J. P. H. J. Rutges, R. A. Duit, J. A. Kummer, J. E. J. Bekkers, F. C

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A validated new histological classification for intervertebral disc degeneration J.P.H.J. Rutges, R.A. Duit, J.A. Kummer, J.E.J. Bekkers, F.C. Oner, R.M. Castelein, W.J.A. Dhert, L.B. Creemers Osteoarthritis and Cartilage Volume 21, Issue 12, Pages 2039-2047 (December 2013) DOI: 10.1016/j.joca.2013.10.001 Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Histological examples of each degeneration grade per scorings item of the new histological IVD degeneration classification. A: Endplate (HE), B: Morphology AF (HE), C Boundary AF and NP (HE), D: Cellularity NP (HE), E: Matrix NP (HE), F: NP matrix staining (Saf O) and G: NP matrix staining (ABPR). The number 0 represents no degenerative characteristics, 1 mild degenerative characteristics and 2 severe characteristics of degeneration. HE: hematoxylin and eosin staining. Saf O: safranin-O staining and ABPR: alcian blue and picrosirius red staining. Scale bars represent 2.0 mm in A, B, C, F, G, 200 um in D and 500 um in E. A description of each scoring item can be found in Table II. Osteoarthritis and Cartilage 2013 21, 2039-2047DOI: (10.1016/j.joca.2013.10.001) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Additionally the Saf O sections can be used for evaluation of the morphology of the AF and to the boundary between AF and NP tissue. B: Morphology AF Saf O and C: Boundary AF and NP Saf O. The number 0 represents no degenerative characteristics, 1 mild degenerative characteristics and 2 severe characteristics of degeneration. Scale bars represent 2.0 mm in all images. A description of each scoring item can be found in Table II. Osteoarthritis and Cartilage 2013 21, 2039-2047DOI: (10.1016/j.joca.2013.10.001) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Boos and new IVD degeneration score in all five macroscopic degeneration grades according Thompson et al. Osteoarthritis and Cartilage 2013 21, 2039-2047DOI: (10.1016/j.joca.2013.10.001) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Scatter plot of GAG content in NP for the Boos and the new classification (dots). Scatter plot of age for the Boos and the new classification (squares). Scatter and Bland Altman plot of the Boos and the new classification (triangles). Osteoarthritis and Cartilage 2013 21, 2039-2047DOI: (10.1016/j.joca.2013.10.001) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions