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Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index

Christoph Weiler1*, Mercedes Lopez-Ramos1, H Michael Mayer2, Andreas Korge2, Christoph J Siepe2, Karin Wuertz34, Veronique Weiler15, Norbert Boos34 and Andreas G Nerlich6

Author Affiliations

1 Institute of Pathology, Ludwig-Maximilians-University Munich, Germany

2 Spine Center, Orthopaedic Clinic Munich-Harlaching, Germany

3 Spine Research Group, Competence Center for Applied Biotechnology and Molecular Medicine, University Zurich, Switzerland

4 AO Spine Research Network, Duebendorf, Switzerland

5 Institute of Pathology, Academic Clinic Munich-Harlaching, Germany

6 Institute of Pathology, Academic Clinic Munich-Bogenhausen, Germany

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BMC Research Notes 2011, 4:497  doi:10.1186/1756-0500-4-497

Published: 16 November 2011



Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI) is limited to date. The current study was designed to correlate major physico-clinical parameters from a population of orthopaedic spine center patients (gender, age and BMI) with a quantitative histologic degeneration score (HDS).


Excised lumbar disc material from 854 patients (529 men/325 women/mean age 56 (15-96) yrs.) was graded based on a previously validated histologic degeneration score (HDS) in a cohort of surgical disc samples that had been obtained for the treatment of either disc herniation or discogenic back pain. Cases with obvious inflammation, tumor formation or congenital disc pathology were excluded. The degree of histological changes was correlated with sex, age and BMI.


The HDS (0-15 points) showed significantly higher values in the nucleus pulposus (NP) than in the annulus fibrosus (AF) (Mean: NP 11.45/AF 7.87), with a significantly higher frequency of histomorphological alterations in men in comparison to women. Furthermore, the HDS revealed a positive significant correlation between the BMI and the extent of histological changes. No statistical age relation of the degenerative lesions was seen.


This study demonstrated that histological disc alterations in surgical specimens can be graded in a reliable manner based on a quantitative histologic degeneration score (HDS). Increased BMI was identified as a positive risk factor for the development of symptomatic, clinically significant disc degeneration.

disc degeneration; histologic degeneration score (HDS); body mass; ageing; surgical material