Nerve ingrowth into diseased intervertebral disc in chronic back pain

Freemont, Anthony J.; Peacock, T. E.; Goupille, Philippe; Hoyland, Judith A.; O’Brien, John P.; Jayson, Malcom I V

doi:10.1016/s0140-6736(97)02135-1

Cited by 873 publications

(644 citation statements)

References 18 publications

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“…Moreover, the disc tissue is supposed to be antigenic and may induce the immunoreaction and the recruitment of inflammatory cells that further impede healing. The inflammatory granulation tissue can certainly produce some proinflammatory cytokine and mediators such as prostaglandin E 2 , IL-6, and IL-8 [3] that can sensitize the nociceptors within the painful discs [5,6,7,10]. The discogenic low back pain might occur when the intradiscal pressure increases with the trunk motion such as flexion or extension.…”

Section: Discussionmentioning

confidence: 99%

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

et al. 2005

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Section: Discussionmentioning

confidence: 99%

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

et al. 2005

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“…Progressively small nerve fibers form along with the granulation tissue [70]. Nerve growth factor promotes the collateral sprouting of additional peripheral sensory nerves into the inner AF and the NP, increases nerve survival, and increases the action and sensitivity of nociceptive sensory neurons [1,5,15,17,24,25,46,105].…”

Section: If the Disc Is Aneural And Avascular Why Does It Cause So Mmentioning

confidence: 99%

Molecular Basis of Intervertebral Disc Degeneration and Herniations: What Are the Important Translational Questions?

Kadow

Sowa

et al. 2015

Clinical Orthopaedics &Amp; Related Research

219

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Background Intervertebral disc degeneration is a common condition with few inexpensive and effective modes of treatment, but current investigations seek to clarify the underlying process and offer new treatment options. It will be important for physicians to understand the molecular basis for the pathology and how it translates to developing clinical treatments for disc degeneration. In this review, we sought to summarize for clinicians what is known about the molecular processes that causes disc degeneration.

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“…Intervertebral disc pain presupposes disc innervation [12]. The normal intervertebral disc has been shown to be aneural except in the outermost part of the annulus fibrosus both in humans and rats [5,21].…”

Section: Innervationmentioning

confidence: 99%

“…The normal intervertebral disc has been shown to be aneural except in the outermost part of the annulus fibrosus [5,21]. According to several histological studies, in response to disc degeneration and lamellar disruption, neovascularization with unmyelinated nerve fibers and ingrowth of Schwann cells occur [8,12,17].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, in humans, intervertebral disc inflammation promotes axonal growth of calcitonin gene-related peptide (CGRP; a marker of pain neuropeptide)-immunoreactive (IR) fibers into the inner layers of the disc, and the presence of CGRP-IR fibers in the disc indicates that the disc can be a source of pain sensation [2,23,30]. On the other hand, it was reported that growth-associated protein 43 (GAP43; a marker of axonal growth)-IR fibers were detected in human painful intervertebral discs and inhibition of nerve fibers ingrowth into the discs could benefit patients with chronic low back pain [3,12,35,36].…”

Section: Introductionmentioning

confidence: 99%

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Lumbar posterolateral fusion inhibits sensory nerve ingrowth into punctured lumbar intervertebral discs and upregulation of CGRP immunoreactive DRG neuron innervating punctured discs in rats

et al. 2009

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Degeneration of lumbar intervertebral discs is thought to be a cause of low back pain. Studies have found that a cause of discogenic low back pain is intervertebral disc inflammation and axonal growth of afferent fibers innervating the disc. Lumbar spine fusion for chronic discogenic low back pain is considered an effective procedure. However, no study has investigated the mechanism of pain relief. We did this by applying Fluoro-Gold (FG) to the ventral aspect of the L4-L5 intervertebral discs of 40 rats. We exposed the nucleus pulposus to the annulus fibrosus in a disc punctured model. Rats were divided into 4 groups. Group A: Punctured intervertebral disc with sham posterolateral fusion (PLF) (n = 10), Group B: Punctured intervertebral disc with PLF (n = 15), Group C: Normal intervertebral disc (no puncture) with PLF (n = 10), and Group D: Normal disc (no disc puncture) with sham PLF (n = 5). Four weeks after surgery, bilateral L1-L5 dorsal root ganglia (DRGs) were stained with growth-associated protein 43 (GAP43), a marker of axonal growth, and calcitonin gene-related peptide (CGRP), a neuropeptide marker of pain. Bone union was evaluated using X-ray imaging. Of the FG-labeled neurons, the proportions of GAP43-and CGRP-immunoreactive (IR) neurons in Group A were significantly higher than in Group D (P \ 0.05). The proportions of GAP43-and CGRP-IR neurons in bone union rats in Group B were significantly lower than in nonunion rats in Group B and in the rats in Group A (P \ 0.05). No significant differences in GAP43-and CGRP-IR neurons were observed between bone union and nonunion rats in Group C and the rats in Group D (P [ 0.05). PLF is strongly related to the downregulation of GAP43 and CGRP expression. Therefore, PLF may suppress the increase of inflammatory neuropeptides and the process of axonal growth. Moreover, these results may explain, in part, the mechanism of pain relief following lumbar spinal fusion for chronic discogenic low back pain in humans.

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Nerve ingrowth into diseased intervertebral disc in chronic back pain

Cited by 873 publications

References 18 publications

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

Molecular Basis of Intervertebral Disc Degeneration and Herniations: What Are the Important Translational Questions?

Lumbar posterolateral fusion inhibits sensory nerve ingrowth into punctured lumbar intervertebral discs and upregulation of CGRP immunoreactive DRG neuron innervating punctured discs in rats

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