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Eremina GM, Smolin AY. Effect of patient-specific factors on regeneration in lumbar spine at healthy disc and total disc replacement. Computer simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108172. [PMID: 38669718 DOI: 10.1016/j.cmpb.2024.108172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative diseases of the spine have a negative impact on the quality of life of patients. This study presents the results of numerical modelling of the mechanical behaviour of the lumbar spine with patient-specific conditions at physiological loads. This paper aims to numerically study the influence of degenerative changes in the spine and the presence of an endoprosthesis on the creation of conditions for tissue regeneration. METHODS A numerical model of the mechanical behaviour of lumbar spine at healthy and after total disc replacement under low-energy impacts equivalent to physiological loads is presented. The model is based on the movable cellular automaton method (discrete elements), where the mechanical behaviour of bone tissue is described using the Biot poroelasticity accounting for the presence and transfer of interstitial biological fluid. The nutritional pathways of the intervertebral disc in cases of healthy and osteoporotic bone tissues were predicted based on the analysis of the simulation results according to the mechanobiological principles. RESULTS Simulation of total disc replacement showed that osseointegration of the artificial disc plates occurs only in healthy bone tissue. With total disc replacement in a patient with osteoporosis, there is an area of increased risk of bone resorption in the near-contact area, approximately 1 mm wide, around the fixators. Dynamic loads may improve the osseointegration of the implant in pathological conditions of the bone tissue. CONCLUSIONS The results obtained in the case of healthy spine and osteoporotic bone tissues correspond to the experimental data on biomechanics and possible methods of IVD regeneration from the position of mechanobiological principles. The results obtained with an artificial disc (with keel-type fixation) showed that the use of this type of endoprosthesis in healthy bone tissues allows to reproduce the function of the natural intervertebral disc and does not contribute to the development of neoplastic processes. In the case of an artificial disc with osteoporosis of bone tissues, there is a zone with increased risk of tissue resorption and development of neoplastic processes in the area near the contact of the implant attachment. This circumstance can be compensated by increasing the loading level.
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Affiliation(s)
- Galina M Eremina
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia.
| | - Alexey Yu Smolin
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia
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Wang Y, He X, Chen S, Weng Y, Liu Z, Pan Q, Zhang R, Li Y, Wang H, Lin S, Yu H. Annulus Fibrosus Repair for Lumbar Disc Herniation: A Meta-Analysis of Clinical Outcomes From Controlled Studies. Global Spine J 2024; 14:306-321. [PMID: 37068762 PMCID: PMC10676185 DOI: 10.1177/21925682231169963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES This study aimed to summarize the clinical efficacy and safety of the various annular defect repair methods that have emerged in recent years. METHODS A meta-analysis of randomized and non-randomized controlled trials was conducted. Articles from PubMed, Embase, and the Cochrane Library (CENTRAL) on Lumbar disc herniation treatment with annular repair published from inception to April 2, 2022 were included. We summarized the clinical efficacy and safety of annular repair techniques based on a random-effects model meta-analysis. RESULTS 7 randomized controlled studies and 8 observational studies with a total of 2161 participants met the inclusion criteria. The pooled data analysis showed that adding the annular repair technique reduced postoperative recurrence rate, reoperation rate, and loss of intervertebral height compared with lumbar discectomy alone. Subgroup analysis based on different annular repair techniques showed that the Barricaid Annular Closure Device (ACD) was effective in preventing re-protrusion and reducing reoperation rates, while there was no significant difference between the other subgroups. The annulus fibrosus suture (AFS) did not improve the postoperative Oswestry Disability Index (ODI). No statistically significant difference was observed in the incidence of adverse events between the annular repair and control groups. CONCLUSIONS Lumbar discectomy combined with ACD can effectively reduce postoperative recurrence and reoperation rates in patients with LDH. AFS alone was less effective in reducing recurrence and reoperation rates and did not improve postoperative pain and function.
