School of Computer Science, Engineering & Mathematics, Faculty of Science & Engineering, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
Expert Rev Med Devices. 2011 May;8(3):357-76. doi: 10.1586/erd.11.1.
Intervertebral disc biodevices that employ motion-preservation strategies (e.g., nucleus replacement, total disc replacement and posterior stabilization devices) are currently in use or in development. However, their long-term performance is unknown and only a small number of randomized controlled trials have been conducted. In this article, we discuss the following biodevices: interbody cages, nuclear pulposus replacements, total disc replacements and posterior dynamic stabilization devices, as well as future biological treatments. These biodevices restore some function to the motion segment; however, contrary to expectations, the risk of adjacent-level degeneration does not appear to have been reduced. The short-term challenge is to replicate the complex biomechanical function of the motion segment (e.g., biphasic, viscoelastic behavior and nonlinearity) to improve the quality of motion and minimize adjacent level problems, while ensuring biodevice longevity for the younger, more active patient. Biological strategies for regeneration and repair of disc tissue are being developed and these offer exciting opportunities (and challenges) for the longer term. Responsible introduction and rigorous assessment of these new technologies are required. In this article, we will describe the properties of the disc, explore biodevices currently in use for the surgical treatment of low back pain (with an emphasis on lumbar total disc replacement) and discuss future directions for biological treatments. Finally, we will assess the challenges ahead for the next generation of biodevices designed to replace the disc.
目前，采用运动保留策略（如核置换、全椎间盘置换和后路稳定装置）的椎间盘中已经在使用或开发中。然而，它们的长期性能尚不清楚，只有少数随机对照试验已经进行。在本文中，我们讨论了以下生物假体：椎间融合器、髓核置换物、全椎间盘置换物和后路动态稳定装置，以及未来的生物治疗方法。这些生物假体恢复了运动节段的一些功能；然而，与预期相反，相邻节段退变的风险似乎并没有降低。短期的挑战是复制运动节段的复杂生物力学功能（例如双相、粘弹性行为和非线性），以提高运动质量并最小化相邻节段的问题，同时确保年轻、更活跃的患者的生物假体的长期使用。正在开发用于椎间盘组织再生和修复的生物策略，这为长期治疗提供了令人兴奋的机会（和挑战）。需要负责任地引入和严格评估这些新技术。在本文中，我们将描述椎间盘的特性，探讨目前用于治疗腰痛的外科手术的生物假体（重点介绍腰椎全椎间盘置换术），并讨论未来生物治疗的方向。最后，我们将评估下一代旨在替代椎间盘的生物假体所面临的挑战。
