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Jiang H, Qin H, Yang Q, Huang L, Liang X, Wang C, Moro A, Xu S, Wei Q. Effective delivery of miR-150-5p with nucleus pulposus cell-specific nanoparticles attenuates intervertebral disc degeneration. J Nanobiotechnology 2024; 22:292. [PMID: 38802882 PMCID: PMC11129471 DOI: 10.1186/s12951-024-02561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The use of gene therapy to deliver microRNAs (miRNAs) has gradually translated to preclinical application for the treatment of intervertebral disc degeneration (IDD). However, the effects of miRNAs are hindered by the short half-life time and the poor cellular uptake, owing to the lack of efficient delivery systems. Here, we investigated nucleus pulposus cell (NPC) specific aptamer-decorated polymeric nanoparticles that can load miR-150-5p for IDD treatment. METHODS The role of miR-150-5p during disc development and degeneration was examined by miR-150-5p knockout (KO) mice. Histological analysis was undertaken in disc specimens. The functional mechanism of miR-150-5p in IDD development was investigated by qRT-PCR assay, Western blot, coimmunoprecipitation and immunofluorescence. NPC specific aptamer-decorated nanoparticles was designed, and its penetration, stability and safety were evaluated. IDD progression was assessed by radiological analysis including X-ray and MRI, after the annulus fibrosus needle puncture surgery with miR-150-5p manipulation by intradiscal injection of nanoparticles. The investigations into the interaction between aptamer and receptor were conducted using mass spectrometry, molecular docking and molecular dynamics simulations. RESULTS We investigated NPC-specific aptamer-decorated polymeric nanoparticles that can bind to miR-150-5p for IDD treatment. Furthermore, we detected that nanoparticle-loaded miR-150-5p inhibitors alleviated NPC senescence in vitro, and the effects of the nanoparticles were sustained for more than 3 months in vivo. The microenvironment of NPCs improves the endo/lysosomal escape of miRNAs, greatly inhibiting the secretion of senescence-associated factors and the subsequent degeneration of NPCs. Importantly, nanoparticles delivering miR-150-5p inhibitors attenuated needle puncture-induced IDD in mouse models by targeting FBXW11 and inhibiting TAK1 ubiquitination, resulting in the downregulation of NF-kB signaling pathway activity. CONCLUSIONS NPC-targeting nanoparticles delivering miR-150-5p show favorable therapeutic efficacy and safety and may constitute a promising treatment for IDD.
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Affiliation(s)
- Hua Jiang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
| | - Hongyu Qin
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Qinghua Yang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Longao Huang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiao Liang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Congyang Wang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Abu Moro
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Sheng Xu
- Research Centre for Regenerative Medicine, Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Qingjun Wei
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
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Chen X, Chen Z, Ma G, Sha J, Zhao S, Liu Z, Chen N, Yang H. Reactive Oxygen Species Induced Upregulation of TRPV1 in Dorsal Root Ganglia Results in Low Back Pain in Rats. J Inflamm Res 2024; 17:2245-2256. [PMID: 38623469 PMCID: PMC11017985 DOI: 10.2147/jir.s446841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Background Dorsal root ganglia (DRGs) contain sensory neurons that innervate intervertebral discs (IVDs) and may play a critical role in mediating low-back pain (LBP), but the potential pathophysiological mechanism needs to be clarified. Methods A discogenic LBP model in rats was established by penetration of a lumbar IVD. The severity of LBP was evaluated through behavioral analysis, and the gene and protein expression levels of pro-algesic peptide substance P (SP) and calcitonin gene-related peptide (CGRP) in DRGs were quantified. The level of reactive oxygen species (ROS) in bilateral lumbar DRGs was also quantified using dihydroethidium staining. Subsequently, hydrogen peroxide solution or N-acetyl-L-cysteine was injected into DRGs to evaluate the change in LBP, and gene and protein expression levels of transient receptor potential vanilloid-1 (TRPV1) in DRGs were analyzed. Finally, an inhibitor or activator of TRPV1 was injected into DRGs to observe the change in LBP. Results The rats had remarkable LBP after disc puncture, manifesting as mechanical and cold allodynia and increased expression of the pro-algesic peptides SP and CGRP in DRGs. Furthermore, there was significant overexpression of ROS in bilateral lumbar DRGs, while manipulation of the level of ROS in DRGs attenuated or aggravated LBP in rats. In addition, excessive ROS in DRGs stimulated upregulation of TRPV1 in DRGs. Finally, activation or inhibition of TRPV1 in DRGs resulted in a significant increase or decrease of discogenic LBP, respectively, suggesting that ROS-induced TRPV1 has a strong correlation with discogenic LBP. Conclusion Increased ROS in DRGs play a primary pathological role in puncture-induced discogenic LBP, and excessive ROS-induced upregulation of TRPV1 in DRGs may be the underlying pathophysiological mechanism to cause nerve sensitization and discogenic LBP. Therapeutic targeting of ROS or TRPV1 in DRGs may provide a promising method for the treatment of discogenic LBP.
