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Kheirollahi A, Sadeghi S, Orandi S, Moayedi K, Khajeh K, Khoobi M, Golestani A. Chondroitinase as a therapeutic enzyme: Prospects and challenges. Enzyme Microb Technol 2024; 172:110348. [PMID: 37898093 DOI: 10.1016/j.enzmictec.2023.110348] [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: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
The chondroitinases (Chase) are bacterial lyases that specifically digest chondroitin sulfate and/or dermatan sulfate glycosaminoglycans via a β-elimination reaction and generate unsaturated disaccharides. In recent decades, these enzymes have attracted the attention of many researchers due to their potential applications in various aspects of medicine from the treatment of spinal cord injury to use as an analytical tool. In spite of this diverse spectrum, the application of Chase is faced with several limitations and challenges such as thermal instability and lack of a suitable delivery system. In the current review, we address potential therapeutic applications of Chase with emphasis on the challenges ahead. Then, we summarize the latest achievements to overcome the problems by considering the studies carried out in the field of enzyme engineering, drug delivery, and combination-based therapy.
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Affiliation(s)
- Asma Kheirollahi
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Solmaz Sadeghi
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Orandi
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiana Moayedi
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khajeh
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14115-154, Iran
| | - Mehdi Khoobi
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Golestani
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Poletto DL, Crowley JD, Tanglay O, Walsh WR, Pelletier MH. Preclinical in vivo animal models of intervertebral disc degeneration. Part 1: A systematic review. JOR Spine 2023; 6:e1234. [PMID: 36994459 PMCID: PMC10041387 DOI: 10.1002/jsp2.1234] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 12/24/2022] Open
Abstract
Intervertebral disc degeneration (IVDD), a widely recognized cause of lower back pain, is the leading cause of disability worldwide. A myriad of preclinical in vivo animal models of IVDD have been described in the literature. There is a need for critical evaluation of these models to better inform researchers and clinicians to optimize study design and ultimately, enhance experimental outcomes. The purpose of this study was to conduct an extensive systematic literature review to report the variability of animal species, IVDD induction method, and experimental timepoints and endpoints used in in vivo IVDD preclinical research. A systematic literature review of peer-reviewed manuscripts featured on PubMed and EMBASE databases was conducted in accordance with PRISMA guidelines. Studies were included if they reported an in vivo animal model of IVDD and included details of the species used, how disc degeneration was induced, and the experimental endpoints used for analysis. Two-hundred and fifty-nine (259) studies were reviewed. The most common species, IVDD induction method and experimental endpoint used was rodents(140/259, 54.05%), surgery (168/259, 64.86%) and histology (217/259, 83.78%), respectively. Experimental timepoint varied greatly between studies, ranging from 1 week (dog and rodent models), to >104 weeks in dog, horse, monkey, rabbit, and sheep models. The two most common timepoints used across all species were 4 weeks (49 manuscripts) and 12 weeks (44 manuscripts). A comprehensive discussion of the species, methods of IVDD induction and experimental endpoints is presented. There was great variability across all categories: animal species, method of IVDD induction, timepoints and experimental endpoints. While no animal model can replicate the human scenario, the most appropriate model should be selected in line with the study objectives to optimize experimental design, outcomes and improve comparisons between studies.
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Affiliation(s)
- Daniel L. Poletto
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of MedicineUniversity of New South Wales (UNSW) Sydney, Prince of Wales HospitalSydneyAustralia
| | - James D. Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of MedicineUniversity of New South Wales (UNSW) Sydney, Prince of Wales HospitalSydneyAustralia
| | - Onur Tanglay
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of MedicineUniversity of New South Wales (UNSW) Sydney, Prince of Wales HospitalSydneyAustralia
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of MedicineUniversity of New South Wales (UNSW) Sydney, Prince of Wales HospitalSydneyAustralia
| | - Matthew H. Pelletier
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of MedicineUniversity of New South Wales (UNSW) Sydney, Prince of Wales HospitalSydneyAustralia
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Salzer E, Mouser VHM, Tryfonidou MA, Ito K. A bovine nucleus pulposus explant culture model. J Orthop Res 2022; 40:2089-2102. [PMID: 34812520 PMCID: PMC9542046 DOI: 10.1002/jor.25226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Low back pain is a global health problem that is frequently caused by intervertebral disc degeneration (IVDD). Sulfated glycosaminoglycans (sGAGs) give the healthy nucleus pulposus (NP) a high fixed charge density (FCD), which creates an osmotic pressure that enables the disc to withstand high compressive forces. However, during IVDD sGAG reduction in the NP compromises biomechanical function. The aim of this study was to develop an ex vivo NP explant model with reduced sGAG content and subsequently investigate biomechanical restoration via injection of proteoglycan-containing notochordal cell-derived matrix (NCM). Bovine coccygeal NP explants were cultured in a bioreactor chamber and sGAG loss was induced by chondroitinase ABC (chABC) and cultured for up to 14 days. Afterwards, diurnal loading was studied, and explant restoration was investigated via injection of NCM. Explants were analyzed via histology, biochemistry, and biomechanical testing via stress relaxation tests and height measurements. ChABC injection induced dose-dependent sGAG reduction on Day 3, however, no dosing effects were detected after 7 and 14 days. Diurnal loading reduced sGAG loss after injection of chABC. NCM did not show an instant biomechanical (equilibrium pressure) or biochemical (FCD) restoration, as the injected fixed charges leached into the medium, however, NCM stimulated proliferation and increased Alcian blue staining intensity and matrix organization. NCM has biological repair potential and biomaterial/NCM combinations, which could better entrap NCM within the NP tissue, should be investigated in future studies. Concluding, chABC induced progressive, time-, dose- and loading-dependent sGAG reduction that led to a loss of biomechanical function. Keywords biomechanics | intervertebral disc | matrix degradation | low back pain | proteoglycans.
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Affiliation(s)
- Elias Salzer
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenNoord‐BrabantThe Netherlands
| | - Vivian H. M. Mouser
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenNoord‐BrabantThe Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenNoord‐BrabantThe Netherlands
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4
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Comparisons between needle puncture and chondroitinase ABC to induce intervertebral disc degeneration in rabbits. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2788-2800. [PMID: 35739423 DOI: 10.1007/s00586-022-07287-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aimed to compare the effect of needle puncture and chondroitinase ABC (ChABC) injection on inducing intervertebral disc (IVD) degeneration (IVDD) in rabbits. METHODS Sixteen New Zealand white rabbits were used in this study. Briefly, the rabbits were divided into four groups. In the annulus fibrosis (AF) needle puncture group, a 16-G needle was used to puncture the L5-6 and L6-7 IVDs, while in the sham group, these IVDs were not punctured. In the ChABC group, 30 μL 0.5 Unit/mL ChABC was injected into L5-6 and L6-7 IVDs using a 26-G needle, while in the vehicle group, these IVDs were injected with 30 μL phosphate-buffered saline (PBS). X-ray and MRI scans were performed at the 4th, 12th and 16th weeks postoperatively. Histological, immunohistochemical and biochemical analyses were performed at the 16th week postoperatively. RESULTS Both needle puncture and ChABC successfully established IVDD in rabbits at 4th, 12th and 16th weeks, confirmed by X-ray and MRI scan. The progression of IVDD went in a time-dependent manner. The IVDD in the ChABC group was less severe than in the needle puncture group throughout the study. Aggrecan and type II collagen significantly decreased, while tumor necrosis factor-α and superoxide dismutase 2 increased in the needle puncture and ChABC groups, compared with the sham and PBS groups. CONCLUSIONS Both AF needle puncture and ChABC injection can successfully induce IVDD in rabbits. Compared with ChABC injection, AF needle puncture can induce more severe IVDD.
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Sloan SR, Wipplinger C, Kirnaz S, Navarro-Ramirez R, Schmidt F, McCloskey D, Pannellini T, Schiavinato A, Härtl R, Bonassar LJ. Combined nucleus pulposus augmentation and annulus fibrosus repair prevents acute intervertebral disc degeneration after discectomy. Sci Transl Med 2021; 12:12/534/eaay2380. [PMID: 32161108 DOI: 10.1126/scitranslmed.aay2380] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
Tissue-engineered approaches for the treatment of early-stage intervertebral disc degeneration have shown promise in preclinical studies. However, none of these therapies has been approved for clinical use, in part because each therapy targets only one aspect of the intervertebral disc's composite structure. At present, there is no reliable method to prevent intervertebral disc degeneration after herniation and subsequent discectomy. Here, we demonstrate the prevention of degeneration and maintenance of mechanical function in the ovine lumbar spine after discectomy by combining strategies for nucleus pulposus augmentation using hyaluronic acid injection and repair of the annulus fibrosus using a photocrosslinked collagen patch. This combined approach healed annulus fibrosus defects, restored nucleus pulposus hydration, and maintained native torsional and compressive stiffness up to 6 weeks after injury. These data demonstrate the necessity of a combined strategy for arresting intervertebral disc degeneration and support further translation of combinatorial interventions to treat herniations in the human spine.
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Affiliation(s)
- Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sertaç Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Tania Pannellini
- Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY 10065, USA
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA. .,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
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Lee NN, Salzer E, Bach FC, Bonilla AF, Cook JL, Gazit Z, Grad S, Ito K, Smith LJ, Vernengo A, Wilke H, Engiles JB, Tryfonidou MA. A comprehensive tool box for large animal studies of intervertebral disc degeneration. JOR Spine 2021; 4:e1162. [PMID: 34337336 PMCID: PMC8313180 DOI: 10.1002/jsp2.1162] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Preclinical studies involving large animal models aim to recapitulate the clinical situation as much as possible and bridge the gap from benchtop to bedside. To date, studies investigating intervertebral disc (IVD) degeneration and regeneration in large animal models have utilized a wide spectrum of methodologies for outcome evaluation. This paper aims to consolidate available knowledge, expertise, and experience in large animal preclinical models of IVD degeneration to create a comprehensive tool box of anatomical and functional outcomes. Herein, we present a Large Animal IVD Scoring Algorithm based on three scales: macroscopic (gross morphology, imaging, and biomechanics), microscopic (histological, biochemical, and biomolecular analyses), and clinical (neurologic state, mobility, and pain). The proposed algorithm encompasses a stepwise evaluation on all three scales, including spinal pain assessment, and relevant structural and functional components of IVD health and disease. This comprehensive tool box was designed for four commonly used preclinical large animal models (dog, pig, goat, and sheep) in order to facilitate standardization and applicability. Furthermore, it is intended to facilitate comparison across studies while discerning relevant differences between species within the context of outcomes with the goal to enhance veterinary clinical relevance as well. Current major challenges in pre-clinical large animal models for IVD regeneration are highlighted and insights into future directions that may improve the understanding of the underlying pathologies are discussed. As such, the IVD research community can deepen its exploration of the molecular, cellular, structural, and biomechanical changes that occur with IVD degeneration and regeneration, paving the path for clinically relevant therapeutic strategies.
