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Pathophysiologie der Bandscheibendegeneration

Literaturübersicht – Teil 2

Pathophysiology of intervertebral disc degeneration

Review of the literature – Part 2

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Zusammenfassung

Die Bandscheiben altern schneller als fast jedes andere Gewebe, da ihre Ernährung in einem avaskulären Gewebe behindert ist [25, 96, 83]. Die maßgeblichste strukturelle Veränderung, die im Degenerationsprozess abläuft, ist die Abnahme von Wassergehalt und osmotischem Druck, vor allem im Nucleus pulposus und im inneren Teil des Anulus fibrosus [95, 25, 57], sowie die Abnutzung der Matrix [46]. Der abnehmende osmotische Druck in alternden Bandscheiben verstärkt die Öffnung existierender Risse trotz der Abnahme der Scherkräfte im Anulus [112]. Fibröse Veränderungen des Nukleus, Desorganisation des Anulus sowie Veränderungen des Wirbelkörpers und der Endplatten geschehen vor allem im 5.–7. Lebensjahrzehnt. Diese Veränderungen sind in den unteren Bandscheiben stärker ausgeprägt als in den oberen und gehen der Formierung von Rissen und Spalten voraus. Der zeitliche Ablauf weist auf eine strenge Korrelation von Spalt- und Rissbildungen hin, die in der ersten Dekade im Nukleus beginnen, während Randläsionen unabhängig davon entstehen und deutlich später eintreten [51].

Abstract

Intervertebral discs age more rapidly than most other tissues because the nutritional supply is hindered by avascular tissue [25, 96, 83]. The most decisive structural alterations in the degenerative process are a decrease in water content and osmotic pressure, especially in the nucleus polposus and in the inner part of the annulus fibrosus [95, 25, 57], as well as wear of the matrix [46]. The decrease in osmotic pressure in aging intervertebral discs strengthens the opening of existing tears despite a decrease in shearing forces in the annulus [112]. Fibrous changes of the nucleus, disorganization of the annulus and changes to the vertebra and endplates occur in particular in the 5th–7th decades of life. These alterations are more intensive in the lower regions than in the upper and precede the formation of tears and clefts. The time scale indicates a strong correlation to tear and cleft formation, which begin in the nucleus in the first decade, whereas marginal lesions are formed independently and occur much later [51].

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Schürer, R. Pathophysiologie der Bandscheibendegeneration. Manuelle Medizin 46, 77–81 (2008). https://doi.org/10.1007/s00337-007-0569-y

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