Prognostic scores in intensive care

Type X collagen has so far not been reported to occur in human intervertebral discs. The objective of this study was therefore to investigate the occurrence of type X collagen in human lumbar intervertebral discs during ageing and degeneration. Ninety intervertebral discs with adjacent endplates were excised in toto from individuals (0-86 years) without known spinal disease and were processed for routine decalcified histology. Appropriate slices of each disc were processed for immunohistochemistry using a type-specific, monoclonal antibody raised against human type X collagen. Each intervertebral disc was examined for macroscopic and histomorphological features of disc degeneration. Immunohistochemically, a positive specific type X staining was observed in the hypertrophic zone of the growth plate and only in the interstitial matrix of juvenile (<2 years) nucleus pulposus. In adult discs, type X collagen could be localized in conjunction with advanced disc degeneration and first occurred in the disc matrix (i.e., pericellular region) of a 47-year-old specimen. Positive type X staining of the disc matrix was more frequently found in senile (>70 years) discs with end stages of disc degeneration. This study provides the first evidence for the occurrence of type X collagen in human lumbar intervertebral discs and it appears that type X collagen is re-expressed in late stages of disc degeneration.     

Intragenic polymorphisms of the vitamin D receptor gene associated with intervertebral disc degeneration

STUDY DESIGN: A study in genetic epidemiology of disc degeneration, based on lifetime exposure data, findings on magnetic resonance imaging, and genotyping of intragenic markers. OBJECTIVES: To pursue the potential correlation between common allelic variations in the vitamin D receptor locus and degeneration of the intervertebral disc. SUMMARY OF BACKGROUND DATA: Familial aggregation has been observed in intervertebral disc degeneration, but the relative significance of the genetic component and shared environmental influences is unknown. The identification of relevant candidate genes associated with disc degeneration would specify a genetic component and increase our understanding of the etiopathogenesis of disc degeneration. METHODS: From the population-based Finnish Twin cohort, 85 pairs of male monozygotic twins were selected based on exposure to suspected risk factors for disc degeneration. Interview data were gathered on relevant lifetime exposures, and thoracic and lumbar disc degeneration was determined through quantitative and qualitative assessments of signal intensity on magnetic resonance imaging, and qualitative assessments of disc bulging and disc height narrowing. Possible associations were examined between disc degeneration measures and two polymorphisms of the coding region of the vitamin D receptor locus. RESULTS: Two intragenic polymorphisms of the vitamin D receptor gene revealed an association with disc degeneration. Quantitatively assessed signal intensities of thoracic and lumbar (T6-S1) discs were 12.9% worse in men with the Taql tt genotype and 4.5% worse in men with the Tt genotype, compared with signal intensity in men with the TT genotype (age adjusted P = 0.003). A similar pattern was found between disc signal intensity and Fokl genotypes; men with the ff and Ff genotypes had mean signal intensities that were 9.3% and 4.3% lower, respectively, than those in men with FF genotypes (age-adjusted P = 0.006). The summary scores of qualitatively assessed signal intensity, bulging, and disc height were 4.0% and 6.9% worse in men with Ff and ff genotypes, respectively, when compared with those in men with the FF genotype (age-adjusted P = 0.029). CONCLUSION: Specific vitamin D receptor alleles were associated with intervertebral disc degeneration as measured by T2-weighted signal intensity, demonstrating for the first time, the existence of genetic susceptibility to this progressive, age-related degenerative process.     

Objective measurement of the height of lumbar intervertebral disks from lateral roentgen views of the spine

OBJECTIVE: Published methods to quantify height of lumbar discs from lateral radiographic views of the lumbar spine yield inaccurate results due to distortion in central projection. Normal values of disc height have not been compiled. METHODS: Starting from an analysis of the imaging properties of vertebral bodies in a lateral view and following a logical evolution of Farfan's proposal, a new protocol for the measurement of disc height is given which is independent of distortion. A database of normal values of the height of lumbar discs from T12/L1 to L5/S1 was compiled from 892 lateral views of healthy male and female subjects in the age range between 16 and 57 years. RESULTS: Employing the new protocol, height of all discs on a lateral view can be measured. Variations in position (standing, side-lying) do not influence the result. Retrospective investigations are feasible. The precision of the disc height measurement amounts to 4.15%. Normal, age-appropriate values for the height of lumbar discs are given for the first time. In the individual case, disc height can be quantitatively evaluated by comparison with the normative database. CLINICAL RELEVANCE: The new protocol can be employed to quantitatively identify processes which effect a decrease of disc height. In the individual case, the new protocol and the comparison with the normal database can be employed to quantitatively assess overload injury to lumbar discs in compensation cases.     

