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Pathomorphology

  • F. Postacchini
  • W. Rauschning

Abstract

Pathomorphologic studies on lumbar discs in individuals of varying ages have led to the identification of various stages of disc degeneration. The grading proposed by Friberg and Hirsch (27), and later adopted by Nachemson (57), identifies four types of disc morphology, whilst that of Thompson et al. (81) distinguishes five types. Adams et al. (2), based on pathomorphologic and discographic studies, have identified five types of disc: cottonball, lobular, irregular, fissured and ruptured (Fig. 5.1).

Keywords

Vertebral Body Spinal Canal Nucleus Pulposus Disc Herniation Disc Degeneration 
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References

  1. 1.
    Abdullah A. F., Ditto E. W., Byrd E. B. et al.: Extreme-lateral lumbar disc herniations, clinical syndrome and special problems of diagnosis. J. Neurosurg. 41: 229–234, 1974.PubMedCrossRefGoogle Scholar
  2. 2.
    Adams M. A., Dolan P., Hutton W. C.: The stages of disc degeneration as revealed by discograms. J. Bone Joint Surg. 68-B: 36–41, 1986.Google Scholar
  3. 3.
    Adams M. A., Hutton W. C.: Prolapsed intervertebral disc: a hyperflexion injury. Spine 7: 184–191, 1982.PubMedCrossRefGoogle Scholar
  4. 4.
    Adams M. A., Hutton W. C.: Gradual disc prolapse. Spine 6: 524–531, 1985.CrossRefGoogle Scholar
  5. 5.
    Alexander C. J.: Sheuermann’s disease — a traumatic spondy-lodystrophy? Skel. Radiol. 1: 209–221, 1977.CrossRefGoogle Scholar
  6. 6.
    American Academy of Orthopaedic Surgeons. A glossary on spinal terminology. Prepared by Committee on the Spine. Chicago: American Academy of Orthopaedic Surgery, 32: 1985.Google Scholar
  7. 7.
    Angtuaco E. J. C., Holder J. C., Boop W. C. et al.: Computed tomographic discography in the evaluation of extreme lateral disc herniation. Neurosurgery 14: 350–352, 1984.PubMedCrossRefGoogle Scholar
  8. 8.
    Armstrong J. R.: Lumbar disc lesions. Pathogenesis and treatment of low back pain and sciatica. E.S. Livingstone, Edinburgh and London, 1967.Google Scholar
  9. 9.
    Barbera J., Gonzales-Darder J., Garcia-Vasquez F.: Intraradicular herniated lumbar disc. Case report. J. Neurosurg. 60: 858–860, 1984.PubMedCrossRefGoogle Scholar
  10. 10.
    Bianchi M. C., Puglioli M., Collavoli P. L. et al.: Spazio epidurale posteriore: rara sede di migrazione di frammenti discali liberi. Riv. Neurorad. 6: 283–289, 1993.Google Scholar
  11. 11.
    Blikra G.: Intradural herniated lumbar disc. J. Neurosurg. 31: 676–679, 1969.PubMedCrossRefGoogle Scholar
  12. 12.
    Bozzao A., Gallucci M., Aprile I. et al.: Evoluzione spontanea dell’ernia discale lombare nei pazienti trattati con terapia non chirurgica. Riv. Neurorad. 6: 267–274, 1993.Google Scholar
  13. 13.
    Bush K., Cowan N., Katz D. E. et al.: The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine 17: 1205–1212, 1992.PubMedCrossRefGoogle Scholar
  14. 14.
    Carcavilla L. I., Gomez Perun J., Eiras J. et al.: Hernie discale lombaire intradurale; apport de deux cas. Neurochirurgie 28: 421–424, 1982.PubMedGoogle Scholar
  15. 15.
    Chitkata Y. K.: Clinicopathologic study of changes in prolapsed intervertebral disks. Arch. Pathol. Lab. Med. 115: 481–483, 1991.Google Scholar
  16. 16.
