Mechanical Initiation of Intervertebral Disc Degeneration

Adams, Michael A.; Freeman, Brian J. C.; Morrison, Helen P.; Nelson, IW; Dolan, Patricia

doi:10.1097/00007632-200007010-00005

Cited by 700 publications

(496 citation statements)

References 80 publications

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“…These changes increase the shear forces on the endplates and micro-fractures may occur. The observed MC that developed in the absence of infection possibly due to the result of a biomechanical impact, reflecting oedema secondary to micro-fractures and subsequent inflammation, or a result of an inflammatory process from pro-inflammatory chemicals penetrating through the micro-fractures from the nucleus pulposus as proposed by Adams et al [32,33].…”

Section: Discussionmentioning

confidence: 88%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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Purpose To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema) in vertebrae are observed in 6 % of the general population and in 35-40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated the presence of low virulent anaerobic microorganisms, predominantly Propionibacterium acnes, in 7-53 % of patients. At the time of a herniation these low virulent anaerobic bacteria may enter the disc and give rise to an insidious infection. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production. Methods Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent antiseptic sterile protocols were followed. Results Sixty-one patients were included, mean age 46.4 years (SD 9.7), 27 % female. All patients were immunocompetent. No patient had received a previous epidural steroid injection or undergone previous back surgery. In total, microbiological cultures were positive in 28 (46 %) patients. Anaerobic cultures were positive in 26 (43 %) patients, and of these 4 (7 %) had dual microbial infections, containing both one aerobic and one anaerobic culture. No tissue specimens had more than two types of bacteria identified. Two (3 %) cultures only had aerobic bacteria isolated. In the discs with a nucleus with anaerobic bacteria, 80 % developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of those with aerobic bacteria and only 44 % of patients with negative cultures developed new MC. The association between an anaerobic culture and new MCs is highly statistically significant (P = 0.0038), with an odds ratio of 5.60 (95 % CI 1.51-21.95). Conclusion These findings support the theory that the occurrence of MCs Type 1 in the vertebrae adjacent to a previously herniated disc may be due to oedema surrounding an infected disc. The discs infected with anaerobic bacteria were more likely (P \ 0.0038) to develop MCs in the adjacent vertebrae than those in which no bacteria were found or those in which aerobic bacteria were found.

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Section: Discussionmentioning

confidence: 88%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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“…Disc degeneration in animal models is still a matter of debate [1,[8][9][10][11][12][13]. Most studies with mechanically induced disc degeneration demonstrated a correlation between compression force and disc degeneration [1, 9, Fig.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of its invasive nature, there have been mostly in vitro approaches and only one human in vivo study reported a negative correlation between the degree of disc degeneration and IVD pressure [21]. Also, a pressure decline of 25% in 38 human cadaver lumbar discs with mechanical endplate injury has been shown [1].…”

mentioning

confidence: 99%

Intradiscal pressure measurements in normal discs, compressed discs and compressed discs treated with axial posterior disc distraction: an experimental study on the rabbit lumbar spine model

et al. 2005

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“…Both genetic inheritance [9,10] and high mechanical loading [1,4,26] were identified as possible causes of this pathology. Once the process is initiated, a cascade of inevitable cell-mediated responses starts, leading to further degenerative phenomena [5].…”

Section: Introductionmentioning

confidence: 99%

The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

et al. 2010

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Degeneration of the intervertebral disc is related to progressive changes in the disc tissue composition and morphology, such as water loss, disc height loss, endplate calcification, osteophytosis. These changes may be present separately or, more frequently, in various combinations. This work is aimed to the biomechanical investigation of a wide range of clinical scenarios of disc degeneration, in which the most common degenerative changes are present in various combinations. A poroelastic non-linear finite element model of the healthy L4-L5 human spine segment was employed and randomly scaled to represent ten spine segments from different individuals. Six different degenerative characteristics (water loss in the nucleus pulposus and annulus fibrosus; calcification and thickness reduction of endplate cartilage; disc height loss; osteophyte formation; diffuse sclerosis) were modeled in 30 randomly generated models, 10 for each overall degree of degeneration (mild, moderate, severe). For each model, a daily loading cycle including 8 h of rest, 16 h in the standing position with superimposed two flexion-extension motion cycles was simulated. A tendency to an increase of stiffness with progressing overall degeneration was observed, in compression, flexion and extension. Hence, instability for mild degeneration was not predicted. Facet forces and fluid loss decreased with disc degeneration. Nucleus, annulus and endplate degeneration, disc height loss, osteophytosis and diffuse sclerosis all induced a statistically significant decrease in the total daily disc height variation, facet force and flexibility in flexion-extension. Therefore, grading systems for disc degeneration should include all the degenerative changes considered in this work, since all of them had a significant influence on the spinal biomechanics.

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Mechanical Initiation of Intervertebral Disc Degeneration

Cited by 700 publications

References 80 publications

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

Intradiscal pressure measurements in normal discs, compressed discs and compressed discs treated with axial posterior disc distraction: an experimental study on the rabbit lumbar spine model

The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models

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