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Affiliation(s)
- Yangbin Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xiaoyu He
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shupeng Chen
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yiyong Weng
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhihua Liu
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Qunlong Pan
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Rongmou Zhang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yizhong Li
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Hanshi Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Royal National Orthopaedic Hospital NHS Trust, Quanzhou, Fujian, China; Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia
| | - Haiming Yu
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Zhou D, Liu H, Zheng Z, Wu D. Design principles in mechanically adaptable biomaterials for repairing annulus fibrosus rupture: A review. Bioact Mater 2024; 31:422-439. [PMID: 37692911 PMCID: PMC10485601 DOI: 10.1016/j.bioactmat.2023.08.012] [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: 06/01/2023] [Revised: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023] Open
Abstract
Annulus fibrosus (AF) plays a crucial role in the biomechanical loading of intervertebral disc (IVD). AF is difficult to self-heal when the annulus tears develop, because AF has a unique intricate structure and biologic milieu in vivo. Tissue engineering is promising for repairing AF rupture, but construction of suitable mechanical matching devices or scaffolds is still a grand challenge. To deeply know the varied forces involved in the movement of the native annulus is highly beneficial for designing biomimetic scaffolds to recreate the AF function. In this review, we overview six freedom degrees of forces and adhesion strength on AF tissue. Then, we summarize the mechanical modalities to simulate related forces on AF and to assess the characteristics of biomaterials. We finally outline some current advanced techniques to develop mechanically adaptable biomaterials for AF rupture repair.
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Affiliation(s)
- Dan Zhou
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Hongmei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
- Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
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Wang Z, Huang S, Xu L, Bu J, Liu G, Wang H, Liang J, Xia M, Chen T, Ma C, Dai K, Liu G. A retrospective study of the mid-term efficacy of full-endoscopic annulus fibrosus suture following lumbar discectomy. Front Surg 2022; 9:1011746. [PMID: 36386503 PMCID: PMC9640660 DOI: 10.3389/fsurg.2022.1011746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/03/2022] [Indexed: 06/21/2024] Open
Abstract
AIMS Full-endoscopic discectomy is associated with a high risk of disc reherniation due to the poor mechanical strength of the annulus fibrosus after scar healing. It is technically difficult to place a full-endoscopic annulus fibrosus suture. We designed an annulus fibrosus suture device that can be used to suture annulus defects under microendoscopy. The present study investigated the safety and feasibility of this technology. PATIENTS AND METHODS We retrospectively analyzed the outcomes of patients who underwent surgical treatment for lumbar disc herniation (LDH) from January 2018 to October 2020. We compared 40 patients with LDH treated with full-endoscopic annulus fibrosus suture following lumbar discectomy (LD + AFS group) with 42 patients treated with lumbar discectomy alone (LD group) regarding demographic data, symptoms, and recurrence and reoperation rates. Lumbar MRI and CT were performed 3 and 12 months. A 10-point visual analog scale (VAS) and the Oswestry Disability Index (ODI) was used to evaluate pain and the lumbar spine function. RESULTS The cohort comprised 82 patients, including 40 patients in the LD + AFS group and 42 in the LD group. All operations were successfully completed without serious complications. Reherniation occurred in no patients in the LD + AFS group and three patients in the LD group. The VAS scores for lumbar and leg pain and ODI score were significantly improved postoperatively (p < 0.05). CONCLUSION Compared with conventional lumbar discectomy, full-endoscopic annulus fibrosus suture following full-endoscopic lumbar discectomy is a safe and effective minimally invasive technique that reduces the LDH recurrence rate.
