Intervertebral Disc Lesions: A New Etiological Concept

By W.J. McCormick, MD

Summary: In this remarkable 1954 article, Canadian physician W.J. McCormick presents physiological and biochemical principles that go to the core of orthopedic medicine, chiropractic spinal care, and osteopathy. While many health experts fail to understand the ultimate cause of connective-tissue decay, McCormick is clear: “The most definitely established physiological function of vitamin C is that of assisting in the formation of collagen for the maintenance of stability and elasticity of connective tissues generally, and this would include the bones, cartilages, muscles, and vascular tissues…In deficiency of the vitamin, instability and fragility of all such tissues is believed to be caused by the breakdown of ‘the intercellular cement substance’ (collagen), resulting in easy rupture of any and all of these connective tissues, which would include the intervertebral discs.” As Dr. McCormick emphasized throughout his life, the effects of subclinical scurvy (vitamin C deficiency) cannot be understated, though they are often overlooked. From the Archives of Pediatrics, 1954. Lee Foundation for Nutritional Research reprint 5D.

[The following is a transcription of the original Archives document. To view or download the original document, click here.]


Intervertebral Disc Lesions: A New Etiological Concept

Our knowledge of the pathology of the intervertebral discs is a modern development, [occurring] mostly within the last quarter century. It is more than likely that lesions of these structures were equally if not more prevalent in earlier times but were not generally recognized until X-ray technique became a major factor in physical diagnosis. Another reason for nonrecognition of these lesions may have been the fact that the vertebral column is so firmly bound together with ligaments and fasciae that it has not been customary to make minute examination of these structures in routine anatomical dissections or postmortem investigations. The extensive postmortem studies of Schmorl (1927–1932) gave initial impetus to the subject, following which there has been a constantly expanding bibliography.

The intervertebral disc lesions most commonly met with consist of mass or partial displacement (“slipping discs”) or rupture of the annulus fibrosis with herniation of the semifluid nucleus pulposus, often resulting in disabling neurological lesions from impingement on spinal nerve structures. These lesions of the discs have usually been related etiologically to traumatism, although a definite history of such is obtainable in [only] a minority of cases. The possibility of preconditioning etiological factors, in the form of degenerative changes, has been intimated by most writers, but the exact nature or cause of such changes has not been clarified.

In the earlier etiological concepts, the role of congenital defects was emphasized. Later, functional strain—or traumatism superimposed upon such faulty tissue—was given prominence. According to Beadle, “It is submitted as the most probable theory that certain faults in the texture of the cartilage matrix occur…and give rise to the rupture of the cartilage by minute traumatic influences that would have no effect on perfectly normal tissue.”1

As degenerative changes advance in the disc structure, the elasticity of the annulus fibrosus and fluid content of the nucleus pulposus lessens; this loss of function is sometimes hastened by deposition of calcium, and the efficacy of the confining fibroelastic network is lost. When the stage of rupture and herniation is reached, the resultant lacerations are often accompanied by extensive hemorrhages, which further complicate the picture. That these lesions are not due to senile degenerative changes is shown by the age incidence, which, beginning in the second decade, reaches its peak in the fourth decade, after which it gradually declines. Key has reported intervertebral disc lesions in young children and adolescents.2

From a carefully correlated study of the nutritional background of subjects of intervertebral disc lesions and from the records of analogous postmortem findings regarding the condition of cartilaginous structures in scurvy, as cited by Lind3 in his classical treatise on this subject (1753), the writer is convinced that deficiency of vitamin C plays an important etiological role in these lesions.

The most definitely established physiological function of vitamin C is that of assisting in the formation of collagen for the maintenance of stability and elasticity of connective tissues generally, and this would include the bones, cartilages, muscles, and vascular tissues—in fact, all tissues of mesenchymal origin. In deficiency of the vitamin, instability and fragility of all such tissues is believed to be caused by the breakdown of “the intercellular cement substance” (collagen), resulting in easy rupture of any and all of these connective tissues, which would include the intervertebral discs.

