1
|
Nikpasand M, Middendorf JM, Ella VA, Jones KE, Ladd B, Takahashi T, Barocas VH, Ellingson AM. Automated magnetic resonance imaging-based grading of the lumbar intervertebral disc and facet joints. JOR Spine 2024; 7:e1353. [PMID: 39011368 PMCID: PMC11249006 DOI: 10.1002/jsp2.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
Background Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter-rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public-access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter-rater reliability associated with these grading systems. Methods Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. Results The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. Conclusion The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM).
Collapse
Affiliation(s)
- Maryam Nikpasand
- Department of Mechanical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Jill M Middendorf
- Department of Mechanical Engineering Johns Hopkins University Baltimore Maryland USA
| | - Vincent A Ella
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Kristen E Jones
- Department of Neurosurgery University of Minnesota Minneapolis Minnesota USA
| | - Bryan Ladd
- Department of Neurosurgery University of Minnesota Minneapolis Minnesota USA
| | - Takashi Takahashi
- Department of Radiology University of Minnesota Minneapolis Minnesota USA
| | - Victor H Barocas
- Department of Mechanical Engineering University of Minnesota Minneapolis Minnesota USA
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Arin M Ellingson
- Department of Orthopedic Surgery University of Minnesota Minneapolis Minnesota USA
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health University of Minnesota Minneapolis Minnesota USA
| |
Collapse
|
2
|
Nordberg RC, Hight JM, Kim AN, Meka RS, Elder BD, Hu JC, Athanasiou KA. Biomechanical, biochemical, and histological characterization of sacroiliac joint cartilage in the Yucatan minipig. J Mech Behav Biomed Mater 2024; 157:106658. [PMID: 39018919 DOI: 10.1016/j.jmbbm.2024.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024]
Abstract
Although the sacroiliac (SI) joint can be a source of lower back and buttock pain, no comprehensive characterization studies on SI cartilage have been conducted. Using the minipig as a large animal model, this study conducted the first biomechanical, biochemical, and histological characterization of SI joint cartilage. Because previous literature has reported that sacral cartilage and iliac cartilage within the SI joint are histologically distinct, concomitantly it was expected that functional properties of the sacral cartilage would differ from those of the iliac cartilage. Creep indentation, uniaxial tension, biochemical, and histological analyses were conducted on the sacral and iliac cartilage of skeletally mature female Yucatan minipigs (n = 6-8 for all quantitative tests). Concurring with prior literature, the iliac cartilage appeared to be more fibrous than the sacral cartilage. Glycosaminoglycan content was 2.2 times higher in the sacral cartilage. The aggregate modulus of the sacral cartilage was 133 ± 62 kPa, significantly higher than iliac cartilage, which only had an aggregate modulus of 51 ± 61 kPa. Tensile testing was conducted in both cranial-caudal and ventral-dorsal axes, and Young's modulus values ranged from 2.5 ± 1.5 MPa to 13.6 ± 1.5 MPa, depending on anatomical structure (i.e., sacral vs. iliac) and orientation of the tensile test. The Young's modulus of sacral cartilage was 5.5 times higher in the cranial-caudal axis and 2.0 times higher in the ventral-dorsal axis than the iliac cartilage. The results indicate that the sacral and iliac cartilages are functionally distinct from each other. Understanding the distinct differences between sacral and iliac cartilage provides insight into the structure and function of the SI joint, which may inform future research aimed at repairing SI joint cartilage.
Collapse
Affiliation(s)
- Rachel C Nordberg
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA
| | - Justin M Hight
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA
| | - Andrew N Kim
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA
| | - Rithika S Meka
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA
| | - Benjamin D Elder
- Department of Neurosurgery, Orthopedics, and Biomedical Engineering, Mayo Clinic School of Medicine, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA, 92617, USA.
| |
Collapse
|
3
|
Sasanuma H, Takahashi T, Kawai S, Saitsu A, Kurashina W, Iijima Y, Saito T, Takeshita K. Morphological and histological evaluation of the tendon-bone junction in porcine shoulders to create a rotator cuff tear and repair model. J Orthop Sci 2023:S0949-2658(23)00325-1. [PMID: 38007298 DOI: 10.1016/j.jos.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study aimed to morphologically and histologically examine whether pig is useful as models for rotator cuff tear (RCT). METHODS The morphology of the scapula and humerus bones was evaluated by taking X-ray and three-dimensional computed tomography (3D CT) scans of the right shoulders of five female pigs (age: 4 months). The rotator cuff (RC) footprint at the humeral insertion of these was observed and its shape was measured. Next, they underwent general anesthesia and an acute rotator cuff tear/rotator cuff repair (RCT/RCR) model was created using a deltoid split approach. Four weeks after surgery, the animals were euthanized, the shoulder joints were harvested, and the repaired RC was evaluated by hematoxylin and eosin staining and toluidine blue staining. RESULTS The scapula of the pig had a vestigial acromion, in contrast to that in humans. The supraspinatus and infraspinatus tendons were connected so as to overlap each other and attached to the postero-superior part of the greater tuberosity. These tendons were located extra-articularly, separate from the joint capsule. The average antero-posterior length of the foot print was 17.4 ± 0.7 mm on the medial margin and 19.1 ± 2.2 mm on the lateral margin. The maximum medial-to-lateral width of it was 5.1 ± 0.5 mm. In all RCT/RCR models at 4 weeks after surgery, the repaired RC compound tendon was visually confirmed to be continuous with the footprint. Histologically, it was confirmed that regeneration of the four-layer structure of the bone-tendon junction had occurred. CONCLUSION Porcine supraspinatus and infraspinatus attachment to the greater tuberosity have a structure similar to that of sheep and dogs, which is advantageous for creating the RCT/RCR model. It might be used for future in vivo studies of shoulder joint diseases. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Pigs could potentially serve as a viable model for rotator cuff tears.
