The Natural History of Herniated Nucleus Pulposus With Radiculopathy

Komori, Hiromichi; Shinomiya, Kenichi; Nakai, Osamu; Yamaura, Isakichi; Takeda, Syuichi; Furuya, K.

doi:10.1097/00007632-199601150-00013

Cited by 379 publications

(249 citation statements)

References 13 publications

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“…The type of herniation (protrusion, extrusion or sequestration) together with age and duration of symptoms have been correlated to different degrees of molecular changes within the disc cells and its extracellular matrix [16]. In addition, serial magnetic resonance imaging (MRI) studies have documented the spontaneous resorption of non-operatively treated herniated discs [17,31]. Contact between the herniated fragment of the ID and the epidural space was thought to trigger an autoimmune response with inflammatory cell infiltration and in situ neovascularization, leading to the progressive resorption of the herniated fragment and regression of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation

et al. 2010

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The involvement of matrix metalloproteinases (MMPs) in both the pathogenesis of intervertebral disc (ID) herniation and the spontaneous regression of herniated ID fragments remains only partially elucidated. The purpose of the present study was to simultaneously examine the transcript levels of a large number of MMPs (-1, -3, -8, -9, -13 and -14) and ADAMTS-4 (a disintegrin and metalloproteinase with thrombospondin motifs) and to investigate their correlation with the clinicopathologic profile of patients suffering from symptomatic lumbar ID herniation. mRNA expression levels were determined by means of the real-time polymerase chain reaction in 63 herniated and 10 control ID specimens. Our results showed multiple positive correlations among all MMPs and ADAMTS-4 mRNA in herniated samples, indicating their possible synergistic effect in ID herniation. MMP-9 and -13 mRNA levels were significantly elevated in patients with chronic pain, presumably as a consequence of neovascularization and chronic inflammation. Smoking habits were found to have a negative dose-dependent effect on the transcript levels of MMP-3 and MMP-13 and a positive correlation with pain intensity, suggesting an unfavorable role for smoking in the regression process of herniated disc fragments. Our findings provide evidence of the molecular portrait of MMPs and ADAMTS-4 in lumbar ID herniation, as well as of its association with the clinicopathological profile of the patients included in this study, reinforcing the hypothesis of MMPs involvement in the natural history of ID herniation. However, further studies are necessary to elucidate the exact role of MMPs in the resorption process of herniated lumbar discs.

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Section: Introductionmentioning

confidence: 99%

Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation

et al. 2010

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“…Komori et al [5] using MRI to identify morphological changes in the form of lumbar disc prolapse subjected 77 patients to Saunders lumbar traction sessions. All patients were diagnosed with disc herniation with symptoms of unilateral pain radiating to the lower limb and muscle weakness on the side of pain.…”

Section: Discussionmentioning

confidence: 99%

“…Pain is the major complaint concerning the spine and induced by noxious stimuli at the site of injury indicates tissue damage [5,6].…”

Section: Introductionmentioning

confidence: 99%

Multiple Impulse Therapy and Saunders Lumbar Traction Methods in the Treatment of Low Back Pain: A Randomized Controlled Trial

Pingot¹,

Pingot²,

Haładaj³

et al. 2017

J Nov Physiother

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“…3 HD patients showed a progressive decrease in disc size, which most commonly occurred in uncontained HD exposed to the epidural space, suggesting a contribution of vascularization to HD, because normal intervertebral discs lack blood supply and are nourished by diffusion from endplates of upper and lower vertebrae. 3 In addition, contrast media-enhanced MRI revealed a high degree of contrast uptake and elevated blood supply to HD. 4 Our study demonstrated that the tendency of HD to spontaneously resorb is directly proportional to the degree of contrast enhancement, strongly suggesting a contribution of vascularization.…”

mentioning

confidence: 99%

TNF‐α–induced NF‐κB signaling reverses age‐related declines in VEGF induction and angiogenic activity in intervertebral disc tissues

Ohba

Haro

Ando

et al. 2008

Journal Orthopaedic Research

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We previously demonstrated that VEGF and its receptors were expressed in human herniated discs (HD). TNF-a induced VEGF, resulting in neovascularization of disc tissues in a model of HD. The goal of the current research was to investigate the precise role of TNF-a-induced VEGF and the mechanism of angiogenesis in disc tissues. We performed ELISAs, Western blots, and immunohistological examinations to assess the role of TNF-a-induced VEGF using organ disc cultures with wild type, TNF receptor 1-null (TNF-RI null ), or TNF receptor 2-null (TNF-RII null ) mice. VEGF induction was inhibited when we used TNF-RI null -derived disc tissues. NF-kB pathway inhibitors also strongly suppressed VEGF induction. Thus, TNF-a induced VEGF expression in disc cells primarily through the NF-kB pathway. In addition, VEGF immunoreactivity was detected predominantly in annulus fibrosus cells and increased after TNF-a stimulation. TNF-a treatment also resulted in CD31 expression on endothelial cells and formation of an anastomosing network. In contrast, angiogenic activity was strongly inhibited in the presence of NF-kB inhibitors or anti-VEGF antibody. Our data show angiogenesis activity in disc tissues is regulated by VEGF and the NF-kB pathway, both of which are induced by TNF-a. The level of angiogenic activity in disc tissues was closely related to aging. Because neovascularization of HD is indispensable for HD resorption, the prognosis of HD and the rate of the resorption process in patients may vary as a function of the patient's age. ß

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The Natural History of Herniated Nucleus Pulposus With Radiculopathy

Cited by 379 publications

References 13 publications

Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation

Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation

Multiple Impulse Therapy and Saunders Lumbar Traction Methods in the Treatment of Low Back Pain: A Randomized Controlled Trial

TNF‐α–induced NF‐κB signaling reverses age‐related declines in VEGF induction and angiogenic activity in intervertebral disc tissues

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