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Affiliation(s)
- Xinyong Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Gongchang Ma
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Jianjun Sha
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Shan Zhao
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Zuoqing Liu
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Nong Chen
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China
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Alini M, Diwan AD, Erwin WM, Little CB, Melrose J. An update on animal models of intervertebral disc degeneration and low back pain: Exploring the potential of artificial intelligence to improve research analysis and development of prospective therapeutics. JOR Spine 2023; 6:e1230. [PMID: 36994457 PMCID: PMC10041392 DOI: 10.1002/jsp2.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
Animal models have been invaluable in the identification of molecular events occurring in and contributing to intervertebral disc (IVD) degeneration and important therapeutic targets have been identified. Some outstanding animal models (murine, ovine, chondrodystrophoid canine) have been identified with their own strengths and weaknesses. The llama/alpaca, horse and kangaroo have emerged as new large species for IVD studies, and only time will tell if they will surpass the utility of existing models. The complexity of IVD degeneration poses difficulties in the selection of the most appropriate molecular target of many potential candidates, to focus on in the formulation of strategies to effect disc repair and regeneration. It may well be that many therapeutic objectives should be targeted simultaneously to effect a favorable outcome in human IVD degeneration. Use of animal models in isolation will not allow resolution of this complex issue and a paradigm shift and adoption of new methodologies is required to provide the next step forward in the determination of an effective repairative strategy for the IVD. AI has improved the accuracy and assessment of spinal imaging supporting clinical diagnostics and research efforts to better understand IVD degeneration and its treatment. Implementation of AI in the evaluation of histology data has improved the usefulness of a popular murine IVD model and could also be used in an ovine histopathological grading scheme that has been used to quantify degenerative IVD changes and stem cell mediated regeneration. These models are also attractive candidates for the evaluation of novel anti-oxidant compounds that counter inflammatory conditions in degenerate IVDs and promote IVD regeneration. Some of these compounds also have pain-relieving properties. AI has facilitated development of facial recognition pain assessment in animal IVD models offering the possibility of correlating the potential pain alleviating properties of some of these compounds with IVD regeneration.
