The Histological And MRI Study Of Adolescents With Herniated Lumbar Intervertebral Disc And The Morphological Analysis Of The Sagittal Sacrum With L5/S1 Dysplasia Of Adolescent

Chapter 1MMP-3,IL-17,VEGF and Collagen II expressions in the herniated nucleus pulposus between adolescent and aged patientsObjective:To analyze the molecular pathogenesis of lumbar intervertebral disc herniation in both adolescent and aged patients by investigating the expression of MMP-3,IL-17,VEGF and Collagen II in the herniated nucleus pulposus.Methods:60 intervertebral discs from adolescent and aged lumbar intervertebral disc herniation patients who received surgical intervention from February 2015 to December 2016 were collected.27 adolescent patients and 33 aged patients were included,with the average age 18.6±2.4 years(ranging from 13 to 21 years)in adolescent group and 54.0±10.3 years(ranging from 41 to 73 years)in aged group.HE staining was used to detected the degeneration of the intervertebral disc.The expression of MMP-3?IL-17?VEGF and Collagen II was tested by immunohistochemistry techniques.Then data analysis was counted by optical microscope.Results:Compare to aged group,There were less positive expression with MMP-3 but more positive expression with IL-17 and VEGF in adolescent group,and there were significant difference between the two group(33..3%Versus 81.8%;83.3%Versus 45.4%;66.7%Versus 31.8%).HE staining confirmed that discs of the aged group were degenerated tissue,while the young group were not obviously degenerated.Conclusion:Pathological proved the adolescent patient with lumbar intervertebral disc herniation were not obviously degenerated as the older were.Immunological and inflammatory reaction may be the main reason of disc herniation in the adolescent.Chapter 2No Modic changes were found in adolescent patients with disc herniationObjective:To evaluate if there are Modic changes in the lumbar MRI of adolescent patients with lumbar disc hemiation(ALDH).Methods:A total of 68 patients with ALDH who received surgical intervention from September 2006 to February 2016,including 51 males and 12 females,with the average age 16.0±3.1 years(ranging from 11 to 20 years),were included in this study.Sagittal magnetic resonance(MR)images of lumbar spine before surgery were evaluated with regards to Modic changes.Also,the level and type of disc herniations as well as the grade of intervertebral disc degeneration were recorded.Results:Totally,408 lumbar discs and 816 vertebral endplates(T12/L1—L5/S1)were reviewed in all of the patients.None was detected with Modic changes at any level of lumbar spine.87(21.3%)discs were identified with herniation,in 49 patients(72.1%)with single-level herniation and 19 patients(27.9%)with double-level herniation.In terms of disc degeneration,27 discs(31.0%)were graded with Pfirrmann ?,43discs(49.4%)with Pfirrmann ?,and 17discs(19.6%)with Pfirrmann ?.but none with Pfirrmann ?.Conclusion:There is not any evidence of Modic changes in the current cohort with ALDH,despite a relatively lower grade of degeneration in the herniated discs.It is suggested that disc degeneration might not be the main cause of ALDHChapter 3The sagittal morphology of sacrum in adolescents with L5-S1 dysplastic spondylolisthesisObjectives:To evaluate the sagittal morphology of sacrum in adolescents with L5-S1 dysplastic spondylolisthesis.Methods:13 adolescent patients with L5/S1 dysplastic spondylolisthesis(gender,2 males and 11 females;mean age,12.2±3.1 years;range,9 to 18 years)and age-matched control group of 30 normal adolescents were recruited in this retrospective study.All patients were received surgical intervention from May 2002 to March 2016 in our hospital.Radiographic measurements including sacral morphology parameters,postural parameters were carried on the standing upright lateral radiographs of the spine and pelvis.Independent samples t tests was used to analyze the differences of radiographic parameters.Results:Adolescent patients with L5-S1 dysplastic spondylolisthesis had significant morphologic difference in segmental sacrum morphology and global sacral configuration.There were 10 domed sacrums,6 wedged L5 vertebral bodys and 9 lumbosacral kyphosis among 13 dysplastic patients.The sacral angle and S1 superior angle of dysplastic groups were much lower,but both sacral kyphosis in Cobb method(50.1°±10.6 versus 18.1°±10.4°)and in Ferguson method(40.5°±9.9° versus 23.1°±11.5°)were higher than those in control group,it meant that dysplastic patients characterized with a more vertical first sacral vertebrae and much severer global sacral kyphosis.Compare to control group,the lumbosacral angle,sacral table angle and S1 index of dysplastic group were extremely lesser.While sagittal vertical axis(46.5mm±42.3mm versus-25.6mm±21.8mm),L5 incidence,pelvic tilt and sagittal pelvic thickness in dysplastic group were significantly higher than those in control group,sacral slope were much lesser.The dysplastic patients had a abmormal posture containing trunk forward leaning,pelvic retroversion and vertical sacrum.In comparison with the mild dysplastic spondylolisthesis group(5cases),the high group(8cases)were significantly higher on slip percentage(67.3%±18.6%versus 45.4%±12.5%),sacral kyphosis in Ferguson method(45.8±8.4 versus 32.2±5.1)and sagittal vertical axis(52.6±24.7 versus 21.6±9.5).Conclusions:Adolescents with dysplastic spondylolisthesis not only present lumbosacral malformation but also characterized with severe global sacral kyphosis.To compensate sagittal imbalance,pelvic retroversion and vertical sacrum occur due to trunk forward leaning.And these abmormal morphology are influenced by the degree of dysplastic.For these patients,close observation and early surgical intervention are required when abmormal sagittal posture appears.