The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion

Kim, Ho-Joong; Kang, Kyoung‐Tak; Chun, Hye‐Yeong; Lee, Choon-Ki; Chang, Bong Soon; Yeom, Jin Sup

doi:10.1007/s00586-014-3462-0

Cited by 56 publications

(53 citation statements)

References 31 publications

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“…Although the exact mechanism remains uncertain, increased motion and altered biomechanical stresses appear to play a role in the development of ASDD . Fusion length, sagittal alignment, and age are potential risk factors for ASDD .…”

Section: Discussionmentioning

confidence: 99%

“…Although the exact mechanism remains uncertain, increased motion and altered biomechanical stresses appear to play a role in the development of ASDD. (36)(37)(38)(39) Fusion length, sagittal alignment, and age are potential risk factors for ASDD. (3,40) Postmenopausal osteoporosis is a condition in which loss of bone mass tends to cause fragility fractures of vertebrae.…”

Section: Discussionmentioning

confidence: 99%

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Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats

Zhou

Tian

Gou

et al. 2015

Journal of Bone and Mineral Research

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Osteoporosis, which is prevalent in postmenopausal or aged populations, is thought to be a contributing factor to adjacent segment disc degeneration (ASDD), and the incidence and extent of ASDD may be augmented by osteopenia. Parathyroid hormone (PTH) (1-34) has already been shown to be beneficial in osteoporosis, lumbar fusion and matrix homeostasis of intervertebral discs. However, whether PTH(1-34) has a reversing or retarding effect on ASDD in osteopenia has not been confirmed. In the present study, we evaluated the effects of intermittent PTH(1-34) on ASDD in an ovariectomized (OVX) rat model. One hundred 3-month-old female Sprague-Dawley rats underwent L 4 -L 5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after OVX surgery. Control groups were established accordingly. PTH(1-34) was intermittently administered immediately after PLF surgery and lasted for 8 weeks using the following groups (n ¼ 20) (V ¼ vehicle): ShamþV, OVXþV, ShamþPLFþV, OVXþPLFþV, OVXþPLFþPTH. The fused segments showed clear evidence of eliminated motion on the fusion-segment based on manual palpation. Greater new bone formation in histology was observed in PTH-treated animals compared to the control group. The extent of ASDD was significantly increased by ovariotomy. Intermittent PTH(1-34) significantly alleviated ASDD by preserving disc height, microvessel density, relative area of vascular buds, endplate thickness and the relative area of endplate calcification. Moreover, protein expression results showed that PTH(1-34) not only inhibited matrix degradation by decreasing MMP-13, ADAMTS-4 and Col-I, but also promote matrix synthesis by increasing Col-II and Aggrecan. In conclusion, PTH(1-34), which effectively improves lumbar fusion and alleviates ASDD in ovariectomized rats, may be a potential candidate to ameliorate the prognosis of lumbar fusion in osteopenia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats

Zhou

Tian

Gou

et al. 2015

Journal of Bone and Mineral Research

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“…7,8 The primary goal of these approaches is to relieve neurologic impingement via restoration of IVD height and spinal stability and to preserve spinal motion, respectively. Although these interventions may relieve the symptoms of IVD degeneration, they suffer from significant drawbacks including inducing adjacent segment degeneration in proximal IVDs, 9,10 and they do not recapitulate normal spinal biomechanics or the native composite architecture of the entire IVD.…”

Section: Introductionmentioning

confidence: 99%

Decellularization and characterization of a whole intervertebral disk xenograft scaffold

Hensley

Rames

Casler

et al. 2018

J Biomedical Materials Res

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Intervertebral disk (IVD) degeneration is a multifactor process that results in the physical destruction of the nucleus pulposus (NP) and annulus fibrosus (AF). This compromises IVD function and causes significant disability and economic burden. Strategies to replace the entire composite structure of the IVD are limited and most approaches do not recapitulate the heterogenous biochemical composition, microarchitecture or mechanical properties of the native tissue. Our central hypothesis was that donor IVDs which resemble the size and biochemistry of human lumbar IVDs could be successfully decellularized while retaining the tissue's structure and function with the long-term goal of creating a composite scaffold for tissue engineering the human IVD. Accordingly, we optimized a procedure to decellularize bovine tail IVDs using a combination of detergents, ultrasonication, freeze-thaw cycles, and nucleases. The resultant decellularized whole IVD xenografts retained distinct AF and NP regions which contained no visible intact cell nuclei and minimal residual bovine deoxyribose nucleic acid (DNA; 65.98 ± 4.07 and 47.12 ± 13.22 ng/mg, respectively). Moreover, the NP region of decellularized IVDs contained 313.40 ± 50.67 µg/mg glycosaminoglycan. The presence of collagen type II was confirmed via immunohistochemistry. Additionally, histological analysis of the AF region of decellularized IVDs demonstrated retention of the native angle-ply collagen microarchitecture. Unconfined compression testing demonstrated no significant differences in swelling pressure and toe-region modulus between fresh and decellularized IVDs. However, linear region moduli, peak stress and equilibrium moduli were all significantly reduced. Together, this research demonstrates a successful initial step in developing a biomimetic acellular whole IVD xenograft scaffold for use in IVD tissue engineering. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2412-2423, 2018.

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“…ASD is a radiographic observation of long-term degenerative changes at mobile segments above or below a fused spine. Although such changes are multifactorial, the altered biomechanical stresses are thought to play a key role in development of ASD [4344]. Therefore, there may be an advantage in motion-sparing arthroplasty techniques, as the use of instrumented fusion is thought to increase the risk of ASD compared to non-instrumented fusion; this is presumably due to the rigidity caused by instrumentation as with literature demonstrating a trend towards lower prevalence of ASD with motion-sparing techniques [45].…”

Section: Operative Treatmentmentioning

confidence: 99%

Operative Management of Lumbar Degenerative Disc Disease

2016

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Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term.

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The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion

Cited by 56 publications

References 31 publications

Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats

Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats

Decellularization and characterization of a whole intervertebral disk xenograft scaffold

Operative Management of Lumbar Degenerative Disc Disease

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