Imaging evaluation and biomechanical characteristics of the novel intradiscal electrothermal annuloplasty in pigs

doi:10.3969/j.issn.2095-4344.1084

Abstract

Abstract:

BACKGROUND: Intervertebral disc herniation can damage the integrity of the annulus fibrosus, which may lead to intervertebral space decreasing, disc degeneration and instability of the motion segment. The removal of the nucleus pulposus will not prevent the progress of this process, but further results in disc degeneration and increases risk of the disc re-herniation.

OBJECTIVE: To explore the disc degeneration after discectomy, and whether intradiscal electrothermal annuloplasty can restore the intervertebral space height, delay disc degeneration and maintain instability of the motion segment.

METHODS: Pigs were randomized into two groups, and received discectomy and intradiscal electrothermal annuloplasty (experimental group) or discectomy (control group). The animals were killed to remove the lumbar specimens after 150 days. Imaging evaluation and biomechanical tests were used to observe the intervertebral disc height, intervertebral disc degeneration and the stability of the motion segment, respectively.

RESULTS AND CONCLUSION: (1) The general situation and amount of removal nucleus pulposus showed insignificant difference between two groups (P > 0.05). (2) The intervertebral disc height and the disc degeneration in the experimental group were significantly superior to those in the control group (P < 0.05). (3) The biomechanical load at the seven normal physiological directions showed that the range of motion of the neutral zone and lumbar region in the experimental group were significantly less than those in the control group (P < 0.05). (4) Our imaging and biomechanical results show that intradiscal electrothermal annuloplasty can maintain the integrity of the annulus fibrosus, intervertebral height, and the stability of the motion segment, decrease disc degeneration.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Intervertebral Disk, Diskectomy, Percutaneous, Swine, Biomechanics, Tissue Engineering

CLC Number:

R459.9|R318

Shu Gao, Chen Xiaodong, Zhai Mingyu, Li Quanxiu, Liang Pengzhan, Yang Xuejun, Zhao Haibo, Yu Chenqiang, Bai Xueling, Li Long. Imaging evaluation and biomechanical characteristics of the novel intradiscal electrothermal annuloplasty in pigs[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(8): 1214-1221.

Figures/Tables 3

References

[1] 饶书城,宋跃明,主编.脊柱外科手术学[M]3版.北京:人民卫生出版社,2007: 466.

[2] Herron L.Recurrent disc herniation: results of repeat laminectomy and discectomy.Spinal Disord. 1994;7(2):161-166.

[3] Gerrit JB,Martin B,Darko L, et al.The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device. Eur Spine J.2013;22:1030-1036.

[4] Melrose J, Smith SM, Little CB, et al. Recent advances in annular pathobiology provide insights intorim-lesion mediated intervertebral disc degeneration and potential new approaches to annular repairstrategies.Eur Spine J. 2008;17(9):1131-1148.

[5] Wang J, Tsai YY. The leakage pathway and effect of needle gauge on degree of disc injury post anuiarpuncture: a comparative study using aged human and adolescent porcine discs. Spine. 2007;32(17): 1809-1815.

[6] 康然,黄桂成,李海声,等.纤维环切开法建立猪腰推间盘退变动物模型[J].实用老年医学,2012,2(2):141-145.

[7] Wang YH, Kuo TF, Wang JL. The implantation of non-cell-based materials to prevent the recunrent discherniation: an in vivo porcine model using quantitative discomanometry examination. Eur Spine J. 2007; 16(7):1021-1027.

[8] 陈晓东,白雪岭. 椎间盘的纤维环用修补器:中国, ZL 2014 2 0860497. X[P].2016-07-27.

[9] 王宇鹏,银和平,吴一民,等.缝合和粘合两种方法修复山羊腰椎间盘纤维环缺损[J].中国组织工程研究,2018, 22(26): 4156-4161.

[10] Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability pothesis. Spinal Disord. 1992;5(4):390-396; discussion 397.

[11] Lequin MB, Barth M, Thome C, et al. Primary limited lumbar discectomy with an annulus closure device: one-year clinical and radiographic results from a prospective, multi-center study. Korean J Spine. 2012;9(4):340-347.

