• 한국임상수의학회지
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• 제40권1호
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• pp.38-43
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• 2023

This study compared the degree of disc degeneration of intervertebral disc between normal disc and disc disease using Magnetic Resonance images of tholacolumbar and lumbar vertebrae in dogs. The sample population consisted of 72 dogs and 188 intervertebral discs. These dogs were divided into four groups according to MRI criteria: normal, disc protrusion, disc extrusion, and fibrocartilaginous embolism. The Pfirrmann classification developed by Pfirrmann for use in human medicine was used to assess the degree of disc degeneration. Statistical analysis revealed that disc diseases had a significant difference in the degree of disc degeneration compared to normal discs in the intervertebral disc. Fibrocartilaginous embolism was found to have a relatively low disc degenerative change compared to two other disc disease groups, disc protrusion and disc extrusion. Disc degeneration in the disc extrusion group was slightly higher than that in the disc protrusion group, although the difference between the two groups was not statistically significant.

• The Journal of Korean Physical Therapy
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• 제15권2호
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• pp.52-66
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• 2003

The intervertebral disc is a cartilaginous structure that resembles articular cartilage in its biochemistry, but morphologically it is clearly different. It shows degenerative and ageing changes earlier than does any other connective tissue in the body, It is believed to be important clinically because there is an association of disc degeneration with back pain. Degenerative changes in the intervertebral disc are thought to develop as aging, mechanical stress and metabolic factors. Genetic factors may also play a part in the onset or progress of the degenerative process. They, together with environmental factors, may act as determinants of the structural characteristics of the intervertebral disc and produce a tendency to generation, In this short review we outline the morphplogy and biochemistry of normal intervertebral disc and the changes that arise during degeneration. Therefore this study will review degeneration of intervertebral disc, so we will have knowledge about low back pain associated with degenerative change in the intervertebral disc.

• Journal of Korean Neurosurgical Society
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• 제44권5호
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• pp.327-333
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• 2008

Objective: The purpose of this study is to verify the usefulness of the rabbit model for disc degeneration study. Materials: The L1-L2, L2-L3, L3-L4. or L4-L5 lumbar intervertebral disc (IVD) of 9 mature male New Zealand White rabbits were injured by inserting a 16-gauge needle to a depth of 5 mm in the left anterolateral annulus fibrosus while leaving L5-L6 IVD uninjured. Three other rabbits also received intradiscal injections of rabbit disc cells transfected with adenovirus and bone morphogenetic protein-2 (ad-BMP-2) at L4-L5 in addition to injury by 16-gauge needle at the L1-L2 level. Using digitized radiographs, measurements of IVD height were made and analyzed by using the disc height index (DHI). Magnetic resonance imaging (MRI) scans of the injured discs, injected discs, and uninjured L5-L6 discs were performed at 15 weeks post surgery and compared with preoperative MRI scans. Results: All twelve rabbits showed consistent results of disc degeneration within 15 weeks following annular puncture. DHIs of injured discs were significantly lower than that of the uninjured L5-L6 discs (p<0.05). The mean value of disc degeneration grade of injured discs was significantly higher than that of uninjured discs (p<0.05). The injection of disc cell transfected with ad-BMP-2 did not induce disc regeneration at 15 weeks after injection. Conclusion: This study showed that the injured disc had a significant change in DHI on simple lateral radiograph and disc degeneration grade on MRI scans within 15 weeks in all rabbits. Rabbit annular puncture model can be useful as a disc degeneration model in vivo.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.432-437
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• 2006