Collapse
Affiliation(s)
- Hideyuki Sasanuma
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Tsuneari Takahashi
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shigeo Kawai
- Tochigi Medical Center Shimotsuga, Department of Diagnostic Pathology, 420-1, Ohira, Tochigi, 329-4498, Japan
| | - Akihiro Saitsu
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Wataru Kurashina
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuki Iijima
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tomohiro Saito
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Katsushi Takeshita
- Jichi Medical University Hospital, Graduate School of Medicine, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
4
|
Middendorf JM, Budrow CJ, Ellingson AM, Barocas VH. The Lumbar Facet Capsular Ligament Becomes More Anisotropic and the Fibers Become Stiffer With Intervertebral Disc and Facet Joint Degeneration. J Biomech Eng 2023; 145:051004. [PMID: 36478033 PMCID: PMC9933886 DOI: 10.1115/1.4056432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Degeneration of the lumbar spine, and especially how that degeneration may lead to pain, remains poorly understood. In particular, the mechanics of the facet capsular ligament may contribute to low back pain, but the mechanical changes that occur in this ligament with spinal degeneration are unknown. Additionally, the highly nonlinear, heterogeneous, and anisotropic nature of the facet capsular ligament makes understanding mechanical changes more difficult. Clinically, magnetic resonance imaging (MRI)-based signs of degeneration in the facet joint and the intervertebral disc (IVD) correlate. Therefore, this study examined how the nonlinear, heterogeneous mechanics of the facet capsular ligament change with degeneration of the lumbar spine as characterized using MRI. Cadaveric human spines were imaged via MRI, and the L2-L5 facet joints and IVDs were scored using the Fujiwara and Pfirrmann grading systems. Then, the facet capsular ligament was isolated and biaxially loaded. The nonlinear mechanical properties of the ligament were obtained using a nonlinear generalized anisotropic inverse mechanics analysis (nGAIM). Then a Holzapfel-Gasser-Ogden (HGO) model was fit to the stress-strain data obtained from nGAIM. The facet capsular ligament is stiffer and more anisotropic at larger Pfirrmann grades and higher Fujiwara scores than at lower grades and scores. Analysis of ligament heterogeneity showed all tissues are highly heterogeneous, but no distinct spatial patterns of heterogeneity were found. These results show that degeneration of the lumbar spine including the facet capsular ligament appears to be occurring as a whole joint phenomenon and advance our understanding of lumbar spine degeneration.
Collapse
Affiliation(s)
- Jill M Middendorf
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | | | - Arin M Ellingson
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN 55455
| | - Victor H Barocas
- Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455
| |
Collapse
|
5
|
Zhao J, Li C, Qin T, Jin Y, He R, Sun Y, Liu Z, Wu T, Duan C, Cao Y, Hu J. Mechanical overloading-induced miR-325-3p reduction promoted chondrocyte senescence and exacerbated facet joint degeneration. Arthritis Res Ther 2023; 25:54. [PMID: 37016437 PMCID: PMC10071751 DOI: 10.1186/s13075-023-03037-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE Lumbar facet joint (LFJ) degeneration is one of the main causes of low back pain (LBP). Mechanical stress leads to the exacerbation of LFJ degeneration, but the underlying mechanism remains unknown. This study was intended to investigate the mechanism of LFJ degeneration induced by mechanical stress. METHODS Here, mice primary chondrocytes were used to screen for key microRNAs induced by mechanical overloading. SA-β-gal staining, qRT-PCR, western blot, and histochemical staining were applied to detect chondrocyte senescence in vitro and in vivo. We also used a dual-luciferase report assay to examine the targeting relationship of miRNA-325-3p (miR-325-3p) and Trp53. By using NSC-207895, a p53 activator, we investigated whether miR-325-3p down-regulated trp53 expression to reduce chondrocyte senescence. A mice bipedal standing model was performed to induce LFJ osteoarthritis. Adeno-associated virus (AAV) was intraarticularly injected to evaluate the effect of miR-325-3p on facet joint degeneration. RESULTS We observed chondrocyte senescence both in human LFJ osteoarthritis tissues and mice LFJ after bipedally standing for 10 weeks. Mechanical overloading could promote chondrocyte senescence and senescence-associated secretory phenotype (SASP) expression. MicroRNA-array analysis identified that miR-325-3p was obviously decreased after mechanical overloading, which was further validated by fluorescence in situ hybridization (FISH) in vivo. Dual-luciferase report assay showed that miR-325-3p directly targeted Trp53 to down-regulated its expression. MiR-325-3p rescued chondrocyte senescence in vitro, however, NSC-207895 reduced this effect by activating the p53/p21 pathway. Intraarticular injection of AAV expressing miR-325-3p decreased chondrocyte senescence and alleviated LFJ degeneration in vivo. CONCLUSION Our findings suggested that mechanical overloading could reduce the expression of miR-325-3p, which in turn activated the p53/p21 pathway to promote chondrocyte senescence and deteriorated LFJ degeneration, which may provide a promising therapeutic strategy for LFJ degeneration.
