title: Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease.
abstract: We obtained intervertebral discs with cartilage endplates and underlying cancellous bone at operation from patients with degenerative disc disease and then used immunohistochemical techniques to localise the nerves and nerve endings in the specimens. We used antibodies for the ubiquitous neuronal protein gene product 9.5 (PGP 9.5). Immunoreactivity to neuropeptide Y was used to identify autonomic nerves and calcitonin gene-related peptide (CGRP) and substance P to identify sensory nerves. Blood vessels were identified by immunoreactivity with platelet-endothelial cell-adhesion molecule (CD31; PECAM). In a control group with no known history of chronic back pain, nerve fibres immunoreactive to PGP 9.5 and neuropeptide Y were most closely related to blood vessels, with occasional substance P and CGRP immunoreactivity. In patients with severe back pain and markedly reduced disc height, proliferation of blood vessels and accompanying nerve fibres was observed in the endplate region and underlying vertebral bodies. Many of these nerves were immunoreactive to substance P or CGRP, and in addition, substance P- and CGRP-immunoreactive nociceptors were seen unrelated to blood vessels. Quantification by image analysis showed a marked increase in CGRP-containing sensory nerve fibres compared with normal control subjects. We speculate that a chemotactic response to products of disc breakdown is responsible for the proliferation of vascularity and CGRP-containing sensory nerves found in the endplate region and vertebral body adjacent to degenerate discs. The neuropeptides substance P and CGRP have potent vasodilatory as well as pain-transmitting effects. The increase in sensory nerve endings suggests increase in blood flow, perhaps as an attempt to augment the nutrition of the degenerate disc. The increase in the density of sensory nerves, and the presence of endplate cartilage defects, strongly suggest that the endplates and vertebral bodies are sources of pain; this may explain the severe pain on movement experienced by some patients with degenerative disc disease.
authors.affiliation: Department of Histochemistry, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
authors.forename: M F
authors.initials: MF
authors.lastname: Brown
authors.forename: M V
authors.initials: MV
authors.lastname: Hukkanen
authors.forename: I D
authors.initials: ID
authors.lastname: McCarthy
authors.forename: D R
authors.initials: DR
authors.lastname: Redfern
authors.forename: J J
authors.initials: JJ
authors.lastname: Batten
authors.forename: H V
authors.initials: HV
authors.lastname: Crock
authors.forename: S P
authors.initials: SP
authors.lastname: Hughes
authors.forename: J M
authors.initials: JM
authors.lastname: Polak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015740:Calcitonin Gene-Related Peptide / Q000032:analysis; D002356:Cartilage / Q000098:blood supply / Q000294:innervation*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007403:Intervertebral Disc / Q000098:blood supply / Q000294:innervation*; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009411:Nerve Endings; D009419:Nerve Tissue Proteins / Q000032:analysis; D009475:Neurons, Afferent / Q000473:pathology*; D009478:Neuropeptide Y / Q000032:analysis; D009619:Nociceptors / Q000473:pathology; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000032:analysis; D013373:Substance P / Q000032:analysis; D013564:Sympathetic Nervous System / Q000473:pathology*; D013869:Thiolester Hydrolases / Q000032:analysis; D043222:Ubiquitin Thiolesterase
chemical_list: D009419:Nerve Tissue Proteins; D009478:Neuropeptide Y; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D013373:Substance P; D013869:Thiolester Hydrolases; D043222:Ubiquitin Thiolesterase; D015740:Calcitonin Gene-Related Peptide