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Affiliation(s)
- Naomi N. Lee
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Elias Salzer
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Frances C. Bach
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Andres F. Bonilla
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityColoradoUSA
| | - James L. Cook
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Zulma Gazit
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Lachlan J. Smith
- Departments of Neurosurgery and Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrea Vernengo
- AO Research Institute DavosDavosSwitzerland
- Department of Chemical EngineeringRowan UniversityGlassboroNew JerseyUSA
| | - Hans‐Joachim Wilke
- Institute of Orthopaedic Research and BiomechanicsUniversity Hospital UlmUlmGermany
| | - Julie B. Engiles
- Department of Pathobiology, New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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Sloan SR, Wipplinger C, Kirnaz S, Delgado R, Huang S, Shvets G, Härtl R, Bonassar LJ. Imaging the local biochemical content of native and injured intervertebral disc using Fourier transform infrared microscopy. JOR Spine 2020; 3:e1121. [PMID: 33392456 PMCID: PMC7770196 DOI: 10.1002/jsp2.1121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
Alterations to the biochemical composition of the intervertebral disc (IVD) are hallmarks of aging and degeneration. Methods to assess biochemical content, such as histology, immunohistochemistry, and spectrophotometric assays, are limited in their ability to quantitatively analyze the spatial distribution of biochemical components. Fourier transform infrared (FTIR) microscopy is a biochemical analysis method that can yield both quantitative and high-resolution data about the spatial distribution of biochemical components. This technique has been largely unexplored for use with the IVD, and existing methods use complex analytical techniques that make results difficult to interpret. The objective of the present study is to describe an FTIR microscopy method that has been optimized for imaging the collagen and proteoglycan content of the IVD. The method was performed on intact and discectomized IVDs from the sheep lumbar spine after 6 weeks in vivo in order to validate FTIR microscopy in healthy and degenerated IVDs. FTIR microscopy quantified collagen and proteoglycan content across the entire IVD and showed local changes in biochemical content after discectomy that were not observed with traditional histological methods. Changes in collagen and proteoglycans content were found to have strong correlations with Pfirrmann grades of degeneration. This study demonstrates how FTIR microscopy is a valuable research tool that can be used to quantitatively assess the local biochemical composition of IVDs in development, degeneration, and repair.
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Affiliation(s)
- Stephen R. Sloan
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Christoph Wipplinger
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Sertaç Kirnaz
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Robert Delgado
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Steven Huang
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Gennady Shvets
- Applied Engineering and PhysicsCornell UniversityIthacaNew YorkUSA
| | - Roger Härtl
- Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew YorkUSA
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Borem R, Walters J, Madeline A, Madeline L, Gill S, Easley J, Mercuri J. Characterization of chondroitinase-induced lumbar intervertebral disc degeneration in a sheep model intended for assessing biomaterials. J Biomed Mater Res A 2020; 109:1232-1246. [PMID: 33040470 DOI: 10.1002/jbm.a.37117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
Intervertebral disc (IVD) degeneration (IVDD) leads to structural and functional changes. Biomaterials for restoring IVD function and promoting regeneration are currently being investigated; however, such approaches require validation using animal models that recapitulate clinical, biochemical, and biomechanical hallmarks of the human pathology. Herein, we comprehensively characterized a sheep model of chondroitinase-ABC (ChABC) induced IVDD. Briefly, ChABC (1 U) was injected into the L1/2 , L2/3 , and L3/4 IVDs. Degeneration was assessed via longitudinal magnetic resonance (MR) and radiographic imaging. Additionally, kinematic, biochemical, and histological analyses were performed on explanted functional spinal units (FSUs). At 17-weeks, ChABC treated IVDs demonstrated significant reductions in MR index (p = 0.030) and disc height (p = 0.009) compared with pre-operative values. Additionally, ChABC treated IVDs exhibited significantly increased creep displacement (p = 0.004) and axial range of motion (p = 0.007) concomitant with significant decreases in tensile (p = 0.034) and torsional (p = 0.021) stiffnesses and long-term viscoelastic properties (p = 0.016). ChABC treated IVDs also exhibited a significant decrease in NP glycosaminoglycan: hydroxyproline ratio (p = 0.002) and changes in microarchitecture, particularly in the NP and endplates, compared with uninjured IVDs. Taken together, this study demonstrated that intradiscal injection of ChABC induces significant degeneration in sheep lumbar IVDs and the potential for using this model in evaluating biomaterials for IVD repair, regeneration, or fusion.
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Affiliation(s)
- Ryan Borem
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Joshua Walters
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Allison Madeline
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Lee Madeline
- Department of Radiology, Greenville Health System, Greenville, South Carolina, USA
| | - Sanjitpal Gill
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Department of Orthopaedic Surgery, Medical Group of the Carolinas-Pelham, Spartanburg Regional Healthcare System, Greer, South Carolina, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Jeremy Mercuri
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
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Schwan S, Ludtka C, Friedmann A, Heilmann A, Baerthel A, Brehm W, Wiesner I, Meisel HJ, Goehre F. Long-Term Pathology of Ovine Lumbar Spine Degeneration Following Injury Via Percutaneous Minimally Invasive Partial Nucleotomy. J Orthop Res 2019; 37:2376-2388. [PMID: 31283052 DOI: 10.1002/jor.24402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
The focus of this work is to assess the long-term progression of degeneration in the ovine lumbar spine following a minimally invasive model injury comparable to the damage of an intervertebral disc (IVD) herniation. A partial nucleotomy was performed on 18 sheep via the percutaneous dorsolateral approach. The animals were culled at 6 and 12 months to evaluate the damaged and neighboring functional spine units (FSUs) for degenerative characteristics via μ-CT and histology. Both quantitative μ-CT and histology investigations demonstrated statistically significant differences between the native and damaged FSUs investigated. Qualitative analysis of μ-CT revealed numerous pathological markers consistent with intervertebral disc degeneration (IDD), with differences in frequency and severity between the native and damaged FSUs. The annulus fibrosus reforms a pressure seal within 6 weeks, but the extent of the trauma is significant enough to initiate IVD degeneration, which is already clearly visible at 6 months and especially so 12 months post-op. IDD pathology consistent with signs of a herniation was seen in both the 6- and 12-month groups. This technique provides a useful model injury for the preclinical evaluation of IDD in large animal models, especially in regards to simulating disc herniation as well as for testing the efficacy of associated therapies in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2376-2388, 2019.
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Affiliation(s)
- Stefan Schwan
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany.,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Christopher Ludtka
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,University of Tennessee Health Science Center, University of Tennessee, 910 Madison Ave., Memphis, Tennessee, 38163
| | - Andrea Friedmann
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany.,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Andreas Heilmann
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany
| | - Andre Baerthel
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,Department of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Walther Brehm
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,Department of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Ingo Wiesner
- Department of General Surgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Hans J Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Felix Goehre
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany.,Department of Neurosurgery, University Hospital and University of Helsinki, Helsinki, Finland
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10
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Wang T, Pelletier MH, Christou C, Oliver R, Mobbs RJ, Walsh WR. A novel in vivo large animal model of lumbar spinal joint degeneration. Spine J 2018; 18:1896-1909. [PMID: 29800709 DOI: 10.1016/j.spinee.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative disc disease (DDD) is a common, widespread socioeconomic problem. Appropriate large animal models of DDD are required for improved understanding and to serve as preclinical test beds for therapeutic strategies. PURPOSE To evaluate the effects of short and medium duration immobilization on the sheep lumbar intervertebral disc (IVD) and facet joints (FJs), and to establish a large animal model for DDD research. STUDY DESIGN An in vivo sheep model evaluating the effect of short- and medium-term immobilization on disc degeneration. METHODS Eighteen sheep were equally randomized into three groups: short-term (6-week) immobilization (n=6), medium-term (26-week) immobilization (n=6), and control (no surgery) (n=6). Immobilization of L3-L4 was achieved with pedicle screw and rod implantation, the IVD was kept intact, and the annulus and end plates were not disrupted. The IVD and FJs were assessed with planar radiography, computerized tomography (CT), magnetic resonance imaging (MRI), pure moment biomechanical testing, and histologic analysis. RESULTS Disc height was reduced for 6- and 26-week immobilization groups. The MRI and histologic analysis demonstrated significant disc degeneration for both immobilized groups compared with control, but no statistical difference was detected between short- and medium-term duration. Progressive degenerative changes in FJs were observed with micro-CT and histologic end points. Immobilization significantly reduced lateral bending and flexion-extension range of motion. CONCLUSIONS The mechanical environment set up by immobilization alone is capable of inducing lumbar disc degeneration at both 6 and 26 weeks in sheep. Longer duration immobilization did not advance disc degeneration process beyond of that found with short duration. The present model produces a degenerative disc with intact annulus and without acute injury, more closely representing the scenario common in human disc degeneration. This provides a suitable large animal in vivo model for the evaluation of the new therapies for disc degeneration. Further studies would do well to examine the effect of remobilization after immobilization in this model.
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Affiliation(s)
- Tian Wang
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Chris Christou
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Rema Oliver
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Ralph J Mobbs
- Neurospine Clinic, Prince of Wales Hospital, University of New South Wales, Barker St, Randwick, Sydney, NSW 2031, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia.
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Paul CPL, Emanuel KS, Kingma I, van der Veen AJ, Holewijn RM, Vergroesen PPA, van de Ven PM, Mullender MG, Helder MN, Smit TH. Changes in Intervertebral Disk Mechanical Behavior During Early Degeneration. J Biomech Eng 2018; 140:2678255. [PMID: 29801164 DOI: 10.1115/1.4039890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 11/08/2022]
Abstract
Intervertebral disk (IVD) degeneration is commonly described by loss of height and hydration. However, in the first stage of IVD degeneration, this loss has not yet occurred. In the current study, we use an ex vivo degeneration model to analyze the changes in IVDs mechanical behavior in the first phase of degeneration. We characterize these changes by stretched-exponential fitting, and suggest the fitted parameters as markers for early degeneration. Enzymatic degeneration of healthy lumbar caprine IVDs was induced by injecting 100 μL of Chondroïtinase ABC (Cabc) into the nucleus. A no-intervention and phosphate buffered saline (PBS) injected group were used as controls. IVDs were cultured in a bioreactor for 20 days under diurnal, simulated-physiological loading (SPL) conditions. Disk deformation was continuously monitored. Changes in disk height recovery behavior were quantified using stretched-exponential fitting. Disk height, histological sections, and water- and glycosaminoglycan (GAG)-content measurements were used as gold standards for the degenerative state. Cabc injection caused significant GAG loss from the nucleus and had detrimental effects on poro-elastic mechanical properties of the IVDs. These were progressive over time, with a propensity toward more linear recovery behavior. On histological sections, both PBS and Cabc injected IVDs showed moderate degeneration. A small GAG loss yields changes in IVD recovery behavior, which can be quantified with stretched-exponential fitting. Parameters changed significantly compared to control. Studies on disk degeneration and biomaterial engineering for degenerative disk disease (DDD) could benefit from focusing on IVD biomechanical behavior rather than height and water-content, as a marker for early disk degeneration.
