Influences of Nutrition Supply and Pathways on the Degenerative Patterns in Human Intervertebral Disc.

STUDY DESIGN Investigation of the effects of the impairment of different nutritional pathways on the intervertebral disc degeneration patterns in terms of spatial distributions of cell density, glycosaminoglycan content, and water content. OBJECTIVE The aim of this study was to test the hypothesis that impairment of different nutritional pathways would result in different degenerative patterns in human discs. SUMMARY OF BACKGROUND DATA Impairment of nutritional pathways has been found to affect cell viability in the disc. However, details on how impairment of different nutritional pathways affects the disc degeneration patterns are unknown. METHODS A 3D finite element model was used for this study. This finite element method was based on the cell-activity coupled mechano-electrochemical theory for cartilaginous tissues. Impairment of the nutritional pathways was simulated by lowering the nutrition level at the disc boundaries. Effects of the impartment of cartilaginous endplate-nucleus pulposus (CEP-NP) pathway only (Case 1), annulus fibrosus (AF) pathway only (Case 2), and both pathways (Case 3) on disc degeneration patterns were studied. RESULTS The predicted critical levels of nutrition for Case 1, Case 2, and Case 3 were around 30%, 20%, and 50% of the reference values, respectively. Below this critical level, the disc degeneration would occur. Disc degeneration appeared mainly in the NP for Case 1, in the outer AF for Case 2, and in both the NP and inner to middle AF for Case 3. For Cases 1 and 3, the loss of water content was primarily located in the mid-axial plane, which is consistent with the horizontal gray band seen in some T2-weighted magnetic resonance imaging (MRI). For the disc geometry used in this study, it was predicted that there existed a high-intensity zone (for Case 3), as seen in some T2-weighted MRI images. CONCLUSION Impairment of different nutrition pathways results in different degenerative patterns. LEVEL OF EVIDENCE N/A.