Objective : In order to establish the index of degeneration, the authors performed a histochemical study with Safranin-O staining and investigated the occurrence of apoptosis in the human intervertebral disc. Methods : Eighteen intervertebral disc specimens surgically extracted from the patients and two additional specimens from the autopsied cases were stained with Safranin-O for proteoglycan according to a standard protocol. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate- biotin nick end labeling[TUNEL] was used to detect the fragmented DNA known to be associated with apoptotic cell death and classification scheme was formulated for categorization of the degree of Safranin-O staining [normal, moderate reduction, faint] by modification of Makin's histological-histochemical grading. The Kruskal-Wallis H test and Chi-square test were used for statistical analysis. Results : The statistical results showed a significant difference in the mean age between "normal" Safranin-O staining group and the others [19.3 versus 55, 43.4, p=0021]. However, there was no statistically significant correlation between Safranin-O staining and MR grading of disc degeneration. Only six of eighteen surgical specimens and none in autopsies showed positive apoptotic cells in TUNEL staining. Conclusion : The determination of the degree of degeneration in surgically obtained disc tissue per se by histochemical staining or by the degree of apoptosis that corresponds to its morphologic change was not feasible.

• Asian Spine Journal
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• 제12권6호
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• pp.1060-1068
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• 2018

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.16-22
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• 2009

Objective : This study was designed to investigate automated pressure-controlled discography (APCD) findings, to calculate the elastance of intervertebral discs, and to assess the relationship between the calculated elastance and disc degeneration. Methods : APCD was performed in 19 patients. There were a total of 49 intervertebral discs treated. Following intradiscal puncture, a dye was constantly injected and the intradiscal pressure was continuously measured. The elastance of the intervertebral disc was defined as unit change in intradiscal pressure per fractional change in injected dye volume. Disc degeneration was graded using a modified Dallas discogram scale. Results : The mean elastance was 43.0${\pm}$9.6 psi/mL in Grade 0, 39.5${\pm}$8.3 psi/mL in Grade 1, 30.5${\pm}$22.3 psi/mL in Grade 2, 30.5${\pm}$22.3 psi/mL in Grade 3, 13.2${\pm}$8.3 psi/mL in Grade 4 and 6.9${\pm}$3.8 psi/mL in Grade 5. The elastance showed significant negative correlation with the degree of degeneration ($R^2$=0.529, P=0.000). Conclusion: APCD liberates the examiner from the data acquisition process during discography. This will likely improve the quality of data and the reliability of discography. Elastance could be used as an indicator of disc degeneration.

• 대한정형외과학회지
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• 제56권5호
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• pp.413-418
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• 2021

목적: 경추에서 후관절 비대칭성이 후관절 퇴행과 추간판 퇴행에 미치는 영향력에 대해 조사하고자 한다. 대상 및 방법: 2017년 1월부터 2018년 12월까지 총 100명의 환자를 대상으로 경추 제5-6번의 후관절 비대칭성을 후향적으로 분석하였다. 컴퓨터 단층촬영(computed tomography, CT)에서 수평면, 시상면, 관상면에 대한 양쪽 후관절 각도를 측정하였으며 자기공명영상 촬영(magnetic resonance imaging, MRI) 및 CT에서 후관절의 퇴행을 등급 체계를 이용하여 평가하였다. 추간판 퇴행은 MRI 시상면, 수평면에서 5등급으로 나누어 평가하였다. 좌우 후관절 각도 차이가 7도 이상인 경우를 비대칭군으로, 7도 미만인 경우를 대조군으로 구분하였다. 결과: 환자의 평균 나이는 비대칭군에서 55.44±12.3세(31-81세)였으며 대조군에서는 55.66±10.7세(32-76세)였다. 비대칭군의 경우 남성이 32명, 여성이 18명이었고 대조군에서는 남성이 24명, 여성이 26명이었다. 관절 퇴행은 비대칭군에서 24명(48.0%), 대조군에서 14명(28.0%)으로 측정되었으며 유의한 차이를 보였다(p=0.037). 추간판 퇴행은 비대칭군에서 29명(58.0%), 대조군에서 17명(34.0%)으로 측정되었으며 유의한 차이를 보였다(p=0.005). 다변량 분석 결과상 후관절 비대칭성이 후관절 퇴행과 추간판 퇴행에 영향을 주는 인자였다. 결론: 경추 제5-6번에서 경추 후관절 퇴행 및 추간판 퇴행이 유의하게 많이 발생하였으며 후관절 비대칭성이 후관절 퇴행 및 추간판 퇴행에 영향을 주는 인자로 생각된다.