Collapse
Affiliation(s)
- Jinyun Zhao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Chengjun Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Tian Qin
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Yuxin Jin
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Rundong He
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Yi Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Zhide Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Tianding Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Chunyue Duan
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Yong Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| | - Jianzhong Hu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Road 87, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 China
| |
Collapse
|
6
|
Gupta S, Xiao R, Fainor M, Mauck RL, Smith HE, Gullbrand SE. Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration. J Orthop Res 2023; 41:674-683. [PMID: 35770853 PMCID: PMC9800647 DOI: 10.1002/jor.25407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
The zygapophyseal joints of the spine, also known as the facet joints, are paired diarthrodial joints posterior to the intervertebral disc and neural elements. The pathophysiology of facet osteoarthritis (OA), as well as crosstalk between the disc and facets, remains largely understudied compared to disc degeneration. The purpose of this study was to characterize alterations to human facet cartilage and subchondral bone across a spectrum of degeneration and to investigate correlations between disc and facet degeneration. Human lumbar facet articular surfaces from six independent donors were subject to creep indentation mechanical testing to quantify cartilage mechanical properties, followed by microcomputed tomography (µCT) analyses for subchondral bone morphometry. The degenerative state of each articular surface was assessed via macroscopic scoring and via Osteoarthritis Research Society International histopathology scoring. Our data suggest reduced facet cartilage compressive and tensile moduli and increased permeability with increasing degenerative grade, particularly at the lower levels of the spine. µCT analyses revealed spinal level-dependent alterations to the subchondral bone, with an increase in trabecular bone at the L4-L5 level, but a decrease at the upper levels of the lumbar spine with increasing degenerative grade. Cortical bone volume fraction was generally decreased with increasing degenerative grade across spinal levels. Correlation analysis revealed several associations between quantitative measures of disc degeneration and facet OA. This study showed that alterations in the mechanical properties of facet cartilage and in the structural properties of facet subchondral bone correlated with aspects of disc degeneration and were highly dependent on spinal level.
Collapse
Affiliation(s)
- Sachin Gupta
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Fainor
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert L. Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Harvey E. Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah E. Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
7
|
Huang C, Liu Z, Wei Z, Fang Z, Xi Z, Cai P, Li J. Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study. Front Surg 2023; 9:1004642. [PMID: 36713678 PMCID: PMC9877423 DOI: 10.3389/fsurg.2022.1004642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background The fixation-induced biomechanical deterioration will increase the risk of adjacent segment diseases (ASD) after lumbar interbody fusion with Bilateral pedicle screw (BPS) fixation. The accurate adjustment of insertional pedicle screw positions is possible, and published studies have reported its mechanical effects. However, no studies clarified that adjusting insertional screw positions would affect the postoperative biomechanical environment and the risk of ASD. The objective of this study was to identify this issue and provide theoretical references for the optimization of insertional pedicle screw position selections. Methods The oblique lumbar interbody fusion fixed by BPS with different insertional positions has been simulated in the L4-L5 segment of our previously constructed and validated lumbosacral model. Biomechanical indicators related to ASD have been computed and recorded under flexion, extension, bending, and axial rotation loading conditions. Results The change of screw insertional positions has more apparent biomechanical effects on the cranial than the caudal segment. Positive collections can be observed between the reduction of the fixation length and the alleviation of motility compensation and stress concentration on facet cartilages. By contrast, no pronounced tendency of stress distribution on the intervertebral discs can be observed with the change of screw positions. Conclusions Reducing the fixation stiffness by adjusting the insertional screw positions could alleviate the biomechanical deterioration and be an effective method to reduce the risk of ASD caused by BPS.
