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Chai Q, Zhang B, Da Y, Wang W, Gao Y, Yao M, Zhu H, Yang X, Zhu Y. Enhancement and Repair of Degenerative Intervertebral Disc in Rats Using Platelet-Rich Plasma/Ferulic Acid Hydrogel. Cartilage 2023; 14:506-515. [PMID: 36899464 PMCID: PMC10807731 DOI: 10.1177/19476035231157341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Intervertebral degenerative disc (IDD) disease is one of the most common clinical conditions causing low back pain. The main objective of this study was to investigate the repair effect of platelet-rich plasma (PRP) and ferulic acid (FA) hydrogel compound on degenerative discs in rats in combination with bioengineering technology, which may provide a strong theoretical basis for the future treatment of IDD. METHODS Forty-five male Sprague-Dawley rats were randomly divided into groups A-F; MRI was performed in each group at 0, 4, and 8 weeks after injection; and disc tissues were obtained after executing the animals. The histomorphology, apoptosis, and protein synthesis of intervertebral discs in each group were observed by hematoxylin-eosin, Masson, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and Western blot. RESULTS The release concentration of all groups reached the peak at 12 hours, and the highest concentration was found in the hydrogel/PRP/FA group at the same time. The MTT assay showed that hydrogel/PRP/FA is well-cytocompatible. The results of animal experiments show that hydrogel/PRP/FA has a good effect on degenerative intervertebral disc in rats. CONCLUSION PRP/FA-rich hydrogel compound plays an active role in promoting extracellular matrix synthesis, strengthening and repairing degenerated intervertebral discs in rats.
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Affiliation(s)
- Qiang Chai
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Baining Zhang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yifeng Da
- Department of Region A, Spinal Surgery Center, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wenlei Wang
- Department of Region B, Joint Surgery Center, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yidan Gao
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Mingyu Yao
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - He Zhu
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xuejun Yang
- Department of Orthopaedics, The Affiliated People’s Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yong Zhu
- Department of Orthopaedics, The Affiliated People’s Hospital of Inner Mongolia Medical University, Hohhot, China
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Chen X, Kohan S, Bhargav D, Choi J, Perera S, Dean C, Chopra N, Sial A, Sandhu HS, Apos E, Appleyard R, Diwan AD. Phase 1 evaluation of an elastomeric nucleus pulposus device as an option to augment disc at microdiscectomy: Experimental results from biomechanical and biocompatibility testing and first in human. JOR Spine 2023; 6:e1250. [PMID: 37361335 PMCID: PMC10285756 DOI: 10.1002/jsp2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Whilst microdiscectomy is an excellent reliever of pain for recalcitrant lumbar disc herniation (LDH), it has a high failure rate over time due to the ensuing reduction in mechanical stabilization and support of the spine. One option is to clear the disc and replace it with a nonhygroscopic elastomer. Here, we present the evaluation of biomechanical and biological behavior of a novel elastomeric nucleus device (Kunovus disc device [KDD]), consisting of a silicone jacket and a two-part in situ curing silicone polymer filler. Materials and Methods ISO 10993 and American Society for Testing and Materials (ASTM) standards were used to evaluate the biocompatibility and mechanics of KDD. Sensitization, intracutaneous reactivity, acute systemic toxicity, genotoxicity, muscle implantation study, direct contact matrix toxicity assay, and cell growth inhibition assay were performed. Fatigue test, static compression creep testing, expulsion testing, swell testing, shock testing, and aged fatigue testing were conducted to characterize the mechanical and wear behavior of the device. Cadaveric studies to develop a surgical manual and evaluate feasibility were conducted. Finally, a first-in-human implantation was conducted to complete the proof of principle. Results The KDD demonstrated exceptional biocompatibility and biodurability. Mechanical tests showed no Barium-containing particles in fatigue test, no fracture of nucleus in static compression creep testing, no extrusion and swelling, and no material failure in shock and aged fatigue testing. Cadaver training sessions showed that KDD was deemed implantable during microdiscectomy procedures in a minimally invasive manner. Following IRB approval, the first implantation in a human showed no intraoperative vascular and neurological complications and demonstrated feasibility. This successfully completed Phase 1 development of the device. Conclusion The elastomeric nucleus device may mimic native disc behavior in mechanical tests, offering an effective way for treating LDH by way of Phase 2 and subsequent clinical trials or postmarket surveillance in the future.
