Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
Spine (Phila Pa 1976). 2011 May 20;36(12):939-44. doi: 10.1097/BRS.0b013e3181e8b1d5.
In vitro evaluation of a chemical, injectable intervention for discectomy induced destabilization.
To investigate the ability of two collagen crosslinking agents to restore mechanical properties to lumbar joints destabilized by surgical decompression procedures.
Posterior decompression surgery is a common procedure indicated for tissue pathology that interferes with surrounding neural structures. Previous in vitro, analytical, and clinical studies have shown that removal of load-supporting tissue can compromise joint stability mandating some form of postsurgical stabilization. Currently, no nonsurgical treatments are capable of restoring stability and preventing subsequent degeneration. Exogenous crosslinking of intact discs has shown a fourfold increase in joint stability.
Fifteen bovine lumbar intervertebral joints were randomly separated into methylglyoxal or genipin treatment groups. Flexion-extension flexibility was quantified in three conditions: intact, postdecompression surgery, and after crosslinking reagent injections. Instability was quantified by calculating neutral zone (NZ), percentage of hysteresis, range of motion, and percentage of strain energy.
Simulated surgical decompression increased NZ 111% (P = 0.009), 28% (P = 0.004), range of motion 57% (P = 0.003), and decreased strain energy 37% (P = 0.004). For those discs undergoing methylglyoxal treatment NZ was subsequently reduced 68% (P = 0.012), hysteresis 28% (P = 0.018), range of motion 29% (P = 0.012), and strain energy was increased 71% (P = 0.018). For discs subjected to genipin treatment, NZ was reduced 52% (P = 0.018), hysteresis 23% (P = 0.012), range of motion 44% (P = 0.017), and strain energy was increased 66% (P = 0.012). Mean NZ was lower than intact mean after both methylglyoxal and genipin treatments, 10% and 17% less, respectively, but these differences were not significant. Mean values for all other parameters posttreatment were within 6% of the corresponding intact mean values.
Injections of crosslinking reagents into lumbar intervertebral discs after simulated decompression surgery restored joint stability according to all parameters. Similar results were found for genipin and methylglyoxal reagents. Implementing exogenous collagen crosslinking as an adjunct to current surgical decompression procedures may be beneficial in preventing or delaying subsequent spinal instability and degeneration.
一种化学、可注射干预措施治疗椎间盘切除术引起的失稳的体外评估。
研究两种胶原交联剂恢复因手术减压而不稳定的腰椎关节的机械性能的能力。
后路减压术是一种常见的手术，用于治疗干扰周围神经结构的组织病理学。先前的体外、分析和临床研究表明，去除承重组织会破坏关节稳定性，需要进行某种形式的术后稳定。目前，没有非手术治疗能够恢复稳定性并防止随后的退化。完整椎间盘的外源性交联已显示出关节稳定性提高了四倍。
将 15 个牛腰椎椎间关节随机分为甲基乙二醛或京尼平处理组。在三种条件下量化屈伸灵活性：完整、减压手术后和交联试剂注射后。通过计算中立区 (NZ)、滞后百分比、运动范围和应变能百分比来量化不稳定性。
模拟手术减压使 NZ 增加 111%（P = 0.009），28%（P = 0.004），运动范围增加 57%（P = 0.003），应变能减少 37%（P = 0.004）。对于接受甲基乙二醛治疗的那些椎间盘，NZ 随后降低了 68%（P = 0.012），滞后降低了 28%（P = 0.018），运动范围降低了 29%（P = 0.012），应变能增加了 71%（P = 0.018）。对于接受京尼平处理的椎间盘，NZ 降低了 52%（P = 0.018），滞后降低了 23%（P = 0.012），运动范围降低了 44%（P = 0.017），应变能增加了 66%（P = 0.012）。治疗后的 NZ 平均值低于完整平均值，分别低 10%和 17%，但这些差异无统计学意义。治疗后所有其他参数的平均值均在相应完整平均值的 6%以内。
在模拟减压手术后向腰椎间盘内注射交联试剂可根据所有参数恢复关节稳定性。京尼平和甲基乙二醛试剂的结果相似。将外源性胶原交联作为当前手术减压程序的辅助手段，可能有助于预防或延迟随后的脊柱不稳定和退化。