Thoracic discography. A safe and reliable technique

OBJECTIVES: To evaluate the safety and reliability of discography used to investigate thoracic disc degeneration observed on magnetic resonance (MR) imaging studies in patients with clinical pain, we analyzed retrospectively the results of thoracic discograms performed on 100 outpatients. METHODS: After MR imaging, clinically suspect, morphologically abnormal thoracic discs and at least one, nearby, control level were injected with either nonionic contrast or saline, filmed, and individually described by the patient as concordant versus nonconcordant relative to clinical pain and rated in intensity on a scale of 0-10. RESULTS: There were no serious complications in the series, and the authors resolved whether the injected discs related to pain in each case. They found discs with anular tears, intrinsic degeneration, and/or associated vertebral body endplate infractions to be painful approximately 75% of the time. Clinical concordance was approximately 50%. Control levels were usually painless. CONCLUSIONS: They conclude that thoracic discography can be performed safely by experienced individuals as a reliable tertiary diagnostic procedure to determine if degenerated discs on MR studies are related to clinical complaints.     

Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation

STUDY DESIGN: The correlation between discogenic lumbar pain and disc morphology was investigated by using magnetic resonance imaging and discography. OBJECTIVES: To assess the various pathologic parameters seen on magnetic resonance imaging in patients with discogenic lumbar pain and to correlate them with observations on discography. SUMMARY OF BACKGROUND DATA: Although numerous previous studies on the subject have been performed, the correlations between various pathologic findings on magnetic resonance imaging and pain reproduction by provoked discography have not been explained fully. METHODS: One hundred and one lumbar discs in 39 patients were studied with magnetic resonance imaging and pain provocation discography. When pain reproduction under discography was concordant, various pathologic parameters on magnetic resonance imaging were analyzed by three statistical parameters to determine the associated magnetic resonance imaging findings. RESULTS: Radial tears commonly are demonstrated on magnetic resonance imaging in discs with concordant pain on discography. The presence of these tears is not a reliable predictor of a painful disc on discography. Although a high-intensity zone on T2-weighted images is a relatively reliable predictor of pain, the statistical values were lower than those in previous studies. Massive degeneration and severe disc height loss were rare in this population. These findings were good predictors of pain on disc injection. CONCLUSIONS: Although the lumbar intervertebral discs with posterior combined anular tears are likely to produce pain, the validity of these signs for predicting discogenic lumbar pain is limited.     

Severe primary HIV-1 infection among black persons in Barbados

The purpose of this long-term follow-up was (1) to investigate disc changes in the olisthetic segment in patients treated conservatively, (2) to compare disc changes above the slipped vertebra in conservatively treated patients with those in operatively treated patients, and (3) to establish possible relations of disc changes to the degree of the slip and to subjective back pain symptoms of the patients. The subjects were 227 patients with isthmic L5 olisthesis diagnosed under 20 years of age (mean 13.8 years) with a mean follow-up of 15.4 (range 5-30) years. Of these, 145 patients had been treated with segmental fusion and 82 had been treated conservatively. At follow-up, standing anteroposterior and lateral radiographs as well as flexion/extension views of the lumbar spine were taken. Disc degeneration was graded semiquantitatively: 0 = normal disc height, 1 = decrease of disc height < 50%, 2 = decrease > or = 50%, and 3 = obliteration of the disc. In the conservatively treated patients degeneration of the olisthetic disc was distributed by grade as follows: O: n = 38, 1: n = 24, 2: n = 14, 3: n = 6. No motion at all was observed in the olisthetic segment in 40 patients (48%) with a mean slip of 30%, segmental motion of 4 degrees-18 degrees was found in 42 patients with a mean slip of 14%. There was a statistically significant association of the degree of slip to the severity of disc degeneration and non-mobility of the segment. Grade 1 degeneration of the L4/5 disc occurred in 25.6% of the conservatively treated patients and in 32% of 48 patients treated with L5-S1 fusion. This correlated with the severity of the slip, but not with pain symptoms or pathologic segmental mobility at the time of follow-up. Out of 84 patients with L4-S1 fusion, in 17% grade 1 degeneration of the L3/4 disc was observed, and 3 out of 13 patients (23%) with L3-S1 fusion had grade 1 degeneration of the disc above the fusion. The disc changes had no correlation with subjective pain symptoms. It is concluded that the natural course of isthmic spondylolisthesis is associated with disc degeneration and spontaneous stabilization of the olisthetic segment. Fusion operations do not significantly increase the rate of disc degeneration in the adjacent disc above the fusion after a mean postoperative follow-up of 13.8 years. No correlation between the number of degenerated discs or the degree of degeneration and subjective low back pain symptoms was found.     