Collapse
Affiliation(s)
- Chenyi Huang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zongchao Liu
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhangchao Wei
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, China
| | - Zhipeng Xi
- Department of Spine Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Ping Cai
- Department of Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China,Correspondence: Jingchi Li Ping Cai
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China,Correspondence: Jingchi Li Ping Cai
| |
Collapse
|
8
|
Middendorf JM, Barocas VH. MRI‐based degeneration grades for lumbar facet joints do not correlate with cartilage mechanics. JOR Spine 2023. [DOI: 10.1002/jsp2.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Jill M. Middendorf
- Department of Mechanical Engineering Johns Hopkins University Baltimore Maryland USA
| | - Victor H. Barocas
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota USA
| |
Collapse
|
9
|
Nordberg RC, Kim AN, Hight JM, Meka RS, Elder BD, Hu JC, Athanasiou KA. Biochemical and biomechanical characterization of the cervical, thoracic, and lumbar facet joint cartilage in the Yucatan minipig. J Biomech 2022; 142:111238. [PMID: 35933954 PMCID: PMC9910803 DOI: 10.1016/j.jbiomech.2022.111238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Facet joint arthrosis causes pain in approximately 7 % of the U.S. population, but current treatments are palliative. The objective of this study was to elucidate structure-function relationships and aid in the development of future treatments for the facet joint. This study characterized the articular surfaces of cervical, thoracic, and lumbar facet cartilage from skeletally mature (18-24 mo) Yucatan minipigs. The minipig was selected as the animal model because it is recognized by the U.S. Food and Drug Administration (FDA) and the American Society for Testing and Materials (ASTM) as a translationally relevant model for spine-related indications. It was found that the thoracic facets had a ∼2 times higher aspect ratio than lumbar and cervical facets. Lumbar facets had 6.9-9.6 times higher % depth than the cervical and thoracic facets. Aggregate modulus values ranged from 135 to 262 kPa, much lower than reported aggregate modulus in the human knee (reported to be 530-701 kPa). The tensile Young's modulus values ranged from 6.7 to 20.3 MPa, with the lumbar superior facet being 304 % and 286 % higher than the cervical inferior and thoracic superior facets, respectively. Moreover, 3D reconstructions of entire vertebral segments were generated. The results of this study imply that structure-function relationships in the facet cartilage are different from other joint cartilages because biochemical properties are analogous to other articular cartilage sources whereas mechanical properties are not. By providing functional properties and a 3D database of minipig facet geometries, this work may supply design criteria for future facet tissue engineering efforts.
Collapse
Affiliation(s)
- Rachel C Nordberg
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Andrew N Kim
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Justin M Hight
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Rithika S Meka
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Benjamin D Elder
- Department of Neurosurgery, Orthopedics, and Biomedical Engineering, Mayo Clinic School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, 3131 Engineering Hall, University of California, Irvine, CA 92617, USA.
| |
Collapse
|
10
|
Nordberg RC, Otarola GA, Wang D, Hu JC, Athanasiou KA. Navigating regulatory pathways for translation of biologic cartilage repair products. Sci Transl Med 2022; 14:eabp8163. [PMID: 36001677 PMCID: PMC9918326 DOI: 10.1126/scitranslmed.abp8163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Long-term clinical repair of articular cartilage remains elusive despite advances in cartilage tissue engineering. Only one cartilage repair therapy classified as a "cellular and gene therapy product" has obtained Food and Drug Administration (FDA) approval within the past decade although more than 200 large animal cartilage repair studies were published. Here, we identify the challenges impeding translation of strategies and technologies for cell-based cartilage repair, such as the disconnect between university funding and regulatory requirements. Understanding the barriers to translation and developing solutions to address them will be critical for advancing cell therapy products for cartilage repair to clinical use.
Collapse
Affiliation(s)
- Rachel C Nordberg
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697 USA
| | - Gaston A Otarola
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697 USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697 USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697 USA
| |
Collapse
|
11
|
Okamoto A, Takeshima Y, Yokoyama S, Nishimura F, Nakagawa I, Park YS, Nakase H. Prevalence and Clinical Impact of Cervical Facet Joint Degeneration on Degenerative Cervical Myelopathy: a Novel Computed Tomography Classification Study. Neurospine 2022; 19:393-401. [PMID: 35577337 PMCID: PMC9260546 DOI: 10.14245/ns.2143258.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate cervical facet joint degeneration using a newly developed classification, investigate its prevalence and relationship with cervical degenerative spondylolisthesis, and clarify its clinical significance in patients with degenerative cervical myelopathy (DCM).
Methods This study included 145 consecutive patients with DCM who underwent surgical treatment. Clinical variables and radiological findings were analyzed. A new 6-grade computed tomography (CT) classification for cervical facet joint degeneration was adapted, and its prevalence was evaluated by categorizing the joints into those at responsible and those at nonresponsible spinal segmental levels. We evaluated the association between rapidly progressive myelopathy and the presence of significant facet joint degeneration or spondylolisthesis at the responsible segmental level.
Results Finally, 140 patients with a mean age of 64.1 ± 12.8 years were analyzed. The prevalence of grade 1, 2, 3, 4, 5A, and 5B classification in all facet joints was 72.0%, 9.5%, 10.9%, 4.3%, 2.9%, and 0.4%, respectively. There was a statistically significant difference in the distribution of CT grades between the joints at the responsible and nonresponsible segmental levels (p < 0.001), with a high prevalence of grade 4 or 5B degeneration at the responsible segmental level, reflecting articular irregularity. There was also a statistically significant relationship between rapidly progressive myelopathy and grade 4 or 5B degeneration at the responsible segmental level (p < 0.001), but not between rapidly progressive myelopathy and spondylolisthesis (p = 0.255).