Today, the hemorrhagic tendency is regarded as a cardinal symptom of deficiency of vitamin C, or subclinical scurvy, but Lind3 makes a more subtle observation. After reporting that in scurvy the muscles are found in postmortem examination to be so “lax and tender that they readily fall apart,” he records a similar “laxity” of the intestinal musculature and continues, “Why the scurvy should so frequently, and in so singular a manner, affect the cartilages of the ribs—so as sometimes to separate them altogether from their connection with the breastbone—and why it seats itself so commonly in the joint of the knee, I own I am at a loss to account for.”

In this connection Lind3 cites the pathological findings of Willis, the great English anatomist of “circle of Willis” fame, who in his Tractus de Scorbuto (1667) relates a symptom that he had observed several times, namely, “a crackling of the bones upon moving the joints. Even upon turning in bed, by rubbing of the vertebrae on each other, a considerable noise was perceived, like to the rough handling of a skeleton,” which, he remarks, is an almost sure sign of incurability.

Lind3 also cites similar findings reported by the great French surgeon Poupart, whose name is linked with “Poupart’s ligament” and who in his many postmortem studies on scurvy victims in Paris (1699) is quoted as follows:

“In some (clinical scurvy cases), when moved, we heard a small grating (crepitus) of the bones. Upon opening these bodies (postmortem), the epiphyses were found entirely separated from the bones, which by rubbing against each other occasioned this noise. In some we perceived a small, low noise when they breathed. In those (postmortem) the cartilages of the sternum were found separated from the bony part of the ribs. All those in whose breast (chest) any matter or serosity was found had their ribs thus separated from the cartilages, and the bony part of the ribs next the sternum was carious for four fingers breadth…The ligaments of the joints (throughout the body) were corroded and loose. Instead of finding in the cavities of the joints the usual sweet, oily mucilage (synovial fluid), there was only a greenish liquor. All the young persons under eighteen had in some degree their epiphyses separated from the body of the bones.”4

If such gross cartilaginous lesions were found in times past in frank cases of scurvy, it is only logical to conclude that lesions of lesser degree—such as we now find in the intervertebral discs, the semilunar cartilages of the knee, the sacroiliac synchondrosis, and so on—may be etiologically related to deficiency of vitamin C in the many unrecognized subclinical cases of scurvy. These modern lesions of cartilaginous structures differ from those of frank scurvy only in degree. In all such lesions, whether involving dislocation of the discs or cartilages or rupture and herniated extrusion of their collagenous contents, there is obvious evidence of loss of stability of the connective tissues involved, which can be accounted for physiologically by nutritional deficiency of vitamin C.

It would seem almost unbelievable that in this day and age, when fresh fruits and vegetables are so plentiful, that any of our population should be found deficient in vitamin C, but during the last fifteen years in the writer’s practice as a nutritionist, more than 5,000 qualitative chemical tests for vitamin C status in clinical cases have been made, and less than 10 percent of adult subjects have been found to be at optimal level in this respect. It is true that our infants and young children are better provided for in this respect than at any time in the past, since it is now routine practice to include citrus and other fresh fruit juices in their diet from early infancy until they leave the nursery. But then there follows a marked nutritional deterioration due to the inroads of candy, soft drinks, and so on; and later—in teenage and early-adult life—tea, coffee, tobacco, and alcohol further distort the normal nutritional pattern.

Vitamin C, aside from its action as a vitamin, is a potent chemical-reducing agent, being thus capable of neutralizing both inorganic and organic toxins such as lead poisoning in painters, rattlesnake bite, and scorpion sting. For this same reason, it has powerful chemotherapeutic effect in infectious diseases, as stressed by the author in previous papers. But this chemical action is reciprocal—in that the vitamin suffers a proportionate loss, making less of it available for physiological needs.

As evidence of this reverse effect, the writer has found—in both clinical and laboratory research—that the smoking of one cigarette neutralizes in the body approximately 25 mg of ascorbic acid, or the equivalent of the vitamin C content of one average-size orange. On this basis the ability of the heavy smoker to maintain normal vitamin C status from dietary sources is obviously questionable, and this alone may account for the prevalence of vitamin C deficiency in our modern adult population. Incidentally, the writer has found that all his intervertebral-disc cases have been heavy smokers and definitely C-hypovitaminotic by chemical test.