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Affiliation(s)
- Xiaolong Chen
- Spine Labs, St. George & Sutherland Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Kunovus TechnologiesSydneyNew South WalesAustralia
| | - Saeed Kohan
- St. George Hospital, University of New South WalesSydneyNew South WalesAustralia
| | | | | | | | - Cameron Dean
- Kunovus TechnologiesSydneyNew South WalesAustralia
| | - Neha Chopra
- Spine Labs, St. George & Sutherland Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Spine Service, Department of Orthopaedic SurgerySt. George Hospital CampusSydneyNew South WalesAustralia
| | - Alisha Sial
- Spine Labs, St. George & Sutherland Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Spine Service, Department of Orthopaedic SurgerySt. George Hospital CampusSydneyNew South WalesAustralia
| | - Harvinder S. Sandhu
- Spinal Surgical Service, Hospital for Special Surgery, Weill Medical College of Cornell UniversityNew YorkNew YorkUSA
| | - Esther Apos
- Kunovus TechnologiesSydneyNew South WalesAustralia
- Cmsscidoc Pty LtdMelbourneVictoriaAustralia
| | - Richard Appleyard
- Orthopaedic Biomechanics Research Group, Department of Biomedical Sciences, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Ashish D. Diwan
- Spine Labs, St. George & Sutherland Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Spine Service, Department of Orthopaedic SurgerySt. George Hospital CampusSydneyNew South WalesAustralia
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Wang H, Zhu J, Xia Y, Li Y, Fu C. Application of platelet-rich plasma in spinal surgery. Front Endocrinol (Lausanne) 2023; 14:1138255. [PMID: 37008931 PMCID: PMC10057539 DOI: 10.3389/fendo.2023.1138255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
With the aging of the population and changes in lifestyle, the incidence of spine-related diseases is increasing, which has become a major global public health problem; this results in a huge economic burden on the family and society. Spinal diseases and complications can lead to loss of motor, sensory, and autonomic functions. Therefore, it is necessary to identify effective treatment strategies. Currently, the treatment of spine-related diseases includes conservative, surgical, and minimally invasive interventional therapies. However, these treatment methods have several drawbacks such as drug tolerance and dependence, adjacent spondylosis, secondary surgery, infection, nerve injury, dural rupture, nonunion, and pseudoarthrosis. Further, it is more challenging to promote the regeneration of the interstitial disc and restore its biomechanical properties. Therefore, clinicians urgently need to identify methods that can limit disease progression or cure diseases at the etiological level. Platelet-rich plasma (PRP), a platelet-rich form of plasma extracted from venous blood, is a blood-derived product. Alpha granules contain a large number of cytokines, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor, platelet factor 4 (PF-4), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β (TGF-β). These growth factors allow stem cell proliferation and angiogenesis, promote bone regeneration, improve the local microenvironment, and enhance tissue regeneration capacity and functional recovery. This review describes the application of PRP in the treatment of spine-related diseases and discusses the clinical application of PRP in spinal surgery.
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Culbert MP, Warren JP, Dixon AR, Fermor HL, Beales PA, Wilcox RK. Evaluation of injectable nucleus augmentation materials for the treatment of intervertebral disc degeneration. Biomater Sci 2021; 10:874-891. [PMID: 34951410 DOI: 10.1039/d1bm01589c] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Back pain affects a person's health and mobility as well as being associated with large health and social costs. Lower back pain is frequently caused by degeneration of the intervertebral disc. Current operative and non-operative treatments are often ineffective and expensive. Nucleus augmentation is designed to be a minimally invasive method of restoring the disc to its native healthy state by restoring the disc height, and mechanical and/or biological properties. The majority of the candidate materials for nucleus augmentation are injectable hydrogels. In this review, we examine the materials that are currently under investigation for nucleus augmentation, and compare their ability to meet the design requirements for this application. Specifically, the delivery of the material into the disc, the mechanical properties of the material and the biological compatibility are examined. Recommendations for future testing are also made.
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Affiliation(s)
- Matthew P Culbert
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK, LS2 9JT.
| | - James P Warren
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK, LS2 9JT.
| | - Andrew R Dixon
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK, LS2 9JT.
| | - Hazel L Fermor
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK, LS2 9JT.
| | - Paul A Beales
- School of Chemistry, Astbury Centre for Structural Molecular Biology and Bragg Centre for Materials Research, University of Leeds, UK, LS2 9JT
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK, LS2 9JT.