Conclusion This novel CT classification for facet joints deserves additional evaluation in patients with DCM. Abnormal findings on the articular surfaces might be related to the progression of myelopathy.
Collapse
Affiliation(s)
- Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
- Corresponding Author Yasuhiro Takeshima Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| |
Collapse
|
12
|
Nordberg RC, Espinosa MG, Hu JC, Athanasiou KA. A Tribological Comparison of Facet Joint, Sacroiliac Joint, and Knee Cartilage in the Yucatan Minipig. Cartilage 2021; 13:346S-355S. [PMID: 34105385 PMCID: PMC8804757 DOI: 10.1177/19476035211021906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Pathology of the facet and sacroiliac (SI) joints contributes to 15% to 45% and 10% to 27% of lower back pain cases, respectively. Although tissue engineering may offer novel treatment options to patients suffering from cartilage degeneration in these joints, the tribological characteristics of the facet and SI joints have not been studied in either the human or relevant large animal models, which hinders the development of joint-specific cartilage implants. DESIGN Cartilage was isolated from the knee, cervical facet, thoracic facet, lumbar facet, and SI joints of 6 skeletally mature Yucatan minipigs (Sus scrofa). Tribological characteristics were assessed via coefficient of friction testing, interferometry, and immunohistochemistry for lubricin organization. RESULTS Compared with the knee, the coefficient of friction was higher by 43% in the cervical facet, 77% in the thoracic facet, 37% in the lumbar facet, and 28% in the SI joint. Likewise, topographical features of the facet and SI joints varied significantly, ranging from a 114% to 384% increase and a 48% to 107% increase in global and local surface roughness measures, respectively, compared with the knee. Additionally, the amount of lubricin in the SI joint was substantially greater than in the knee. Statistical correlations among the various tribological parameters revealed that there was a significant correlation between local roughness and coefficient of friction, but not global roughness or the presence of lubricin. CONCLUSION These location-specific tribological characteristics of the articular cartilages of the spine will need to be taken into consideration during the development of physiologically relevant, functional, and durable tissue-engineered replacements for these joints.
Collapse
Affiliation(s)
- Rachel C. Nordberg
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | | | - Jerry C. Hu
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA,Kyriacos A. Athanasiou, Department of
Biomedical Engineering, University of California, 3418 Engineering Hall, Irvine,
CA 92617, USA.
| |
Collapse
|
13
|
Link JM, Hu JC, Athanasiou KA. Chondroitinase ABC Enhances Integration of Self-Assembled Articular Cartilage, but Its Dosage Needs to Be Moderated Based on Neocartilage Maturity. Cartilage 2021; 13:672S-683S. [PMID: 32441107 PMCID: PMC8804832 DOI: 10.1177/1947603520918653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To enhance the in vitro integration of self-assembled articular cartilage to native articular cartilage using chondroitinase ABC. DESIGN To examine the hypothesis that chondroitinase ABC (C-ABC) integration treatment (C-ABCint) would enhance integration of neocartilage of different maturity levels, this study was conducted in 2 phases. In phase I, the impact on integration of 2 treatments, TCL (TGF-β1, C-ABC, and lysyl oxidase like 2) and C-ABCint, was examined via a 2-factor, full factorial design. In phase II, construct maturity (2 levels) and C-ABCint concentration (3 levels) were the factors in a full factorial design to determine whether the effective C-ABCint dose was dependent on neocartilage maturity level. Neocartilages formed or treated per the factors above were placed into native cartilage rings, cultured for 2 weeks, and, then, integration was studied histologically and mechanically. Prior to integration, in phase II, a set of treated constructs were also assayed to provide a baseline of properties. RESULTS In phase I, C-ABCint and TCL treatments synergistically enhanced interface Young's modulus by 6.2-fold (P = 0.004) and increased interface tensile strength by 3.8-fold (P = 0.02) compared with control. In phase II, the interaction of the factors C-ABCint and construct maturity was significant (P = 0.0004), indicating that the effective C-ABCint dose to improve interface Young's modulus is dependent on construct maturity. Construct mechanical properties were preserved regardless of C-ABCint dose. CONCLUSIONS Applying C-ABCint to neocartilage is an effective integration strategy with translational potential, provided its dose is calibrated appropriately based on implant maturity, that also preserves implant biomechanical properties.