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Affiliation(s)
- Cornelis P L Paul
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam 1081 BT, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Pieter-Paul A Vergroesen
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam 1081 BT, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands.,Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands e-mail:
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12
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Zhu D, Tapadia MD, Palispis W, Luu M, Wang W, Gupta R. Attenuation of Robust Glial Scar Formation Facilitates Functional Recovery in Animal Models of Chronic Nerve Compression Injury. J Bone Joint Surg Am 2017; 99:e132. [PMID: 29257018 DOI: 10.2106/jbjs.17.00396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Late surgery for chronic nerve compression injuries usually improves sensation but rarely reverses motor atrophy. We hypothesized that a persistent glial scar after chronic nerve compression injury might account for poor motor recovery and that degradation of the glial scar as an adjunct to surgical decompression would improve functional recovery. METHODS A previously described model of chronic nerve compression injury was created in C57BL/6 mice and Sprague-Dawley rats, and the nerves were harvested early or late after electrophysiological confirmation of the injury. Western blot, polymerase chain reaction, and quantitative immunohistochemical analyses were performed to determine levels of chondroitin sulfate proteoglycans and extracellular matrix molecules. Subsets of mice were treated either with surgical decompression alone or with decompression coupled with intraepineurial injection of a low dose (0.1 μgμL) or a high dose (0.2 μg/μL) of chondroitinase ABC at 6 weeks after injury. RESULTS Aggrecan showed the greatest change in mRNA and protein levels at the early and late time points following creation of the chronic nerve compression injury. Quantitative immunohistochemical analysis revealed early aggrecan upregulation localized primarily to the endoneurium and late upregulation localized to the perineurium and epineurium (p < 0.0105). Quantitative immunohistochemical analysis for collagen IV, laminin-α2, and fibronectin also showed early upregulation with perineurial scarring. Quantitative immunohistochemical analysis and Western blot analysis for aggrecan demonstrated a marked increase in the endoneurium at the early time points and upregulation of expression in the epineurium and perineurium at the late time points. Decompression along with intraepineurial injection of high-dose chondroitinase ABC at 6 weeks after creation of the compression injury resulted in marked attenuation of decorin and aggrecan expression with functional improvement in nerve conduction velocity. CONCLUSIONS Significant upregulation of chondroitin sulfate proteoglycans and other extracellular matrix components contributes to the pathogenesis of compression neuropathies in murine models. The administration of chondroitinase ABC degrades these chondroitin sulfate proteoglycans and improves functional recovery after chronic nerve compression injury; thus, it can be considered as a possible therapeutic adjunct.
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Affiliation(s)
- Diana Zhu
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Minal D Tapadia
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Winnie Palispis
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Michele Luu
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Weiping Wang
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Ranjan Gupta
- Peripheral Nerve Research Laboratory, Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
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13
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Reitmaier S, Graichen F, Shirazi-Adl A, Schmidt H. Separate the Sheep from the Goats: Use and Limitations of Large Animal Models in Intervertebral Disc Research. J Bone Joint Surg Am 2017; 99:e102. [PMID: 28976436 DOI: 10.2106/jbjs.17.00172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Approximately 5,168 large animals (pigs, sheep, goats, and cattle) were used for intervertebral disc research in identified studies published between 1985 and 2016. Most of the reviewed studies revealed a low scientific impact, a lack of sound justifications for the animal models, and a number of deficiencies in the documentation of the animal experimentation. The scientific community should take suitable measures to investigate the presumption that animal models have translational value in intervertebral disc research. Recommendations for future investigations are provided to improve the quality, validity, and usefulness of animal studies for intervertebral disc research. More in vivo studies are warranted to comprehensively evaluate the suitability of animal models in various applications and help place animal models as an integral, complementary part of intervertebral disc research.
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Affiliation(s)
- Sandra Reitmaier
- 1Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany 2École Polytechnique, Montréal, Canada
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14
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Bhangare KP, Kaye AD, Knezevic NN, Candido KD, Urman RD. An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain. Anesthesiol Clin 2017; 35:341-350. [PMID: 28526154 DOI: 10.1016/j.anclin.2017.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. An extensive literature review focuses on new treatments for CLBP. Their safety and efficacy were evaluated and are described in detail in this review. The investigation identified new treatments for CLBP including chemonucleolysis, platelet-rich plasma injections, artemin, tanezumab, and stem cells. Further research and innovation are needed to implement these methods into practice and assess clinical significance. The current evidence suggests that there are promising new agents for the treatment of CLBP.
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Affiliation(s)
- Karishma Patel Bhangare
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alan D Kaye
- Department of Anesthesiology and Pain Medicine, Louisiana State University School of Medicine, LSU Health Science Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology and Pain Medicine, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA
| | - Kenneth D Candido
- Department of Anesthesiology and Pain Medicine, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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15
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Gullbrand SE, Malhotra NR, Schaer TP, Zawacki Z, Martin JT, Bendigo JR, Milby AH, Dodge GR, Vresilovic EJ, Elliott DM, Mauck RL, Smith LJ. A large animal model that recapitulates the spectrum of human intervertebral disc degeneration. Osteoarthritis Cartilage 2017; 25:146-156. [PMID: 27568573 PMCID: PMC5182186 DOI: 10.1016/j.joca.2016.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/01/2016] [Accepted: 08/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to establish a large animal model that recapitulates the spectrum of intervertebral disc degeneration that occurs in humans and which is suitable for pre-clinical evaluation of a wide range of experimental therapeutics. DESIGN Degeneration was induced in the lumbar intervertebral discs of large frame goats by either intradiscal injection of chondroitinase ABC (ChABC) over a range of dosages (0.1U, 1U or 5U) or subtotal nucleotomy. Radiographs were used to assess disc height changes over 12 weeks. Degenerative changes to the discs and endplates were assessed via magnetic resonance imaging (MRI), semi-quantitative histological grading, microcomputed tomography (μCT), and measurement of disc biomechanical properties. RESULTS Degenerative changes were observed for all interventions that ranged from mild (0.1U ChABC) to moderate (1U ChABC and nucleotomy) to severe (5U ChABC). All groups showed progressive reductions in disc height over 12 weeks. Histological scores were significantly increased in the 1U and 5U ChABC groups. Reductions in T2 and T1ρ, and increased Pfirrmann grade were observed on MRI. Resorption and remodeling of the cortical boney endplate adjacent to ChABC-injected discs also occurred. Spine segment range of motion (ROM) was greater and compressive modulus was lower in 1U ChABC and nucleotomy discs compared to intact. CONCLUSIONS A large animal model of disc degeneration was established that recapitulates the spectrum of structural, compositional and biomechanical features of human disc degeneration. This model may serve as a robust platform for evaluating the efficacy of therapeutics targeted towards varying degrees of disc degeneration.
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Affiliation(s)
- S E Gullbrand
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - N R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - T P Schaer
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - Z Zawacki
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - J T Martin
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - J R Bendigo
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - A H Milby
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - G R Dodge
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - E J Vresilovic
- Penn State Hershey Bone and Joint Institute, Pennsylvania State University, Hershey, PA, United States
| | - D M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - R L Mauck
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - L J Smith
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States.
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16
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Mechanics and biology in intervertebral disc degeneration: a vicious circle. Osteoarthritis Cartilage 2015; 23:1057-70. [PMID: 25827971 DOI: 10.1016/j.joca.2015.03.028] [Citation(s) in RCA: 557] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 02/02/2023]
Abstract
Intervertebral disc degeneration is a major cause of low back pain. Despite its long history and large socio-economical impact in western societies, the initiation and progress of disc degeneration is not well understood and a generic disease model is lacking. In literature, mechanics and biology have both been implicated as the predominant inductive cause; here we argue that they are interconnected and amplify each other. This view is supported by the growing awareness that cellular physiology is strongly affected by mechanical loading. We propose a vicious circle of mechanical overloading, catabolic cell response, and degeneration of the water-binding extracellular matrix. Rather than simplifying the disease, the model illustrates the complexity of disc degeneration, because all factors are interrelated. It may however solve some of the controversy in the field, because the vicious circle can be entered at any point, eventually leading to the same pathology. The proposed disease model explains the comparable efficacy of very different animal models of disc degeneration, but also helps to consider the consequences of therapeutic interventions, either at the cellular, material or mechanical level.
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17
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Pathomechanisms of discogenic low back pain in humans and animal models. Spine J 2015; 15:1347-55. [PMID: 24657737 DOI: 10.1016/j.spinee.2013.07.490] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 02/10/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although explored in humans and animal models, the pathomechanisms of discogenic low back pain (LBP) remain unknown. PURPOSE The aim of this study was to review the literature about the pathomechanisms of discogenic LBP. METHODS Animal models of discogenic pain and specimens from degenerated human intervertebral discs (IVDs) have provided clues about the pathomechanisms of discogenic LBP. Painful discs are characterized by a confluence of innervation, inflammation, and mechanical hypermobility. These three possible mechanisms are discussed in this review. RESULTS Animal models and specimens from humans have revealed sensory innervation of lumbar IVDs and sensory nerve ingrowth into the inner layer of IVDs. Cytokines such as tumor necrosis factor-α and interleukins induce this ingrowth. Nerve growth factor has also been recently identified as an inducer of ingrowth. Finally, disc degeneration induces several collagenases; their action results in hypermobility and pain. CONCLUSIONS To treat discogenic LBP, it is important to prevent sensitization of sensory nerve fibers innervating the IVD, to suppress pathogenic increases of cytokines, and to decrease disc hypermobility.
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Cincu R, Lorente FDA, Gomez J, Eiras J, Agrawal A. One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy. Asian J Neurosurg 2015; 10:21-5. [PMID: 25767571 PMCID: PMC4352623 DOI: 10.4103/1793-5482.151504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc. METHODS In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed. RESULTS There were 27 male and 23 female with followup mean follow up of 115 months (range 105-130 months) with a mean age was 52 years (range 26-74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3-4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions. CONCLUSIONS Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.
