Crystal deposits in the human intervertebral disc: implications for disc degeneration.
BACKGROUND
Although crystal deposition in cartilage and synovial fluid has received much attention, crystal formation and the role that crystal deposits play are virtually unexplored in the intervertebral disc. In articular cartilage matrix, crystal deposits are associated with altered extracellular matrix (ECM) and cell phenotypic features, but crystal deposition in the human intervertebral disc has received much less attention.


OBJECTIVE
To determine the incidence of crystal deposits in the annulus and to evaluate associated disc cell and ECM features.


METHODS
Human intervertebral disc annulus tissue was obtained in a prospective study of the presence of crystals in the disc ECM. Human Subjects Institutional Review Board approved experimental studies.


METHODS
Two hundred eight sequential disc specimens were submitted from surgical disc procedures performed on individuals with herniated discs, degenerative disc disease, or recurrent disc herniation. During this same time period, three disc specimens were received from nonsurgical donors and added to the study population.


METHODS
Histologic features with special attention to crystal deposition.


METHODS
Specimens were processed undecalcified and examined for the histologic presence of crystal deposits and ECM features around the crystals.


RESULTS
The proportion of specimens containing crystals was determined to be 14.7%; crystals displayed varying sizes, morphology, and polarized light birefringence features. Pyrophosphate crystals were most common, but oxalate-like crystals were also present. ECM in crystal regions showed previously recognized alterations.


CONCLUSIONS
This study shows that the incidence of crystal deposits in discs is approximately 15% and is thus a relatively common occurrence. These data are important because masses of crystals not only disrupt disc ECM but may also accelerate preexisting degenerative changes via an elevation in matrix metalloproteinases (as previously recognized in cartilage). Because failure of the structural integrity of the disc can result in annular tears and subsequent disc herniation, the mechanisms of crystal formation and the relationship between crystals and disc degeneration merit further investigations.
Gruber
Helen E
HE
Department of Orthopaedic Surgery, Orthopedic Research Biology, Carolinas Medical Center, Charlotte, NC 28232, USA. helen.gruber@carolinashealthcare.org
Norton
H James
HJ
Sun
Yubo
Y
Hanley
Edward N
EN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001718:Birefringence; D003460:Crystallization; D011756:Diphosphates / Q000737:chemistry* / Q000378:metabolism; D005109:Extracellular Matrix / Q000737:chemistry* / Q000378:metabolism; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000378:metabolism* / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008859:Microscopy, Polarization; D008875:Middle Aged; D010070:Oxalates / Q000737:chemistry* / Q000378:metabolism; D011446:Prospective Studies; D013122:Spinal Diseases / Q000209:etiology*
D011756:Diphosphates; D010070:Oxalates