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Affiliation(s)
- Mauro Alini
- AO Research Institute Davos Platz Switzerland
| | - Ashish D. Diwan
- Spine Service, Department of Orthopedic Surgery, St. George & Sutherland Campus, Clinical School University of New South Wales Sydney New South Wales Australia
| | - W. Mark Erwin
- Department of Surgery University of Toronto Ontario Canada
| | - Chirstopher B. Little
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
| | - James Melrose
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
- Graduate School of Biomedical Engineering The University of New South Wales Sydney New South Wales Australia
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Zhu P, Kong F, Wu X, Dong Z, Du J, Mao Y, Zhou H, Liu Y, Mao H, Gu Y, Yang H, Geng D. A Minimally Invasive Annulus Fibrosus Needle Puncture Model of Intervertebral Disc Degeneration in Rats. World Neurosurg 2023; 169:e1-e8. [PMID: 36283650 DOI: 10.1016/j.wneu.2022.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The needle puncture model in rats has been accepted as an ordinary model to induce intervertebral disc degeneration (IVDD). However, the model primarily penetrated the whole intervertebral disc, resulting in injury to the nucleus pulposus (NP) and annulus fibrosus (AF). The intention of this research was to explore a minimally invasive approach through needle puncture of the AF percutaneously in rats. METHODS Twenty SD rats underwent puncture at Co8/9 via a 20 G percutaneous needle. The needle was slowly advanced perpendicular to the tail skin to penetrate the whole AF without damaging the NP limited by a hand-made sheath. The X-rays and magnetic resonance imaging T2 relaxation was evaluated at 1, 2, and 3 weeks to assess the disc height index and signal changes. Histological and immunohistochemical staining of the IVD were obtained under a light microscope. RESULTS X-rays showed that the disc height had progressively narrowed to 49% of baseline 3 weeks after injury. magnetic resonance imaging evaluation demonstrated that the mean T2-weighted signal intensity at 3 weeks was 43% of that in the uninjured control group at the Co8/9 level. Histological staining demonstrated disorganized lamellae in the AF and decreased proteoglycan content and cellularity within the NP in the injured discs. CONCLUSIONS The present research demonstrates a reliable and convenient approach to induce an AF tear in rats through percutaneous needle puncture. This model reduces harm to the experimental animals significantly while imitating the progressive degeneration process. More importantly, the model confirmed that AF damage alone could lead to IVDD and provided a research method for AF degeneration in IVDD.
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Affiliation(s)
- Pengfei Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fanchen Kong
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiexing Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhongchen Dong
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiacheng Du
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yubo Mao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yijie Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiqin Mao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ye Gu
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First People's Hospital of Changshu City, Changshu, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Dechun Geng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Zhang F, Wang S, Li B, Tian W, Zhou Z, Liu S. Intradiscal injection for the management of low back pain. JOR Spine 2022; 5:e1186. [PMID: 35386759 PMCID: PMC8966879 DOI: 10.1002/jsp2.1186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain (LBP) is a common clinical problem and a major cause of physical disability, imposing a prominent socioeconomic burden. Intervertebral disc degeneration (IDD) has been considered the main cause of LBP. The current treatments have limited efficacy because they cannot address the underlying degeneration. With an increased understanding of the complex pathological mechanism of IDD, various medications and biological reagents have been used for intradiscal injection for the treatment of LBP. There is increasing clinical evidence showing the benefits of these therapies on symptomatic relief and their potential for disc repair and regeneration by targeting the disrupted pathways underlying the cause of the disease. A brief overview of the potential and limitations for these therapies are provided in this review, based on the recent and available data from clinical trials and systematic reviews. Finally, future perspectives are discussed.
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Affiliation(s)
- Fu Zhang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery The Seventh Affiliated Hospital of Sun Yat-sen University Shenzhen China
| | - Songjuan Wang
- Department of Medical Ultrasonic The Seventh Affiliated Hospital of Sun Yat-sen University Shenzhen China
| | - Baoliang Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery The Seventh Affiliated Hospital of Sun Yat-sen University Shenzhen China
| | - Wei Tian
- Laboratory of Bone Tissue Engineering Beijing Laboratory of Biomedical Materials, Beijing Research Institute of Orthopaedics and Traumatology, Beijing JiShuiTan Hospital Beijing China
| | - Zhiyu Zhou
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery The Seventh Affiliated Hospital of Sun Yat-sen University Shenzhen China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology The First Affiliated Hospital of Sun Yat-sen University Guangzhou China
| | - Shaoyu Liu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery The Seventh Affiliated Hospital of Sun Yat-sen University Shenzhen China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology The First Affiliated Hospital of Sun Yat-sen University Guangzhou China
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Reactive Oxygen Species Mediate Low Back Pain by Upregulating Substance P in Intervertebral Disc Degeneration. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6681815. [PMID: 34093962 PMCID: PMC8140854 DOI: 10.1155/2021/6681815] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Abstract
Reactive oxygen species (ROS) are thought to have a strong correlation with a number of intervertebral disc (IVD) diseases. Here, we aimed to determine whether ROS represent an etiology of low back pain (LBP) during IVD degeneration. Thirty degenerated intervertebral disc samples were obtained from patients, and ROS levels were quantified using dihydroethidium (DHE) staining. The results suggested a significant correlation between the ROS level and the severity of LBP. Subsequently, a puncture-induced LBP model was established in rats, and ROS levels significantly increased compared with those in the sham surgery group, accompanied with severe puncture-induced IVD degeneration. In addition, when ROS levels were increased by H2O2 administration or decreased by NAC treatment, the rats showed increased or decreased LBP, respectively. Based on this evidence, we further determined that stimulation with H2O2 in nucleus pulposus cells (NPCs) in vivo or in vitro resulted in upregulation of substance P (SP), a peptide thought to be involved in the synaptic transmission of pain, and that the severity of LBP decreased when SP levels were increased by exogenous SP administration or neutralized via aprepitant treatment in the IVDs of rats. In conclusion, ROS are primary inducers of LBP based on clinical and animal data, and the mechanism involves ROS stimulation of NPCs to secrete SP, which is a critical neurotransmitter peptide, to promote LBP in IVDs. Therefore, reducing the level of ROS with specific drugs and inhibiting SP may be alternative methods to treat LBP in the clinic.