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Affiliation(s)
- Rafael Cincu
- Department of Neurosurgery, University General Hospital, Valencia, Spain
| | | | - Joaquin Gomez
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose Eiras
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Amit Agrawal
- Department of Surgery Datta Meghe Institute of Medical Sciences, Sawangi, Meghe, Wardha, India
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19
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Detiger SEL, Helder MN, Smit TH, Hoogendoorn RJW. Adverse effects of stromal vascular fraction during regenerative treatment of the intervertebral disc: observations in a goat model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1992-2000. [PMID: 25682272 DOI: 10.1007/s00586-015-3803-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 12/18/2022]
Abstract
Stromal vascular fraction (SVF), an adipose tissue-derived heterogeneous cell mixture containing, among others, multipotent adipose stromal cells (ASCs) and erythrocytes, has proved beneficial for a wide range of applications in regenerative medicine. We sought to establish intervertebral disc (IVD) regeneration by injecting SVF intradiscally during a one-step surgical procedure in an enzymatically (Chondroitinase ABC; cABC) induced goat model of disc degeneration. Unexpectedly, we observed a severe inflammatory response that has not been described before, including massive lymphocyte infiltration, neovascularisation and endplate destruction. A second study investigated two main suspects for these adverse effects: cABC and erythrocytes within SVF. The same destructive response was observed in healthy goat discs injected with SVF, thereby eliminating cABC as a cause. Density gradient removal of erythrocytes and ASCs purified by culturing did not lead to adverse effects. Following these observations, we incorporated an extra washing step in the SVF harvesting protocol. In a third study, we applied this protocol in a one-step procedure to a goat herniation model, in which no adverse responses were observed either. However, upon intradiscal injection of an identically processed SVF mixture into our goat IVD degeneration model during a fourth study, the adverse effects surprisingly occurred again. Despite our quest for the responsible agent, we eventually could not identify the mechanism through which the observed destructive responses occurred. Although we cannot exclude that the adverse effects are species-dependent or model-specific, we advertise caution with the clinical application of autologous SVF injections into the IVD until the responsible agent(s) are identified.
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Affiliation(s)
- Suzanne E L Detiger
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,
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Abstract
Even after 20 years of granting orphan status for chondroitinase by US FDA, there is no visible outcome in terms of clinical use. The reasons are many. One of them could be lack of awareness regarding the biological application of the enzyme. The biological activity of chondroitinase is due to its ability to act on chondroitin sulfate proteoglycans (CSPGs). CSPGs are needed for normal functioning of the body. An increase or decrease in the level of CSPGs results in various pathological conditions. Chondroitinase is useful in conditions where there is an increase in the level of CSPGs, namely spinal cord injury, vitreous attachment and cancer. Over the last decade, various animal studies showed that chondroitinase could be a good drug candidate. Research focusing on developing a suitable carrier system for delivering chondroitinase needs to be carried out so that pharmacological activity observed in vitro and preclinical studies could be translated to clinical use. Further studies on distribution of chondroitinase as well need to be focused so that chondroitinase with desired attributes could be discovered. The present review article discusses about various biological applications of chondroitinase, drug delivery systems to deliver the enzyme and distribution of chondroitinase among microbes.
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Affiliation(s)
- Narayanan Kasinathan
- a Department of Pharmaceutical Biotechnology , Manipal College of Pharmaceutical Sciences, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal , Karnataka , India
| | - Subrahmanyam M Volety
- a Department of Pharmaceutical Biotechnology , Manipal College of Pharmaceutical Sciences, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal , Karnataka , India
| | - Venkata Rao Josyula
- a Department of Pharmaceutical Biotechnology , Manipal College of Pharmaceutical Sciences, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal , Karnataka , India
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Smuck M, Levin J, Zemper E, Ali A, Kennedy DJ. A quantitative study of intervertebral disc morphologic changes following plasma-mediated percutaneous discectomy. PAIN MEDICINE 2014; 15:1695-703. [PMID: 25186460 DOI: 10.1111/pme.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantitatively evaluate interval magnetic resonance imaging (MRI) changes in disc morphology following plasma-mediated percutaneous discectomy. DESIGN/SETTING A retrospective comparison of pretreatment and posttreatment MRIs at a single university spine clinic. SUBJECTS From a group of 60 consecutively treated patients, 15 met the study inclusion and exclusion criteria. All had either failed treatment or had other clinical reasons for a posttreatment MRI. METHODS Two independent physicians electronically measured disc protrusion size and disc height at the treatment discs and adjacent discs on pre- and posttreatment MRI scans. Additionally, images were compared for gross anatomic changes including disc degeneration by Pfirrman classification, new disc herniations, high intensity zone (HIZ), vertebral endplate changes, post-contrast enhancement, and changes in segmental alignment. Pearson r correlation was used to determine interobserver reliability between the two physicians' MRI measurements. Paired t-tests were calculated for comparisons of pre- and posttreatment MRI measurements, and an ANOVA was performed for comparison of pre- to posttreatment changes in disc height measurements at treatment levels relative to adjacent levels. RESULTS Correlation was high for measurement of disc height change (r = 0.89; P < 0.0001) and good for anteroposterior protrusion size change (r = 0.51; P = 0.0512). Disc height at treated discs demonstrated a small but statistically significant mean interval reduction of 0.48 mm (P = 0.0018). This remained significant when compared with the adjacent control discs (P < 0.0001). Pretreatment mean disc protrusion size (4.74 mm; range 3.75-6.55 mm) did not differ significantly (P = 0.1145) from posttreatment protrusion size (4.42 mm; range 2.55-7.95 mm). Gross anatomic changes at treatment levels included reduced disc protrusion size (N = 6), enlarged protrusion (N = 3), resolution of HIZ (N = 3), and improvement in endplate signal changes (N = 1). Also, 11/15 posttreatment MRIs included post-contrast images that showed epidural fibrosis (N = 1), rim enhancement (N = 2), and enhancement of the posterior annulus (N = 4). CONCLUSIONS Based on MRI examinations, subtle anatomic changes may occur following plasma-mediated percutaneous discectomy. Further study is required to determine the clinical relevance of these changes.
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Affiliation(s)
- Matthew Smuck
- PM&R Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Haro H, Nishiga M, Ishii D, Shimomoto T, Kato T, Takenouchi O, Koyanagi S, Ohba T, Komori H. Experimental chemonucleolysis with recombinant human matrix metalloproteinase 7 in human herniated discs and dogs. Spine J 2014; 14:1280-90. [PMID: 24295797 DOI: 10.1016/j.spinee.2013.11.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 10/11/2013] [Accepted: 11/21/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Chemonucleolysis has been proposed as a less invasive technique than surgery for patients with lumbar disc herniation. Once chymopapain had been approved as a chemonucleolysis drug, it was withdrawn because of serious complications. A novel agent with fewer complications would be desirable. PURPOSE The purpose of this study was to investigate the effects of recombinant human matrix metalloproteinase 7 (rhMMP-7) in experimental chemonucleolysis in vitro and in vivo and examine its effects on tissue damage. STUDY DESIGN The study design is the experimental study using human herniated discs and enzyme substrates in vitro and dogs in vivo. METHODS The effects of rhMMP-7 on the degradation of human herniated discs were examined by measuring the wet weight in vitro. The correlations between the decrease in wet weight by rhMMP-7 and the conditions associated with herniated discs were also analyzed. The effects of rhMMP-7 on the proteoglycan and water contents were respectively examined with alcian blue staining and T2-weighted magnetic resonance imaging at 7 days after intradiscal injection in dogs. The distribution of [125I]-labeled rhMMP-7 was investigated by autoradioluminography at 7 days after intradiscal injection in dogs. An epidural injection study with rhMMP-7 was performed to evaluate the effects on the tissue damage around the discs at 1 and 13 weeks after the treatment in dogs. The Type 1 and 2 collagen cleavage rates were measured and compared with those of aggrecan in vitro. RESULTS Recombinant human matrix metalloproteinase 7 concentration dependently decreased the wet weight of herniated discs in vitro. The decrease in wet weight of the discs by rhMMP-7 did not significantly correlate with the conditions associated with herniated discs. Intradiscal injection of rhMMP-7 reduced the proteoglycan and water contents, with an increase in the serum keratan sulfate levels. Radioactivity of [125I]-labeled rhMMP-7 was detected in the nucleus pulposus and annulus fibrosus but not in the muscle. Epidural injection of rhMMP-7 had no effect on the injection site or the nerve tissues. The Type 1 and 2 collagen cleavage rates of rhMMP-7 were 1,000-fold weaker than those of aggrecan. CONCLUSIONS This study demonstrated experimental chemonucleolysis with rhMMP-7 in vitro and in vivo. The effects of rhMMP-7 were not affected by the conditions associated with herniated discs. The epidural injection study together with the autoradioluminography and in vitro enzyme assay suggests that intradiscal injection of rhMMP-7 may not induce tissue damage around the discs because of its distribution and substrate selectivity. Recombinant human matrix metalloproteinase 7 may be a novel and promising chemonucleolysis agent.
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Affiliation(s)
- Hirotaka Haro
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
| | - Miyuki Nishiga
- Teijin Institute for Bio-Medical Research, Teijin Pharma Limited, Tokyo, Japan
| | - Daisuke Ishii
- Teijin Institute for Bio-Medical Research, Teijin Pharma Limited, Tokyo, Japan
| | - Takasumi Shimomoto
- Teijin Institute for Bio-Medical Research, Teijin Pharma Limited, Tokyo, Japan
| | - Tsuyoshi Kato
- Department of Orthopaedic and Spinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Osami Takenouchi
- Teijin Institute for Bio-Medical Research, Teijin Pharma Limited, Tokyo, Japan
| | - Satoshi Koyanagi
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kumamoto, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Hiromichi Komori
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
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Lawless IM, Ding B, Cazzolato BS, Costi JJ. Adaptive velocity-based six degree of freedom load control for real-time unconstrained biomechanical testing. J Biomech 2014; 47:3241-7. [PMID: 25016485 DOI: 10.1016/j.jbiomech.2014.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/21/2014] [Accepted: 06/18/2014] [Indexed: 01/28/2023]
Abstract
Robotic biomechanics is a powerful tool for further developing our understanding of biological joints, tissues and their repair. Both velocity-based and hybrid force control methods have been applied to biomechanics but the complex and non-linear properties of joints have limited these to slow or stepwise loading, which may not capture the real-time behaviour of joints. This paper presents a novel force control scheme combining stiffness and velocity based methods aimed at achieving six degree of freedom unconstrained force control at physiological loading rates.
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Affiliation(s)
- I M Lawless
- Biomechanics and Implants Research Group, Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Australia
| | - B Ding
- School of Mechanical Engineering, University of Adelaide, Australia
| | - B S Cazzolato
- School of Mechanical Engineering, University of Adelaide, Australia
| | - J J Costi
- Biomechanics and Implants Research Group, Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Australia.
