The involvement of matrix metalloproteinases and inflammation in lumbar disc herniation

STUDY DESIGN

Surgically obtained herniated lumbar disc specimens were stained with hematoxylin-eosin or toluidine blue (for detection of proteoglycans) or were immunostained with monoclonal antibodies (CD68), antihuman interstitial collagenase (matrix metalloproteinase [MMP]-1) and antihuman stromelysin (MMP-3).

OBJECTIVE

To investigate the possible correlation of matrix metalloproteinase activity to granulation tissue formation and lumbar disc herniation, depending on the type of herniation.

SUMMARY OF BACKGROUND DATA

Interstitial collagenase and stromelysin have been implicated in the degradation of the matrix of articular cartilage in rheumatoid arthritis, osteoarthritis and degenerated disc tissues. However, their role in the herniation of the intervertebral disc has received little study.

METHODS

Twenty-one specimens of lumbar disc herniation (classified as protrusions, subligamentous extrusions, transligamentous extrusions, and sequestrations) and four nonherniated discs were stained with hematoxylin-eosin or toluidine blue or were immunostained with monoclonal antibodies to CD20, CD45RO, and CD68, anti-MMP-1, and anti-MMP-3, using the avidin-biotin-peroxidase complex method. The amount of granulation tissue and results of staining were graded to examine differences in histology among the four herniation types.

RESULTS

In sequestration and transligamentous extrusion specimens, granulation tissue containing many CD68-positive macrophages was commonly observed. Most cells in granulation tissue, as well as chondrocytes, stained positively with anti-MMP-1 and anti-MMP-3 antibodies. Granulation tissue was less commonly observed in subligamentous extrusions and was absent from most protrusion specimens and all nonherniated specimens. B and T lymphocytes could not be demonstrated in granulation tissue.

CONCLUSIONS

The increased staining of MMP-1 and MMP-3 associated with inflammatory cells of granulation tissue in herniated discs suggests a causal correlation of these proteinases to tissue degradation in herniation.

Symptomatic monostotic fibrous dysplasia of the thoracic spine

STUDY DESIGN

A case report of monostotic fibrous dysplasia of the thoracic spine with symptoms of chest and back pain.

OBJECTIVE

To treat this lesion with surgery.

SUMMARY OF BACKGROUND DATA

Monostotic fibrous dysplasia of the thoracic spine is rarely seen. Few reports of this disorder appear in the literature. This is the fifth case of monostotic fibrous dysplasia of the thoracic spine presented to date.

METHODS

The patient was a 48-year-old woman with monostotic fibrous dysplasia involving the thoracic spine of the 10th vertebral body and the 10th left rib. Surgical removal of the tumor was carried out. The defect was packed with hydroxyapatite graft material. Arthrodesis or internal fixation was not made.

RESULTS

The diagnosis of fibrous dysplasia was made histologically. No obvious recurrence of the lesion has been seen for 3 years.

CONCLUSION

Surgical removal of the tumor and transplantation of hydroxyapatite was effective treatment for the reported patient.

[An evaluation of cervical spinal canal stenosis--a correlation with cerebrospinal fluid pressure using a semiconductor and its coefficients]

This study was conducted to determine whether the cerebrospinal fluid pressure (CSFP) obtained by the lumbar puncture technique is capable of evaluating the pathological state of the cervical spinal canal stenosis (CSCS). A method was developed in which the CSFP was measured with a small piezoelectric semiconductor in combination with the lumbar puncture technique. The data thus obtained were quantitatively analysed using a personal computer. Using this method, we studied patients with cervical myelopathy due to vertebral canal stenosis. The CSFP wave form obtained by compression of the cervical region was converted into a regression curve using the computer. In order to estimate the vertebral canal stenosis ratio (spinal cord/dural tube) of patients with CSCS by CSFP, multiple regression analysis was performed to obtain a multiple regression with respective parameters as expository variables. Descending curve coefficients (CND, CFD and CED) were found to be useful as parameters estimating the state of CSCS by means of CSFP analysis. On the basis of these parameters, CND, the coefficient of a descending curve obtained at the neutral cervical position, and CED, the coefficient of a descending curve obtained at the extended position, patients with CSCS were able to distinguish from normal subjects. The multiple regression equation (Y = 73.2-3890 CNA-4740 CND + 3620 CFD-10470 CEA-802 CED-0.119 NPP) was statistically significant at P = 0.01, therefore, useful in estimating the vertebral canal stenosis ratio. On the contrary, the values calculated from the multiple regression equation were not well correlated with either the JOA (Japanese Orthopedic Association) scores evaluated in accordance with the JOA Criteria or with the spinal compression ratio (anterior-to-posterior diameter/right-to-left diameter).