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7
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Yang S, Boudier-Revéret M, Chang MC. Use of Pulsed Radiofrequency for the Treatment of Discogenic Back Pain: A Narrative Review. Pain Pract 2020; 21:594-601. [PMID: 33296544 DOI: 10.1111/papr.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Low-back pain (LBP) is one of the most frequently reported symptoms of patients who visit pain clinics, and a significant proportion of them have discogenic pain. Pulsed radiofrequency (PRF) stimulation is an effective treatment for various types of pain. PURPOSE We reviewed articles which investigated the effectiveness of intradiscal PRF for controlling discogenic LBP. METHODS AND MATERIALS We searched PubMed for papers published prior to August 7, 2020, in which intradiscal PRF was used for treating discogenic LBP. The key search phrase was (intradiscal PRF) for identifying potentially relevant articles. We included articles in which intradiscal PRF was used for controlling LBP. Review articles were excluded. RESULTS Nine publications were included in this review. Except for one study, all other studies showed positive therapeutic outcomes after treating discogenic LBP using intradiscal PRF. However, the quality of these studies was not high. CONCLUSIONS This review showed that intradiscal PRF appears to be a helpful treatment method for patients with discogenic LBP. Our review provides insights into the degree of evidence of the therapeutic effects of intradiscal PRF for alleviating discogenic LBP. For confirmation of the effectiveness of intradiscal PRF on discogenic LBP, more high-quality studies are necessary.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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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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Lee JH, Choi KC, Lee JH. Could the Splitting of the Annulus During Percutaneous Endoscopic Lumbar Diskectomy (PELD) Be a Culprit for Recurrent Disk Herniation?: An Analysis of the Reherniation Pattern After PELD. World Neurosurg 2019; 132:e623-e629. [PMID: 31442646 DOI: 10.1016/j.wneu.2019.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore which preoperative radiologic variables have propensity for reherniation and to evaluate whether the inherent annulus splitting procedure during percutaneous endoscopic lumbar diskectomy (PELD) could prompt reherniation, we assessed the correlation between the anatomic location of annular penetration and reherniation. METHODS Three hundred and fifty patients who underwent PELD for central or subarticular disk herniation through a transforaminal approach were followed-up for at least 24 months. Fifty-four subjects that were reoperated for recurrent herniation were allocated as the reherniation group and the other 296 subjects were allocated as the non-reherniation group. The numerical rating scale score, another lumbosacral disk herniation (LDH) lesion in addition to the PELD level (another LDH), location (central or subarticular) and severity of LDH (protrusion or extrusion), and tear of the posterior longitudinal ligament (PLL) were compared between the 2 groups to identify which variables could be predictive factors for reherniation. To assess the influences of PELD on reherniation, location and severity of reherniation were compared with those of initial herniation. RESULTS The location at the subarticular region and the existence of a concomitant PLL tear during initial LDH were significantly related to subsequent reherniation. The location and severity of these reherniations were significantly retained when compared with those of primary herniation. CONCLUSIONS PLL tear and subarticular herniation were significantly related to recurrent disk herniation. Reherniation patterns after PELD generally matched those of primary herniation. The annulus penetrating step during PELD did not increase the risk of reherniation.
