Humoral Regulation of Blood Flow in the Vertebral Endplate

Wallace, Angus; Wyatt, Betty; McCarthy, Ian; Hughes, Sean

doi:10.1097/00007632-199406000-00004

Cited by 44 publications

(26 citation statements)

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“…The steroid dosage in the present study was lower and maintained longer than in the previous study and than in studies in rabbits in which osteonecrosis was found [42]. Using the same methylprednisolone protocol as in the present study, the authors have found decreased vertebral endplate and cancellous bone blood flow in growing pigs [6] which may be due to the different blood supply [37].…”

Section: Discussionsupporting

confidence: 46%

“…Also in clinical studies, increased fibrinogen plasma levels have been reported under steroid treatment [37]. Increased plasma fibrinogen is associated with enhanced hyperviscosity and hypercoagulability [30].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, children receiving methylprednisolone treatment have been reported to have disturbed growth and skeletal maturation [36] and osteonecrosis in 3.4% [lo] to 35% [34] of cases. Corticosteroids (CSs) have been suggested to cause changes in the coagulability of blood [37] and hypercoagulability has been related to skeletal lesions in children [39] and Legg-Perthes'-disease [ 151. Most recent work has shown that short-term high dose methylprednisolone treatment caused selective bone blood flow reduction in growing pigs [7].…”

Section: Introductionmentioning

confidence: 99%

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The effect of long‐term methylprednisolone treatment on the femoral head in growing pigs

Drescher

Jensen

et al. 2002

Journal Orthopaedic Research

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The efTect of long term steroid treatment on coagulation, intraosseous pressure (IOP), femoral head (FH) blood flow, and histology in the normal organism was investigated in this study in growing pigs. From 24 growing female Danish Landrace pigs from 12 litters, 12 animals daily received 100 nig methylprednisolone orally for three months. Their 12 sister pigs served as controls without steroid treatment. Prothrombin time, activated partial thromboplastin time (aPTT), fibrinogen, and antithrombin 111 levels were recorded in jugular venous blood. Blood flow of the hip regions was measured by means of the radioactive microsphere technique. Metaphyseal and epiphyseal IOP of the left or right proximal femur were measured. Histomorphometry of the left or right FH epiphysis was performed. Major growth inhibition was found in the corticosteroid (CS) treated group. In CS pigs, aPTT was shortened to 500'0 compared to control pigs. Plasma fibrinogen was higher in the CS animals. Total F H blood flow was not digerent while regional blood flow in the cranial subregion of the F H epiphysis was higher in the CS group. Metaphyseal and epiphyseal 1OP of the proximal femur were not different in the CS animals. Histomorphometrically, cancellous bone volume

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of long‐term methylprednisolone treatment on the femoral head in growing pigs

Drescher

Jensen

et al. 2002

Journal Orthopaedic Research

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“…Blood flow in the region of the endplates is not entirely passive as there are muscarinic receptors present that can influence disc nutrition under altered physiological conditions [55]. 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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“…Water can also diffuse through the endplates to maintain a proper intra-discal pressure, which ultimately results in an appropriate disc height for mechanical function [2,48]. Poor supply of essential nutrients and build up of waste products are often cited as significant contributors to degeneration of the intervertebral disc [1,12,38,60,64,65]. There appears to be a strong link between degeneration of the intervertebral disc and changes to the adjacent endplate.…”

Section: Background To the Conceptmentioning

confidence: 99%

Injectable biomaterials and vertebral endplate treatment for repair and regeneration of the intervertebral disc

2006

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The objectives of augmentation of the nucleus pulposus following disc removal are to prevent disc height loss and the associated biomechanical and biochemical changes. Flowable materials may be injected via a small incision, allowing minimally invasive access to the disc space. Fluids can interdigitate with the irregular surgical defects and may even physically bond to the adjacent tissue. Injectable biomaterials allow for incorporation and uniform dispersion of cells and/or therapeutic agents. Injectable biomaterials have been developed that may act as a substitute for the disc nucleus pulposus. Our work has focused on the evaluation of a recombinant protein copolymer consisting of amino acid sequence blocks derived from silk and elastin structural proteins as an injectable biomaterial for augmentation of the nucleus pulposus. This implant, NuCore TM Injectable Nucleus is being developed by Spine Wave (Shelton, CT). The NuCore

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Humoral Regulation of Blood Flow in the Vertebral Endplate

Cited by 44 publications

References 0 publications

The effect of long‐term methylprednisolone treatment on the femoral head in growing pigs

The effect of long‐term methylprednisolone treatment on the femoral head in growing pigs

The vertebral endplate: disc degeneration, disc regeneration

Injectable biomaterials and vertebral endplate treatment for repair and regeneration of the intervertebral disc

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