    Ciappetta P., Delhni R., Cantore G.: Intradural lumbar disc hernia. Description of three cases. Neurosurgery 8: 104–107, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    Collins D. H.: The pathology of articular and spinal diseases. E. Arnold, London, 1949.Google Scholar
  18. 18.
    Copius Pereboom J. W.: Some biochemical and histochemical properties of the age pigment in the human intervertebral disc. Histochemie 37: 119–130, 1973.CrossRefGoogle Scholar
  19. 19.
    Crean J. K. G., Roberts S., Eisenstein S. M. et al.: Turnover of the connective tissue matrix in diseased intervertebral disc. Proc. International Society for the Study of the Lumbar Spine. Burlington, Vermont, 1996.Google Scholar
  20. 20.
    Dandy W. E.: Serious complications of ruptured intervertebral disks. JAMA 119: 474–477, 1942.CrossRefGoogle Scholar
  21. 21.
    Deucher W. G., Love J. G.: Pathologic aspects of posterior protrusion of the intervertebral discs. Arch. Pathol. 27: 201–211, 1939.Google Scholar
  22. 22.
    Doita M., Kanatani T., Harada T. et al.: Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine 21: 235–241, 1996.PubMedCrossRefGoogle Scholar
  23. 23.
    Donaldson W. F., Star M. J., Thorne R. P.: Surgical treatment for the far lateral herniated lumbar disc. Spine 18: 1263–1267, 1993.PubMedCrossRefGoogle Scholar
  24. 24.
    Eckert C., Decker A.: Pathological studies of the intervertebral discs. J. Bone Joint Surg. 29: 447–454, 1947.PubMedGoogle Scholar
  25. 25.
    Epstein N. E., Epstein J. A., Mauri T.: Treatment of fractures of the vertebral limbus and spinal stenosis in five adolescents and five adults. Neurosurgery 24: 595–604, 1989.PubMedCrossRefGoogle Scholar
  26. 26.
    Farfan H. F., Huberdeau R. M., Dubow H. I.: Lumbar intervertebral disc degeneration. The influence of geometrical features on the pattern of disc degeneration. A post-mortem study J. Bone Joint Surg. 54-A: 492–510, 1972.Google Scholar
  27. 27.
    Friberg S., Hirsch C.: Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop. Scand. 19: 222–242, 1949.PubMedCrossRefGoogle Scholar
  28. 28.
    Gado M., Patel J., Hodges F. J.: Lateral disc herniation into the lumbar intervertebral foramen. AJNR 4: 598–600, 1983.PubMedGoogle Scholar
  29. 29.
    Garfin S. R.: Discussion on extreme lateral disc herniation. J. Spinal Disord. 2: 139–140, 1989.Google Scholar
  30. 30.
    Giunti A., Laus M. Le radicolopatie spinali. A. Gaggi, ologna, 1992.Google Scholar
  31. 31.
    Gronblad M., Virri J., Tolonen J. et al.: A controlled immuno-histochemical study of inflammatory cells in disc herniation tissue. Spine 19: 2744–2751, 1994.PubMedCrossRefGoogle Scholar
  32. 32.
    Harada Y., Nakahara S.: A pathologic study of lumbar disc herniation in the elderly. Spine 14: 1020–1024, 1989.PubMedCrossRefGoogle Scholar
  33. 33.
    Hilton R. C., Ball J.: Vertebral rim lesions in the dorsolumbar spine. Ann. Rheum. Dis. 43: 302–307, 1984.PubMedCrossRefGoogle Scholar
  34. 34.
    Hirabayashi S., Kumano K., Tsuiki T. et al.: A dorsally displaced free fragment of lumbar disc herniation and its interesting histologic findings. A case report. Spine 15: 1231–1233, 1990.PubMedCrossRefGoogle Scholar
  35. 35.
    Ingelmark B. E.: Function of and pathological changes in the spinal joints. Acta Anat. Suppl. 36: 12–41, 1959.CrossRefGoogle Scholar
  36. 36.
    Ito T., Yamada M., Ikuta F. et al.: Histologic evidence of absorption of sequestration-type herniated disc. Spine 21: 230–234, 1996.PubMedCrossRefGoogle Scholar