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Affiliation(s)
- Zhenfei Wang
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Sen Huang
- XuZhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Long Xu
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Jinhui Bu
- XuZhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Guangpu Liu
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Hui Wang
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Jun Liang
- XuZhou Central Hospital, XuZhou, China
| | - Mengjiao Xia
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Tao Chen
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Chao Ma
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Kerong Dai
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guangwang Liu
- Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
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Eremina G, Smolin A, Xie J, Syrkashev V. Development of a Computational Model of the Mechanical Behavior of the L4-L5 Lumbar Spine: Application to Disc Degeneration. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6684. [PMID: 36234026 PMCID: PMC9572952 DOI: 10.3390/ma15196684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Degenerative changes in the lumbar spine significantly reduce the quality of life of people. In order to fully understand the biomechanics of the affected spine, it is crucial to consider the biomechanical alterations caused by degeneration of the intervertebral disc (IVD). Therefore, this study is aimed at the development of a discrete element model of the mechanical behavior of the L4-L5 spinal motion segment, which covers all the degeneration grades from healthy IVD to its severe degeneration, and numerical study of the influence of the IVD degeneration on stress state and biomechanics of the spine. In order to analyze the effects of IVD degeneration on spine biomechanics, we simulated physiological loading conditions using compressive forces. The results of modeling showed that at the initial stages of degenerative changes, an increase in the amplitude and area of maximum compressive stresses in the disc is observed. At the late stages of disc degradation, a decrease in the value of intradiscal pressure and a shift in the maximum compressive stresses in the dorsal direction is observed. Such an influence of the degradation of the geometric and mechanical parameters of the tissues of the disc leads to the effect of bulging, which in turn leads to the formation of an intervertebral hernia.
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Affiliation(s)
- Galina Eremina
- Institute of Strength Physics and Materials Science, Siberian Branch of the Russian Academy of Sciences, Pr. Akademicheskii, 2/4, 634055 Tomsk, Russia
| | - Alexey Smolin
- Institute of Strength Physics and Materials Science, Siberian Branch of the Russian Academy of Sciences, Pr. Akademicheskii, 2/4, 634055 Tomsk, Russia
| | - Jing Xie
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Vladimir Syrkashev
- Department of General Medicine, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia
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Rasoulian A, Vakili-Tahami F, Smit TH. Linear and Nonlinear Biphasic Mechanical Properties of Goat IVDs Under Different Swelling Conditions in Confined Compression. Ann Biomed Eng 2021; 49:3296-3309. [PMID: 34480262 DOI: 10.1007/s10439-021-02856-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
To define technical specifications for artificial substitutes, it is necessary to model their mechanical behaviour. Here we studied the linear and nonlinear biphasic models for Nucleus Pulposus (NP) and Annulus Fibrosus (AF). The associated material parameters were obtained using confined compression stress relaxation tests on goat intervertebral disc (IVD) samples. The first parameter, aggregate modulus HA0, which essentially describes load-bearing capacity of the solid phase, was larger for AF (HA0 = 0.53 ± 0.06 MPa) than for NP (HA0 = 0.26 ± 0.04 MPa). For hydraulic permeability, which quantifies the ability to transmit interstitial fluid, it was the opposite (k0 = (0.20 ± 0.07) × 10-15 m4/Ns for AF and k0 = (0.67 ± 0.08)×10-15 m4/Ns for NP). The values of nonlinearity coefficients, nonlinear stiffening coefficient β and non-dimensional nonlinear permeability coefficient M, reflected that these tissues had nonlinear elastic behaviour and permeability. Also, investigating the effect of swelling conditions in sample preparation showed that for both AF and NP, confined-swollen samples had higher aggregate modulus and lower permeability values compared to the free-swollen ones. The quantitative description of the nonlinear properties of AF and NP provided a better understanding of IVD behaviour as well as technical specifications for their artificial substitutes.
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Affiliation(s)
- Akbar Rasoulian
- Department of Mechanical Engineering, University of Tabriz, 29 Bahman Blvd., 5166616471, Tabriz, Iran.,Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Farid Vakili-Tahami
- Department of Mechanical Engineering, University of Tabriz, 29 Bahman Blvd., 5166616471, Tabriz, Iran.
