The Journal of Bone and Joint Surgery (American). 2006;88:30-35.
doi:10.2106/JBJS.E.01290
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Nutrient Supply and Intervertebral Disc Metabolism

Thijs Grunhagen, MSc, Geoffrey Wilde, BSc, Dahbia Mokhbi Soukane, BSc, Saeed A. Shirazi-Adl, PhD and Jill P.G. Urban, PhD

Corresponding author:
Jill P.G. Urban, PhD
University Laboratory of Physiology, Oxford University, Parks Road, Oxford OX1 3PT, United Kingdom.
E-mail address: jpgu{at}physiol.ox.ac.uk

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Arthritis Research Campaign and the European Union (EU consortium, Eurodisc QLK6-CT-2002-02582). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The metabolic environment of disc cells is governed by the avascular nature of the tissue. Because cellular energy metabolism occurs mainly through glycolysis, the disc cells require glucose for survival and produce lactic acid at high rates. Oxygen is also necessary for cellular activity, although not for survival; its pathway of utilization is unclear. Because the tissues are avascular, disc cells depend on the blood supply at the margins of the discs for their nutrients. The nucleus and inner anulus of the disc are supplied by capillaries that arise in the vertebral bodies, penetrate the subchondral bone, and terminate at the bone-disc junction. Small molecules such as glucose and oxygen then reach the cells by diffusion under gradients established by the balance between the rate of transport through the tissue to the cells and the rate of cellular demand. Metabolites such as lactic acid are removed by the reverse pathway. The concentrations of nutrients farthest from the source of supply can thus be low; oxygen concentrations as low as 1% have been measured in the discs of healthy animals. Although gradients cannot be measured easily in humans, they can be calculated. Measured concentrations in surgical patients are in agreement with calculated values.


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