  37. 37.
    Jackson R. P., Glah J. J.: Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine 12: 577–585, 1987.PubMedCrossRefGoogle Scholar
  38. 38.
    Jane J. A., Haworth G. S., Broaddus W. C. et al.: A neurosurgical approach to far lateral disc herniation. Technical note. J. Neurosurg. 72: 143–144, 1990.CrossRefGoogle Scholar
  39. 39.
    Jenkins L. E., Bowman M., Cother H. B. et al.: Intradural herniation of a lumbar intervertebral disc. Case report. J. Spinal Disord. 2: 196–200, 1989.PubMedCrossRefGoogle Scholar
  40. 40.
    Kambin P., Nixon J., Chait A. et al.: Annular protrusion: pathophysiology and roentgenographic appearance. Spine 13: 671–675, 1988.PubMedGoogle Scholar
  41. 41.
    Kanatani T., Ozaki T., Doita M. et al.: The production of matrix metalloproteinases (MMP-1, 3) and the inhibitor of matrix metalloproteinases (TIMP) in the cells from sequestrated disc of lumbar spine. Proc. International society for the study of the lumbar spine. Burlington, Vermont, 1996.Google Scholar
  42. 42.
    Kanemoto M., Hukuda S., Komiya Y. et al.: Immuno-histochemical study of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in human intervertebral discs. Spine 21: 1–8, 1996.PubMedCrossRefGoogle Scholar
  43. 43.
    Kataoka O., Nishibayashi Y., Sho T.: Intradural lumbar disc herniation. Report of three cases with a review of the literature. Spine 14: 529–533, 1989.PubMedCrossRefGoogle Scholar
  44. 44.
    Kirkaldy-Willis W. H., Wedge J. N., Yong-Hing K. et al.: Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3: 319–328, 1976.CrossRefGoogle Scholar
  45. 45.
    Knuttson F.: The vacuum phenomenon in the intervertebral discs. Acta Radiol. 23: 173–179, 1942.CrossRefGoogle Scholar
  46. 46.
    Lindblom K.: Intervertebral disc degeneration considered as a pressure atrophy. J. Bone Joint Surg. 39-A: 933–945, 1957.PubMedGoogle Scholar
  47. 47.
    Lindblom K., Hultqvist G.: Absorption of protruded disc tissue. J. Bone Joint Surg. 32-A: 557–560, 1950.PubMedGoogle Scholar
  48. 48.
    Lutz J. D., Smith R. R., Jones H. M.: CT myelography of a fragment of a lumbar disk sequestered posterior to the thecal sac. AJNR 11: 610–611, 1990.PubMedGoogle Scholar
  49. 49.
    Lyous A. E., Wise B. L.: Subarachnoid rupture of intervertebral disc fragments. J. Neurosurg. 18: 242–244, 1961.CrossRefGoogle Scholar
  50. 50.
    Maigne J. Y., Rime B., Deligne B.: Computed tomographic follow-up study of forty-eight cases of nonoperatively treated lumbar intervertebral disc herniation. Spine 17: 1071–1074, 1992.PubMedCrossRefGoogle Scholar
  51. 51.
    Marega T.: Due casi di ernia del disco lombare espulsi nel sacco durale. Arch. Putti 23: 467–474, 1968.PubMedGoogle Scholar
  52. 52.
    McCall I. W., Park W. M., O’Brien J. P.: Acute traumatic intraosseous disc herniation. Spine 10: 134–137, 1985.PubMedCrossRefGoogle Scholar
  53. 53.
    McCulloch J. A.: Principles of microsurgery for lumbar disc disease. Raven Press, New York, 1989.Google Scholar
  54. 54.
    Milgram J. M.: Osteoarthritic changes at the severely degenerative disc in humans. Spine 7: 498–505, 1982.PubMedCrossRefGoogle Scholar
  55. 55.
    Miller J. A. A., Schmatz B. S., Schultz A. B.: Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine 13: 173–178, 1988.PubMedCrossRefGoogle Scholar
  56. 56.
    Mixter W. J., Barr J. S.: Rupture of the intervertebral disc with involvement of the spinal canal. N. Engl. J. Med. 211: 210–215, 1934.CrossRefGoogle Scholar