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.,Department of Medical Biology, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1085 AZ, The Netherlands
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7
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Du J, Long R, Nakai T, Sakai D, Benneker L, Zhou G, Li B, Eglin D, Iatridis J, Alini M, Grad S, Li Z. Functional cell phenotype induction with TGF-β1 and collagen-polyurethane scaffold for annulus fibrosus rupture repair. Eur Cell Mater 2020; 39:1-17. [PMID: 31899537 PMCID: PMC7027376 DOI: 10.22203/ecm.v039a01] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Appropriate cell sources, bioactive factors and biomaterials for generation of functional and integrated annulus fibrosus (AF) tissue analogues are still an unmet need. In the present study, the AF cell markers, collagen type I, cluster of differentiation 146 (CD146), mohawk (MKX) and smooth muscle protein 22α (SM22α) were found to be suitable indicators of functional AF cell induction. In vitro 2D culture of human AF cells showed that transforming growth factor β1 (TGF-β1) upregulated the expression of the functional AF markers and increased cell contractility, indicating that TGF-β1-pre-treated AF cells were an appropriate cell source for AF tissue regeneration. Furthermore, a tissue engineered construct, composed of polyurethane (PU) scaffold with a TGF-β1-supplemented collagen type I hydrogel and human AF cells, was evaluated with in vitro 3D culture and ex vivo preclinical bioreactor-loaded organ culture models. The collagen type I hydrogel helped maintaining the AF functional phenotype. TGF-β1 supplement within the collagen I hydrogel further promoted cell proliferation and matrix production of AF cells within in vitro 3D culture. In the ex vivo IVD organ culture model with physiologically relevant mechanical loading, TGF-β1 supplement in the transplanted constructs induced the functional AF cell phenotype and enhanced collagen matrix synthesis. In conclusion, TGF-β1-containing collagen-PU constructs can induce the functional cell phenotype of human AF cells in vitro and in situ. This combined cellular, biomaterial and bioactive agent therapy has a great potential for AF tissue regeneration and rupture repair.
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Affiliation(s)
- J. Du
- AO Research Institute Davos, Davos, Switzerland
| | - R.G. Long
- AO Research Institute Davos, Davos, Switzerland,Icahn School of Medicine at Mount Sinai, New York, USA,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - T. Nakai
- Tokai University School of Medicine, Isehara, Japan,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - D. Sakai
- Tokai University School of Medicine, Isehara, Japan,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - L.M. Benneker
- Inselspital, University of Bern, Bern, Switzerland,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - G. Zhou
- Shenzhen Key Laboratory of Anti-Aging and Regenerative Medicine, Department of Medical Cell Biology and Genetics, Health Sciences Centre, Shenzhen University, Shenzhen, China
| | - B. Li
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, China
| | - D. Eglin
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - J.C. Iatridis
- Icahn School of Medicine at Mount Sinai, New York, USA,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - M. Alini
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - S. Grad
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland
| | - Z. Li
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Program Annulus Fibrosus Repair, AO Foundation, Davos, Switzerland,Address for correspondence: Zhen Li, PhD, AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland. Telephone number: +41 814142325
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Walters JD, Gill SS, Mercuri JJ. Ethanol-mediated compaction and cross-linking enhance mechanical properties and degradation resistance while maintaining cytocompatibility of a nucleus pulposus scaffold. J Biomed Mater Res B Appl Biomater 2019; 107:2488-2499. [PMID: 30767383 PMCID: PMC6697250 DOI: 10.1002/jbm.b.34339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/11/2018] [Accepted: 01/26/2019] [Indexed: 01/01/2023]
Abstract
Intervertebral disc degeneration is a complex, cell-mediated process originating in the nucleus pulposus (NP) and is associated with extracellular matrix catabolism leading to disc height loss and impaired spine kinematics. Previously, we developed an acellular bovine NP (ABNP) for NP replacement that emulated human NP matrix composition and supported cell seeding; however, its mechanical properties were lower than those reported for human NP. To address this, we investigated ethanol-mediated compaction and cross-linking to enhance the ABNP's dynamic mechanical properties and degradation resistance while maintaining its cytocompatibility. First, volumetric and mechanical effects of compaction only were confirmed by evaluating scaffolds after various immersion times in buffered 28% ethanol. It was found that compaction reached equilibrium at ~30% compaction after 45 min, and dynamic mechanical properties significantly increased 2-6× after 120 min of submersion. This was incorporated into a cross-linking treatment, through which scaffolds were subjected to 120 min precompaction in buffered 28% ethanol prior to carbodiimide cross-linking. Their dynamic mechanical properties were evaluated before and after accelerated degradation by ADAMTS-5 or MMP-13. Cytocompatibility was determined by seeding stem cells onto scaffolds and evaluating viability through metabolic activity and fluorescent staining. Compacted and cross-linked scaffolds showed significant increases in DMA properties without detrimentally altering their cytocompatibility, and these mechanical gains were maintained following enzymatic exposure. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2488-2499, 2019.
