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Intervertebral disc degeneration

Résumé

La dégénérescence des disques du rachis humain est un phénomène complexe caractérisé par des modifications biochimiques affectant le nucléus pulposus et les couches profondes de l'annulus et l'apparition de fissures et de fentes irradiant de la zone centrale du disque vers sa périphéric. De plus, et sans doute indépendamment de ces phénomènes, apparaissent au niveau des couches superficielles de l'annulus, de petites désinsertions qui sont probablement des ruptures provoquées par les contraintes mécaniques. La présence de déchirures discales liées aux contraintes et dépourvues de tendance spontanée à la guérison, peut initier ou accélérer la dégénérescence de la zone centrale du disque. Nous postulons que la douleur d'origine discale peut être liée aux altérations présentées par la partie périphérique de l'annulus. Bien qu'il puisse sembler logique d'admettre que les disques présentant une hyperpression intradiscale prolongée puissent davantage être enclins à engendrer des douleurs reportées dans les couches superficielles de l'annulus, en raison d'une tension plus élevée, l'analyse des études prospectives n'a pas confirmé de relation entre la reproduction typique d'une douleur à la discographie et des valeurs élevées de pression intradiscale. On en conclut pour le moment, que les seules modifications morphologiques significatives apparaissant chez les patients présentat la reproduction d'une douleur typique à la discographie, sont des altérations diverses de l'annulus affectant ses couches superficielles. Il reste à établir s'il existe une certaine reproduction des fibres nerveuses pendant l'essai de réparation de ces défects.

Summary

Disc degeneration in the human spine is a complex phenomenon characterised by biochemical change in the nucleus pulposus and inner annulus and the formation of clefts and fissures radiating from the central area of the disc towards the periphery. In addition, and probably independent of these phenomena, discrete defects in the outer annular attachement are seen which are likely to be due to mechanical stress and failure. The presence of stress tears in disc tissue and their failure to heal can initiate or accelerate the degeneration of the central component of the intervertebral disc. We postulate that discogenic pain may be linked to damage to the outer portion of the annulus fibrosus. Although it would seem logical to assume that discs with sustained high intradiscal pressure would be more prone to pain referred in the outer annular layers because of higher tensile strain, analysis of prospective studies has failed to confirm a relationship between typical pain reproduction at discography and high pressure values. It is concluded that, at present, the only consistent morphological changes present in patients with pain reproduction at discography are the presence of various annular defects involving the outer layers. Whether nerve ingrowth during attempts at repair of these defects is a consistent feature remains to be established.

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Correspondence to R. D. Fraser.

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Fraser, R.D., Osti, O.L. & Vernon-Roberts, B. Intervertebral disc degeneration. Eur Spine J 1, 205–213 (1993). https://doi.org/10.1007/BF00298361

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Mots-clés

  • Dégénérescence discale
  • Disque intervertébral
  • Arthrose vertébrale lombaire
  • IRM
  • Discographic

Key words

  • Disc degeneration
  • Intervertebral disc
  • Lumbar spondylosis
  • Magnetic resonance imaging
  • Discography