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Dixon AR, Warren JP, Culbert MP, Mengoni M, Wilcox RK. Review of in vitro mechanical testing for intervertebral disc injectable biomaterials. J Mech Behav Biomed Mater 2021; 123:104703. [PMID: 34365096 DOI: 10.1016/j.jmbbm.2021.104703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 01/17/2023]
Abstract
Many early stage interventions for intervertebral disc degeneration are under development involving injection of a biomaterial into the affected tissue. Due to the complex mechanical behaviour of the intervertebral disc, there are challenges in comprehensively evaluating the performance of these injectable biomaterials in vitro. The aim of this review was to examine the different methods that have been developed to mechanically test injectable intervertebral disc biomaterials in an in vitro disc model. Testing methods were examined with emphasis on overall protocol, artificial degeneration method, mechanical testing regimes and injection delivery. Specifically, the effects of these factors on the evaluation of different aspects of device performance was assessed. Broad testing protocols varied between studies and enabled evaluation of different aspects of an injectable treatment. Studies employed artificial degeneration methodologies which were either on a macro scale through mechanical means or on a microscale with biochemical means. Mechanical loading regimes differed greatly across studies, with load being either held constant, ramped to failure, or applied cyclically, with large variability on all loading parameters. Evaluation of the risk of herniation was possible by utilising ramped loading, whereas cyclic loading enabled the examination of the restoration of mechanical behaviour for initial screening of biomaterials and surgical technique optimisation studies. However, there are large variations in the duration or tests, and further work is needed to define an appropriate number of cycles to standardise this type of testing. Biomaterial delivery was controlled by set volume or haptic feedback, and future investigations should generate evidence applying physiological loading during injection and normalisation of injection parameters based on disc size. Based on the reviewed articles and considering clinical risks, a series of recommendations have been made for future intervertebral disc mechanical testing.
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Affiliation(s)
- A R Dixon
- University of Leeds, Institute of Medical and Biological Engineering, Leeds, LS2 9JT, United Kingdom.
| | - J P Warren
- University of Leeds, Institute of Medical and Biological Engineering, Leeds, LS2 9JT, United Kingdom
| | - M P Culbert
- University of Leeds, Institute of Medical and Biological Engineering, Leeds, LS2 9JT, United Kingdom
| | - M Mengoni
- University of Leeds, Institute of Medical and Biological Engineering, Leeds, LS2 9JT, United Kingdom
| | - R K Wilcox
- University of Leeds, Institute of Medical and Biological Engineering, Leeds, LS2 9JT, United Kingdom.
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Effect of Platelet-Rich Plasma on Intervertebral Disc Degeneration In Vivo and In Vitro: A Critical Review. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8893819. [PMID: 33299533 PMCID: PMC7704139 DOI: 10.1155/2020/8893819] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 01/26/2023]
Abstract
Intervertebral disc degeneration (IDD) is a globally occurring disease that represents a significant cause of socioeconomic problems. Currently, the main method for treating IDD is surgery, including discectomy and vertebral fusion. Several in vitro experiments demonstrated that platelet-rich plasma (PRP) could stimulate cell proliferation and extracellular matrix regeneration. Additionally, in vivo experiments have proven that PRP injection could restore intervertebral disc height. Clinical studies demonstrated that PRP injection could significantly relieve patient pain. However, further studies are still required to clarify the roles of PRP in IDD prevention and treatment. This review is aimed at summarizing and critically analyzing the current evidence regarding IDD treatment with PRP.
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Xu J, Gou L, Zhang P, Li H, Qiu S. Platelet-rich plasma and regenerative dentistry. Aust Dent J 2020; 65:131-142. [PMID: 32145082 PMCID: PMC7384010 DOI: 10.1111/adj.12754] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/30/2022]
Abstract
Regenerative dentistry is an emerging field of medicine involving stem cell technology, tissue engineering and dental science. It exploits biological mechanisms to regenerate damaged oral tissues and restore their functions. Platelet‐rich plasma (PRP) is a biological product that is defined as the portion of plasma fraction of autologous blood with a platelet concentration above that of the original whole blood. A super‐mixture of key cytokines and growth factors is present in platelet granules. Thus, the application of PRP has gained unprecedented attention in regenerative medicine. The rationale underlies the utilization of PRP is that it acts as a biomaterial to deliver critical growth factors and cytokines from platelet granules to the targeted area, thus promoting regeneration in a variety of tissues. Based on enhanced understanding of cell signalling and growth factor biology, researchers have begun to use PRP treatment as a novel method to regenerate damaged tissues, including liver, bone, cartilage, tendon and dental pulp. To enable better understanding of the regenerative effects of PRP in dentistry, this review describes different methods of preparation and application of this biological product, and provides detailed explanations of the controversies and future prospects related to the use of PRP in dental regenerative medicine.
