title: Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index.
abstract: BACKGROUND
  Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI) is limited to date. The current study was designed to correlate major physico-clinical parameters from a population of orthopaedic spine center patients (gender, age and BMI) with a quantitative histologic degeneration score (HDS).
  
  
  METHODS
  Excised lumbar disc material from 854 patients (529 men/325 women/mean age 56 (15-96) yrs.) was graded based on a previously validated histologic degeneration score (HDS) in a cohort of surgical disc samples that had been obtained for the treatment of either disc herniation or discogenic back pain. Cases with obvious inflammation, tumor formation or congenital disc pathology were excluded. The degree of histological changes was correlated with sex, age and BMI.
  
  
  RESULTS
  The HDS (0-15 points) showed significantly higher values in the nucleus pulposus (NP) than in the annulus fibrosus (AF) (Mean: NP 11.45/AF 7.87), with a significantly higher frequency of histomorphological alterations in men in comparison to women. Furthermore, the HDS revealed a positive significant correlation between the BMI and the extent of histological changes. No statistical age relation of the degenerative lesions was seen.
  
  
  CONCLUSIONS
  This study demonstrated that histological disc alterations in surgical specimens can be graded in a reliable manner based on a quantitative histologic degeneration score (HDS). Increased BMI was identified as a positive risk factor for the development of symptomatic, clinically significant disc degeneration.
authors.affiliation: Institute of Pathology, Ludwig-Maximilians-University Munich, Germany. Christoph.Weiler@med.uni-muenchen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Weiler
authors.forename: Mercedes
authors.initials: M
authors.lastname: Lopez-Ramos
authors.forename: H Michael
authors.initials: HM
authors.lastname: Mayer
authors.forename: Andreas
authors.initials: A
authors.lastname: Korge
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Siepe
authors.forename: Karin
authors.initials: K
authors.lastname: Wuertz
authors.forename: Veronique
authors.initials: V
authors.lastname: Weiler
authors.forename: Norbert
authors.initials: N
authors.lastname: Boos
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Nerlich
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