Collapse
Affiliation(s)
- Jarrett M. Link
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA,Kyriacos A. Athanasiou, Distinguished
Professor Henry Samueli Chair, Director, DELTAi (Driving
Engineering and Life-science Translational Advances @ Irvine), Department of
Biomedical Engineering, Henry Samueli School of Engineering, University of
California, 3418 Engineering Hall, Irvine, CA 92697, USA.
| |
Collapse
|
14
|
Meli VS, Donahue RP, Link JM, Hu JC, Athanasiou KA, Liu WF. Isolation and characterization of porcine macrophages and their inflammatory and fusion responses in different stiffness environments. Biomater Sci 2021; 9:7851-7861. [PMID: 34514479 DOI: 10.1039/d1bm00746g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluating the host immune response to biomaterials is an essential step in the development of medical devices and tissue engineering strategies. To aid in this process, in vitro studies, whereby immune cells such as macrophages are cultured on biomaterials, can often expedite high throughput testing of many materials prior to implantation. While most studies to date utilize murine or human cells, the use of porcine macrophages has been less well described, despite the prevalent use of porcine models in medical device and tissue engineering development. In this study, we describe the isolation and characterization of porcine bone marrow- and peripheral blood-derived macrophages, and their interactions with biomaterials. We confirmed the expression of the macrophage surface markers CD68 and F4/80 and characterized the porcine macrophage response to the inflammatory stimulus, bacterial lipopolysaccharide. Finally, we investigated the inflammatory and fusion response of porcine macrophages cultured on different stiffness hydrogels, and we found that stiffer hydrogels enhanced inflammatory activation by more than two-fold and promoted fusion to form foreign body giant cells. Together, this study establishes the use of porcine macrophages in biomaterial testing and reveals a stiffness-dependent effect on biomaterial-induced giant cell formation.
Collapse
Affiliation(s)
- Vijaykumar S Meli
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA. .,The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA
| | - Ryan P Donahue
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.
| | - Jarrett M Link
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.
| | - Wendy F Liu
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA. .,The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.,Department of Chemical and Biomolecular Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.,Department of Molecular Biology and Biochemistry, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA
| |
Collapse
|
15
|
Säteri T, Nurro J, Hätinen OP, Hakulinen M, Leinonen V, Elomaa AP. 'Ex Vivo Porcine Models Are Valid for Testing and Training Microsurgical Lumbar Decompression Techniques'. World Neurosurg 2021; 155:e64-e74. [PMID: 34380085 DOI: 10.1016/j.wneu.2021.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal surgeries are the leading causes for patient settlement issues. Recent European Medical Device Regulations aims to reduce complications by enforcing that surgical tools are validated before clinical use. Human cadavers are favored in preclinical use, but due to anatomical variance, decay and scarce supply, alternative synthetic and animal models are used. This study evaluates the fidelity and validity of porcine models in training and assessment of microsurgical decompressive techniques in lumbar spine. METHODS Anatomical dimensions of ten human and five young pig spines were assessed from CT images. Novel 'en bloc' fresh-frozen ex vivo porcine model tissues' fidelity and validity for decompressive surgery was evaluated by three expert neurosurgeons, in comparison to other models. RESULTS The pig's anatomical dimensions were on average 11% smaller than in humans. The pig's L4-L5 was most alike humans and highest similarity was in lamina and spinous process widths, and skin to posterior longitudinal ligament distance. Dimensional variability was higher in humans (F = 19.06-0.56, p<0.05). The pig's tissues were felt as good as living patients and better than cadavers for skin, fascia, bone, facets, ligamentum flavum and dura, but poor for vessels (experts ICC=0.696-0.903). The pig models validity for assessing drills adverse features (friction, jitter, heating, and soft tissue trauma) were reported unanimously excellent. CONCLUSION Pigs are representative for assessing microsurgical decompression techniques in the lower lumbar spine. The novel 'en bloc' pig model can be an asset for industries and clinicians during assessment and training of new spinal techniques.
Collapse
Affiliation(s)
- Tuomas Säteri
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland.
| | - Jussi Nurro
- University of Eastern Finland, AIV Institute, Kuopio, Finland; Saparo Translational Research Oy, Kuopio, Finland
| | | | | | - Ville Leinonen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland
| | - Antti-Pekka Elomaa
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland; Kuopio University Hospital, Microsurgery Center www.microsurgerycenter.com, Kuopio, Finland
| |
Collapse
|
16
|
Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z, Wang N, Xie L, Song Y. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskelet Disord 2021; 22:616. [PMID: 34246272 PMCID: PMC8272903 DOI: 10.1186/s12891-021-04504-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.
Collapse
Affiliation(s)
- Jingchi Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China
| | - Chen Xu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Mengnan Liu
- Macau University of Science and Technology, Macau, 999078, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, 610039, China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China.