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Vadalà G, De Strobel F, Bernardini M, Denaro L, D'Avella D, Denaro V. The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22 Suppl 6:S972-8. [PMID: 24105019 DOI: 10.1007/s00586-013-3007-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 09/08/2013] [Accepted: 09/08/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To characterize in vivo the transpedicular approach (TA) as an alternative route to study intervertebral disc (IVD) regeneration strategies in a sheep model. METHODS 48 IVD of 12 sheep were used. TA was performed under fluoroscopy, followed by nucleotomy (2-mm shaver resector). A polyurethane scaffold was used to repair the end-plate. X-ray and MRI images were acquired pre-, intra- and post-operatively (1, 3, 6 months). Complications were recorded. RESULTS TA was feasible in all animals; nucleus pulposus (NP) from L1 to L5 was accessible. Nucleotomy followed by end-plate repair was achieved. Loss of NP signal intensity was shown in MRI images of the nucleotomy group. CONCLUSIONS TA is feasible in vivo, repeatable after only a short learning period and safely performed without significant morbidity. This animal model allows the study of IVD degeneration physiopathology and investigation of IVD regeneration techniques in vivo.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, 00128, Rome, Italy,
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Nisolle JF, Neveu F, Hontoir F, Clegg P, Kirschvink N, Vandeweerd JM. CT-guided injection technique into intervertebral discs in the ovine lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2760-5. [PMID: 23934381 DOI: 10.1007/s00586-013-2936-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Disc injection to create intervertebral (IVD) disc degeneration (IVDD) has been reported in ovine models, but the techniques have not been thoroughly described. The current ex vivo study aimed to evaluate a computed tomography (CT)-guided injection technique into IVDs in the ovine lumbar spine. METHODS Insertion of needles into the nucleus pulposus was assessed by gross anatomic dissection in two lumbar segments (group A), and injection of liquid within the disc was assessed by discography in six segments (group B). RESULTS The pathway of the needle was simulated on computer after an initial CT scan, followed by control of the insertion process via a laser beam and monitoring scans. In group A, 20 insertions were assessed and 17 needles (85 %) were successfully positioned in the nucleus pulposus. In group B of 30 injections, the rate of success was 90 %. CONCLUSIONS The current study provides useful clinical information that will help surgeons working with an ovine model for research on IVDD. This model could also be useful to train less experienced surgeons or radiologists to disc injection. This CT-guided injection seems to offer several advantages such as ease of use, good success rate and safety to important nervous and vascular structures.
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Affiliation(s)
- Jean Francois Nisolle
- Centre Hospitalier Universitaire Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium
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26
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Liu HF, Zhang H, Qiao GX, Ning B, Hu YL, Wang DC, Hu YG. A novel rabbit disc degeneration model induced by fibronectin fragment. Joint Bone Spine 2013; 80:301-6. [DOI: 10.1016/j.jbspin.2012.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
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Chan SCW, Bürki A, Bonél HM, Benneker LM, Gantenbein-Ritter B. Papain-induced in vitro disc degeneration model for the study of injectable nucleus pulposus therapy. Spine J 2013; 13:273-83. [PMID: 23353003 DOI: 10.1016/j.spinee.2012.12.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 09/27/2012] [Accepted: 12/09/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Proteolytic enzyme digestion of the intervertebral disc (IVD) offers a method to simulate a condition of disc degeneration for the study of cell-scaffold constructs in the degenerated disc. PURPOSE To characterize an in vitro disc degeneration model (DDM) of different severities of glycosaminoglycans (GAG) and water loss by using papain, and to determine the initial response of the human mesenchymal stem cells (MSCs) introduced into this DDM. STUDY DESIGN Disc degeneration model of a bovine disc explant with an end plate was induced by the injection of papain at various concentrations. Labeled MSCs were later introduced in this model. METHODS Phosphate-buffered saline (PBS control) or papain in various concentrations (3, 15, 30, 60, and 150 U/mL) were injected into the bovine caudal IVD explants. Ten days after the injection, GAG content of the discs was evaluated by dimethylmethylene blue assay and cell viability was determined by live/dead staining together with confocal microscopy. Overall matrix composition was evaluated by histology, and water content was visualized by magnetic resonance imaging. Compressive and torsional stiffness of the DDM were also recorded. In the second part, MSCs were labeled with a fluorescence cell membrane tracker and injected into the nucleus of the DDM or a PBS control. Mesenchymal stem cell viability and distribution were evaluated by confocal microscopy. RESULTS A large drop of GAG and water content of the bovine disc were obtained by injecting >30 U/mL papain. Magnetic resonance imaging showed Grade II, III, and IV disc degeneration by injecting 30, 60, and 150 U/mL papain. A cavity in the center of the disc could facilitate later injection of the nucleus pulposus tissue engineering construct while retaining an intact annulus fibrosus. The remaining disc cell viability was not affected. Mesenchymal stem cells injected into the protease-treated DDM disc showed significantly higher cell viability than when injected into the PBS-injected control disc. CONCLUSIONS By varying the concentration of papain for injection, an increasing amount of GAG and water loss could be induced to simulate the different severities of disc degeneration. MSC suspension introduced into the disc has a very low short-term survival. However, it should be clear that this bovine IVD DDM does not reflect a clinical situation but offers exciting possibilities to test novel tissue engineering protocols.
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Affiliation(s)
- Samantha C W Chan
- Tissue & Organ Mechanobiology, Institute of Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
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Oehme D, Goldschlager T, Rosenfeld J, Danks A, Ghosh P, Gibbon A, Jenkin G. Lateral surgical approach to lumbar intervertebral discs in an ovine model. ScientificWorldJournal 2012; 2012:873726. [PMID: 23028255 PMCID: PMC3458268 DOI: 10.1100/2012/873726] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/28/2012] [Indexed: 01/09/2023] Open
Abstract
The sheep is becoming increasingly used as a large animal model for preclinical spine surgery studies. Access to the ovine lumbar intervertebral discs has traditionally been via an anterior or anterolateral approach, which requires larger wound incisions and, at times, significant abdominal retraction. We present a new minimally invasive operative technique for a far-lateral approach to the ovine lumbar spine that allows for smaller incisions, excellent visualisation of intervertebral discs, and minimal abdominal retraction and is well tolerated by animals with minimal morbidity.
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Affiliation(s)
- David Oehme
- The Ritchie Centre, Monash Institute of Medical Research-MIMR, Monash University, Clayton, VIC 3168, Australia.
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Abstract
STUDY DESIGN Investigation of injectable nucleus pulposus (NP) implant. OBJECTIVE To assess the ability of a recently developed injectable hydrogel implant to restore nondegenerative disc mechanics through support of NP functional mechanics. SUMMARY OF BACKGROUND DATA Although surgical intervention for low back pain is effective for some patients, treated discs undergo altered biomechanics and adjacent levels are at increased risk for accelerated degeneration. One potential treatment as an alternative to surgery for degenerated disc includes the percutaneous delivery of agents to support NP functional mechanics. The implants are delivered in a minimally invasive fashion, potentially on an outpatient basis, and do not preclude later surgical options. One of the challenges in designing such implants includes the need to match key NP mechanical behavior and mimic the role of native nondegenerate NP in spinal motion. METHODS The oxidized hyaluronic acid gelatin implant material was prepared. In vitro mechanical testing was performed in mature ovine bone-disc-bone units in 3 stages: intact, discectomy, and implantation versus sham. Tested samples were cut axially for qualitative structural observations. RESULTS Discectomy increased axial range of motion (ROM) significantly compared with intact. Hydrogel implantation reduced ROM 17% (P < 0.05) compared with discectomy and returned ROM to intact levels (ROM intact 0.71 mm, discectomy 0.87 mm, postimplantation 0.72 mm). Although ROM for the hydrogel implant group was statistically unchanged compared with the intact disc, ROM for sham discs, which received a discectomy and no implant, was significantly increased compared with intact. The compression and tension stiffness were decreased with discectomy and remained unchanged for both implant and sham groups as expected because the annulus fibrosus was not repaired. Gross morphology images confirmed no ejection of NP implant. CONCLUSION An injectable implant that mimics nondegenerate NP has the potential to return motion segment ROM to normal subsequent to injury.
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Ghosh P, Moore R, Vernon-Roberts B, Goldschlager T, Pascoe D, Zannettino A, Gronthos S, Itescu S. Immunoselected STRO-3+ mesenchymal precursor cells and restoration of the extracellular matrix of degenerate intervertebral discs. J Neurosurg Spine 2012; 16:479-88. [PMID: 22404141 DOI: 10.3171/2012.1.spine11852] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECT Chronic low-back pain of discal origin is linked strongly to disc degeneration. Current nonsurgical treatments are palliative and fail to restore the disc extracellular matrix. In this study the authors examined the capacity of ovine mesenchymal precursor cells (MPCs) to restore the extracellular matrix of degenerate discs in an ovine model. METHODS Three adjacent lumbar discs of 24 adult male sheep were injected intradiscally with chondroitinase-ABC (cABC) to initiate disc degeneration. The remaining lumbar discs were used as normal controls. Three months after cABC injection, the L3-4 discs of all animals were injected with either a high dose (4 × 10(6) cells, in 12 sheep) or low dose (0.5 × 10(6) cells, in 12 sheep) of MPCs suspended in hyaluronic acid (HA). The adjacent L4-5 degenerate discs remained untreated; the L5-6 discs were injected with HA only. The animals were euthanized at 3 or 6 months after MPC injections (6 sheep from each group at each time point), and histological sections of the lumbar discs were prepared. Radiographs and MR images were obtained prior to cABC injection (baseline), 3 months after cABC injection (pretreatment), and just prior to necropsy (posttreatment). RESULTS Injection of cABC decreased the disc height index (DHI) of target discs by 45%-50%, confirming degeneration. Some recovery in DHI was observed 6 months after treatment in all cABC-injected discs, but the DHI increased to within baseline control values only in the MPC-injected discs. This improvement was accompanied by a reduction in MRI degeneration scores. The histopathology scores observed at 3 months posttreatment for the high-dose MPC-injected discs and at 6 months posttreatment for the low-dose MPC-injected discs were significantly different from those of the noninjected and HA-injected discs (p <0.001) but not from the control disc scores. CONCLUSIONS On the basis of the findings of this study, the authors conclude that the injection of MPCs into degenerate intervertebral discs can contribute to the regeneration of a new extracellular matrix.
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Tzaan WC, Chen HC. Investigating the possibility of intervertebral disc regeneration induced by granulocyte colony stimulating factor-stimulated stem cells in rats. Adv Orthop 2010; 2011:602089. [PMID: 21991419 PMCID: PMC3170822 DOI: 10.4061/2011/602089] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/25/2010] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a multifactorial process that is influenced by contributions from genetic predisposition, the aging phenomenon, lifestyle conditions, biomechanical loading and activities, and other health factors (such as diabetes). Attempts to decelerate disc degeneration using various techniques have been reported. However, to date, there has been no proven technique effective for broad clinical application. Granulocyte colony-stimulating factor (GCSF) is a growth factor cytokine that has been shown to enhance the availability of circulating hematopoietic stem cells to the brain and heart as well as their capacity for mobilization of mesenchymal bone marrow stem cells. GCSF also exerts significant increases in circulating neutrophils as well as potent anti-inflammatory effects. In our study, we hypothesize that GCSF can induce bone marrow stem cells differentiation and mobilization to regenerate the degenerated IVD. We found that GCSF had no contribution in disc regeneration or maintenance; however, there were cell proliferation within end plates. The effects of GCSF treatment on end plates might deserve further investigation.