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Affiliation(s)
- Joshua D. Walters
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Sanjitpal S. Gill
- Department of Orthopaedic Surgery, Medical Group of the Carolinas-Pelham, Spartanburg Regional Healthcare System, Greer, SC, USA
| | - Jeremy J. Mercuri
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC, USA
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Van Hoorick J, Tytgat L, Dobos A, Ottevaere H, Van Erps J, Thienpont H, Ovsianikov A, Dubruel P, Van Vlierberghe S. (Photo-)crosslinkable gelatin derivatives for biofabrication applications. Acta Biomater 2019; 97:46-73. [PMID: 31344513 DOI: 10.1016/j.actbio.2019.07.035] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 12/28/2022]
Abstract
Over the recent decades gelatin has proven to be very suitable as an extracellular matrix mimic for biofabrication and tissue engineering applications. However, gelatin is prone to dissolution at typical cell culture conditions and is therefore often chemically modified to introduce (photo-)crosslinkable functionalities. These modifications allow to tune the material properties of gelatin, making it suitable for a wide range of biofabrication techniques both as a bioink and as a biomaterial ink (component). The present review provides a non-exhaustive overview of the different reported gelatin modification strategies to yield crosslinkable materials that can be used to form hydrogels suitable for biofabrication applications. The different crosslinking chemistries are discussed and classified according to their mechanism including chain-growth and step-growth polymerization. The step-growth polymerization mechanisms are further classified based on the specific chemistry including different (photo-)click chemistries and reversible systems. The benefits and drawbacks of each chemistry are also briefly discussed. Furthermore, focus is placed on different biofabrication strategies using either inkjet, deposition or light-based additive manufacturing techniques, and the applications of the obtained 3D constructs. STATEMENT OF SIGNIFICANCE: Gelatin and more specifically gelatin-methacryloyl has emerged to become one of the gold standard materials as an extracellular matrix mimic in the field of biofabrication. However, also other modification strategies have been elaborated to take advantage of a plethora of crosslinking chemistries. Therefore, a review paper focusing on the different modification strategies and processing of gelatin is presented. Particular attention is paid to the underlying chemistry along with the benefits and drawbacks of each type of crosslinking chemistry. The different strategies were classified based on their basic crosslinking mechanism including chain- or step-growth polymerization. Within the step-growth classification, a further distinction is made between click chemistries as well as other strategies. The influence of these modifications on the physical gelation and processing conditions including mechanical properties is presented. Additionally, substantial attention is put to the applied photoinitiators and the different biofabrication technologies including inkjet, deposition or light-based technologies.
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Affiliation(s)
- Jasper Van Hoorick
- Polymer Chemistry & Biomaterials Group - Centre of Macromolecular Chemistry (CMaC) - Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium; Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium
| | - Liesbeth Tytgat
- Polymer Chemistry & Biomaterials Group - Centre of Macromolecular Chemistry (CMaC) - Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium; Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium
| | - Agnes Dobos
- Research Group 3D Printing and Biofabrication, Institute of Materials Science and Technology, TU Wien, Getreidemarkt 9, 1060 Vienna, Austria
| | - Heidi Ottevaere
- Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium
| | - Jürgen Van Erps
- Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium
| | - Hugo Thienpont
- Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium
| | - Aleksandr Ovsianikov
- Research Group 3D Printing and Biofabrication, Institute of Materials Science and Technology, TU Wien, Getreidemarkt 9, 1060 Vienna, Austria
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Group - Centre of Macromolecular Chemistry (CMaC) - Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Group - Centre of Macromolecular Chemistry (CMaC) - Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium; Brussels Photonics (B-PHOT) - Department of Applied Physics and Photonics, Vrije Universiteit Brussel and Flanders Make, Pleinlaan 2, 1050 Brussels, Belgium.
