title: Significance of cartilage endplate within herniated disc tissue.
abstract: OBJECTIVE
  Disc herniations sometimes contain hyaline cartilage fragments, but their origins and significance are uncertain.
  
  
  METHODS
  Herniations were removed surgically from 21 patients (aged 35-74 years) whose main symptom was sciatica (10 patients) or back pain (11 patients). Frozen sections, 5 µm thick, were examined histologically, and antibodies were used to label the matrix-degrading enzyme MMP 1, pro-inflammatory mediator TNFα, and cell proliferation marker Ki-67. Proportions of each tissue type were quantified by image analysis. Cartilage and bone components of the endplate were examined in 7-µm frozen sections from 16 cadaveric spines, aged 61-98 years.
  
  
  RESULTS
  Cartilage fragments were found in 10/21 herniations. They averaged 5.0 mm in length, comprised 25 % of the herniation area, and two had some bone attached. Hyaline cartilage was more common in herniations from patients with sciatica (7/10) than with back pain (3/11, P = 0.050), and the area (%) of the herniation occupied by the cartilage was greater in sciatica patients (P < 0.05). Cartilage fragments showed little evidence of swelling, proteoglycan loss or inflammatory cell invasion, although cell clustering was common, and TNFα was sometimes expressed. Each cartilage fragment showed at least one straight edge, as if it had been peeled off the bony endplate, and this mechanism of failure was demonstrated in preliminary mechanical experiments.
  
  
  CONCLUSIONS
  Disc herniations often include hyaline cartilage pulled from the vertebral endplates. Cartilage fragments show little swelling or proteoglycan loss, and may be slow to resorb, increasing the risk of persisting sciatica. Loss of cartilage will increase endplate permeability, facilitating endplate inflammation and disc infection.
authors.affiliation: Department of Anatomy, Sikkim Manipal University, Sikkim, India, pollylama@smims.smu.edu.in.
authors.forename: Polly
authors.initials: P
authors.lastname: Lama
authors.forename: Uruj
authors.initials: U
authors.lastname: Zehra
authors.forename: Christian
authors.initials: C
authors.lastname: Balkovec
authors.forename: Henry A
authors.initials: HA
authors.lastname: Claireaux
authors.forename: Luke
authors.initials: L
authors.lastname: Flower
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Harding
authors.forename: Patricia
authors.initials: P
authors.lastname: Dolan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism; D001696:Biomechanical Phenomena / Q000502:physiology; D002102:Cadaver; D017586:Diskectomy; D005260:Female; D006801:Humans; D051457:Hyaline Cartilage / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D007249:Inflammation / Q000378:metabolism; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011509:Proteoglycans / Q000378:metabolism; D012585:Sciatica / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D013718:Tensile Strength / Q000502:physiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015415:Biomarkers; D011509:Proteoglycans; D014409:Tumor Necrosis Factor-alpha