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Affiliation(s)
- Wen-Ching Tzaan
- Department of Neurosurgery, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung 204, Taiwan
- School of Medicine, Chang Gung University, 333 TaoYuan, Taiwan
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung 204, Taiwan
- School of Medicine, Chang Gung University, 333 TaoYuan, Taiwan
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Degenerative anular changes induced by puncture are associated with insufficiency of disc biomechanical function. Spine (Phila Pa 1976) 2009; 34:998-1005. [PMID: 19404174 DOI: 10.1097/brs.0b013e31819c09c4] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo experiments to examine physiologic consequences and in vitro tests to determine immediate biomechanical effects of anular injury by needle puncture. OBJECTIVE To determine whether a relationship exists between induction of degenerative changes in anulus fibrosus (AF) and compromised disc biomechanical function according to injury size. SUMMARY OF BACKGROUND DATA Various studies in intervertebral disc mechanics, degeneration, and regeneration involve the creation of a defect in the anulus fibrosus (AF). However, the impact of the puncture, itself, on biomechanical function and disc health are not understood. METHODS For in vivo experiments, rat caudal discs subjected to percutaneous anular punctures using different gauge size hypodermic needles (18, 22, 26 g) and nonpunctured controls were examined histologically up to 4 weeks postsurgery. For in vitro biomechanical testing, healthy motion segments were isolated and their creep compression response assessed immediately after needle puncture. RESULTS We found that needle size-dependence of creep compression behavior paralleled the size-dependence of degenerative changes in the AF. Specifically, 18-g punctures resulted in inward bulging of the AF, lamellar disorganization, and cellular changes. These changes were not seen in 22- and 26-g punctured discs. Biomechanical tests showed that only 18-g needle punctures led to significant changes in disc mechanics. Importantly, a statistically significant association was found between needle sizes that caused biomechanical changes and induction of degenerative changes in the AF. CONCLUSION Our findings suggest that injury sizes large enough to disrupt biomechanical function are needed to drive degenerative changes in rat caudal disc AF. Based on the data, we believe that small anular defects become sealed, allowing the disc to function normally and the AF to heal. Larger defects appear to require longer wound closure times, and may prolong the duration of impaired disc function.
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Birnbaum K. Percutaneous cervical disc decompression. Surg Radiol Anat 2009; 31:379-87. [PMID: 19190848 DOI: 10.1007/s00276-009-0462-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 12/31/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cervical disc nucleoplasty is a significant and clinically demonstrated innovation in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase. It allows a percutaneous decompression via a 19-gauge needle under utilization of the Coblation technique and under C-arm control. Until now the patients suffering of a cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment. METHODS We wanted to demonstrate a new and practicable anatomical pathway for reaching the cervical disc prolapse comparable to the technique for discography of the cervical spine. The introducer needle is advanced into the disc under fluoroscopic guidance using a standard anterior-lateral approach. The controller delivers radiofrequency energy to quickly ablate tissue at temperatures between 50 degrees and 60 degrees C. The decompression will be done in ablation mode by rotating the device through 180 degrees for 5 s in the posterior, medial and ventral third of the cervical disc. After failed conservative treatment over an average time period of 3 months we treated 26 patients with a contained herniated prolapse or protrusion with radicular arm pain by percutaneous decompression under utilization of the Coblation technique with a controlled energy plasma-mediated field. A randomized control group of 30 patients was treated alone conservatively with medical and physical therapy in the same period. RESULTS The average preoperative VAS was 8.8. With a follow-up time of 2-years we found an average pain reduction with the visual pain score (VAS) of 2.3 who had a further check-up. The VAS was checked 24 h, 1 week, 3, 6, 12 and 24 months postoperatively. No complications with this method were seen. Comparable to the surgically treated group the conservative patients have had a VAS of 8.4. Under using conservative treatment with physical therapy, physiotherapy, analgetics and perineural injections we have had a diminution of the VAS to 5.1 after 2 years. CONCLUSION The percutaneous decompression of the cervical disc protrusion with the Perc DC-Spine Wand by using the Coblation mode is a quick and safe procedure. Furthermore, one may state a persistent pain relief in the follow-up time up to 2 years after the percutaneous decompression of the disc.
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Buttermann GR, Beaubien BP, Saeger LC. Mature runt cow lumbar intradiscal pressures and motion segment biomechanics. Spine J 2009; 9:105-14. [PMID: 18037351 PMCID: PMC4291283 DOI: 10.1016/j.spinee.2007.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Revised: 07/20/2007] [Accepted: 09/28/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The optimal animal model for in vivo testing of spinal implants, particularly total or partial disc replacement devices, has not yet been determined. Mechanical and morphological similarities of calf and human spines have been reported; however, limitations of the calf model include open growth plates and oversized vertebrae with growth. Mature runt cows (Corrientes breed) may avoid these limitations. PURPOSE This study compared vertebral morphology and biomechanical properties of human and runt cow lumbar motion segments. STUDY DESIGN In vivo disc pressure measurements were obtained in six mature runt cows at L4-L5. In vitro evaluation was performed on these same segments and repeated on 12 human motion segments. METHODS Disc pressures were measured in vivo in runt cow (Corrientes breed) L45 discs using a percutaneous transducer with the animal performing various activities. These motion segments were then harvested and morphologic and biomechanical evaluations (disc pressure in compression, flexibility tests to 7.5Nm) were performed on both cow and male human L23 and L45 segments. RESULTS The transverse lumbar disc dimensions were slightly smaller for (mixed gender) cow versus (male) humans, but were within the range of reported (mixed gender) human values. The mean+/-SD disc height was smaller for runt cow (7+/-1mm) versus human discs (13+/-2mm, p<.001). The vertebral bodies of the cow were approximately twice as tall as the human. In vitro testing revealed significantly greater disc pressure response to applied axial loading in the runt cow versus humans (1.27+/-0.18 vs. 0.84+/-0.15kPa/N, respectively) but similar overall stiffness (2.15+/-0.71 vs. 1.91+/-0.94kN/mm, respectively). Runt cow and human segment flexibility curves were similar with the following exceptions: runt cow stiffness was approximately 40% greater in torsion (p<.05), runt cow segment lateral bending motion was greater versus humans (range of motion by 30%, neutral zone by 100%; both p<.05), and flexion range of motion tended to be smaller in runt cow versus human specimens (by approximately 40%, p=NS). In vivo, the standing disc pressure in the runt cow was 0.80+/-0.24MPa. CONCLUSIONS Although no animal replicates the human motion segment, the runt cow lumbar spine had a number of biomechanical and morphological measurements within the range of human values. The closed physes and temporally stable morphology of the mature runt cow may make this model more suitable versus standard calf models for human intradiscal implant studies.
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Easley NE, Wang M, McGrady LM, Toth JM. Biomechanical and radiographic evaluation of an ovine model for the human lumbar spine. Proc Inst Mech Eng H 2008; 222:915-22. [DOI: 10.1243/09544119jeim345] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While various species of animal models have been used in preclinical investigations of spinal implant devices to assess their biological adaptation and biomechanical performance, few studies have made comprehensive comparisons to validate their suitability of modelling the human spine. The purpose of this study was to assess essential biomechanical behaviours and disc morphology of the ovine lumbar model. Flexibility testing was conducted on the spines (L3—L4 and L4—L5) of nine skeletally matured sheep. Segmental rotation and intradiscal pressure were measured and load sharing between the intervertebral disc and posterior elements were calculated on the basis of a simplified parallel spring model. Following the tests, the spinal segments were sectioned into a series of sagittal slabs, and transverse radiographs of these slabs were taken to evaluate the variation in the disc height and end-plate curvature. Comparing the biomechanical and radiographic results with published data on the human lumbar spine, good comparability between the ovine and cadaveric lumbar spines was found in terms of the general disc shape and in most of the biomechanical parameters including the range of motion, neutral zone, and load sharing between the intervertebral disc and posterior elements. A few distinctive differences were also found between the two, including flatter sagittal alignment, smaller disc dimensions, and greater lateral bending motion in the ovine model.
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Affiliation(s)
- N E Easley
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
| | - M Wang
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
| | - L M McGrady
- Department of Orthopaedic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - J M Toth
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
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Lotz JC, Hadi T, Bratton C, Reiser KM, Hsieh AH. Anulus fibrosus tension inhibits degenerative structural changes in lamellar collagen. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1149-59. [PMID: 18668268 DOI: 10.1007/s00586-008-0721-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 05/16/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
Abstract
Mechanical stress is one of the risk factors believed to influence intervertebral disc degeneration. Animal models have shown that certain regimes of compressive loading can induce a cascade of biological effects that ultimately results in cellular and structural changes in the disc. It has been proposed that both cell-mediated breakdown of collagen and the compromised stability of collagen with loss of anular tension could result in degradation of lamellae in the anulus fibrosus (AF). To determine whether this may be important in the AF, we subjected entire rings of de-cellularized AF tissue to MMP-1 digestion with or without tension. Biomechanical testing found trends of decreasing strength and stiffness when tissues were digested without tension compared with those with tension. To determine the physiologic significance of tissue level tension in the AF, we used an established in vivo murine model to apply a disc compression insult known to cause degeneration. Afterward, that motion segment was placed in fixed-angle bending to impose tissue level tension on part of the AF and compression on the contralateral side. We found that the AF on the convex side of bending retained a healthy lamellar appearance, while the AF on the concave side resembled tissues that had undergone degeneration by loading alone. Varying the time of onset and duration of bending revealed that even a brief duration applied immediately after cessation of compression was beneficial to AF structure on the convex side of bending. Our results suggest that both cell-mediated events and cell-independent mechanisms may contribute to the protective effect of tissue level tension in the AF.