Lumbar percutaneous endoscopic interbody fusion

Since 1982, percutaneous endoscopic control has been found to be a fundamental help for selective posterior subligamentary decompression in lumbar contained disc herniations. After the first clinical experience in 1986 with percutaneous intervertebral bone grafting, the need for sufficient percutaneous preparation of the adjacent vertebral plates and postoperative immobilization of the operated on segment became evident. So in 1988, the original eccentrically abrasive end plate cutter for application under discoscopy was introduced. For a preoperative trial and postoperative stabilization, the complementary use of the external pedicle fixation device was standardized in 1988. The use of percutaneous autologous bone interposition was found essential for optimal bony interbody consolidation. The indications were limited strictly to monosegmental lumbar dysfunctions without a need for peridural decompression. In a series of 37 patients with standardized procedure and a mean followup of 33 months, bony interbody consolidation was achieved in 30 cases. The technique desists from any need for blood transfusion, and functional rehabilitation is facilitated because of the very limited percutaneous approach.     

Periarthritis of the shoulder. II. Radiological features

A group of 113 women and 73 men with periarthritis of the shoulder have been studied in detail. Electromyography showed 4 patients with neuralgic amyotrophy who had been referred for the shoulder study but were excluded on this basis. Nerve conduction studies showed little difference between the periarthritic group and a control group, apart from some reduction in amplitude and potential, and in women a suggestion of an increased latency. Duration of the action potential was equal. 6 patients had an undoubtedly long latency compatible with median nerve compression. Degenerative changes were found in the glenohumeral joints in 6-9%. Degenerative changes were found at the acromioclavicular joints in 31% of the men and 44% of the women. Calcification was found around 11 of the shoulder joints. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. Arthrography was performed in 7 patients and there was a reduction in volume of material that could be injected in only one patient. There was obliteration of the axillary fold in that patient, and a torn capsule in a patient who had previously been manipulated. Lateral cervical spine x-rays were compared with films from an epidemiological survey. The disc space/vertebral body height ratio was taken, overcoming the magnification effects shown by technical alterations in the method of taking films. Good intra- and interobserver correlation was found for this ratio, but not for the width of the canal. There was no difference in the disc/body ratio between the periarthritic and control group in the upper cervical region. In the C5/6 and C6/7 intervertebral discs there was evidence of more disc degeneration in the periarthritic group. The differences from the control group were not great because of the high incidence of disc space narrowing and osteophytosis after the age of 45 years in the general population.     

Manual ultrasound of the knee joint. A general practice method for diagnosis of fresh rupture of the anterior cruciate ligament

To determine the long-term outcome of 12 youthful patients with lumbar disc herniation, who, at the time of surgery, were 15 years old and younger (mean age at operation 14.3 years), we assessed their current clinical condition (mean follow-up time 6 years) with a questionnaire inquiring about symptoms and disability, and radiologically with an MRI of the lumbar spine. Clinically, only five patients (40%) were totally asymptomatic and seven patients (60%) had recurring symptoms, both and disability. On MRI, seven patients (60%) had persistent stenosing changes at the operated disc levels and eight patients (65%) also had disc degeneration at other lumbar levels. Despite the symptoms and quite severe radiological findings, the long-term outcome was assessed as good or moderate in eleven patients (90%). As far as comparisons are reasonable, our results appear somewhat less favourable than those in two previous paediatric series, but they agree with those in two recent large series of adults.     

Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham

STUDY DESIGN: A 25-year follow-up study of 606 members of the population-based Framingham cohort, who had received lateral lumbar radiographs in 1967-1968 and 1992-1993, and completed an interview on back symptoms at the second examination. OBJECTIVES: To evaluate whether calcific lesions in the posterior wall of the abdominal aorta, the source of the feeding arteries of the lumbar spine, are associated with disc degeneration or back pain, which would suggest that ischemia of the lumbar spine leads to disc degeneration. METHODS: The presence of radiographic aortic calcification was ascertained in front of each lumbar segment from L1 through L4, and disc degeneration at intervertebral spaces from L1-L2 through L4-L5. The associations between aortic calcification, disc degeneration, and back pain were tested using logistic regression with adjustment for age and sex. RESULTS: At the baseline examination, aortic calcification was significantly associated with general disc degeneration, that is, disc space narrowing or endplate sclerosis at any lumbar level (odds ratio 1.6; 95% confidence interval 1.0-2.5; P = 0.034). In longitudinal, level-specific analyses, comparing local aortic calcifications with disc degeneration at the matching level, aortic calcifications predicted disc deterioration, that is, a decrease in disc space or appearance of endplate sclerosis, between the examinations (odds ratio 1.5; 95% confidence interval 1.3-1.8; P < 0.001). Furthermore, subjects in whom aortic calcifications developed between the examinations had disc deterioration twice as frequently as those in whom aortic calcifications did not develop (odds ratio 2.0; 96% confidence interval 1.2-3.5; P = 0.013). Also, individuals with severe (Grade 3) posterior aortic calcification in front of any lumbar segment were more likely than others to report back pain during adult life (odds ratio 1.6; 95% confidence interval 1.1-2.2; P = 0.014). CONCLUSIONS: Advanced aortic atherosclerosis, presenting as calcific deposits in the posterior wall of the aorta, increases a person's risk for development of disc degeneration and is associated with the occurrence of back pain.     

Age-dependent correlation of low-back pain and lumbar disc regeneration

The prevalence of lumbar disc degeneration in subjects suffering from low-back pain (n = 207; age range 10-49 years) and in age-matched asymptomatic controls (n = 216) was investigated by magnetic resonance imaging. The percentage of subjects with degenerated discs increased with age; starting from the age of 15 years, this increase was more rapid in subjects with low-back pain. Concurrently, the number of degenerated discs was higher in the pain group than in controls. Lumbar disc degeneration manifests earlier and in a greater percentage of subjects with low-back pain than in asymptomatic controls.     

Carpal tunnel syndrome, humeral epicondylitis, and the cervical spine: a study of clinical and dimensional relations

Forty-three patients with idiopathic carpal tunnel syndrome, confirmed by nerve conduction studies and treated by surgery, were compared clinically and radiologically with 43 age- and sex-matched control patients. Patients with carpal tunnel syndrome had a significantly greater prevalence of lateral humeral epicondylitis (tennis elbow) (33%) than controls (7%). Randomised reading of the cervical spine radiographs in ignorance of the groups to which they belonged showed no significant difference in the prevalence of either intervertebral disc degeneration or intraforaminal osteophyte protruion using conventional grading methods. Measurement of the minimum anteroposterior diameter of the cervical spinal canal, the anteroposterior diameters of the cervical vertebral bodies, and the ratio of intervertebral disc height to adjacent vertebral body height in the cervical spine, however, showed a consistent trend to smaller measurements in the carpal tunnel group. Differences were significant at several vertebral levels in each of these dimensions. The narrowing of the intervertebral discs relative to the vertebral bodies in patients with carpal tunnel syndrome may indicate connective tissue changes, which might also occur in the common extensor origin at the elbow or in the contents of the carpal tunnel.     