  57. 57.
    Nachemson A. L.: Lumbar intervertebral pressure. Experimental studies in post-mortem material. Acta Orthop. Scand. Suppl. 43: 1–104, 1960.PubMedGoogle Scholar
  58. 58.
    Ohshima H., Hirano N., Osada R. et al.: Morphologic variation of lumbar posterior longitudinal ligament and the modality of disc herniation. Spine 18: 2408–2411, 1993.PubMedCrossRefGoogle Scholar
  59. 59.
    Paterson J. E., Gray W.: Herniated nucleus pulposus; the free fragment. Br. J. Surg. 34: 509–513, 1952.CrossRefGoogle Scholar
  60. 60.
    Patrick B. S.: Extreme lateral ruptures of lumbar intervertebral discs. Surg. Neurol. 1: 267–273, 1973.PubMedGoogle Scholar
  61. 61.
    Peyser E., Harari A.: Intradural rupture of lumbar intervertebral disk; report of two cases with review of the literature. Surg. Neurol. 8: 95–98, 1977.PubMedGoogle Scholar
  62. 62.
    Porter R. W., Hibbert C. S., Wicks M.: The spinal canal in symptomatic lumbar disc lesions. J. Bone Joint Surg. 60-B: 485–487, 1978.Google Scholar
  63. 63.
    Postacchini F.: Lumbar spinal stenosis and pseudostenosis: definition and classification of pathology. Ital. J. Orthop. Traumatol. 9: 339–350, 1983.PubMedGoogle Scholar
  64. 64.
    Postacchini F.: Lumbar spinal stenosis. Springer-Verlag, Wien New York, 1989.CrossRefGoogle Scholar
  65. 65.
    Postacchini F.: Management of lumbar spinal stenosis. J. Bone Joint Surg. 78-B: 154–164, 1996.Google Scholar
  66. 66.
    Postacchini F., Gumina S., Cinotti G. et al.: Ligamenta flava in lumbar disc herniation and spinal stenosis. Spine 19: 917–922, 1994.PubMedCrossRefGoogle Scholar
  67. 67.
    Postacchini F., Perugia D.: Degenerative lumbar spondylolisthesis. Part I Etiology, pathogenesis, pathomorphology and clinical features. Ital. J. Orthop. Traumat. 17: 165–173, 1991.Google Scholar
  68. 68.
    Ritchie J. H., Fahrni W. H.: Age changes in lumbar intervertebral discs. Can. J. Surg. 13: 65–71, 1970.PubMedGoogle Scholar
  69. 69.
    Ross J. S., Glicklich M., Duchesneau P. M.: Imaging of the lumbar spine. In: Lumbar disc disease. Hardy R. W. Jr., Raven Press, New York 1993.Google Scholar
  70. 70.
    Saal J. A., Saal J. S., Herzog R. J.: The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine 15: 683–686, 1990.PubMedCrossRefGoogle Scholar
  71. 71.
    Saunders J. B., Inman V. T.: Pathology of the intervertebral disk. Arch. Surg. 40: 389–416, 1940.CrossRefGoogle Scholar
  72. 72.
    Savini R., Di Silvestre M., Martucci E. et al.: Le fratture posteriori dei nuclei epifisari vertebrali lombari. Giorn. Ital. Ortop. Traumat. Suppl. 13: 75–81, 1987.Google Scholar
  73. 73.
    Schmorl G., Junghans H.: The human spine in health and disease. Second Edition. Grune and Stratton, New York, 1971.Google Scholar
  74. 74.
    Slater R. A., Pineda A., Porter R. W.: Intradural herniation of lumbar intervertebral discs. Arch. Surg. 90: 266–269, 1965.PubMedCrossRefGoogle Scholar
  75. 75.
    Smith R. V.: Intradural disc rupture. J. Neurosurg. 55: 117–120, 1981.PubMedCrossRefGoogle Scholar
  76. 76.
    Sullivan J. D., Farfan H. F., Kahn D. S.: Pathological changes with intervertebral joint rotational instability in the rabbit. Can. J. Surg. 14: 71–76, 1971.PubMedGoogle Scholar
  77. 77.
    Takahashi H., Suguru T., Okazima Y. et al.: Inflammatory cytokines in the herniated disc of the lumbar spine. Spine 21: 218–224, 1996.PubMedCrossRefGoogle Scholar
