STUDY DESIGN: Investigation of injectable nucleus pulposus (NP) implant. OBJECTIVE: To assess the ability of a recently developed injectable hydrogel implant to restore nondegenerative disc mechanics through support of NP functional mechanics. SUMMARY OF BACKGROUND DATA: Although surgical intervention for low back pain is effective for some patients, treated discs undergo altered biomechanics and adjacent levels are at increased risk for accelerated degeneration. One potential treatment as an alternative to surgery for degenerated disc includes the percutaneous delivery of agents to support NP functional mechanics. The implants are delivered in a minimally invasive fashion, potentially on an outpatient basis, and do not preclude later surgical options. One of the challenges in designing such implants includes the need to match key NP mechanical behavior and mimic the role of native nondegenerate NP in spinal motion. METHODS: The oxidized hyaluronic acid gelatin implant material was prepared. In vitro mechanical testing was performed in mature ovine bone-disc-bone units in 3 stages: intact, discectomy, and implantation versus sham. Tested samples were cut axially for qualitative structural observations. RESULTS: Discectomy increased axial range of motion (ROM) significantly compared with intact. Hydrogel implantation reduced ROM 17% (P < 0.05) compared with discectomy and returned ROM to intact levels (ROM intact 0.71 mm, discectomy 0.87 mm, postimplantation 0.72 mm). Although ROM for the hydrogel implant group was statistically unchanged compared with the intact disc, ROM for sham discs, which received a discectomy and no implant, was significantly increased compared with intact. The compression and tension stiffness were decreased with discectomy and remained unchanged for both implant and sham groups as expected because the annulus fibrosus was not repaired. Gross morphology images confirmed no ejection of NP implant. CONCLUSION: An injectable implant that mimics nondegenerate NP has the potential to return motion segment ROM to normal subsequent to injury.
STUDY DESIGN: Investigation of injectable nucleus pulposus (NP) implant. OBJECTIVE: To assess the ability of a recently developed injectable hydrogel implant to restore nondegenerative disc mechanics through support of NP functional mechanics. SUMMARY OF BACKGROUND DATA: Although surgical intervention for low back pain is effective for some patients, treated discs undergo altered biomechanics and adjacent levels are at increased risk for accelerated degeneration. One potential treatment as an alternative to surgery for degenerated disc includes the percutaneous delivery of agents to support NP functional mechanics. The implants are delivered in a minimally invasive fashion, potentially on an outpatient basis, and do not preclude later surgical options. One of the challenges in designing such implants includes the need to match key NP mechanical behavior and mimic the role of native nondegenerate NP in spinal motion. METHODS: The oxidized hyaluronic acid gelatin implant material was prepared. In vitro mechanical testing was performed in mature ovine bone-disc-bone units in 3 stages: intact, discectomy, and implantation versus sham. Tested samples were cut axially for qualitative structural observations. RESULTS: Discectomy increased axial range of motion (ROM) significantly compared with intact. Hydrogel implantation reduced ROM 17% (P < 0.05) compared with discectomy and returned ROM to intact levels (ROM intact 0.71 mm, discectomy 0.87 mm, postimplantation 0.72 mm). Although ROM for the hydrogel implant group was statistically unchanged compared with the intact disc, ROM for sham discs, which received a discectomy and no implant, was significantly increased compared with intact. The compression and tension stiffness were decreased with discectomy and remained unchanged for both implant and sham groups as expected because the annulus fibrosus was not repaired. Gross morphology images confirmed no ejection of NP implant. CONCLUSION: An injectable implant that mimics nondegenerate NP has the potential to return motion segment ROM to normal subsequent to injury.
Authors: K Kadoya; Y Kotani; K Abumi; T Takada; N Shimamoto; Y Shikinami; T Kadosawa; K Kaneda Journal: Spine (Phila Pa 1976) Date: 2001-07-15 Impact factor: 3.468
Authors: Nicholas A Temofeew; Katherine R Hixon; Sarah H McBride-Gagyi; Scott A Sell Journal: J Mater Sci Mater Med Date: 2017-01-31 Impact factor: 3.896
Authors: Claire G Jeong; Aubrey T Francisco; Zhenbin Niu; Robert L Mancino; Stephen L Craig; Lori A Setton Journal: Acta Biomater Date: 2014-05-21 Impact factor: 8.947
Authors: Sarah E Gullbrand; Thomas P Schaer; Prateek Agarwal; Justin R Bendigo; George R Dodge; Weiliam Chen; Dawn M Elliott; Robert L Mauck; Neil R Malhotra; Lachlan J Smith Journal: Acta Biomater Date: 2017-07-19 Impact factor: 8.947
Authors: Lachlan J Smith; Deborah J Gorth; Brent L Showalter; Joseph A Chiaro; Elizabeth E Beattie; Dawn M Elliott; Robert L Mauck; Weiliam Chen; Neil R Malhotra Journal: Tissue Eng Part A Date: 2014-03-21 Impact factor: 3.845
Authors: Kathryn T Weber; Timothy D Jacobsen; Robert Maidhof; Justin Virojanapa; Chris Overby; Ona Bloom; Shaheda Quraishi; Mitchell Levine; Nadeen O Chahine Journal: Curr Rev Musculoskelet Med Date: 2015-03
Authors: S E Gullbrand; N R Malhotra; T P Schaer; Z Zawacki; J T Martin; J R Bendigo; A H Milby; G R Dodge; E J Vresilovic; D M Elliott; R L Mauck; L J Smith Journal: Osteoarthritis Cartilage Date: 2016-08-26 Impact factor: 6.576
Authors: M Likhitpanichkul; M Dreischarf; S Illien-Junger; B A Walter; T Nukaga; R G Long; D Sakai; A C Hecht; J C Iatridis Journal: Eur Cell Mater Date: 2014-07-18 Impact factor: 3.942