Injuries in the adolescent porcine spine exposed to mechanical compression

STUDY DESIGN: An experimental porcine study in which functional lumbar spinal units were tested in compression to failure. Biomechanical, radiographic, magnetic resonance imaging, and histological characteristics are described. OBJECTIVES: To explain the different patterns of injury seen in adults and adolescents resulting from traumatic injury to the vertebrae and to explain the mechanism behind traumatic displacement of the ring apophysis seen in athletes. SUMMARY OF BACKGROUND DATA: Recent investigations of the spine in adolescent who have sustained trauma have shown injuries to the growth zone, whereas studies of adults have shown injuries to the vertebral body. A higher frequency of abnormalities in the discs, the vertebral bodies, the endplates, and the ring apophyses has been demonstrated in athletes with high loads on the spine. There is controversy over the etiology of these changes. METHODS: Twelve functional lumbar spinal units (vertebra-disc-vertebra) obtained from six young male pigs were tested in compression to failure. All units were examined with plain radiography and magnetic resonance imaging before and after compression. After the compression, histologic samples were taken from the injury site. RESULTS: Identical traumatic changes were seen in all functional lumbar spinal units, i.e., fracture in the endplate through the growth zone posteriorly and displacement of the anulus fibrosus with a bony fragment at the point of insertion of the vertebra. The nucleus pulposus was ruptured and displaced through the fracture line in all cases. The injuries were not seen on radiographs but were detected on magnetic resonance images, as confirmed on microscopic and histologic examination. CONCLUSION: This study shows that the weakest part of the lumbar spine of the juvenile pig, when compressed, is the growth zone and the junction between the point of insertion of the anulus fibrosus and the vertebra. This location of weakness may explain the high frequency of disc degeneration and "persisting apophysis" seen in the spine of athletes.     

A case report on surgery for chylothorax after anterior spinal fusion: usefulness and effectiveness of intraoperative milk administration and postoperative OK-432 administration]

After having reported preliminary results of soft system stabilization according to Graf in a series of 27 patients with degenerative disc disease of the lumbar spine in early 1995 the authors report long term clinical and radiological results of this patient series (n = 25). At a mean period of postoperative observation of 50 months excellent, good, satisfactory, moderate and poor results were obtained in 62, 9%, 11, 1% and 11, 1%, 7, 4% and 7, 4% of the patients, respectively. The well-known phenomenon of loss of disc height at the level of posterolateral fusion and instrumentation as well as overcharge of adjacent segments were not observed after soft system stabilization. Regional as well as global lumbar lordosis were maintained and, although statistically not significant, an increase of intervertebral distance was observed in adjacent segments in flexion of the lumbar spine. These phenomena might represent pressurization of instrumented as well as adjacent discs after the insertion of ligament prostheses. It is the impression of the authors, that the Graf technique leads to good surgical results in degenerative disc disease with destabilization of lumbar motion segment(s) if the following criteria are strictly respected: 1. No or only mild arthrotic changes of the facet joints 2. Preferably minor disc degeneration/only mild loss of intervertebral distance. 3. Well trained low back muscles and 4. A clear-cut, repeatedly demonstrated pain-relief on trial anaesthesia of the corresponding articular nerves and while wearing a probatory jacket.     

Soft tissue for allograft reconstruction of the human knee: a survey of the American Association of Tissue Banks

STUDY DESIGN: The reactions to sequestrated disc fragments, which were removed surgically from 35 patients, were examined histologically. OBJECTIVES: To elucidate whether or not there is histologic evidence of absorption of sequestrated discs. SUMMARY OF BACKGROUND DATA: Spontaneous disappearance or diminution of lumbar herniated discs in the spinal canal has been recognized, and this could be a possible explanation for relief of symptoms without surgery. The mechanism of this phenomenon is unclear. METHODS: Sequestrated discs removed surgically from 35 patients were examined histologically. RESULTS: In 30 cases, neovascularization was observed at the periphery of the sequestrated discs. Many foamy cells (macrophages) were present in the vascularized areas. In addition, immunohistochemistry revealed that many spindle-shaped, fibroblast-like cells were positive for CD68, a marker of macrophages. No fibrous scar formation was observed in any region. CONCLUSION: These findings suggest that organization is not a main course for this type of herniated disc and that a kind of "absorption" process occurs predominantly in the healing stage.     

Meningovertebral ligaments and their putative significance in low back pain

OBJECTIVE: To determine the presence and morphology of the meningovertebral ligaments (ligaments of Hofmann) as well as postulate their possible contribution to low back pain. DESIGN: Sagittal dissections were performed on 12 embalmed cadaver specimens including the L5/S1 intervertebral level cephalad to T1. Meningovertebral ligaments were labeled and documented in both the lumbar and thoracic regions. RESULTS: Meningovertebral ligaments were found in both the lumbar and thoracic regions of all cadaveric specimens. These ligaments were much more prevalent in the lumbar vertebral column but were also present throughout the thoracic vertebral column. The meningovertebral ligaments in the lumbar region were more robust as well as more frequently encountered than those found in the thoracic region. CONCLUSION: Dural sac attachments to the posterior aspect of the vertebral bodies and the posterior longitudinal ligament could act to traction the dural sac in the event of nuclear bulge or herniation. The prevalence of these ligaments in the lumbar spine, coupled with the high incidence of herniated nucleus pulposus and disc bulges in this region, may compound the effects of disc pathology and result in increased low back pain.     

