title: In vivo effects of bupivacaine and gadobutrol on the intervertebral disc following discoblock and discography: a histological analysis.
abstract: OBJECTIVE
  The aim of the present study was to histologically compare chondrotoxicity in surgically harvested intervertebral discs (IVDs) of patients following discoblock, discography, or no preoperative intervention.
  
  
  METHODS
  Thirty patients (IVD degeneration Modic ≥ 2°, Pfirrmann 3° or 4°) at L4/5 or L5/S1 who were planned for anterior lumbar interbody fusion were randomly assigned to three groups (open MRI: group DG - discography with gadobutrol; group DB - discoblock with bupivacaine at 4 weeks prior to surgery; group C - no intervention). The intervertebral discs were histologically evaluated and compared using ANOVA and Bonferroni tests for cell count, apoptosis, and proliferation.
  
  
  RESULTS
  A reduced cell count (groups DG vs. DB vs. C: 14.9 ± 7.1, 9.2 ± 3.8, and 16.6 ± 5.2 cells/mm2, respectively; pANOVA= 0.016), increased apoptosis (groups DG vs. DB vs. C: 34.9 ± 10.2, 47.4 ± 16.3, 32.6 ± 12.2 %, respectively; pANOVA= 0.039) and increased cell proliferation (post hoc pDB vs. DG or C p < 0.001; for 3-7 cell monoclonal cell nests: groups DG vs. DB vs. C: 2.4 ± 1, 3.9 ± 1, 2.2 ± 1.1, respectively; pinterventionx nest size= 0.006) were found in the IVDs of patients in group DB.
  
  
  CONCLUSIONS
  This in vivo study suggests that chondrotoxic effects occur in IVD cells after the intradiscal injection of bupivacaine but not after gadobutrol administration.
  
  
  CONCLUSIONS
  • Local bupivacaine administration to intervertebral discs leads to cell toxicity and proliferation. • Gadobutrol demonstrated no significant effect on cell count, apoptosis, or cell proliferation. • In vivo cytotoxicity was demonstrated histologically in humans for the first time. • Addition/administration of bupivacaine during discographies must be judged critically.
authors.affiliation: Klinik für Orthopädie, Friedrich-Schiller-Universität Jena, Campus Waldkrankenhaus "Rudolf Elle" Eisenberg, Klosterlausnitzer Strasse 81, 07607, Eisenberg, Germany. patrick.strube@uni-jena.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Strube
authors.affiliation: Institut für Pathologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Berit M
authors.initials: BM
authors.lastname: Pfitzner
authors.affiliation: Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Streitparth
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Tony
authors.initials: T
authors.lastname: Hartwig
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Putzier
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D007403:Intervertebral Disc / Q000000981:diagnostic imaging; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods*; D009942:Organometallic Compounds / Q000008:administration & dosage*; D013123:Spinal Fusion / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D002045:Bupivacaine
keywords: Analgesic discography; Apoptosis; Bupivacaine; Discoblock; Gadobutrol