Wang Jaw-Lin, Tsai Yi-Chian, Wang Yao-Hung
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1809-15. doi: 10.1097/BRS.0b013e31811ec282.
An in vitro biomechanical study using aged human and adolescent porcine discs.
To find the leakage pathway and effect of needle gauge on the degree of disc injury post anular puncture.
Spinal needles are widely used for minimal invasive disc surgeries and disc degeneration/regeneration research. Applications of anular puncture require different diameters of spinal needles. However, the effect of needle diameters on the disc injury has not been systematically studied yet.
Four groups of experiments were conducted: 1) porcine thoracic disc, 2) human thoracic disc, 3) porcine thoracic disc with 200 N external loading, and 4) porcine lumbar discs. The disc was punctured consecutively with needles from smaller diameter to larger diameter. After each anular puncture, the quantitative discomanometry technique was conducted to quantify the disc rupture pressure and volume. The association between needle gauge and rupture pressure and volume was analyzed.
The degree of disc injury increased with the diameter of needle. For an aged human thoracic disc, the anulus fibrosus cannot hold pressure more than 2 MPa after a 21-gauge-needle-anular-puncture. The leakage pathway of injected saline was through the anular fissure but was through the endplate when the disc was next to an osteoporotic vertebrae. The pressure holding power of porcine disc is stronger than of human disc. The rupture pressure of porcine lumbar disc is higher than of porcine thoracic disc. The axial compressive external loading increased the disc rupture pressure. The rupture volumes were not affected by the dimension of injury fissure. The rupture volume was at level of 0.3 mL without external loading and at 0.2 mL with external loading.
A spinal needle of < or = 22 gauge and injection volume of < or = 0.2 mL are recommended to prevent postsurgery leakage.
一项使用老年人类和青少年猪椎间盘的体外生物力学研究。
寻找穿刺针规格对椎间盘穿刺后椎间盘损伤程度的影响及渗漏途径。
脊柱穿刺针广泛应用于微创椎间盘手术及椎间盘退变/再生研究。椎间盘穿刺操作需要不同直径的脊柱穿刺针。然而，针直径对椎间盘损伤的影响尚未得到系统研究。
进行四组实验：1）猪胸椎间盘；2）人类胸椎间盘；3）施加200 N外部负荷的猪胸椎间盘；4）猪腰椎间盘。用直径由小到大的针依次对椎间盘进行穿刺。每次椎间盘穿刺后，采用定量椎间盘测压技术量化椎间盘破裂压力和容积。分析穿刺针规格与破裂压力和容积之间的关系。
椎间盘损伤程度随针直径增大而增加。对于老年人类胸椎间盘，21号针穿刺后，纤维环无法承受超过2 MPa的压力。注入盐水的渗漏途径是通过纤维环裂隙，但当椎间盘紧邻骨质疏松椎体时则通过终板。猪椎间盘的压力保持能力强于人类椎间盘。猪腰椎间盘的破裂压力高于猪胸椎间盘。轴向压缩外部负荷增加了椎间盘破裂压力。破裂容积不受损伤裂隙尺寸的影响。无外部负荷时破裂容积为0.3 mL，有外部负荷时为0.2 mL。
建议使用22号及以下规格的脊柱穿刺针，注射量≤0.2 mL，以防止术后渗漏。
