Influence of Complex Loading Conditions on Intervertebral Disc Failure

Berger-Roscher, Nikolaus; Casaroli, Gloria; Rasche, Volker; Villa, Tomaso; Galbusera, Fabio; Wilke, Hans–Joachim

doi:10.1097/brs.0000000000001699

Cited by 54 publications

(61 citation statements)

References 42 publications

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“…All endplate defect dimensions were also in significant correlation with posterior bulging of the intervertebral discs supporting the previous observation linking lumbar disc herniation with endplate junction failure and endplate damage . There are number of studies who have reported, based from cartilaginous and bony endplates in the surgical samples of herniated discs, that the pathophysiology of lumbar disc herniation is more likely to be mechanical and the high bending movements can cause overstretching of the annular fibers which can pull off the vertebral endplate causing junctional failure and endplate damage . Another possible explanation of this phenomenon may be that dehydrated and fibrosed discs due to endplate damage are more prone to develop fissures and tears causing disc to bulge and prolapse…”

Section: Discussionsupporting

confidence: 81%

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Zehra

Cheung

Bow

et al. 2019

Journal Orthopaedic Research

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The aim of the current study was to investigate the multi-dimensional characteristics of lumbar endplate defects in humans in relation to disc degeneration and other MRI phenotypes as well as their role with pain and disability. A total of 108 subjects were recruited and underwent 3T MRI of the lumbar spine. Structural endplate defects were identified and their dimensions were measured in terms of maximum width and depth, and were then standardized to the actual width of the endplate and depth of the vertebral body, respectively. Both width and depth of all endplate defects in each subject were added separately and scores were assigned on the basis of size from 1 to 3. Combining both scores provided "cumulative endplate defect scores." Disc degeneration scores, Modic changes, disc displacement, HIZ, and facet joint changes were assessed. Subject demographics, pain profile, and Oswestry Disability Index (ODI) were also obtained. Endplate defects were observed in 67.5% of the subjects and in 13.5% of the endplates. All dimensions of endplate defects showed significance with disc degenerative scores, Modic changes, and posterior disc displacement (p < 0.05). Maximum width (p ¼ 0.009) and its standardized value (p ¼ 0.02), and cumulative endplate defect scores (p ¼ 0.004) increased with narrow facet joints. Cumulative endplate defect scores showed a strong positive association with ODI (p < 0.05) compared to disc degenerative scores. Large size endplate defects were strongly associated with degenerative spine changes and more back-related disability. Findings from this study stress the need to assess endplate findings from a multi-dimensional perspective, whose role may have clinical utility. ß 2019 Orthopaedic Research

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Section: Discussionsupporting

confidence: 81%

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Zehra

Cheung

Bow

et al. 2019

Journal Orthopaedic Research

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“…Despite this, the combination of experimental [31] and numerical results on the basis of a statistical investigation allowed identifying if a stress was predictive or not of the failure in a specific region. The conclusions were not based on a pre-defined limit of failure but on the predictivity of the stress values relative to the experimental outcomes.…”

Section: Discussionmentioning

confidence: 99%

Numerical Prediction of the Mechanical Failure of the Intervertebral Disc under Complex Loading Conditions

et al. 2017

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Finite element modeling has been widely used to simulate the mechanical behavior of the intervertebral disc. Previous models have been generally limited to the prediction of the disc behavior under simple loading conditions, thus neglecting its response to complex loads, which may induce its failure. The aim of this study was to generate a finite element model of the ovine lumbar intervertebral disc, in which the annulus was characterized by an anisotropic hyperelastic formulation, and to use it to define which mechanical condition was unsafe for the disc. Based on published in vitro results, numerical analyses under combined flexion, lateral bending, and axial rotation with a magnitude double that of the physiological ones were performed. The simulations showed that flexion was the most unsafe load and an axial tensile stress greater than 10 MPa can cause disc failure. The numerical model here presented can be used to predict the failure of the disc under all loading conditions, which may support indications about the degree of safety of specific motions and daily activities, such as weight lifting.

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“…For in vivo models, mechanical properties can be assessed ex vivo on intact spinal motion segments or isolated tissue samples . In the case of motion segments, multi‐axis loads can be applied to similar physiological deformations, including those likely to lead to failure . Direct, in vivo evaluation of disc mechanical properties is possible using emerging technologies such as magnetic resonance elastography .…”

Section: Selecting Physiologically and Clinically Relevant Efficacy Mmentioning

confidence: 99%

“…85 In the case of motion segments, multi-axis loads can be applied to similar physiological deformations, including those likely to lead to failure. 141 Direct, in vivo evaluation of disc mechanical properties is possible using emerging technologies such as magnetic resonance elastography. 142,143 Where direct evaluation is impossible, assessments of extracellular matrix composition and organization through biochemical and histological assays, or imaging (eg, MRI or contrast-enhanced CT), represent important surrogates for mechanical function.…”

Section: Structural and Biomechanical Outcome Measuresmentioning

confidence: 99%

Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: Recommendations of the ORS spine section

et al. 2018

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Intervertebral disc degeneration is strongly associated with chronic low back pain, a leading cause of disability worldwide. Current back pain treatment approaches (both surgical and conservative) are limited to addressing symptoms, not necessarily the root cause. Not surprisingly therefore, long‐term efficacy of most approaches is poor. Cell‐based disc regeneration strategies have shown promise in preclinical studies, and represent a relatively low‐risk, low‐cost, and durable therapeutic approach suitable for a potentially large patient population, thus making them attractive from both clinical and commercial standpoints. Despite such promise, no such therapies have been broadly adopted clinically. In this perspective we highlight primary obstacles and provide recommendations to help accelerate successful clinical translation of cell‐based disc regeneration therapies. The key areas addressed include: (a) Optimizing cell sources and delivery techniques; (b) Minimizing potential risks to patients; (c) Selecting physiologically and clinically relevant efficacy metrics; (d) Maximizing commercial potential; and (e) Recognizing the importance of multidisciplinary collaborations and engaging with clinicians from inception through to clinical trials.

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Influence of Complex Loading Conditions on Intervertebral Disc Failure

Abstract: 4.

Cited by 54 publications

References 42 publications

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Numerical Prediction of the Mechanical Failure of the Intervertebral Disc under Complex Loading Conditions

Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: Recommendations of the ORS spine section

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