Peredo Ana P, Gullbrand Sarah E, Mauck Robert L, Smith Harvey E
Department of Bioengineering School of Engineering and Applied Science, University of Pennsylvania Philadelphia Pennsylvania USA.
McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA.
JOR Spine. 2021 Feb 11;4(1):e1133. doi: 10.1002/jsp2.1133. eCollection 2021 Mar.
Intervertebral disc (IVD) herniations, caused by annulus fibrosus (AF) tears that enable disc tissue extrusion beyond the disc space, are very prevalent, especially among adults in the third to fifth decade of life. Symptomatic herniations, in which the extruded tissue compresses surrounding nerves, are characterized by back pain, numbness, and tingling and can cause extreme physical disability. Patients whose symptoms persist after nonoperative intervention may undergo surgical removal of the herniated tissue via microdiscectomy surgery. The AF, however, which has a poor endogenous healing ability, is left unrepaired increasing the risk for re-herniation and pre-disposing the IVD to degenerative disc disease. The lack of understanding of the mechanisms involved in native AF repair limits the design of repair systems that overcome the impediments to successful AF restoration. Moreover, the complexity of the AF structure and the challenging anatomy of the repair environment represents a significant challenge for the design of new repair devices. While progress has been made towards the development of an effective AF repair technique, these methods have yet to demonstrate long-term repair and recovery of IVD biomechanics. In this review, the limitations of endogenous AF healing are discussed and key cellular events and factors involved are highlighted to identify potential therapeutic targets that can be integrated into AF repair methods. Clinical repair strategies and their limitations are described to further guide the design of repair approaches that effectively restore native tissue structure and function.
椎间盘（IVD）突出是由纤维环（AF）撕裂导致椎间盘组织挤出椎间盘间隙引起的，非常普遍，尤其是在30至50岁的成年人中。有症状的突出，即挤出的组织压迫周围神经，其特征为背痛、麻木和刺痛，并可导致严重的身体残疾。非手术干预后症状持续的患者可能会通过显微椎间盘切除术手术切除突出的组织。然而，由于AF的内源性愈合能力较差，术后未对其进行修复，这增加了再次突出的风险，并使IVD易患椎间盘退变疾病。对天然AF修复所涉及机制的缺乏了解限制了能够克服成功修复AF障碍的修复系统的设计。此外，AF结构的复杂性和修复环境具有挑战性的解剖结构对新型修复装置的设计构成了重大挑战。虽然在开发有效的AF修复技术方面已经取得了进展，但这些方法尚未证明能长期修复并恢复IVD生物力学。在这篇综述中，我们讨论了内源性AF愈合的局限性，并强调了所涉及的关键细胞事件和因素，以确定可整合到AF修复方法中的潜在治疗靶点。描述了临床修复策略及其局限性，以进一步指导有效恢复天然组织结构和功能的修复方法的设计。
