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Comparative Study
. 2010;128(2):63-8.
doi: 10.1590/s1516-31802010000200004.

Correlations between radiographic, magnetic resonance and histological examinations on the degeneration of human lumbar intervertebral discs

Delio Eulalio Martins  1 , Valdeci Manoel de Oliveira, Maria Teresa de Seixas Alves, Marcelo Wajchenberg, Elcio Landim, João Carlos Belloti, Eduardo Barros Puertas, Akira Ishida
Affiliations
Comparative Study

Correlations between radiographic, magnetic resonance and histological examinations on the degeneration of human lumbar intervertebral discs

Delio Eulalio Martins et al. Sao Paulo Med J. 2010.

Abstract
in English, Portuguese

Context and objective: There is controversy regarding which imaging method is best for identifying early degenerative alterations in intervertebral discs. No correlations between such methods and histological finds are presented in the literature. The aim of this study was to correlate the thickness of intervertebral discs measured on simple radiographs with the degree of degeneration seen on magnetic resonance images and the histological findings relating to nerve ends inside the discs.

Design and setting: Cross-sectional correlation study on the lumbar spines of human cadavers, at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

Methods: Ten lumbar spinal columns were extracted from human cadavers and subjected to magnetic resonance imaging and simple radiography. They were classified according to the degree of disc degeneration seen on magnetic resonance, and the thickness of the discs was measured on radiographs. The intervertebral discs were then extracted, embedded in paraffin and analyzed immunohistochemically with protein S100, and the nerve fibers were counted and classified.

Results: No correlation was observed between the thickness of the intervertebral discs and the degree of degeneration seen on magnetic resonance images. Only the uppermost lumbar discs (L1/L2 and L2/L3) presented a correlation between their thickness and type I and IV nerve endings.

Conclusion: Reduced disc thickness is unrelated to increased presence of nerve ends in intervertebral discs, or to the degree of disc degeneration.

Contexto E Objetivo:: Há controvérsia sobre qual o melhor método de imagem para identificar alterações degenerativas precoces do disco intervertebral. Falta na literatura correlação desses métodos com os achados histológicos. O objetivo deste estudo foi relacionar a altura dos discos intervertebrais medidos em radiografias simples com o grau de degeneração nas imagens de ressonância magnética e os achados histológicos das terminações nervosas encontradas no interior do disco.

Tipo De Estudo E Local:: Estudo transversal de correlação em coluna lombar de cadáveres humanos, na Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil.

Métodos:: Dez colunas lombares foram retiradas de cadáveres humanos e submetidas a imagens de ressonância magnética e radiografias simples. Foram classificadas de acordo com o grau de degeneração dos discos pela ressonância e mensuradas as alturas dos discos nas radiografias. Os discos intervertebrais foram retirados, incluídos em parafina e foi realizado estudo imunoistoquímico com proteína S100; as fibras nervosas foram contadas e classificadas.

Resultados:: Não foi observada correlação entre a altura dos discos intervertebrais com o grau de degeneração nas imagens de ressonância magnética. Apenas os discos lombares altos (L1/L2 e L2/L3) apresentaram correlação entre a altura e as terminações nervosas dos tipos I e IV.

Conclusão:: A diminuição da altura dos discos não está relacionada ao aumento de terminações nervosas nos discos intervertebrais e nem com o grau de degeneração dos discos.

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Figures

Figure 1.
Figure 1.. Measurement of disc height according to a method modified from Farfan. Disc height = (h1 + h2 + H1 + H2)/4. A: anteroinferior corner of the upper vertebral body; B: posteroinferior corner of the upper vertebral body; C: anterosuperior corner of the lower vertebral body; D: posterosuperior corner of the lower vertebral body.
Figure 2.
Figure 2.. Photomicrograph of intervertebral disc stained by means of an immunohistochemical method for protein S100. Magnification 400 x. Black arrows demonstrate type I fibers; white arrows demonstrate type II fibers.
Figure 3.
Figure 3.. Photomicrograph of intervertebral disc stained by means of an immunohistochemical method for protein S100. Magnification 400 x. The white arrow demonstrates a type III fiber, stained brown. A Type IV fiber (black arrow), at the periphery of a blood vessel can also be seen.
Figure 4.
Figure 4.. Relationship between thickness and total quantity of nerve fibers in L1/L2 discs.
Figure 5.
Figure 5.. Relationship between thickness and quantity of type IV nerve fibers in L1/L2 discs.
Figure 6.
Figure 6.. Relationship between thickness and total quantity of nerve fibers in L2/L3 discs.
Figure 7.
Figure 7.. Relationship between thickness and quantity of type I nerve fibers in L2/L3 discs.
Figure 8.
Figure 8.. Relationship between thickness and quantity of type II nerve fibers in L2/L3 discs.
Figure 9.
Figure 9.. Relationship between thickness and quantity of type III fibers in L2/L3 discs.
Figure 10.
Figure 10.. Relationship between thickness and quantity of type IV fibers in L2/L3 discs.
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