  78. 78.
    Takata T., Inoue S., Takahashi H. et al.: Fracture of the posterior margin of a lumbar vertebral body. J. Bone Joint Surg. 70-A: 589–594, 1988.Google Scholar
  79. 79.
    Tanaka M., Nakahara S., Inoue H.: A pathologic study of discs in the elderly. Separation between the cartilaginous end-plate and the vertebral body. Spine 18: 1456–1462, 1993.PubMedGoogle Scholar
  80. 80.
    Teng P., Papatheodorou C.: Intradural dislocation of lumbar disc. Neurochirurgia 7: 57–63, 1964.PubMedGoogle Scholar
  81. 81.
    Thompson J. P., Pearce R. H., Schechter M. T. et al.: Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc. Spine 15: 411–415, 1990.PubMedCrossRefGoogle Scholar
  82. 82.
    Tibrewal S. B., Pearcy M. J., Portek I. et al.: A prospective study of lumbar spinal movements before and after discectomy using biplanar radiography. Correlation of clinical and radiographic findings. Spine 10: 455–460, 1985.PubMedCrossRefGoogle Scholar
  83. 83.
    Tsuji H., Maruta K., Maeda A.: Postoperative intraradicular intervertebral disc herniation. Spine 16: 998–1000, 1991.PubMedCrossRefGoogle Scholar
  84. 84.
    Vernon-Roberts B.: Pathology of degenerative spondylosis. In: The lumbar spine and back pain. Jayson M. Ed., Sector Publishing Ltd., London, 1976.Google Scholar
  85. 85.
    Vernon-Roberts B., Pirie C. J.: Healing trabecular microfracture in the bodies of lumbar vertebrae. Ann. Rheum. Dis. 32: 406–412, 1973.PubMedCrossRefGoogle Scholar
  86. 86.
    Vernon-Roberts B., Pirie C. J.: Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheum. Rehabil. 16: 13–21, 1977.CrossRefGoogle Scholar
  87. 87.
    Weidner N., Rice D. T.: Intervertebral disk material: criteria for determining probable prolapse. Hum. Pathol. 19: 406–410, 1988.PubMedCrossRefGoogle Scholar
  88. 88.
    Wetzel F. T., Wilson S. C., Manale B. L. et al.: Neural compression due to osteochondral fragments. Report of two cases and review of the literature. Spine 17: 1259–1264, 1992.PubMedCrossRefGoogle Scholar
  89. 89.
    Winston K., Rumbaugh C., Colucci V.: The vertebral canals in lumbar disc disease. Spine 9: 414–417, 1984.PubMedCrossRefGoogle Scholar
  90. 90.
    Yasuma T., Arai K., Suzuki F.: Age-related phenomena in the lumbar intervertebral discs. Lipofuscin and amyloid deposition. Spine 17: 1194–1198, 1992.PubMedCrossRefGoogle Scholar
  91. 91.
    Yasuma T., Arai K., Yamauchi Y.: The histology of lumbar intervertebral disc herniation. The significance of small blood vessels in the extruded tissue. Spine 18: 1761–1765, 1993.PubMedCrossRefGoogle Scholar
  92. 92.
    Yasuma T., Koh S., Okamura T. et al.: Istological changes in aging lumbar intervertebral discs. Their role in protrusion and prolapse. J. Bone Joint Surg. 72-A: 220–229, 1990.Google Scholar
  93. 93.
    Yasuma T., Makino E., Saito S. et al.: Histological development of intervertebral disc herniation. J. Bone Joint Surg. 68-A: 1066–1072, 1986.Google Scholar
  94. 94.
    Yong-Hing K., Kirkaldy-Willis W. N.: The three-joint complex. In: The Lumbar Spine. Weinstein J. N., Wiesel S. Eds., W. B. Saunders Co., Philadelphia, 1990.Google Scholar

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© Springer-Verlag Wien 1999

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  • F. Postacchini
  • W. Rauschning

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