Abstract
Introduction
Disc degeneration is often scored using macroscopic and microscopic scoring systems. Although reproducible, these scores may not accurately reflect declining function in a degenerated disc. Accordingly, we compared macroscopic and microscopic degeneration scores with measurements of disc function.
Methods
Thirteen cadaveric motion segments (62–93 yrs) were compressed to 1kN while a pressure-transducer was pulled across the mid-sagittal diameter of the disc. Resulting stress profiles indicated intradiscal pressure (IDP), and maximum stress in the anterior (MaxStress_Ant) and posterior (MaxStress_Post) annulus. Macroscopic grade (1–4) of disc degeneration was based on visual examination of mid-sagittal sections, using subscales that yielded a maximum score of 48. Microscopic grade (1–4) was based on histological sections of the disc + vertebral body taken from anterior annulus, nucleus pulposus and posterior annulus, using subscale scores that totalled 108. Cartilage endplate thickness (CEP_thickness) was measured histologically, and porosity of the bony endplates was measured using micro-CT. ANOVA was used to compare between grades, and regression was used to establish dependence on scores.
Results
IDP and CEP_thickness both decreased with increasing macroscopic grade (1–4) of degeneration (P= 0.021 & 0.022 respectively). Also, IDP, CEP_thickness and MaxStress_Ant decreased with increasing macroscopic score (1–48) (R2 = 0.39, P = 0.022; R2 = 0.36, P = 0.03; R2 = 0.30, P = 0.04 respectively).
IDP and MaxStress_Ant decreased with increasing microscopic grade (1–4) of degeneration (P=0.05 & 0.005 respectively) and increasing microscopic score (1–108) (R2 = 0.36, P = 0.02; R2 = 0.47, P = 0.009 respectively) whereas inferior endplate porosity increased with increasing microscopic grade (P = 0.05) and score (R2 = 0.36, P = 0.03).
Conclusion
Macroscopic and microscopic ‘degeneration’ scores both reflect changes in disc function and endplate integrity.
