Published in:
01-01-2017 | Interventional
In vivo effects of bupivacaine and gadobutrol on the intervertebral disc following discoblock and discography: a histological analysis
Published in: European Radiology | Issue 1/2017
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Objectives
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; p
ANOVA = 0.016), increased apoptosis (groups DG vs. DB vs. C: 34.9 ± 10.2, 47.4 ± 16.3, 32.6 ± 12.2 %, respectively; p
ANOVA = 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; p
intervention
x 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.
Key Points
• 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.