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Affiliation(s)
- J Xu
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - L Gou
- Center for Genetic Medicine, Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - P Zhang
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - H Li
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - S Qiu
- Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
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Akeda K, Yamada J, Linn ET, Sudo A, Masuda K. Platelet-rich plasma in the management of chronic low back pain: a critical review. J Pain Res 2019; 12:753-767. [PMID: 30881089 PMCID: PMC6394242 DOI: 10.2147/jpr.s153085] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Low back pain (LBP) is now regarded as the first cause of disability worldwide and should be a priority for future research on prevention and therapy. Intervertebral disc (IVD) degeneration is an important pathogenesis of LBP. Platelet-rich plasma (PRP) is an autologous blood concentrate that contains a natural concentration of autologous growth factors and cytokines and is currently widely used in the clinical setting for tissue regeneration and repair. PRP has great potential to stimulate cell proliferation and metabolic activity of IVD cells in vitro. Several animal studies have shown that the injection of PRP into degenerated IVDs is effective in restoring structural changes (IVD height) and improving the matrix integrity of degenerated IVDs as evaluated by magnetic resonance imaging (MRI) and histology. The results of this basic research have shown the great possibility that PRP has significant biological effects for tissue repair to counteract IVD degeneration. Clinical studies for evaluating the effects of the injection of PRP into degenerated IVDs for patients with discogenic LBP have been reviewed. Although there was only one double-blind randomized controlled trial, all the studies reported that PRP was safe and effective in reducing back pain. While the clinical evidence of tissue repair of IVDs by PRP treatment is currently lacking, there is a great possibility that the application of PRP has the potential to lead to a feasible intradiscal therapy for the treatment of degenerative disc diseases. Further large-scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic LBP.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie 514-8507, Japan,
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie 514-8507, Japan,
| | - Erikka T Linn
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA 92093-0863, USA
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie 514-8507, Japan,
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA 92093-0863, USA
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Musapoor A, Nikkhoo M, Haghpanahi M. A finite element study on intra-operative corrective forces and evaluation of screw density in scoliosis surgeries. Proc Inst Mech Eng H 2018; 232:1245-1254. [DOI: 10.1177/0954411918810707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scoliosis is an abnormal sideways curvature of the spine and rib cage, which may need surgical treatments. Most of the corrective maneuvers in scoliosis surgeries are based on surgeon’s experience; hence, there is great interest of understanding how the correction ratio can be influenced by the magnitude of forces and moments. Therefore, the objective of this study was to develop and validate a detailed finite element model of the thoracolumbar which can be used to simulate the scoliosis surgeries based on patient-specific clinical images. The validated models of five patients were carefully developed, and the surgery procedures were simulated and the corrective forces were estimated using inverse finite element analysis during the surgery. Furthermore, parametric studies including the influences of the corrective force magnitude and screw density were evaluated. The results showed that the maximum estimated correction force and moment were 173 (±55.43) N and 10.67 (±2.02) N m, respectively, which were aligned with measured clinical observations. The sensitivity analysis on the magnitude of applied force to the screws showed that correction ratio was slightly increased in level 1 (i.e. FB = 1.3 × F) but decreased in level 2 (i.e. FB = 1.6 × F). In addition, the parametric study on increasing the number of pedicle screws showed that there was no significant difference between lower and higher screw density. However, the stress distribution was significantly greater using higher screw density during correction maneuvers. In conclusion, this study shows a direct relationship between the applied force/moment and screw density and the correction ratio up to a border line which should be defined accurately. This detailed computational modeling can be used in clinic in hope of achieving the optimum outcome of scoliosis surgery using individual patient-specific characterization.
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Affiliation(s)
- Ameneh Musapoor
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Haghpanahi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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Biomechanical response of intact, degenerated and repaired intervertebral discs under impact loading – Ex-vivo and In-Silico investigation. J Biomech 2018; 70:26-32. [DOI: 10.1016/j.jbiomech.2018.01.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 01/30/2023]
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Abstract
Degenerative disc disease is a progressive, chronic disorder with strong association to pain, where the dysregulated tissue environment signals disc cells, thereby leading to a low inflammatory process and slow extracellular matrix degradation and fibrosis in a perpetual vicious cycle, generating a structural and functional failure of intervertebral disc joint (IVDJ). Among current biologic therapies, there is an emerging minimally invasive strategy that consists of infiltrating plasma rich in growth factors, a safe and efficacious therapeutic approach for other musculoskeletal degenerative conditions. This review summarizes the homeostasis and degeneration of IVDJ, discusses some results on basic science and therapeutic use of platelet-rich plasma products and advances an alternative minimally invasive biologic therapy in IVDJ degeneration and chronic back pain.
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Affiliation(s)
- Eduardo Anitua
- BTI - Biotechnology Institute, Laboratory of Regenerative Medicine, Jose Maria Cagigal Kalea, 19, 01007 Vitoria-Gasteiz, Álava, Spain.,University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), C/Jacinto Quincoces, 39,01007 Vitoria-Gasteiz, Álava, Spain
| | - Sabino Padilla
- BTI - Biotechnology Institute, Laboratory of Regenerative Medicine, Jose Maria Cagigal Kalea, 19, 01007 Vitoria-Gasteiz, Álava, Spain.,University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), C/Jacinto Quincoces, 39,01007 Vitoria-Gasteiz, Álava, Spain
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