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Raheem HM, Bay B, Rochefort S. Viscoelastic properties of a novel hydrogel/foam composites for nucleus pulposus replacement. SN APPLIED SCIENCES 2019. [DOI: 10.1007/s42452-019-0855-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Calvo-Echenique A, Cegoñino J, Correa-Martín L, Bances L, Palomar APD. Intervertebral disc degeneration: an experimental and numerical study using a rabbit model. Med Biol Eng Comput 2017; 56:865-877. [DOI: 10.1007/s11517-017-1738-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
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Lowe J, Almarza AJ. A review of in-vitro fibrocartilage tissue engineered therapies with a focus on the temporomandibular joint. Arch Oral Biol 2017; 83:193-201. [PMID: 28787640 DOI: 10.1016/j.archoralbio.2017.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
The inability of fibrocartilage, specifically the temporomandibular joint (TMJ) disc, to regenerate and remodel following injury presents a unique problem for clinicians. Tissue engineering then offers a potential regenerative therapy. In vitro testing provides a valuable screening tool for potential tissue engineered solutions. The conclusions drawn for TMJ in vitro research were compared against state of the art fibrocartilage studies in the knee meniscus, and annulus fibrosus of the intervertebral disc (IVD). For TMJ disc regeneration, in vitro tissue engineered approaches, focused on cellular therapies with fibrochondrocytes, have displayed an inability to produce enough collagen, as well as an inability to recapitulate native mechanical properties. Biomaterial approaches have recapitulated the native properties of the TMJ disc, but their in vivo efficacy has yet to be determined. By comparison, the knee meniscus field is the most progressive in the use of stem cells as a cell source. The knee meniscus field has moved away from measuring mechanical properties, and are instead more focused on biochemistry and gene expression. IVD studies mainly use electrospun scaffolds, and have produced the best success in mechanical properties. The TMJ field, in comparison to knee meniscus and IVD, needs to employ stem cell therapies, new biomaterials and manufacturing techniques, and cutting edge molecular assays, in future in vitro approaches to screen for viable technologies to move to in vivo studies.
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Affiliation(s)
- Jesse Lowe
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, United States; Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA 15260, United States.
| | - Alejandro J Almarza
- Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA 15260, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, United States; Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA 15260, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, United States.
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13
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Casaroli G, Galbusera F, Jonas R, Schlager B, Wilke HJ, Villa T. A novel finite element model of the ovine lumbar intervertebral disc with anisotropic hyperelastic material properties. PLoS One 2017; 12:e0177088. [PMID: 28472100 PMCID: PMC5417645 DOI: 10.1371/journal.pone.0177088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
The Ovine spine is an accepted model to investigate the biomechanical behaviour of the human lumbar one. Indeed, the use of animal models for in vitro studies is necessary to investigate the mechanical behaviour of biological tissue, but needs to be reduced for ethical and social reasons. The aim of this study was to create a finite element model of the lumbar intervertebral disc of the sheep that may help to refine the understanding of parallel in vitro experiments and that can be used to predict when mechanical failure occurs. Anisotropic hyperelastic material properties were assigned to the annulus fibrosus and factorial optimization analyses were performed to find out the optimal parameters of the ground substance and of the collagen fibers. For the ground substance of the annulus fibrosus the investigation was based on experimental data taken from the literature, while for the collagen fibers tensile tests on annulus specimens were conducted. Flexibility analysis in flexion-extension, lateral bending and axial rotation were conducted. Different material properties for the anterior, lateral and posterior regions of the annulus were found. The posterior part resulted the stiffest region in compression whereas the anterior one the stiffest region in tension. Since the flexibility outcomes were in a good agreement with the literature data, we considered this model suitable to be used in conjunction with in vitro and in vivo tests to investigate the mechanical behaviour of the ovine lumbar disc.
