What changes occur in the biochemistry of the disc with disc degeneration

• Annulus. The ratio and relative distribution of type 1 to type 2 collagen changes in the outer annulus. A decrease in collagen cross-links occurs, making the annulus more susceptible to mechanical failure

• Nucleus. Matrix changes occur including fragmentation of proteoglycans (mainly aggrecan), increase in the ratio of keratin sulfate to chondroitin sulfate, decreases in proteoglycan and water concentrations, and decrease in number of viable cells

• Endplate. Thickening and calcification in the endplate region leads to decreased blood supply and impaired disc nutrition, which contributes to tissue breakdown in the endplate region and nucleus (Fig. 45-2)

Fibroblast Co||agen 1

Fibroblast Co||agen 1

Figure 45-2. Microstructure of the intervertebral disc. The annulus fibrosus consists of densely packed layers of collagen type 1 fibers maintained by fibroblast cells. The fiber direction of each layer is perpendicular to the adjacent layer. The nucleus pulposus contains collagen type 2 fibers providing support, proteoglycan aggregates that attach water molecules, and chondrocytes that maintain the type 2 collagen and the proteoglycan matrix in which it is embedded. (From Chung SA, Khan SN, Diwan Ad. The molecular basis of disc degeneration. Orthop Clin North Am 203;34:209-19. Fig. 1 on p. 210.)

Figure 45-2. Microstructure of the intervertebral disc. The annulus fibrosus consists of densely packed layers of collagen type 1 fibers maintained by fibroblast cells. The fiber direction of each layer is perpendicular to the adjacent layer. The nucleus pulposus contains collagen type 2 fibers providing support, proteoglycan aggregates that attach water molecules, and chondrocytes that maintain the type 2 collagen and the proteoglycan matrix in which it is embedded. (From Chung SA, Khan SN, Diwan Ad. The molecular basis of disc degeneration. Orthop Clin North Am 203;34:209-19. Fig. 1 on p. 210.)

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