Lateral Surgical Approach to Lumbar Intervertebral Discs in an Ovine Model

Oehme, David; Goldschlager, Tony; Rosenfeld, Jeffrey V.; Danks, Andrew; Ghosh, Peter; Gibbon, Anne; Jenkin, Graham

doi:10.1100/2012/873726

Cited by 25 publications

(32 citation statements)

References 23 publications

(17 reference statements)

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“…However, as already described in other studies, the posterior longitudinal ligament is often partially calcified or even ossified serving as a protective barrier [18]. For these same reasons, to study implants and regenerative disc strategies in vivo, the ovine lumbar IVDs have traditionally been accessed via an anterior or anterolateral approach [5,19].…”

Section: Discussionmentioning

confidence: 99%

The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

et al. 2013

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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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Section: Discussionmentioning

confidence: 99%

The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

et al. 2013

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“…The L1-2 and L5-6 discs served as untreated controls. 55 Disc defects after microdiscectomy received either no treatment (NIL), a gelatin/fibrin glue scaffold only (SCAF), or MPCs and PPS in the same scaffold (MPC+PPS+SCAF). Necropsies were undertaken at 6 months and the spines isolated.…”

Section: Methodsmentioning

confidence: 99%

“…1A). 55 Intraoperative lateral radiographs were acquired to identify the correct levels and to allow for calculation of disc height index (DHI). The L2-3, L3-4, and L4-5 discs then underwent a standardized microdiscectomy.…”

Section: Surgical Technique and Administration Of Mpcs+ppsmentioning

confidence: 99%

Mesenchymal progenitor cells combined with pentosan polysulfate mediating disc regeneration at the time of microdiscectomy: a preliminary study in an ovine model

Oehme

Ghosh

Shimmon

et al. 2014

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Object Following microdiscectomy, discs generally fail to undergo spontaneous regeneration and patients may experience chronic low-back pain and recurrent disc prolapse. In published studies, formulations of mesenchymal progenitor cells combined with pentosan polysulfate (MPCs+PPS) have been shown to regenerate disc tissue in animal models, suggesting that this approach may provide a useful adjunct to microdiscectomy. The goal of this preclinical laboratory study was to determine if the transplantation of MPCs+PPS, embedded in a gelatin/fibrin scaffold (SCAF), and transplanted into a defect created by microdiscectomy, could promote disc regeneration. Methods A standardized microdiscectomy procedure was performed in 18 ovine lumbar discs. The subsequent disc defects were randomized to receive either no treatment (NIL), SCAF only, or the MPC+PPS formulation added to SCAF (MPCs+PPS+SCAF). Necropsies were undertaken 6 months postoperatively and the spines analyzed radiologically (radiography and MRI), biochemically, and histologically. Results No adverse events occurred throughout the duration of the study. The MPC+PPS+SCAF group had significantly less reduction in disc height compared with SCAF-only and NIL groups (p < 0.05 and p < 0.01, respectively). Magnetic resonance imaging Pfirrmann scores in the MPC+PPS+SCAF group were significantly lower than those in the SCAF group (p = 0.0213). The chaotropic solvent extractability of proteoglycans from the nucleus pulposus of MPC+PPS+SCAF-treated discs was significantly higher than that from the SCAF-only discs (p = 0.0312), and using gel exclusion chromatography, extracts from MPC+PPS+SCAF-treated discs also contained a higher percentage of proteoglycan aggregates than the extracts from both other groups. Analysis of the histological sections showed that 66% (p > 0.05) of the MPC+PPS+SCAF-treated discs exhibited less degeneration than the NIL or SCAF discs. Conclusions These findings demonstrate the capacity of MPCs in combination with PPS, when embedded in a gelatin sponge and sealed with fibrin glue in a microdiscectomy defect, to restore disc height, disc morphology, and nucleus pulposus proteoglycan content.

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“…Also, sheep spines allow for an evaluation of the success of the study using fusion assessments commonly used in clinical practice. When considering spinal fusion in large animal models, it is apparent that due to the biomechanical properties of the spine a biped primate animal model [such as in (221)] should ideally preferred over a quadruped large animal model [for example ovine (222) or porcine (223)]. But given the expenses and limited availability of primate testing as well as ethical concerns due to the close phylogenical relation, it is more feasible to trial large numbers of scaffold variations in the most appropriate quadruped large animal models and then evaluate the best performing scaffold in a primate model, if possible (184).…”

Section: Minimally-invasive Ovine Thoracic Spine Fusion Modelmentioning

confidence: 99%

Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective

et al. 2013

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The role of Bone Tissue Engineering in the field of Regenerative Medicine has been the topic of substantial research over the past two decades. Technological advances have improved orthopaedic implants and surgical techniques for bone reconstruction. However, improvements in surgical techniques to reconstruct bone have been limited by the paucity of autologous materials available and donor site morbidity. Recent advances in the development of biomaterials have provided attractive alternatives to bone grafting expanding the surgical options for restoring the form and function of injured bone. Specifically, novel bioactive (second generation) biomaterials have been developed that are characterised by controlled action and reaction to the host tissue environment, whilst exhibiting controlled chemical breakdown and resorption with an ultimate replacement by regenerating tissue. Future generations of biomaterials (third generation) are designed to be not only osteoconductive but also osteoinductive, i.e. to stimulate regeneration of host tissues by combining tissue engineering and in situ tissue regeneration methods with a focus on novel applications. These techniques will lead to novel possibilities for tissue regeneration and repair. At present, tissue engineered constructs that may find future use as bone grafts for complex skeletal defects, whether from post-traumatic, degenerative, neoplastic or congenital/developmental "origin" require osseous reconstruction to ensure structural and functional integrity. Engineering functional bone using combinations of cells, scaffolds and bioactive factors is a promising strategy and a particular feature for future development in the area of hybrid materials which are able to exhibit suitable biomimetic and mechanical properties. This review will discuss the state of the art in this field and what we can expect from future generations of bone regeneration concepts.

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Lateral Surgical Approach to Lumbar Intervertebral Discs in an Ovine Model

Cited by 25 publications

References 23 publications

The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

Mesenchymal progenitor cells combined with pentosan polysulfate mediating disc regeneration at the time of microdiscectomy: a preliminary study in an ovine model

Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective

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