decades explored more and more solid evidences to prove that most of the patients need no surgery at all and would be cured by conservative therapy without any changes of protruded nucleus pulposus at involved segment. The modern management of LDH suggests that we should not only pay attention to the protruded disk but also to the biomechanical balance of spinal column again as we had for thousands of years,which is concluded from the reviews of previous reports and history of LDH recognition in the paper. The only thing we should care more about is how to make full use of our modern knowledge to adjust our view of observation and management in clinical practice of spinal manipulation and to make a further understanding of the pathomechanics of LDH.
Humans ; Intervertebral Disc Displacement ; pathology ; therapy ; Lumbar Vertebrae ; pathology ; Manipulation, Spinal ; methods ; trends

Adult ; Cell Surface Extensions ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged

OBJECTIVESTo provide the anatomical basis for surgical treatment of extraforaminal lumbar disc herniation (EFLDH) by paraspinous muscle splitting approach and to investigate the effect of its application.

METHODSThe relationship among the intertransverse processes, lateral margin of the pars interarticularis, anterior ramus of the lumbar nerve, and anterior ramus of the lumbar artery was studied in 34 cadaveric specimens. From October 1993 to October 1999, eleven cases of extraforaminal lumbar disc herniation were treated by paraspinous muscle splitting approach and retroperitoneal approach.

RESULTSIn the extraforaminal region, the anterior ramus of the lumbar artery and venus locate ventrally to the superior half of the intertransverse space, and the anterior ramus of the lumbar artery runs downward behind the nerve. The distance from the lateral margin of the pars interarticularis to the nerve root and the angle between the nerve root and midline sagittal plane were 1.0 - 2.0 cm and 7 degrees - 25 degrees respectively which increased gradually from L(1) to L(5). The period of follow up in 10 of 11 cases was 23 - 98 months. Evaluation according to Low Back Outcome Score showed excellent results in 8 cases, and good in 2.

CONCLUSIONSurgical treatment of EFLDH by paraspinous muscle splitting approach is safe, effective and minimal invasive.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged

OBJECTIVETo investigate the effects of spinal manipulation (SM) on brain functional activity in patients with lumbar disc herniation (LDH).

METHODSEleven patients with LDH were recruited in the study. All patients received 6 times of lumbar SM treatment and then clinical efficacy was evaluated. All patients received brain functional magnetic resonance imaging (fMRI) scans before and after SM treatment.

RESULTSThree subjects dropped out and 8 subjects completed the study, among whom 4 cases were effective and 4 ineffective after SM treatment. The required pressure value producing the same level (VAS 50) pain was (7.43 ± 1.47) kg and (10.53 ± 0.55) kg before and after SM treatment in effective patients(P<0.05); however, there was no significant difference in ineffective patients (P>0.05). Compared to pre-treatment level, the brain functional activity in effective patients was mainly inhibited, the inhibited areas were located in the right side of prefrontal cortex and cerebellum; while the brain functional activity was generally enhanced in ineffective patients.

CONCLUSIONSM can affect the brain functional activity of patients with LDH, the inhibited areas is mainly located in prefrontal cortex and cerebellum when SM treatment is effective.

Brain ; physiopathology ; Humans ; Intervertebral Disc Displacement ; therapy ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Manipulation, Spinal