Vadalà Gianluca, Russo Fabrizio, De Strobel Francesca, Bernardini Marco, De Benedictis Giulia Maria, Cattani Caterina, Denaro Luca, D'Este Matteo, Eglin David, Alini Mauro, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy.
J Orthop Res. 2018 Sep;36(9):2460-2468. doi: 10.1002/jor.23905. Epub 2018 Apr 24.
Novel preclinical models that do not damage the annulus fibrosus (AF) of the intervertebral disc are required to study the efficacy of new regenerative strategies for the nucleus pulposus (NP). The aim of the study was to characterize a preclinical ovine model of intervertebral disc degeneration (IDD) induced by endplate (EP) damage and repair via the transpedicular approach, with or without partial nucleotomy, while keeping the AF intact. Twelve adult sheep were used. By the transpedicular approach, a 2 mm tunnel was drilled to the NP through the EP. A partial-nucleotomy was performed. The tunnel was sealed using a polyurethane scaffold. Lumbar discs were assigned to different groups: L1-2: nucleotomy; L2-3: EP tunnel; L3-4: nucleotomy + EP repair; L4-5: EP tunnel + repair; L5-6: control. X-Ray and MRI were performed at 0, 1, 3, and 6 months after surgery. Disc height and MRI indexes were calculated. Macro- and micro-morphology were analyzed. Pfirrmann and Thompson grades were assigned. The treated discs exhibited a progressive decrease in NP signal intensity and MRI index, displaying specific grades of degeneration based on the surgical treatment. According to Pfirrmann and Thompson grades different procedures were staged as: EP tunnel + repair: grade-II; EP tunnel: grade-III, nucleotomy + EP repair: grade-IV; nucleotomy: grade-V. A new stepwise model of IDD to study and test safety and efficacy of novel strategies for NP regeneration has been characterized. The different degrees of IDD have been observed similar to Pfirrmann and Thompson grading system. The intact AF allows for loading studies and eliminating the need for AF closure. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2460-2468, 2018.
为了研究针对髓核(NP)的新型再生策略的疗效,需要不损伤椎间盘纤维环(AF)的新型临床前模型。本研究的目的是描述一种通过经椎弓根入路造成终板(EP)损伤并修复(有或无部分髓核切除术),同时保持AF完整的椎间盘退变(IDD)的临床前绵羊模型。使用了12只成年绵羊。通过经椎弓根入路,经EP钻一个2毫米的通道至NP。进行部分髓核切除术。用聚氨酯支架封闭通道。将腰椎间盘分为不同组:L1-2:髓核切除术;L2-3:EP通道;L3-4:髓核切除术+EP修复;L4-5:EP通道+修复;L5-6:对照组。在术后0、1、3和6个月进行X线和MRI检查。计算椎间盘高度和MRI指数。分析大体和微观形态。评定Pfirrmann和Thompson分级。治疗后的椎间盘NP信号强度和MRI指数逐渐降低,根据手术治疗显示出特定的退变分级。根据Pfirrmann和Thompson分级,不同手术步骤分级如下:EP通道+修复:II级;EP通道:III级,髓核切除术+EP修复:IV级;髓核切除术:V级。已经描述了一种用于研究和测试NP再生新策略安全性和有效性的IDD新的逐步模型。观察到的不同程度的IDD与Pfirrmann和Thompson分级系统相似。完整的AF允许进行负荷研究并无需封闭AF。©2018骨科研究学会。由Wiley Periodicals, Inc.出版。《矫形外科研究杂志》36:2460 - 2468, 2018。