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Affiliation(s)
- Jung Hwan Lee
- Department of Rehabilitation Medicine, Namdarun Rehabilitation Clinic, Yong In City, Gyeonggi-Do, South Korea
| | - Kyung-Chul Choi
- Department of Neurosurgery, Leon Wiltse Memorial Hospital, An Yang City, Gyeonggi-Do, South Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Dong Dae Mun Gu, Seoul, South Korea.
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10
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Biomechanical test protocols to detect minor injury effects in intervertebral discs. J Mech Behav Biomed Mater 2019; 95:13-20. [PMID: 30947120 DOI: 10.1016/j.jmbbm.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/26/2019] [Accepted: 03/22/2019] [Indexed: 01/21/2023]
Abstract
Intervertebral discs (IVDs) maintain flexibility of the spine and bear mechanical load. Annulus fibrosus (AF) defects are associated with IVD degeneration and herniation which disrupt biomechanical function and can cause pain. AF puncture injuries can induce IVD degeneration but are needed to inject therapies. Identifying small AF defects with biomechanical testing can be difficult because IVDs have a complex, composite structure and nonlinear biomechanical properties that are dependent on AF fiber tension. It remains unclear how choice of biomechanical testing protocols affect the sensitivity of biomechanical properties to AF injuries. This study determined whether axial preload or magnitude of cyclic axial or torsional testing affected the ability to detect minor AF defects in rat caudal motion segments using ex vivo biomechanical testing. Intact and injured motion segments were subjected to a repeated measures study design with multiple biomechanical testing protocols that varied axial tension-compression force amplitude (±1.6 N, ±8.0 N, ±16.0 N), axial preload (-1.6 N, -8.0 N, -16.0 N, corresponding to -0.1 MPa, -0.5 MPa, and -1.0 MPa, respectively), and torsional rotation angle (±10°, ±15°, and ±20°). Biomechanical properties obtained from the lowest force testing conditions for axial tension-compression (±1.6 N), axial preload (-1.6 N), and angular rotation (±10°) exhibited the largest differences in biomechanical properties between intact and injured conditions. Biomechanical properties determined under low axial force or torsion amplitudes involve less AF fiber tension and were most sensitive to injury. Low force testing protocols are recommended for detecting minor structural AF defects and may enable more precise assessments of IVD injuries, healing or repair.
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The Frequency of Resurgery after Percutaneous Lumbar Surgery Using Dekompressor in a Ten-Year Period. Minim Invasive Surg 2018; 2018:5286760. [PMID: 30402284 PMCID: PMC6198552 DOI: 10.1155/2018/5286760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
To prevent open surgical procedures, minimally invasive techniques, like Dekompressor (PLDD), have been developed. The absence of reherniation is an important factor correlating with clinical success after lumbar surgery. In this retrospective, observational study, the frequency of additional open surgery after PLDD in a long time retrospective was examined. The correlation between clinical symptoms and outcome was assessed, and the time between PLDD and open surgery was analyzed. Consecutive patients after PLDD between 2005 and 2007 were included. MacNab's outcome criteria were used to evaluate patient satisfaction. The need for additional open surgery of the lumbar spine, the period between Dekompressor and resurgery, and the treated levels were analyzed. In total, 73 patients were included in this study. The patients were seen one month after PLDD. The majority of patients (76.7%) had additional radicular pain. The most common level treated was L4-5 (58.9%). The follow-up time was longer than 5 years in 30.1% of the patients and longer than 10 years in 6.82%. The short-term success rate was 67.1%. Additional surgery was performed in 26.0% of patients, with 78.9% of the reoperations undertaken during the first year after PLDD. These patients had a statistically significant worse outcome (P = 0.025). Radicular pain was present in all patients with an early subsequent surgery, but only in 50% of patients with late surgery (P = 0.035). Significantly more patients with poor pain relief had radicular pain (P = 0.04). The short-term success rate was worsened by a resurgery rate of 26.0%. Subsequent surgery, a short time after PLDD, suggests that PLDD is not a replacement for open discectomy. Because patients with radicular pain had a worse outcome and more frequent resurgeries, whether radicular pain is an ideal indication for PLDD should be discussed.
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