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Morphological changes in the human cervical intervertebral disc post trauma: response to fracture-type and degeneration grade over time

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Abstract

Purpose

In the first 24 h post-intervertebral disc (IVD) trauma, up to 75 % cell death has been reported. In addition, burst fractures cause post-traumatic disc degeneration by elevated pro-apoptotic and pro-inflammatory gene transcription. Moreover, some patients have pre-trauma degenerative disc disease. The aim of the study was to assess histological changes and cell-death over a time period of up to 1 year caused by mechanical and structural factors.

Methods

116 anterior portions of IVDs of the cervical spine were studied histologically by light microscopy and ultrastructurally by transmission electron microscopy (TEM). The group was investigated with regard to three main parameters: fracture mechanism (compressive vs. tensile/shear loads), degeneration grade (low vs. high) and endplate fracture (with vs. without). Disc architecture (e.g. ruptures) was studied histologically. Cell morphology was examined ultrastructurally to quantify cell-death, healthy and balloon cells. According to ultrastructural observations, two time-groups (up to 6 days vs. later) were established. Statistical analyses were carried out within and between time-groups.

Results

Histological changes were obvious in the annulus fibrosus where ruptures with haematoma were replaced by granulation tissue. Significant differences in cell-death were seen in the first few days due to different loads. In contrast to the more degenerated segments, low degenerated ones revealed significantly less cell death with time post-trauma. Interestingly, no difference was found between groups after the sixth day. Cell-death (mean 44 % for all investigated groups) remained high after day 6 post-trauma.

Conclusion

IVDs retrieved from low grade degenerated segments revealed a significant recovery, with less cell-death and a partially restored disc matrix, although cell-death remained high. Long-term clinical studies of stabilized segments arising from different fracture mechanisms are required.

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Acknowledgments

Supported by ÖNB (Österreichische Nationalbank, Jubiläumsfonds—Project Numbers: ÖNB 8590; ÖNB 10032.

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Authors and Affiliations

  1. Department of Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Ingrid Sitte, Miranda Klosterhuber & Richard Andreas Lindtner

  2. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

    Martin Cornelius Freund

  3. Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria

    Sabrina Barbara Neururer

  4. Division of Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria

    Kristian Pfaller

  5. Department of Traumatology and Sports Medicine, Sankt Vinzenz Krankenhaus Zams, Zams, Austria

    Anton Kathrein

Authors
  1. Ingrid Sitte
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  2. Miranda Klosterhuber
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  3. Richard Andreas Lindtner
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  4. Martin Cornelius Freund
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  7. Anton Kathrein
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Correspondence to Ingrid Sitte.

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The authors do not have any conflicts of interest.

Ethics commission

UN 1052; UN 1653; UN 3849. The study and recruitment procedures were approved by the Ethics Committee, Medical University of Innsbruck. All participants gave written informed consent after full explanation of study procedures.

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Sitte, I., Klosterhuber, M., Lindtner, R.A. et al. Morphological changes in the human cervical intervertebral disc post trauma: response to fracture-type and degeneration grade over time. Eur Spine J 25, 80–95 (2016). https://doi.org/10.1007/s00586-015-4089-5

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  • DOI: https://doi.org/10.1007/s00586-015-4089-5

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