Effects of steroid and lipopolysaccharide on spontaneous resorption of herniated intervertebral discs. An experimental study in the rabbit.

STUDY
DESIGN: Histologic examination was performed on autografted intervertebral disc materials of rabbit models, which were partially incised through a retroperitoneal approach at L1-L2 and grafted within the posterior epidural space at L4.
OBJECTIVE: To evaluate whether the resorption process of the herniated intervertebral disc is influenced and controlled by treatments with medications. SUMMARY OF BACKGROUND DATA: Regarding resorption of herniated intervertebral discs, recent studies of magnetic resonance images and histologic investigations of surgically resected specimens in lumber disc herniation patients have been reported. It has been shown that inflammatory factors may play an important role in the mechanism of resorption of the herniated intervertebral disc. However, little is known about the origin of newly formed vessels and inflammatory cells detected in herniated disc specimens from patients. In this study, The resorption process of disc material grafted into the epidural space was observed in a rabbit model.
METHODS: Thirty-six adult rabbits were used. The L1-L2 intervertebral disc was partially incised through a retroperitoneal approach. The harvested disc material, which contains the nucleus pulposus and the anulus fibrosus were placed into the posterior epidural space at L4 of the same rabbit. The animals were divided into control, and steroid groups. The control group received no treatment after surgery. In the lipopolysaccharide group, rabbits were injected 1 mg/kg into the peritoneum immediately and at 7 days after surgery. In the steroid group, rabbits were injected with 1 mg/kg betamethasone into the epidural space daily from 1 to 7 days after surgery. Rabbits of each group were killed for histologic examination at 1, 2, 4, and 8 weeks after surgery.
RESULTS: At 1 and 2 weeks after surgery, inflammatory cells and newly formed vessels were more frequently observed in the lipopolysaccharide group than in the control and steroid groups. At 4 weeks after surgery, derangement and loosening of collagen fibers were also observed in the lipopolysaccharide group. At 8 weeks after surgery, fragmentation and partial disappearance of matrix were observed in the control and lipopolysaccharide groups. Most of the intervertebral discs were replaced by fibrous tissues in the lipopolysaccharide group. However, the matrix of the intervertebral disc almost remained.
CONCLUSIONS: Autologous intervertebral disc material grafted into the epidural space was penetrated by newly formed vessels produced from the epidural fat tissue and resolved as the result of inflammatory reaction. Lipopolysaccharide accelerated the replacement of grafted intervertebral disc by fibrous tissue, which suggests the resorption of the disc in the epidural space of the rabbit, whereas high-dose steroid suppressed the replacement.