| |
Collapse
|
17
|
Ribitsch I, Baptista PM, Lange-Consiglio A, Melotti L, Patruno M, Jenner F, Schnabl-Feichter E, Dutton LC, Connolly DJ, van Steenbeek FG, Dudhia J, Penning LC. Large Animal Models in Regenerative Medicine and Tissue Engineering: To Do or Not to Do. Front Bioeng Biotechnol 2020; 8:972. [PMID: 32903631 PMCID: PMC7438731 DOI: 10.3389/fbioe.2020.00972] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Rapid developments in Regenerative Medicine and Tissue Engineering has witnessed an increasing drive toward clinical translation of breakthrough technologies. However, the progression of promising preclinical data to achieve successful clinical market authorisation remains a bottleneck. One hurdle for progress to the clinic is the transition from small animal research to advanced preclinical studies in large animals to test safety and efficacy of products. Notwithstanding this, to draw meaningful and reliable conclusions from animal experiments it is critical that the species and disease model of choice is relevant to answer the research question as well as the clinical problem. Selecting the most appropriate animal model requires in-depth knowledge of specific species and breeds to ascertain the adequacy of the model and outcome measures that closely mirror the clinical situation. Traditional reductionist approaches in animal experiments, which often do not sufficiently reflect the studied disease, are still the norm and can result in a disconnect in outcomes observed between animal studies and clinical trials. To address these concerns a reconsideration in approach will be required. This should include a stepwise approach using in vitro and ex vivo experiments as well as in silico modeling to minimize the need for in vivo studies for screening and early development studies, followed by large animal models which more closely resemble human disease. Naturally occurring, or spontaneous diseases in large animals remain a largely untapped resource, and given the similarities in pathophysiology to humans they not only allow for studying new treatment strategies but also disease etiology and prevention. Naturally occurring disease models, particularly for longer lived large animal species, allow for studying disorders at an age when the disease is most prevalent. As these diseases are usually also a concern in the chosen veterinary species they would be beneficiaries of newly developed therapies. Improved awareness of the progress in animal models is mutually beneficial for animals, researchers, human and veterinary patients. In this overview we describe advantages and disadvantages of various animal models including domesticated and companion animals used in regenerative medicine and tissue engineering to provide an informed choice of disease-relevant animal models.
Collapse
Affiliation(s)
- Iris Ribitsch
- Veterm, Department for Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Pedro M. Baptista
- Laboratory of Organ Bioengineering and Regenerative Medicine, Health Research Institute of Aragon (IIS Aragon), Zaragoza, Spain
| | - Anna Lange-Consiglio
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Luca Melotti
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Florien Jenner
- Veterm, Department for Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eva Schnabl-Feichter
- Clinical Unit of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Luke C. Dutton
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - David J. Connolly
- Clinical Unit of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Frank G. van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jayesh Dudhia
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Louis C. Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
18
|
Li J, Yang G, Liu S, Wang L, Liang Z, Zhang H. Suv39h1 promotes facet joint chondrocyte proliferation by targeting miR-15a/Bcl2 in idiopathic scoliosis patients. Clin Epigenetics 2019; 11:107. [PMID: 31337422 PMCID: PMC6651996 DOI: 10.1186/s13148-019-0706-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/15/2019] [Indexed: 01/07/2023] Open
Abstract
Background Idiopathic scoliosis (IS) is a complex disease with an unclear etiology, and the worldwide prevalence is approximately 2–3%. As an important link between environmental factors and phenotypic differences, epigenetic changes, such as lncRNA, miRNA, and DNA methylation, have recently been reported to be associated with the development of IS. However, the correlation between histone methylation, another classical epigenetic mechanism, and IS has not been determined. In this study, we investigated the morphological changes, alterations in the levels of histone methylation, and cell proliferation-related pathway in inferior facet joint cartilage in 11 IS patients and 10 comparable controls. Results Compared with the control group, narrowed facet joint cartilage but increased proliferative chondrocytes and upregulated collagen type II (COL2A1) and B-cell lymphoma-2 (Bcl2) were observed in IS patients. Additionally, tri-methylation levels of H3K9 (H3K9me3) rather than other lysine sites were significantly increased in IS patients, coinciding with the upregulation of its specific enzyme, suppressor of variegation 3-9, drosophila homolog of 1 (SUV39H1). In addition, Bcl2-targeted miR-15a was downregulated in IS patients, and the level of H3K9me3 in the promoter region of the miR-15a host gene was remarkably increased in IS patients compared with the control group. Moreover, overexpressing SUV39H1 in ATDC5 cells with increased H3K9me3 levels led to similar changes, with increased expression of COL2A1 and Bcl2, decreased expression of miR-15a, and increased cell proliferation. Conclusions Thus, our study suggests that increased chondrocyte proliferation occurs in the facet joint cartilage of IS patients compared with the control group and may be promoted by the elevated levels of H3K9me3 and SUV39H1, which regulate the miR-15a/Bcl2 pathway. This dysregulation of chondrocyte proliferation could result in abnormal spinal growth and may additionally participate in the development and progression of IS. Electronic supplementary material The online version of this article (10.1186/s13148-019-0706-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jiong Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Guanteng Yang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Shaohua Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Longjie Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Zhuotao Liang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Hongqi Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China.
| |
Collapse
|
19
|
O'Leary SA, Paschos NK, Link JM, Klineberg EO, Hu JC, Athanasiou KA. Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annu Rev Biomed Eng 2018; 20:145-170. [DOI: 10.1146/annurev-bioeng-062117-120924] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The zygapophysial joint, a diarthrodial joint commonly referred to as the facet joint, plays a pivotal role in back pain, a condition that has been a leading cause of global disability since 1990. Along with the intervertebral disc, the facet joint supports spinal motion and aids in spinal stability. Highly susceptible to early development of osteoarthritis, the facet is responsible for a significant amount of pain in the low-back, mid-back, and neck regions. Current noninvasive treatments cannot offer long-term pain relief, while invasive treatments can relieve pain but fail to preserve joint functionality. This review presents an overview of the facet in terms of its anatomy, functional properties, problems, and current management strategies. Furthermore, this review introduces the potential for regeneration of the facet and particular engineering strategies that could be employed as a long-term treatment.
