Histopathological Features of Lumbar Disc Protrusion : Clinical Findings

Abstract

Lumbar disc protrusion, the main symptom of low back pain and leg pain, is disease that is highly prevalent in the 30s to 40s, causes temporary disability and causes pain to patients if not treated in time. The type and classification of lumbar disc protrusion is often based on the location and type of  protrusion based on MRI or radiographic images. Currently, there is growing body of research to classify disc prolapse into four types of tissue types : damage-herniation type, degenerative-protrusion type, osteochondrosis with disc protrusion type and intervertebral disc cysts, to assess disease status according to each histotype and to provide concurrent treatment. We aimed to investigate the clinical features of lumbar disc protrusion according to the histopathological pattern. The study population included 96 patients (54 men and 42 women) who were diagnosed with lumbar disc protrusion and treated surgically for 3 years. H-E staining was prepared according to the conventional tissue preparation method using surgical excised male nucleus and fibrous annulus under the diagnosis of lumbar disc protrusion. In the vertebral pulp-fibrous ring, degeneration, destruction, thickening and sclerosis indices, the appearance cells were observed for inflammatory cells, chondroid crypt cells, mature bone cells and synovial epithelial cells. The incidence of histological type was 29.1% with the type of damage-herniation type, 52.0% with degenerative-protrusion type, 15.6% with osteochondrosis with disc protrusion type and 3.1% with degenerative-protrusion type. The incidence of lumbar disc protrusion was calculated according to the histopathological pattern of the patients’ subjective symptoms and electromyographic findings and significance tests were performed for each histological type.  The clinical features of lumbar disc protrusion are as follows: Subjective symptoms included low back pain disconnected in the damage-herniation type, lumbar lordosis and severe muscle atrophy in the degenerative-protrusion type and heavy back pain and neurogenic claudication in the osteochondrosis with disc protrusion  type. Electromyography showed high H-wave elevation in the form of damage-herniation type, moderate conduction velocity delay and H-wave loss in the degenerative-protrusion type and severe conduction velocity delay.