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Affiliation(s)
- Jeffrey C Lotz
- Orthopaedic Bioengineering Laboratory, Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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The effect of relative needle diameter in puncture and sham injection animal models of degeneration. Spine (Phila Pa 1976) 2008; 33:588-96. [PMID: 18344851 DOI: 10.1097/brs.0b013e318166e0a2] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical study and literature review. OBJECTIVES To quantify the acute effect of needle diameter on the in vitro mechanical properties of cadaver lumbar discs in the rat and sheep. To review published in vivo animal studies and evaluate disc changes with respect to the relative needle size. SUMMARY OF BACKGROUND DATA There are many cases where a disc needle puncture or injection is applied to animal models: puncture injuries to induce degeneration, chemonucleolysis to induce degeneration, and delivery of disc therapies. It is not clear what role the size of the needle may have in the outcome. METHODS Mechanics were measured after sham phosphate buffered saline injection with a 27 G or 33 G needle in the rat and with a 27 G needle in the sheep. A literature review was performed to evaluate studies in which animal discs were treated with a needle puncture or a sham injection. For each study, the ratio of the needle diameter to disc height (needle:height) was calculated. RESULTS When the rat was injected with a 27 G needle (52% of disc height), the compression, tension, and neutral zone stiffnesses were 20% to 60% below preinjected values and the neutral zone length was 130% higher; when injected with a 33 G needle (26% of disc height), the only affected property was the neutral zone length, which was only 20% greater. When the sheep was injected with a 27 G needle (10% of disc height), none of the axial properties were different from intact, the torsion stiffness was not different, and the torque range was 15% smaller. Twenty-three in vivo studies in the rat, rabbit, dog, or sheep were reviewed. The disc changes depended on the ratio of needle diameter to disc height as follows: significant changes were not observed for needle:height less than 40%, although between 25% and 40% results were variable and some minor nonsignificant effects were observed, disc changes were universal for needle:height over 40%. CONCLUSION A needle puncture may directly alter mechanical properties via nucleus pulposus depressurization and/or anulus fibrosus damage, depending on the relative needle size. As more basic science research is aimed at treating disc degeneration via injection of therapeutic factors, these findings provide guidance in design of animal studies. Such studies should consider the relative needle size and include sham control groups to account for the potential effects of the needle injection.
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An in vivo model of reduced nucleus pulposus glycosaminoglycan content in the rat lumbar intervertebral disc. Spine (Phila Pa 1976) 2008; 33:146-54. [PMID: 18197098 PMCID: PMC2696404 DOI: 10.1097/brs.0b013e31816054f8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo model resembling early stage disc degeneration in the rat lumbar spine. OBJECTIVE Simulate the reduced glycosaminoglycan content and altered mechanics observed in intervertebral disc degeneration using a controlled injection of chondroitinase ABC (ChABC). SUMMARY OF BACKGROUND DATA Nucleus glycosaminoglycan reduction occurs early during disc degeneration; however, mechanisms through which degeneration progresses from this state are unknown. Animal models simulating this condition are essential for understanding disease progression and for development of therapies aimed at early intervention. METHODS ChABC was injected into the nucleus pulposus, and discs were evaluated via micro-CT, mechanical testing, biochemical assays, and histology 4 and 12 weeks after injection. RESULTS At 4 weeks, reductions in nucleus glycosaminoglycan level by 43%, average height by 12%, neutral zone modulus by 40%, and increases in range of motion by 40%, and creep strain by 25% were found. Neutral zone modulus and range of motion were correlated with nucleus glycosaminoglycan. At 12 weeks, recovery of some mechanical function was detected as range of motion and creep returned to control levels; however, this was not attributed to glycosaminoglycan restoration, because mechanics were no longer correlated with glycosaminoglycan. CONCLUSION An in vivo model simulating physiologic levels of glycosaminoglycan loss was created to aid in understanding the relationships between altered biochemistry, altered mechanics, and altered cellular function in degeneration.
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Hoogendoorn RJ, Wuisman PI, Smit TH, Everts VE, Helder MN. Experimental intervertebral disc degeneration induced by chondroitinase ABC in the goat. Spine (Phila Pa 1976) 2007; 32:1816-25. [PMID: 17762288 DOI: 10.1097/brs.0b013e31811ebac5] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In 2 studies, the injection of chondroitinase ABC into intervertebral discs of mature goats was evaluated as an experimental disc degeneration model. The first study analyzed the development of degeneration in time; the second study determined the optimal enzyme concentration. OBJECTIVES To develop reproducible, slowly progressive disc degeneration in a large animal model. SUMMARY OF BACKGROUND DATA Currently available, small animal models of intervertebral disc degeneration have shortcomings in the comparability to humans in terms of size, geometry, and cell population. Also, the methods to induce degeneration in the current models do not mimic human degeneration, which starts with the loss of proteoglycans. Injecting the enzyme chondroitinase ABC into the nucleus pulposus mimics the loss of proteoglycans. METHODS In Study 1, lumbar intervertebral discs of 17 goats were injected with chondroitinase ABC (0.25 U/mL) or phosphate-buffered saline. Degeneration was analyzed with radiograph analysis, MR imaging, and macroscopic and histologic scoring at 5 different time points (4, 8, 12, 18, and 26 weeks). Six control goats were analyzed. The second study used 6 goats in which 4 different concentrations of chondroitinase ABC (0.2-0.35 U/mL) or phosphate-buffered saline were injected. After 12 weeks, similar analyses as in Study 1 were performed. RESULTS After 12 weeks, degenerative signs were observed in all parameters in Study 1. The degeneration increased up to 18 weeks and leveled off after 26 weeks. The variability, however, was high. The second study showed a concentration dependent effect of chondroitinase ABC with all analyzed parameters. The injection of 0.25 U/mL chondroitinase ABC resulted in disc degeneration after 12 weeks without signs of severe degeneration. CONCLUSION Injection of chondroitinase ABC in the caprine intervertebral disc results in mild, slowly progressive disc degeneration. This effect was optimal at a concentration of 0.25 U/mL. This is a promising model of disc degeneration that deserves further study.
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Affiliation(s)
- Roel J Hoogendoorn
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Wang JL, Tsai YC, Wang YH. The leakage pathway and effect of needle gauge on degree of disc injury post anular puncture: a comparative study using aged human and adolescent porcine discs. Spine (Phila Pa 1976) 2007; 32:1809-15. [PMID: 17762287 DOI: 10.1097/brs.0b013e31811ec282] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vitro biomechanical study using aged human and adolescent porcine discs. OBJECTIVES To find the leakage pathway and effect of needle gauge on the degree of disc injury post anular puncture. SUMMARY OF BACKGROUND DATA Spinal needles are widely used for minimal invasive disc surgeries and disc degeneration/regeneration research. Applications of anular puncture require different diameters of spinal needles. However, the effect of needle diameters on the disc injury has not been systematically studied yet. METHODS Four groups of experiments were conducted: 1) porcine thoracic disc, 2) human thoracic disc, 3) porcine thoracic disc with 200 N external loading, and 4) porcine lumbar discs. The disc was punctured consecutively with needles from smaller diameter to larger diameter. After each anular puncture, the quantitative discomanometry technique was conducted to quantify the disc rupture pressure and volume. The association between needle gauge and rupture pressure and volume was analyzed. RESULTS The degree of disc injury increased with the diameter of needle. For an aged human thoracic disc, the anulus fibrosus cannot hold pressure more than 2 MPa after a 21-gauge-needle-anular-puncture. The leakage pathway of injected saline was through the anular fissure but was through the endplate when the disc was next to an osteoporotic vertebrae. The pressure holding power of porcine disc is stronger than of human disc. The rupture pressure of porcine lumbar disc is higher than of porcine thoracic disc. The axial compressive external loading increased the disc rupture pressure. The rupture volumes were not affected by the dimension of injury fissure. The rupture volume was at level of 0.3 mL without external loading and at 0.2 mL with external loading. CONCLUSION A spinal needle of < or = 22 gauge and injection volume of < or = 0.2 mL are recommended to prevent postsurgery leakage.
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Affiliation(s)
- Jaw-Lin Wang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
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Tester NJ, Plaas AH, Howland DR. Effect of body temperature on chondroitinase ABC's ability to cleave chondroitin sulfate glycosaminoglycans. J Neurosci Res 2007; 85:1110-8. [PMID: 17265470 DOI: 10.1002/jnr.21199] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chondroitinase ABC (Ch'ase ABC) is a bacterial lyase that degrades chondroitin sulfate (CS), dermatan sulfate, and hyaluronan glycosaminoglycans (GAGs). This enzyme has received significant attention as a potential therapy for promoting central nervous system and peripheral nervous system repair based on its degradation of CS GAGs. Determination of the stability of Ch'ase ABC activity at temperatures equivalent to normal (37 degrees C) and elevated (39 degrees C) body temperatures is important for optimizing its clinical usage. We report here data obtained from examining enzymatic activity at these temperatures across nine lots of commercially available protease-free Ch'ase ABC. CS GAG degrading activity was assayed by using 1) immunohistochemical detection of unsaturated disaccharide stubs generated by digestion of proteoglycans in tissue sections and 2) fluorophore-assisted carbohydrate electrophoresis (FACE) and/or high-performance liquid chromatography (HPLC) to separate and quantify unsaturated disaccharide digestion products. Our results indicate that there is a significant effect of lot and time on enzymatic thermostability. Average enzymatic activity is significantly decreased at 1 and 3 days at 39 degrees C and 37 degrees C, respectively. Furthermore, the average activity seen after 1 day was significantly different between the two temperatures. Addition of bovine serum albumin as a stabilizer significantly preserved enzymatic activity at 1 day, but not 3 days, at 39 degrees C. These results show that the CS GAG degrading activity of Ch'ase ABC is significantly decreased with incubation at body temperature over time and that all lots do not show equal thermostability. These findings are important for the design and interpretation of experimental and potential clinical studies involving Ch'ase ABC.
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Affiliation(s)
- Nicole J Tester
- Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
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42
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Obray RW, Filice RW, Beall DP. MR imaging and osseous spinal intervention and intervertebral disk intervention. Magn Reson Imaging Clin N Am 2007; 15:257-71, vii. [PMID: 17599643 DOI: 10.1016/j.mric.2007.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Percutaneous spine intervention, a wide range of invasive spine procedures performed through a puncture hole or through a small incision not requiring soft tissue closure and with few or no skin sutures or staples, is rapidly emerging as an effective alternative to open surgery. This article describes many of the minimally invasive osseous, intervertebral disk, and spinal nerve interventions currently being performed, including both well-established procedures and procedures developed recently. A general introduction to these types of procedures is provided, along with the characteristic pre- and postprocedural MR imaging appearance related to these techniques. The article also discusses reported and theoretical complications that may arise and their respective MR imaging appearances.
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Affiliation(s)
- Rick W Obray
- Department of Radiology, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21283, USA.
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Podhajsky RJ, Belous A, Johnson K, Maul DH, Finch PM. Effects of monopolar radiofrequency heating on intradiscal pressure in sheep. Spine J 2007; 7:229-34. [PMID: 17321974 DOI: 10.1016/j.spinee.2006.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 03/14/2006] [Accepted: 04/07/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT No previous study has assessed the effect of monopolar radiofrequency (RF) heating on intradiscal pressure. PURPOSE To determine the decrease in lumbar intradiscal pressure after monopolar RF heating. STUDY DESIGN/SETTING Intradiscal pressure was measured in sheep lumbar discs treated with monopolar RF heating. METHODS Two monopolar RF heat treatments at 90 degrees C were applied for 2 minutes each to lumbar intervertebral discs of sheep. Intradiscal pressure was measured in live sheep at 0, 7, 14, 21, and 28 days posttreatment. Pressure measurements were taken with a microtip pressure transducer. Electrodes were inserted but not activated in separate discs as a sham control. In vitro sheep spine of different age groups, loading conditions, and electrode orientations were similarly heat treated and intradiscal pressures were measured. RESULTS Intradiscal pressure was significantly reduced 1 week after monopolar RF heating and remained stable through the 4-week observation period. The RF electrode orientation, the age, and the type of disc loading have significant effects on the amount of initial intradiscal pressure reduction. CONCLUSIONS Monopolar RF heating can reduce intradiscal pressure in the lumbar spine of sheep.