[12] Pfirrmann CW, Metzdorf A ,Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001; 26 (17) :1873-1878.

[13] 舒高,翟明玉,马鹏飞. 许莫氏结节在腰腿痛患者中的分布特点与腰椎间盘退变之间的关系[J].中国中医骨伤科杂志,2017,25(3):10-13.

[14] Bouma GJ, Barth M, Ledic D, et al. The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device. Eur Spine J. 2013;22(5):1030-1036.

[15] Li Z, Liu H, Yang H, et al. Both expression of cytokines and posterior annulus fibrosus rupture are essential for pain behavior changes induced by degenerative intervertebral disc: An experimental study in rats. J Orthop Res. 2014; 32(2) :262-272.

[16] Yin M, Mo W, Wu H, et al. Efficacy of caudal epidural steroid injection with targeted indwelling catheter and manipulation in managing patients with lumbar disk herniation and radiculopathy: a prospective, randomized, single-blind controlled trial. World Neurosurg. 2018;114: e29-e34.

[17] Mariconda M, Galasso O, Attingenti P, et al. Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests. Eur Spine J. 2010;19(1):136-143.

[18] McGirt MJ, Ambrossi GL, Datoo G, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal.Neurosurgery. 2009;64(2):338-344; discussion 344-345.

[19] Barth M, Diepers M, Weiss C, et al. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy:part 2: radiographic evaluation and correlation with clinical outcome. Spine. 2008;33(3):273-279.

[20] Gao SG, Lei GH, He HB, et al. Biomechanical comparison of lumbar total disc arthroplasty, discectomy, and fusion: effect on adjacentlevel disc pressure and facet joint force. J Neurosurg Spine. 2011;15(5): 507-514.

[21] Shahadi F, Luecke M, Preuss M, et al. Measurement of intradiscal pressure after lumbar discectomy.Zentralbl Neurochir. 2008;69(2): 87-89.

[22] Chen YC, Lee SH, Chen D. Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers.Spine. 2003;28(7):661-665.

[23] Steffen T, Baramki HG, Rubin R, et al. Lumbar intradiscal pressure measured in the anterior and posterolateral annular regions during asymmetrical loading. Clin Biomech (Bristol, Avon). 1998;13(7): 495-505.

[24] Adams MA, McNally DS, Dolan P. ‘Stress’ distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br. 1996;78(6):965-972.

[25] Trummer M, Eustacchio S, Barth M, et al. Protecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration. Clin Neurol Neurosurg. 2013;115(8):1440-1445.

[26] Parker SL, Grahovac G, Vukas D, et al. Effect of an annular closure device(Barricaid) on same level recurrent disc herniation and disc height loss after primary lumbar discectomy:two-year results of a multi-center prospective cohort study. Clin Spine Surg. 2016; 29(10): 454-460.

[27] Haefell M, Kalberer F, Saegesser D, et al. The course of macroscopic degeneration In the human lumbar intervertebral discs. Spine. 2006;31(14) : 1522-1531.

[28] Gregory DE, Callaghan JP. A comparison of uniaxial and biaxial mechanical properties of the annulus fibrosus: a porcine model. J Biomech Eng. 2011;133(2) : 1-5.

[29] Lisi AJ, O’Neill CW, Lindsey DP, et al. Measurement of in vivo lumbar intervertebral disc pressure during spinal manipulation: a feasibility study. J Appl Biomech.2006;22(3):234-239.

[30] Heuer F, Ulrich S, Claes L, et al. Biomechanical evaluation of conventional anulus fibrosus closure methods required for nucleus replacement. Laboratory investigation. J Neurosurg Spine. 2008;9(3): 307-313.

[31] Chiang CJ, Cheng CK, Sun JS, et al. The effect of a new anular repair after discectomy in intervertebral disc degeneration: an experimental study using a porcine spine model. Spine. 2011;36(10):761-769.

[32] Wilke HJ, Ressel L, Heuer F, et al. Can prevention of a reherniation be investigated? Establishment of a herniation model and experiments with an anular closure device. Spine. 2013;38(10):E587-E593.