J Korean Soc Spine Surg.  2001 Jun;8(2):121-129. 10.4184/jkss.2001.8.2.121.

Correlation among Magnetic Resonance Images, Electron Microscopic Findings, Light Microscopic Findings and Clinical Symptom of the Degeneration of Lumbar Intervertebral Disc

• Ahn JS
• Lee JK
• Hwang DS
• Chung SY
• Jeon TS
• Lee CS

• KMID: 2097751
• DOI: http://doi.org/10.4184/jkss.2001.8.2.121

Abstract

STUDY DESIGN: A retrospective study was performed in patients who had undergone any operation with removal of lumbar intervertebral disc at Chungnam National University Hospital.
OBJECTIVES
To evaluate relationship among magnetic resonance image, electron microscopic findings, light microscopic findings and clinical symptoms in degenerated intervertebral disc. SUMMARY OF LITERATURE REVIEW: Degenerative changes and disc herniations in the intervertebral disc have been shown to be accompanied by changes in the water and proteoglycan content of the tissue.
MATERIALS AND METHODS
Our study followed by any operation with removal of intervertebral disc was carried out on 60 patients at Chungnam National University Hospital from January 1998 to December 1999. In radiographic evaluation we used a criteria from Frymoyer. In clinical evaluation we classified clinical symptom according to scale of Kirkaldy-Willis. And we classified of electron microscopic findings into five grades according to degrees of denudation of proteoglycan from hyalunonic acid. In light microscopic findings, we classified by cell nest formation, noevascularization and amount of muccopolysaccharide.
RESULTS
In radiologic evaluation there were 11 cases in grade III, 28 cases in grade IV, and 21 cases in grade V. There were no grade I, II in our study. In clinical symptom, there were 20 cases in Good, 18 cases in Fair, and 22 cases in Poor. In electron micro-scopic findings, there were 4 cases in grade 3, 35 cases in grade 4, and 21 cases in grade 5. There were no grade I, II in this study. There was a relationship between magnetic resonance image and electron microscopic findings and clinical symptom (p<0.05).
CONCLUSION
Our study of electron microscopic findings of degenerated intervertebral disc may be a help to understand of pathogenesis of disc prolapse.

MeSH Terms

Chungcheongnam-do
Humans
Intervertebral Disc*
Prolapse
Proteoglycans
Retrospective Studies
Proteoglycans

Figure

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  Fig. 1. MRI findings showing pattern of each grade of degeneration of nucleus pulposus Fig. A. Grade I-Homogenous bright Fig. B. Grade II-Horizontal dark band Fig. C. Grade III-Gray tone with dark stippling Fig. D. Grade IV-Almost dark tone with bright stippling Fig. E. Grade V-Total darkness or gross loss of disc height

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  Fig. 2. EM finding showing Grade III(From 41 to 60% of proteoglycan are denuded from hyarulonic acid).

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  Fig. 3. EM finding showing Grade IV(From 61 to 80% of proteoglycan are denuded from hyarulonic acid).

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  Fig. 4. EM finding showing Grade V(Over 81% of proteoglycan are denuded from hyarulonic acid).

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  Fig. 5. LM finding: Disc tissue showing cell nest formation (HE stain, × 400).

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  Fig. 6. LM finding: Disc tissue showing blood vessels (noevascularization) (HE stain, × 200).

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  Fig. 7. LM finding: Disc tissue shows strong positive for neutral muccopolysaccharide in PAS stain (PSA stain, × 200).

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