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Affiliation(s)
- Gloria Casaroli
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Center for Musculoskeletal Research (zmfu), Ulm University, Ulm, Germany
| | - Benedikt Schlager
- Institute of Orthopaedic Research and Biomechanics, Center for Musculoskeletal Research (zmfu), Ulm University, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Center for Musculoskeletal Research (zmfu), Ulm University, Ulm, Germany
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Fernandez C, Marionneaux A, Gill S, Mercuri J. Biomimetic nucleus pulposus scaffold created from bovine caudal intervertebral disc tissue utilizing an optimal decellularization procedure. J Biomed Mater Res A 2016; 104:3093-3106. [PMID: 27507100 PMCID: PMC5832047 DOI: 10.1002/jbm.a.35858] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/14/2016] [Accepted: 08/05/2016] [Indexed: 11/07/2022]
Abstract
Intervertebral disc (IVD) degeneration (IDD) and herniation (IDH) can result in low back pain and impart significant socioeconomic burden. These pathologies involve detrimental alteration to the nucleus pulposus (NP) either via biochemical degradation or extrusion from the IVD, respectively. Thus, engineering living NP tissue utilizing biomaterial scaffolds that recapitulate native NP microarchitecture, biochemistry, mechanical properties, and which support cell viability represents an approach to aiding patients with IDD and IDH. To date, an ideal biomaterial to support NP regeneration has yet to be developed; however, one promising approach to generating biomimetic materials is to employ the decellularization (decell) of xenogeneic NP tissue to remove host DNA while maintaining critical native extracellular matrix (ECM) components. Herein, 13 different procedures were evaluated in an attempt to decell bovine caudal IVD NP tissue. An optimal method was identified which was confirmed to effectively remove bovine DNA, while maintaining physiologically relevant amounts of glycosaminoglycan (GAG) and type II collagen. Unconfined static and dynamic compressive mechanical properties of scaffolds approached values reported for human NP and viability of human amniotic stem cells (hAMSCs) was maintained on noncrosslinked and EDC/NHS treated scaffolds for up to 14 days in culture. Taken together, NP tissue obtained from bovine caudal IVDs can be successfully decelled in order to generate a biomimetic scaffold for NP tissue regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 3093-3106, 2016.
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Affiliation(s)
- Christopher Fernandez
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
| | - Alan Marionneaux
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
| | - Sanjitpal Gill
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
- Department of Orthopaedic Surgery, Spartanburg Regional Healthcare System, Greer, South Carolina
| | - Jeremy Mercuri
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina.
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Long RG, Torre OM, Hom WW, Assael DJ, Iatridis JC. Design Requirements for Annulus Fibrosus Repair: Review of Forces, Displacements, and Material Properties of the Intervertebral Disk and a Summary of Candidate Hydrogels for Repair. J Biomech Eng 2016; 138:021007. [PMID: 26720265 DOI: 10.1115/1.4032353] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Indexed: 02/02/2023]
Abstract
There is currently a lack of clinically available solutions to restore functionality to the intervertebral disk (IVD) following herniation injury to the annulus fibrosus (AF). Microdiscectomy is a commonly performed surgical procedure to alleviate pain caused by herniation; however, AF defects remain and can lead to accelerated degeneration and painful conditions. Currently available AF closure techniques do not restore mechanical functionality or promote tissue regeneration, and have risk of reherniation. This review determined quantitative design requirements for AF repair materials and summarized currently available hydrogels capable of meeting these design requirements by using a series of systematic PubMed database searches to yield 1500+ papers that were screened and analyzed for relevance to human lumbar in vivo measurements, motion segment behaviors, and tissue level properties. We propose a testing paradigm involving screening tests as well as more involved in situ and in vivo validation tests to efficiently identify promising biomaterials for AF repair. We suggest that successful materials must have high adhesion strength (∼0.2 MPa), match as many AF material properties as possible (e.g., approximately 1 MPa, 0. 3 MPa, and 30 MPa for compressive, shear, and tensile moduli, respectively), and have high tensile failure strain (∼65%) to advance to in situ and in vivo validation tests. While many biomaterials exist for AF repair, few undergo extensive mechanical characterization. A few hydrogels show promise for AF repair since they can match at least one material property of the AF while also adhering to AF tissue and are capable of easy implantation during surgical procedures to warrant additional optimization and validation.
