Rahman Tamanna, Tavana Saman, Baxan Nicoleta, Raftery Kay A, Morgan George, Schaer Thomas P, Smith Nigel, Moore Axel, Bull Jonathan, Stevens Molly M, Newell Nicolas
Department of Bioengineering, Imperial College London, London, United Kingdom.
Department of Mechanical Engineering, Biomechanics Group, Imperial College London, London, United Kingdom.
Front Bioeng Biotechnol. 2023 Oct 2;11:1229388. doi: 10.3389/fbioe.2023.1229388. eCollection 2023.
Nucleus replacement has been proposed as a treatment to restore biomechanics and relieve pain in degenerate intervertebral discs (IVDs). Multiple nucleus replacement devices (NRDs) have been developed, however, none are currently used routinely in clinic. A better understanding of the interactions between NRDs and surrounding tissues may provide insight into the causes of implant failure and provide target properties for future NRD designs. The aim of this study was to non-invasively quantify 3D strains within the IVD through three stages of nucleus replacement surgery: intact, post-nuclectomy, and post-treatment. Digital volume correlation (DVC) combined with 9.4T MRI was used to measure strains in seven human cadaveric specimens (42 ± 18 years) when axially compressed to 1 kN. Nucleus material was removed from each specimen creating a cavity that was filled with a hydrogel-based NRD. Nucleus removal led to loss of disc height (12.6 ± 4.4%, = 0.004) which was restored post-treatment (within 5.3 ± 3.1% of the intact state, > 0.05). Nuclectomy led to increased circumferential strains in the lateral annulus region compared to the intact state (-4.0 ± 3.4% vs. 1.7 ± 6.0%, = 0.013), and increased maximum shear strains in the posterior annulus region (14.6 ± 1.7% vs. 19.4 ± 2.6%, = 0.021). In both cases, the NRD was able to restore these strain values to their intact levels ( ≥ 0.192). The ability of the NRD to restore IVD biomechanics and some strain types to intact state levels supports nucleus replacement surgery as a viable treatment option. The DVC-MRI method used in the present study could serve as a useful tool to assess future NRD designs to help improve performance in future clinical trials.
髓核置换已被提议作为一种恢复退变椎间盘生物力学并缓解疼痛的治疗方法。目前已研发出多种髓核置换装置(NRD),然而,目前尚无一种在临床中常规使用。更好地理解NRD与周围组织之间的相互作用,可能有助于深入了解植入物失败的原因,并为未来NRD的设计提供目标特性。本研究的目的是通过髓核置换手术的三个阶段:完整状态、髓核摘除后和治疗后,对椎间盘内的三维应变进行无创定量。数字体积相关(DVC)结合9.4T磁共振成像(MRI)用于测量7个(42±18岁)人体尸体标本在轴向压缩至1kN时的应变。从每个标本中取出髓核材料,形成一个腔,并用基于水凝胶的NRD填充。髓核摘除导致椎间盘高度降低(12.6±4.4%,P = 0.004),治疗后恢复(在完整状态的5.3±3.1%以内,P>0.05)。与完整状态相比,髓核摘除导致外侧纤维环区域的周向应变增加(-4.0±3.4%对1.7±6.0%,P = 0.013),后纤维环区域的最大剪切应变增加(14.6±1.7%对19.4±2.6%,P = 0.021)。在这两种情况下,NRD都能够将这些应变值恢复到完整水平(P≥0.192)。NRD将椎间盘生物力学和某些应变类型恢复到完整状态水平的能力,支持髓核置换手术作为一种可行的治疗选择。本研究中使用的DVC-MRI方法可作为评估未来NRD设计的有用工具,以帮助提高未来临床试验的性能。
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