方法:横断面比较研究。
目的:本研究旨在探讨椎间盘钙化潜能(BMP2表达)及其与MRI可见椎体终板缺损的关系。
方法:从20-76岁(31M/16F)接受手术的患者中获取47例腰椎间盘突出症样本。5μm薄切片用H&E染色,以便根据细胞密度(0-5)从0-15指定组织学变性评分(HDS)。结构改变(0-4),颗粒改变(0-3)和粘液变性(0-3)。切片用抗BMP-2抗体免疫染色以观察这些圆盘中的钙化潜能。此外,术前分析腰椎T2-T1WMRI图像是否存在和类型(典型或非典型)椎体终板缺损,椎间盘退变等级(PfirrmannI-V级),存在高强度区(HIZ),和Modic在操作级别发生变化。
结果:椎体终板缺损,在81%中观察到Modic变化和HIZ,分别为29%和21%的患者。平均HDS和BMP-2表达分别为9±2和平均71±36点/mm2。邻近椎体终板缺损的椎间盘显示细胞密度增加(P=0.004),粘液变性(P=0.002),HDS(P=0.01)和BMP-2表达(P=0.01)。带有HIZ的光盘也增加了HDS,但在BMP2表达增加时观察到显著性(P=.006)。HDS与BMP-2表达呈正相关(r=.30,P=.04)。
结论:这些发现提示椎间盘力学环境的改变与BMP-2的表达密切相关,BMP-2是椎间盘钙化的重要标志。
METHODS: Cross sectional comparative study.
OBJECTIVE: The current study aims to explore the calcification potential (BMP2 expression) of intervertebral discs and its association with the presence of vertebral endplate defects visible on MRI.
METHODS: Forty-seven herniated lumbar disc samples obtained from patients aged 20-76 (31 M/16F) undergoing surgery. Five-µm thin sections were stained with H&E in order to assign a histological degeneration score (HDS) from 0-15 on the basis of cell density (0-5), structural alterations (0-4), granular changes (0-3) and mucus degeneration (0-3). Sections were immuno-stained with anti BMP-2 antibodies to observe the calcification potential in these discs. In addition, pre-operativeT2-T1 W MRI images of the lumbar spine were analyzed for the presence and type (typical or atypical) of vertebral endplate defects, grade of disc degeneration (Pfirrmann grade I-V), presence of high intensity zones (HIZ), and Modic changes at the operated level.
RESULTS: Vertebral endplate defects, Modic changes & HIZ were observed in 81%, 29% and 21% of patients respectively. Mean HDS & BMP-2 expression was 9 ± 2 and mean 71 ± 36 spots/mm2 respectively. Discs with adjacent vertebral endplate defects showed increased cell density (P = .004), mucus degeneration (P = .002), HDS (P = .01) and BMP-2 expression (P = .01). Discs with HIZ also had increased HDS, but significance was seen with increased BMP2 expression (P = .006). HDS showed a positive correlation with BMP 2 expression (r = .30, P = .04).
CONCLUSIONS: These findings suggest that the altered mechanical environment of discs is strongly associated with BMP-2 expression which is an important marker of intervertebral disc calcification.