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Shock absorbing function study on denucleated intervertebral disc with or without hydrogel injection through static and dynamic biomechanical tests in vitro. BIOMED RESEARCH INTERNATIONAL 2014; 2014:461724. [PMID: 25045680 PMCID: PMC4090528 DOI: 10.1155/2014/461724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/13/2014] [Accepted: 06/02/2014] [Indexed: 11/17/2022]
Abstract
Hydrogel injection has been recently proposed as a novel therapy for disc degenerative diseases, with the potential to restore the spine motion and the intervertebral disc height. However, it remains unknown whether the new technique could also maintain the shock absorbing property of the treated intervertebral disc. In this study, 18 porcine lumbar bone-disc-bone specimens were collected and randomly divided into three groups: the normal with intact intervertebral discs, the mimic for the injection of disulfide cross-linked hyaluronan hydrogels following discectomy, and the control disc with discectomy only. In the static compression test, specimens in the mimic group exhibited displacements similar to those in the normal discs, whereas the control group showed a significantly larger displacement range in the first two steps (P < 0.05). With the frequency increasing, all specimens generally displayed an increasing storage modulus, decreasing loss modulus, and tanδ. At any frequency point, the control group exhibited the largest value in all the three parameters among three groups while the normal group was the lowest, with the mimic group being mostly close to the normal group. Therefore, the hydrogel injection into the intervertebral discs greatly restored their shock absorbing function, suggesting that the technique could serve as an effective approach to maintaining biomechanical properties of the degenerative intervertebral disc.
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Elastic, permeability and swelling properties of human intervertebral disc tissues: A benchmark for tissue engineering. J Biomech 2013; 47:2088-94. [PMID: 24438768 DOI: 10.1016/j.jbiomech.2013.12.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/10/2013] [Accepted: 12/16/2013] [Indexed: 01/06/2023]
Abstract
The aim of functional tissue engineering is to repair and replace tissues that have a biomechanical function, i.e., connective orthopaedic tissues. To do this, it is necessary to have accurate benchmarks for the elastic, permeability, and swelling (i.e., biphasic-swelling) properties of native tissues. However, in the case of the intervertebral disc, the biphasic-swelling properties of individual tissues reported in the literature exhibit great variation and even span several orders of magnitude. This variation is probably caused by differences in the testing protocols and the constitutive models used to analyze the data. Therefore, the objective of this study was to measure the human lumbar disc annulus fibrosus (AF), nucleus pulposus (NP), and cartilaginous endplates (CEP) biphasic-swelling properties using a consistent experimental protocol and analyses. The testing protocol was composed of a swelling period followed by multiple confined compression ramps. To analyze the confined compression data, the tissues were modeled using a biphasic-swelling model, which augments the standard biphasic model through the addition of a deformation-dependent osmotic pressure term. This model allows considering the swelling deformations and the contribution of osmotic pressure in the analysis of the experimental data. The swelling stretch was not different between the disc regions (AF: 1.28±0.16; NP: 1.73±0.74; CEP: 1.29±0.26), with a total average of 1.42. The aggregate modulus (Ha) of the extra-fibrillar matrix was higher in the CEP (390kPa) compared to the NP (100kPa) or AF (30kPa). The permeability was very different across tissue regions, with the AF permeability (64 E(-16)m(4)/Ns) higher than the NP and CEP (~5.5 E(-16)m(4)/Ns). Additionally, a normalized time-constant (3000s) for the stress relaxation was similar for all the disc tissues. The properties measured in this study are important as benchmarks for tissue engineering and for modeling the disc's mechanical behavior and transport.
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The application of fiber-reinforced materials in disc repair. BIOMED RESEARCH INTERNATIONAL 2013; 2013:714103. [PMID: 24383057 PMCID: PMC3870616 DOI: 10.1155/2013/714103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/18/2013] [Indexed: 01/08/2023]
Abstract
The intervertebral disc degeneration and injury are the most common spinal diseases with tremendous financial and social implications. Regenerative therapies for disc repair are promising treatments. Fiber-reinforced materials (FRMs) are a kind of composites by embedding the fibers into the matrix materials. FRMs can maintain the original properties of the matrix and enhance the mechanical properties. By now, there are still some problems for disc repair such as the unsatisfied static strength and dynamic properties for disc implants. The application of FRMs may resolve these problems to some extent. In this review, six parts such as background of FRMs in tissue repair, the comparison of mechanical properties between natural disc and some typical FRMs, the repair standard and FRMs applications in disc repair, and the possible research directions for FRMs' in the future are stated.
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