Late results of cervical disc surgery

Late results of cervical disc surgery have been reported and statistically studied in 383 cases: 83% were lateral discs, 13% were central spondylosis discs, and 4% central soft discs. Central spondylosis occured at a higher spinal level, and caused cord compression with or without weakness of the hands, but no pain. A posterior approach was used in all lateral discs, and either an anterior or a posterior approach, with or without fusion, for central discs. Preoperative myelography was always done and is recommended postoperatively in central disc surgery to evaluate the results. Our results were good to excellent in 95% of lateral discs, in 64% of central spondylosis discs, and in an unexpected 91% of 11 cases of central soft discs. There were no recurrences and no serious complications, although 20% developed other cervical or lumbar disc herniations.     

Observations on the miraxonal attraction exercised by sexually immature or adult Biomphalaria glabrata infected or not by Schistosoma mansoni

With CT imaging, the lumbar facet joints are well visualised and enlargement secondary to degeneration may be noted. We measured the cross-sectional area of the superior articular process of the L5 facet joint in 100 consecutive CT scans and in 71 patients, the L4 process was also measured. We found that the mean cross-sectional area was significantly larger at L5 than at L4. Patient age and sex had no significant effect on the size at either L4 or L5. A review of the radiological reports revealed that the 13 patients with degenerative facet joints and radiologically normal discs did not have significantly larger facet joints than the 35 patients with disc disease and radiologically normal facet joints. In conclusion, the term "facet joint hypertrophy" should not be used when osteoarthritic changes are noted on CT scan, because these joints are not significantly larger than normal facet joints.     

Groin pain associated with lower lumbar disc herniation

STUDY DESIGN: Retrospective clinical and magnetic resonance imaging study of patients with groin pain associated with lower lumbar disc herniation. OBJECTIVES: To demonstrate the clinical features and magnetic resonance imaging findings of these patients. SUMMARY OF BACKGROUND DATA: Patients with lumbar disc herniation sometimes report groin pain. Little mention has been made, however, regarding the clinical features of groin pain stemmed from lower lumbar disc herniation until now, with only Murphey referring to groin pain in disc disease. METHODS: A total of 512 patients were diagnosed with singular lower lumbar disc herniation (L4-L5 and L5-S1) at Kakegawa City General Hospital between July 1990 and December 1993. Of these patients, 21 (4.1%) reported groin pain. The characteristic clinical features and magnetic resonance imaging findings of the 21 patients were investigated and compared with the features and findings of patients with no groin pain. RESULTS: Patients with groin pain had a higher mean age and lower rate of low back pain, and L4-L5 discs were more likely to be involved than L5-S1 discs. In their magnetic resonance images, herniation tended to be more central than in patients with no groin pain. CONCLUSIONS: Elderly patients with L4-L5 protruding herniation of the anulus fibrosus were most likely to experience groin pain. The sinuvertebral nerve that innervates the posterior anulus fibrosus, the posterior longitudinal ligament, and the dura was indicated as the afferent nerve of groin pain.     

The topographical characteristics of the blood vessels of the human spine

Methods of roentgen angiography, injections of India ink-gelatin mass, morphometry, microscopy and others were used in an experiment carried out on non-fixed corpses of children and adults for studying functional topography of arteries and veins of the vertebral column. Posterior intercostal and lumbar arteries were established to give off 3-4 anterior and 3-5 lateral branches from each side which penetrate into paradiscal segments of the vertebral body. In 92% one lateral branch runs downwards to the intervertebral disc and lower vertebra. Great number of vertical branches of various diameters come off from intraorganic arteries of horizontal orientation of paradiscal segments to intervertebral discs. The medial segment contains distinct basivertebral, anterior and lateral veins falling into venous plexuses surrounding the vertebrae. The diameter of these veins depends on specific properties of angiotopography, sizes and shape of the vertebra. The regular trends in question aid to explain the question of pathogenesis of hematogenic lesions of the vertebrae and to choose the methods of osteoplastic operations.