title: Effect of a hypercholesterolemia as a starting factor on spinal degeneration in rabbits and role of Vitamin E (α-tocopherol).
abstract: BACKGROUND
  To identify the role of the hypercholesterolemia as a starting factor in discovertebral degeneration that ultimately causes lower back pain, and investigate the role of Vitamin E in this process.
  
  
  METHODS
  The rabbits (n = 32) were divided into two broad experimental groups: A control group, and a hypercholesterolemia group, namely cholesterol, and cholesterol plus Vitamin E groups and they were fed sequentially for 4 or 8 weeks. Serum cholesterol and Vitamin E (α-tocopherol) levels were determined; vascular tissue was prepared for histopathological analyses and vertebra was decalcified for the study.
  
  
  RESULTS
  Cholesterol diet group resulted approximately 44-fold of increase plasma cholesterol levels over the 4-week control values. Additional supplementation with Vitamin E group induced a plasma cholesterol level increase of only 37-fold as compared to the control group. In the cholesterol groups, light microscope examination revealed atherosclerotic plaque in major arteries. However, in the cholesterol plus Vitamin E treatment groups, no lipid accumulation or foam cell formation was visible in the abdominal aorta and vertebral segmental artery. In histopathological examination, we found degenerative changes in the discovertebral unit in cholesterol treated groups.
  
  
  CONCLUSIONS
  Hypercholesterolemia causes fat accumulation in the disc endplate and vertebral body that causes blood supply disturbances which might be a starting factor of discovertebral degeneration. This event was not reversed by the elimination of cholesterol from the diet. Vitamin E supplementation was not effective in reducing fat accumulation in vertebral bone marrow. As a result, we conclude that degeneration of the discovertebral unit is not related to atherosclerotic changes in the major blood vessels.
authors.affiliation: Department of Neurosurgery, American Hospital, Istanbul, Turkey, Turkey.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sasani
authors.affiliation: Department of Neurosurgery, Istanbul Physical Therapy and Rehabilitation Training Hospital, Istanbul, Turkey.
authors.forename: Ahmet Levent
authors.initials: AL
authors.lastname: Aydın
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA.
authors.forename: Nurgul
authors.initials: N
authors.lastname: Aytan
authors.affiliation: Department of Pathology, School of Medicine, Acibadem University, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yapicier
authors.affiliation: Department of Neurosurgery, American Hospital, Istanbul, Turkey, Turkey.
authors.forename: Tunc
authors.initials: T
authors.lastname: Oktenoglu
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Nesrin Kartal
authors.initials: NK
authors.lastname: Ozer
authors.affiliation: Department of Neurosurgery, School of Medicine, Koc University, Istanbul, Turkey.
authors.forename: Ali Fahir
authors.initials: AF
authors.lastname: Ozer
keywords: Atherosclerosis; Vitamin E; disc degeneration; hypercholesterolemia; rabbit spine; spine degenerative disease