Collapse
Affiliation(s)
- Siobhan A. O'Leary
- Department of Biomedical Engineering, University of California, Davis, California 95616, USA
| | - Nikolaos K. Paschos
- Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts 02115, USA
| | - Jarrett M. Link
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California 95816, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| |
Collapse
|
20
|
Wu T, Ni S, Cao Y, Liao S, Hu J, Duan C. Three-dimensional visualization and pathologic characteristics of cartilage and subchondral bone changes in the lumbar facet joint of an ovariectomized mouse model. Spine J 2018; 18:663-673. [PMID: 29155252 DOI: 10.1016/j.spinee.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/28/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is more prevalent among postmenopausal women than men. Ovariectomy (OVX) is an established animal model that mimics the estrogen deficiency of postmenopausal women. Little is known about the three-dimensional (3D) morphologic properties of cartilage and subchondral bone changes in the lumbar facet joint (LFJ) of an OVX mouse model. PURPOSE The purpose of this study was to characterize the 3D morphologic change of cartilage and subchondral bone in the LFJ of an OVX mouse model. STUDY DESIGN Three-dimensional visualization and a histologic study on degenerative changes in cartilage and subchondral bone in the LFJ of an OVX mouse model were conducted. MATERIALS AND METHODS Ovariectomy is performed to mimic postmenopausal changes in adult female mice. We present an imaging tool for 3D visualization of the pathologic characteristics of cartilage and subchondral bone changes LFJ degradation using propagation-based phase-contrast computed tomography (PPCT). The samples were further dissected, fixed, and stained for histologic examination. RESULTS Propagation-based phase-contrast computed tomography imaging provides a 3D visualization of altered cartilage with a simultaneous high detail of the subchondral bone abnormalities in an OVX LFJ model. A quantitative analysis demonstrated that the cartilage volume, the surface area, and thickness were decreased in the OVX group compared with the control group (p<.05). Meanwhile, these decreases were accompanied by an obvious destruction of the subchondral bone surface and a loss of trabecular bone in the OVX group (p<.05). The delineation of the 3D pathologic changes in the PPCT imaging was confirmed by a histopathologic method with Safranin-O staining. Tartrate-resistant acid phosphatase staining revealed an increased number of osteoclasts in the subchondral bone of the OVX mice compared with that of the control group. CONCLUSIONS These results demonstrated that a mouse model of OVX-induced LFJ osteoarthritis (OA)-like changes was successfully established and showed a good resemblance to the human OA pathology. Propagation-based phase-contrast computed tomography has great potential to becomea powerful 3D imaging method to comprehensively characterize LFJ OA and to effectively monitor therapeutics. Moreover, degenerative LFJ possesses a severe morphologic change in the subchondral bone, may be the source of postmenopausal LBP, and has the potential to be a novel therapeutic target for LBP treatment.
Collapse
Affiliation(s)
- Tianding Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Shuangfei Ni
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Shenghui Liao
- School of Information Science and Engineering, Central South University, Lushan South Rd, Changsha, 410008, China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China.
| |
Collapse
|
21
|
Cone SG, Warren PB, Fisher MB. Rise of the Pigs: Utilization of the Porcine Model to Study Musculoskeletal Biomechanics and Tissue Engineering During Skeletal Growth. Tissue Eng Part C Methods 2017; 23:763-780. [PMID: 28726574 PMCID: PMC5689129 DOI: 10.1089/ten.tec.2017.0227] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022] Open
Abstract
Large animal models play an essential role in the study of tissue engineering and regenerative medicine (TERM), as well as biomechanics. The porcine model has been increasingly used to study the musculoskeletal system, including specific joints, such as the knee and temporomandibular joints, and tissues, such as bone, cartilage, and ligaments. In particular, pigs have been utilized to evaluate the role of skeletal growth on the biomechanics and engineered replacements of these joints and tissues. In this review, we explore the publication history of the use of pig models in biomechanics and TERM discuss interspecies comparative studies, highlight studies on the effect of skeletal growth and other biological considerations in the porcine model, and present challenges and emerging opportunities for using this model to study functional TERM.
Collapse
Affiliation(s)
- Stephanie G. Cone
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Paul B. Warren
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B. Fisher
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
22
|
Cao Y, Ni S, Wu T, Duan C, Liao S, Hu J. WITHDRAWN: 3D visualization and pathological characteristics of cartilage and subchondral bone changes in the lumbar facet joint of an Ovariectomized mouse model. Spine J 2017:S1529-9430(17)30322-4. [PMID: 28713051 DOI: 10.1016/j.spinee.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.spinee.2017.11.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
| | - Shuangfei Ni
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
| | - Tianding Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China.
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China.
| | - Shenghui Liao
- School of Information Science and Engineering, Central South University, Changsha, 410008, China.
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
| |
Collapse
|