• The Korean Journal of Pain
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• 제22권1호
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• pp.99-103
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• 2009

We studied the historical changes of intervertebral disc displacement using magnetic resonance imaging. The phenomenon of the spontaneous regression of herniated discs is well known. The case of a 40-years-old male presenting with a large disc herniation at L5-S1, experiencing severe sciatic pain, and having the straight leg raising test positive at 25 degrees is presented. The extruded disc was documented by clinical examination. He was treated conservatively with epidural steroid injection (ESI), medication, physical therapy and self-exercise and reevaluated in 10 weeks later, 30 and 1 year. Large extruded disc can be treated successfully by physical therapy with ESI. However, the degeneration and the dehydration of disc result in decrease of disc height. Consequently, the regression of extruded disc might have been due to the resorption and the dehydration.

• Journal of Korean Neurosurgical Society
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• 제40권5호
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• pp.363-368
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• 2006

Objective : Little is known about the comprehensive molecular and biological mechanism on the development of the degeneration of the intervertebral disc. Many kinds of matrix metalloproteinase[MMP] initiate the degradation of the extracellular matrix including several kinds of collagens and proteoglycans. We compared molecular and immunohistochemical features of degenerated intervertebral disc and normal counterparts in order to investigate the role of MMP-1, 2, 3, 9. Methods : We have evaluated MMP-1, 2, 3, 9 expression in 30 surgically resected lumbar disc from degenerative disc disease patients and 5 normal control cases. RT-PCR[reverse transcriptase-polymerase chain reaction] and immunohistochemistry were performed. Results : By RT-PCR, normal tissue samples showed merely scant expression of MMP-1, 2, 3, 9 mRNA, but degenerated disc samples revealed more pronounced expression. mRNA amplifications were detected in 60%, 63.3%, 70%, 53.3% cases By immunohistochemistry, normal tissue samples showed minimal protein expression of MMP-1, 2, 3, 9, but degenerated disc samples revealed more pronounced expression. Protein expressions were detected in 73.3%, 63.3%, 76.7%, 63.3% cases. Both the mRNA amplification and protein overexpression rates were significantly higher in degenerated disc than in the normal tissue. Concordance between both the mRNA amplification and protein expressions of MMP-1, 3, 9 were not observed, but there is well correlation in MMP-2 expression. Conclusion : We concluded that the over-expressions of the MMP-1, 2, 3, 9 may contribute to the development of degeneration of the intervertebral disc.

• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.323-330
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• 2013

Objective : To develop a simple, reproducible model of disc degeneration in rabbits through percutaneous annular puncture and to confirm the degree of degeneration over time. Methods : Fifteen New Zealand white rabbits (4 to 5 months old and weighing approximately 3 to 3.5 kg each) underwent annular puncture of the L2-L3, L3-L4, and L4-L5 discs. Rabbits were sacrificed at 4, 8, or 20 weeks after puncture. For a longitudinal study to assess changes in disc height over time, serial X-rays were performed at 0, 2, 4, 8, and 20 weeks for rabbits in the 20-week group. Upon sacrifice, the whole spinal column and discs were extracted and analyzed with magnetic resonance imaging (MRI), real time reverse transcriptase-polymerase chain reaction, and histological staining. Results : The X-rays showed a slow, progressive decrease in disc height over time. Significant disc space narrowing compared to preoperative disc height was observed during the time period (p<0.001). The MRI grade, aggrecan, and matrix metalloprotease-13 mRNA expression and hematoxylin and eosin/safranin O/anti-collagen II staining were consistently indicative of degeneration, supporting the results of the X-ray data. Conclusion : Percutaneous annular puncture resulted in slow, reproducible disc degeneration that was confirmed by radiology, biochemistry, and histology. This in vivo model can be used to study and evaluate the safety and efficacy of biologic treatments for degenerative disc disease.