If the writer’s hypothesis as herein set forth is sustained, a new field is opened for the prophylactic and therapeutic use of vitamin C. Even as a means of testing the validity of this hypothesis, supplemental therapeutic trial of the vitamin, in liberal dosage, should be made as part of the nonsurgical management of all suitable cases of intervertebral disc and other cartilaginous lesions. It is conceivable that such means might result in fixation of a slipping disc or cartilage and prevent rupture and herniation of same. “An ounce of prevention is worth a pound of cure.”

By W.J. McCormick, MD, Toronto, Canada. Reprinted by the Lee Foundation for Nutritional Research from Archive of Pediatrics: The Practical Monthly on the Diseases of Infants and Children, 71: 29–33, January 1954, 16 Gothic Avenue, New York. Copyright by E.B. Treat and Co., Inc., New York.

References

1. Beadle, Ormand A. Medical Research Council, Special Report Series, No. 161, 1931.
2. Key, J.A. “Intervertebral Disc Lesions in Children and Adolescents.” J. Bone and Joint Surg., 32A: 97–102, January 1950.
3. Lind, James. Treatise on the Scurvy. Edinborough, 1753.
4. Poupart, Francois. “Etranges effets du Scorbut arrivez a Paris par M. Poupart.” Memoires de l’Academie des Sciences, p. 237, 1699.
5. McCormick, W.J. “Vitamin C in the Prophylaxis and Therapy of Infectious Diseases.” Arch. Pediat., 68: 1–9, January 1951; “Ascorbic Acid as a Chemotherapeutic Agent.” Arch. Pediat., 69: 151–155, April 1952. 

[Ancillary content: image showing title page of third edition of James Lind’s A Treatise on the Scurvy (1772); text as follows—see page 3 of original for actual image:]

A TREATISE ON THE SCURVY
IN THREE PARTS

Containing
An Inquiry into the Nature, Causes, and Cure of that Disease

Together with
A Critical and Chronological View of What Has Been Published on This Subject

By James Lind, MD
Physician to his Majesty’s Royal Hospital at Haflar near Portmouth, and Fellow of the Royal College of Physicians in Edinburgh

The Third Edition, enlarged and improved

LONDON
Printed for S. Crowder, D. Wilson, and G. Nicholls,
T. Cadell, T. Becket and Co.,
G. Pearch, and W. Woodfall
MDCCLXXII

[Excerpts from Dr. McCormick’s “Intervertebral Disc Lesions” regarding A Treatise on the Scurvy:]

“After reporting that in scurvy the muscles are found in postmortem examination to be so ‘lax and tender that they readily fall apart,’ [Lind] records a similar ‘laxity’ of the intestinal musculature and continues, ‘Why the scurvy should so frequently and in so singular a manner affect the cartilages of the ribs—so as sometimes to separate them altogether from their connection with the breastbone—and why it seats itself so commonly in the joint of the knee, I own I am at a loss to account for.”

“Lind also cites similar findings reported by the great French surgeon, Poupart, whose name is linked with ‘Poupart’s ligament’ and who in his many postmortem studies on scurvy victims in Paris (1699) is quoted as follows:

“‘In some (clinical scurvy cases), when moved, we heard a small grating (crepitus) of the bones. Upon opening these bodies (postmortem) the epiphyses were found entirely separated from the bones, which by rubbing against each other occasioned this noise. In some we perceived a small, low noise when they breathed. In those (postmortem) the cartilages of the sternum were found separated from the bony part of the ribs. All those in whose breast (chest) any matter or serosity was found had their ribs thus separated from the cartilages, and the bony part of the ribs next the sternum was carious for four fingers breadth…The ligaments of the joints (throughout the body) were corroded and loose. Instead of finding in the cavities of the joints the usual sweet, oily mucilage (synovial fluid), there was only a greenish liquor. All the young persons under eighteen had in some degree their epiphyses separated from the body of the bones.‘”

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Patrick Earvolino, CN

Patrick Earvolino is a Certified Nutritionist and Special Projects Editor for Selene River Press, Inc.

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