Wieviel Bandscheibengewebe wird bei der perkutanen Nukleotomie tatsächlich entfernt?

Castro, William H. M.; Jerosch, Jörg; Halm, H.; Rondhuis, J.

doi:10.1055/s-2008-1039654

Cited by 5 publications

(3 citation statements)

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“…Results of this and other studies have shown that changes in disc biomechanics are affected by the amount of material removed 70,90,113,114 . Thus, to allow comparison of the masses removed using the different nuclectomy techniques, the excised wet mass needs to be converted to a dry mass, to remove the confounding variability due to disc hydration.…”

Section: Discussionmentioning

confidence: 99%

“…Results of this and other studies have shown that changes in disc biomechanics are affected by the amount of material removed. 70 , 90 , 113 , 114 Thus, to allow comparison of the masses removed using the different nuclectomy techniques, the excised wet mass needs to be converted to a dry mass, to remove the confounding variability due to disc hydration. Furthermore, regardless of the technique used to achieve NP removal, clinical studies have not found a correlation between the amount of material removed and the long‐term outcomes of nuclectomy, thus the appropriate quantity of disc material to be removed is still unclear.…”

Section: Discussionmentioning

confidence: 99%

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An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

et al. 2022

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Background Nuclectomy, also known as nucleotomy, is a percutaneous surgical procedure performed to remove nucleus material from the center of the disc. Multiple techniques have been considered to perform a nuclectomy, however, the advantages and disadvantages of each are not well understood. Aims This in vitro biomechanical investigation on human cadaveric specimens aimed to quantitatively compare three nuclectomy techniques performed using an automated shaver, rongeurs, and laser. Material & Methods Comparisons were made in terms of mass, volume and location of material removal, changes in disc height, and stiffness. Fifteen vertebra–disc–vertebra lumbar specimens were acquired from six donors (40 ± 13 years) and split into three groups. Before and after nucleotomy axial mechanical tests were performed and T2‐weighted 9.4T MRIs were acquired for each specimen. Results When using the automated shaver and rongeurs similar volumes of disc material were removed (2.51 ± 1.10% and 2.76 ± 1.39% of the total disc volume, respectively), while considerably less material was removed using the laser (0.12 ± 0.07%). Nuclectomy using the automated shaver and rongeurs significantly reduced the toe‐region stiffness (p = 0.036), while the reduction in the linear region stiffness was significant only for the rongeurs group (p = 0.011). Post‐nuclectomy, 60% of the rongeurs group specimens showed changes in the endplate profile while 40% from the laser group showed subchondral marrow changes. Discussion From the MRIs, homogeneous cavities were seen in the center of the disc when using the automated shaver. When using rongeurs, material was removed non‐homogeneously both from the nucleus and annulus regions. Laser ablation formed small and localized cavities suggesting that the technique is not suitable to remove large volumes of material unless it is developed and optimized for this application. Conclusion The results demonstrate that both rongeurs and automated shavers can be used to remove large volumes of NP material but the reduced risk of collateral damage to surrounding tissues suggests that the automated shaver may be more suitable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

et al. 2022

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“…Next, a cruciate incision was created in the posterolateral annulus using a #11 scalpel blade. Afterwards, either 2 or 4 mm pituitary rongeurs were used to remove 1.71±0.38 g of nuclear material, which is approximately 50% of NP volume (Castro et al, 1992; Dullerud et al, 1993). Amount of NP removed was not correlated with sample degeneration (r = 0.19, p = 0.5).…”

Section: Methodsmentioning

confidence: 99%

Nucleotomy reduces the effects of cyclic compressive loading with unloaded recovery on human intervertebral discs

Showalter

Malhotra

Vresilovic

et al. 2014

Journal of Biomechanics

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The first objective of this study was to determine the effects of physiological cyclic loading followed by unloaded recovery on the mechanical response of human intervertebral discs. The second objective was to examine how nucleotomy alters the disc’s mechanical response to cyclic loading. To complete these objectives, 15 human L5-S1 discs were tested while intact and subsequent to nucleotomy. The testing consisted of 10,000 cycles of physiological compressive loads followed by unloaded hydrated recovery. Cyclic loading increased compression modulus (3%) and strain (33%), decreased neutral zone modulus (52%), and increased neutral zone strain (31%). Degeneration was not correlated with the effect of cyclic loading in intact discs, but was correlated with cyclic loading effects after nucleotomy, with more degenerate samples experiencing greater increases in both compressive and neutral zone strain following cyclic loading. Partial removal of the nucleus pulposus decreased the compression and neutral zone modulus while increasing strain. These changes correspond to hypermobility, which will alter overall spinal mechanics and may impact low back pain via altered motion throughout the spinal column. Nucleotomy also reduced the effects of cyclic loading on mechanical properties, likely due to altered fluid flow, which may impact cellular mechanotransduction and transport of disc nutrients and waste. Degeneration was not correlated with the acute changes of nucleotomy. Results of this study provide an ideal protocol and control data for evaluating the effectiveness of a mechanically-based disc degeneration treatment, such as a nucleus replacement.

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Evaluation of an In Situ Gelable and Injectable Hydrogel Treatment to Preserve Human Disc Mechanical Function Undergoing Physiologic Cyclic Loading Followed by Hydrated Recovery

Showalter

Elliott

Chen

et al. 2015

Journal of Biomechanical Engineering

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Despite the prevalence of disc degeneration and its contributions to low back problems, many current treatments are palliative only and ultimately fail. To address this, nucleus pulposus replacements are under development. Previous work on an injectable hydrogel nucleus pulposus replacement composed of n-carboxyethyl chitosan, oxidized dextran, and teleostean has shown that it has properties similar to native nucleus pulposus, can restore compressive range of motion in ovine discs, is biocompatible, and promotes cell proliferation. The objective of this study was to determine if the hydrogel implant will be contained and if it will restore mechanics in human discs undergoing physiologic cyclic compressive loading. Fourteen human lumbar spine segments were tested using physiologic cyclic compressive loading while intact, following nucleotomy, and again following treatment of injecting either phosphate buffered saline (PBS) (sham, n ¼ 7) or hydrogel (implant, n ¼ 7). In each compressive test, mechanical parameters were measured immediately before and after 10,000 cycles of compressive loading and following a period of hydrated recovery. The hydrogel implant was not ejected from the disc during 10,000 cycles of physiological compression testing and appeared undamaged when discs were bisected following all mechanical tests. For sham samples, creep during cyclic loading increased (þ15%) from creep during nucleotomy testing, while for implant samples creep strain decreased (À3%) toward normal. There was no difference in compressive modulus or compressive strains between implant and sham samples. These findings demonstrate that the implant interdigitates with the nucleus pulposus, preventing its expulsion during 10,000 cycles of compressive loading and preserves disc creep within human L5-S1 discs. This and previous studies provide a solid foundation for continuing to evaluate the efficacy of the hydrogel implant.

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Wieviel Bandscheibengewebe wird bei der perkutanen Nukleotomie tatsächlich entfernt?

Cited by 5 publications

References 0 publications

An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

Nucleotomy reduces the effects of cyclic compressive loading with unloaded recovery on human intervertebral discs

Evaluation of an In Situ Gelable and Injectable Hydrogel Treatment to Preserve Human Disc Mechanical Function Undergoing Physiologic Cyclic Loading Followed by Hydrated Recovery

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