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Updated: Mar 23, 2026
Optical Sectioning and Visualization of the Intervertebral Disc from Embryonic Development to Degeneration
Published on: July 8, 2021
Histological analysis of surgical samples and a proposed scoring system for infections in intervertebral discs
Prashanth J Rao1, Kevin Phan1, Monish M Maharaj1
1NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
Abstract:
Back pain remains one the most prevalent types of pain and disability worldwide. Infection is estimated to be the underlying cause in approximately 0.01% of patients. Despite recent evidence demonstrating prominent infection rates, a standardised algorithm for diagnosis of disc infection is lacking. Histopathological evaluation can aid in confirming inflammatory changes and also in identifying degenerative changes. Hence, standardising practice through a clear scoring system with regards to inflammation and degeneration may have some utility in the clinical setting. To our knowledge no such systems exist specifically for intervertebral disc infection. A literature review of current methods of scoring inflammation and degeneration in spine surgery and orthopaedic surgery was performed. Based on the current evidence, a scoring system for disc inflammatory and degenerative changes was proposed. We propose four domains for consideration: (1) granulation tissue, (2) dense fibrosis, (3) chronic inflammatory cells, and (4) neutrophil count. The non-standardised nature of diagnosing infections and degeneration in the spinal surgery literature means that this scoring system is currently of particular value. Based on a literature review, our proposed method for diagnosis incorporates a combination of histopathological criteria expected to increase diagnostic sensitivity in the setting of disc infection. Overall, scoring can be applied to surgically obtained material and integrated directly into routine pathological practice.
Insights
A new scoring system for diagnosing intervertebral disc infection is proposed. This histopathological method aids in identifying inflammation and degeneration, improving diagnostic accuracy in spinal surgery.
Area of Science:
- Orthopedics
- Pathology
- Spinal Surgery
Background:
- Back pain and disability are globally prevalent.
- Disc infection is an underdiagnosed cause of back pain, lacking standardized diagnostic algorithms.
- Histopathology is crucial for identifying inflammatory and degenerative changes in the spine.
Purpose of the Study:
- To propose a standardized scoring system for diagnosing intervertebral disc infection.
- To enhance diagnostic sensitivity using histopathological criteria.
- To integrate a scoring system into routine pathological practice for spinal surgery.
Main Methods:
- Conducted a literature review of inflammation and degeneration scoring in spine and orthopedic surgery.
- Developed a novel scoring system based on current evidence.
- Proposed four key histopathological domains: granulation tissue, dense fibrosis, chronic inflammatory cells, and neutrophil count.
Main Results:
- A new scoring system for disc inflammatory and degenerative changes was proposed.
- The system incorporates specific histopathological criteria to improve diagnostic sensitivity.
- This scoring system is valuable due to the current lack of standardized diagnostic methods in spinal surgery.
Conclusions:
- The proposed scoring system offers a standardized approach to diagnosing intervertebral disc infection.
- Integration into routine pathology practice can improve diagnostic accuracy for surgically obtained spinal material.
- This method addresses a critical gap in the current diagnostic landscape for spinal infections.