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Lehnert T, Mundackatharappel S, Schwarz W, Bisdas S, Wetter A, Herzog C, Balzer JO, Mack MG, Vogl TJ. [Nucleolysis in the herniated disk]. Radiologe 2006; 46:513-9. [PMID: 16786388 DOI: 10.1007/s00117-006-1379-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Back pain associated with a herniated disk has become an important and increasing general health problem in Germany and other industrialized countries. After all methods of conservative treatment have been exhausted, nucleolysis may be a minimally invasive alternative to surgery. In nucleolysis, chondrolytic substances or other substances, which reduce the pressure within the disk by other means, are injected into the nucleus pulposus under CT guidance. Among various substances, which have been employed for nucleolysis, an ozone-oxygen mixture appears to be very promising. The water-binding capacity of ozone results in a reduction of pain for several months. Moreover, it has an anti-inflammatory effect and results in an increase of perfusion. Ozone is converted into pure oxygen in the body and has a low allergic potential. Recent minimally invasive therapeutic methods such as percutaneous nucleotomy or laser treatment do not result in superior results compared with nucleolysis.
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Affiliation(s)
- T Lehnert
- Institut für Diagnostische und interventionelle Radiologie, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main.
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45
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Boxberger JI, Sen S, Yerramalli CS, Elliott DM. Nucleus pulposus glycosaminoglycan content is correlated with axial mechanics in rat lumbar motion segments. J Orthop Res 2006; 24:1906-15. [PMID: 16865712 DOI: 10.1002/jor.20221] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The unique biochemical composition and structure of the intervertebral disc allow it to support load, permit motion, and dissipate energy. With degeneration, both the biochemical composition and mechanical behavior of the disc are drastically altered, yet quantitative relationships between the biochemical changes and overall motion segment mechanics are lacking. The objective of this study was to determine the contribution of nucleus pulposus glycosaminoglycan content, which decreases with degeneration, to mechanical function of a rat lumbar spine motion segment in axial loading. Motion segments were treated with varying doses of Chondroitinase-ABC (to degrade glycosaminoglycans) and loaded in axial cyclic compression-tension, followed by compressive creep. Nucleus glycosaminoglycan content was significantly correlated (p < 0.05) with neutral zone mechanical behavior, which occurs in low load transition between tension and compression (stiffness: r = 0.59; displacement: r = -0.59), and with creep behavior (viscous parameter eta(1): r = 0.34; short time constant tau(1): r = 0.46). These results indicate that moderate decreases in nucleus glycosaminoglycan content consistent with early human degeneration affect overall mechanical function of the disc. These decreases may expose the disc to altered internal stress and strain patterns, thus contributing through mechanical or biological mechanisms to the degenerative cascade.
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Affiliation(s)
- John I Boxberger
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081, USA
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46
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Yerramalli CS, Chou AI, Miller GJ, Nicoll SB, Chin KR, Elliott DM. The effect of nucleus pulposus crosslinking and glycosaminoglycan degradation on disc mechanical function. Biomech Model Mechanobiol 2006; 6:13-20. [PMID: 16715318 DOI: 10.1007/s10237-006-0043-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 12/06/2005] [Indexed: 01/08/2023]
Abstract
Altered mechanical loading, secondary to biochemical changes in the nucleus pulposus, is a potential mechanism in disc degeneration. An understanding of the role of this altered mechanical loading is only possible by separating the mechanical and biological effects of early nucleus pulposus changes. The objective of this study was to quantify the mechanical effect of decreased glycosaminoglycans (GAG) and increased crosslinking in the nucleus pulposus using in vitro rat lumbar discs. Following initial mechanical testing the discs were injected according to the four treatment groups: PBS control, chondroitinase-ABC (ChABC) for GAG degradation, genipin (Gen) for crosslinking, or a combination of chondroitinase and genipin (ChABC+Gen). After treatment the discs were again mechanically tested, followed by histology or biochemistry. Neutral zone mechanical properties were changed by approximately 20% for PBS, ChABC, and ChABC+Gen treatments (significant only for PBS in a paired comparison). These trends were reversed with genipin crosslinking alone. With ChABC treatment the effective compressive modulus increased and the GAG content decreased; with the combination of ChABC+Gen the mechanics and GAG content were unchanged. Degradation of nucleus pulposus GAG alters disc axial mechanics, potentially contributing to the degenerative cascade. Crosslinking is unlikely to contribute to degeneration, but may be a potential avenue of treatment.
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Affiliation(s)
- C S Yerramalli
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA
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Guehring T, Unglaub F, Lorenz H, Omlor G, Wilke HJ, Kroeber MW. Intradiscal pressure measurements in normal discs, compressed discs and compressed discs treated with axial posterior disc distraction: an experimental study on the rabbit lumbar spine model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:597-604. [PMID: 16133080 PMCID: PMC3489348 DOI: 10.1007/s00586-005-0953-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 04/06/2005] [Accepted: 04/14/2005] [Indexed: 10/25/2022]
Abstract
Intervertebral disc (IVD) pressure measurement is an appropriate method for characterizing spinal loading conditions. However, there is no human or animal model that provides sufficient IVD pressure data. The aim of our study was to establish physiological pressure values in the rabbit lumbar spine and to determine whether temporary external disc compression and distraction were associated with pressure changes. Measurements were done using a microstructure-based fibreoptic sensor. Data were collected in five control rabbits (N, measurement lying prone at segment L3/4 at day 28), five rabbits with 28 days of axial compression (C, measurement at day 28) and three rabbits with 28 days of axial compression and following 28 days of axial distraction (D, measurement at day 56). Disc compression and distraction was verified by disc height in lateral radiographs. The controls (N) showed a level-related range between 0.25 MPa-0.45 MPa. The IVD pressure was highest at level L3/4 (0.42 MPa; range 0.38-0.45) with a decrease in both cranial and caudal adjacent segments. The result for C was a significant decrease in IVD pressure (0.31 MPa) when compared with controls (P=0.009). D showed slightly higher median IVD pressure (0.32 MPa) compared to C, but significantly lower levels when compared with N (P=0.037). Our results indicate a high range of physiological IVD pressure at different levels of the lumbar rabbit spine. Temporary disc compression reduces pressure when compared with controls. These data support the hypothesis that temporary external compression leads to moderate disc degeneration as a result of degradation of water-binding disc matrix or affected active pumping mechanisms of nutrients into the disc. A stabilization of IVD pressure in discs treated with temporary distraction was observed.
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Affiliation(s)
- Thorsten Guehring
- Department of Orthopaedic Surgery, University of Heidelberg, 69118 Heidelberg, Germany.
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Abstract
Despite the significant impairment associated with degenerative disc disease, a clear understanding of its pathogenesis is still lacking. Currently, no particular model parallels the complex nature of human disc degeneration. Naturally occurring animal models have the drawback that the basis for the high rate of disc degeneration is not known. Although the interventions in artificial animal models that create disc degeneration are known, the relationship of those to the events leading to disc degeneration in humans is not. With the recent progress in biomechanics, cell biology and molecular biology, an easily reproducible and valid animal model may help unlock the complex cascade of events surrounding human disc degeneration.
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Affiliation(s)
- Kern Singh
- Department of Orthopedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA
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Wenger KH, Woods JA, Holecek A, Eckstein EC, Robertson JT, Hasty KA. Matrix remodeling expression in anulus cells subjected to increased compressive load. Spine (Phila Pa 1976) 2005; 30:1122-6. [PMID: 15897824 DOI: 10.1097/01.brs.0000162395.56424.53] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Mechanobiology study of gene expression changes as a result of compressive overload of anular fibrochondrocytes. OBJECTIVE To test hypotheses regarding phenotype shift in genes coding for representative extracellular matrix (ECM) proteins and matrix modulators. SUMMARY OF THE BACKGROUND DATA In degenerative disc disease, the transfer of compressive load through the disc shifts largely from the nucleus onto the anulus. In vivo models simulating this condition have shown derangement of the collagenous ultrastructure in the anulus. In vitro models of cultured anulus cells subjected to static compressive stress generally suggest a down-regulation of synthesis. This study evaluated the expression of specific isomers of genes responsible for mechanical viability and metabolism of the disc under cyclic compressive loads. METHODS Fibrochondrocytes were digested from the anuli of 3, 2-week-old pigs, embedded in 1.5% alginate gel, and hydrostatically compressed at 0.5 Hz for 3 hours to amplitudes of 10 and 30 atm. These levels represented nominal load transfer through the healthy disc and high load transfer through the degenerative disc. Ribonucleic acid was isolated, reverse transcribed, and evaluated by real-time polymerase chain reaction for expression of type I (C-I) and type II (C-II) collagen, aggrecan, the matrix metalloproteinase (MMP-1), and the transforming growth factor beta (TGFbeta-1). Results were expressed at percentages of uncompressed controls. RESULTS The lower pressure of 10 atm resulted in up-regulation of all ECM protein genes. C-I and C-II both averaged 141%, and aggrecan 121% of controls (P < 0.05). MMP-1 and TGFbeta-1 were essentially unchanged. With the pressure increased to 30 atm, C-II remained approximately at the level expressed under lower pressure, but C-I was reduced to 42% of controls (P < 0.05), indicating a phenotype shift. MMP-1 and TGFbeta-1 also were down-regulated to 71% and 54% of controls, respectively (P < 0.05). CONCLUSIONS The up-regulation of the ECM genes with nominal pressure highlights the mechanobiological importance of common activity in fibrocartilage homeostasis. Differential regulation of the 2 primary collagen types with high pressure indicates a capacity of the anulus to remodel according to pathomechanical conditions.
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Affiliation(s)
- Karl H Wenger
- Department of Rheumatology, University of Tennessee Health Science Center, Memphis, TN, USA.
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Alò KM, Wright RE, Sutcliffe J, Brandt SA. Percutaneous Lumbar Discectomy: Clinical Response in an Initial Cohort of Fifty Consecutive Patients With Chronic Radicular Pain. Pain Pract 2004; 4:19-29. [PMID: 17129299 DOI: 10.1111/j.1533-2500.2004.04003.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kenneth M Alò
- Houston Texas Pain Management, PA, Houston, Texas 77090, USA.
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