Deneuville Jean-Philippe, Billot Maxime, Cervantes Alexandra, Peterlongo Sylvain, Meyer Martin, Kolder Mezika, Escande Marie, Bourgeois Mathilde, Pallot Adrien, David Romain, Roulaud Manuel, Ounajim Amine, Laslett Mark, Sarracanie Mathieu, Salameh Najat, Germaneau Arnaud, Rigoard Philippe
PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.
Association Francophone McKenzie (AFMcK - McKenzie Francophonic Association), Paris, France.
Front Bioeng Biotechnol. 2025 Jun 6;13:1582438. doi: 10.3389/fbioe.2025.1582438. eCollection 2025.
The dynamic disc model (DDM) is a theoretical framework in spine mechanics that theorizes the behavior of the within the intervertebral disc under various loads. The model predicts displacement of the away from the bending loads, for example backward displacement of the with a flexion load. These predictions are regularly used as a theoretical basis for explaining certain disc pathologies, such as disc herniation.
We screened seven databases (CENTRAL, Embase, MEDLINE, CINAHL, ScienceDirect, Google Scholar, and HAL) up to July 2024, identifying studies through a PRISMA-guided approach that detailed the mechanical transformation (displacement and deformation) of the under bending load on the intervertebral disc. We conducted a double-blind data extraction and quality assessment of the body of evidence. Finally, we performed a meta-analysis of proportions.
From the 9,269 articles screened, 14 studies were included in the systematic review and meta-analysis. Magnetic Resonance Imaging (MRI) was employed in 92.8% of the studies, revealing four strategies for assessing transformation. The meta-analysis of asymptomatic subjects' data demonstrated that the behavior aligned with dynamic disc model predictions in 85.4% (95% CI = [79.4-91.4]) across spinal regions and bending directions. However, significant heterogeneity and low study quality were noted. Only one study used discography to assess the DDM in a discogenic pain population, identifying discrepancies in transformation and contrast agent leakage.
Evidence for the dynamic disc model for intact discs is of low strength, whereas very limited evidence challenges the dynamic disc model for fissured discs. New multiparametric MRI studies may help guiding future clinical assessment protocols.
CRD42022331774.
动态椎间盘模型（DDM）是脊柱力学中的一个理论框架，它对椎间盘在各种负荷下髓核的行为进行了理论化。该模型预测髓核会远离弯曲负荷发生位移，例如在屈曲负荷下髓核向后位移。这些预测经常被用作解释某些椎间盘病变（如椎间盘突出）的理论基础。
我们检索了截至2024年7月的七个数据库（CENTRAL、Embase、MEDLINE、CINAHL、ScienceDirect、谷歌学术和HAL），通过一种PRISMA指导的方法识别研究，该方法详细阐述了髓核在椎间盘弯曲负荷下的力学转变（位移和变形）。我们对证据主体进行了双盲数据提取和质量评估。最后，我们进行了比例的荟萃分析。
在筛选的9269篇文章中，有14项研究被纳入系统评价和荟萃分析。92.8%的研究采用了磁共振成像（MRI），揭示了四种评估髓核转变的策略。对无症状受试者数据的荟萃分析表明，在脊柱各区域和弯曲方向上，85.4%（95%CI = [79.4 - 91.4]）的髓核行为与动态椎间盘模型的预测一致。然而，注意到存在显著的异质性和研究质量较低的情况。只有一项研究使用椎间盘造影术评估椎间盘源性疼痛人群中的DDM，发现了髓核转变和造影剂渗漏方面的差异。
完整椎间盘的动态椎间盘模型的证据强度较低，而挑战裂隙椎间盘动态椎间盘模型的证据非常有限。新的多参数MRI研究可能有助于指导未来的临床评估方案。
CRD42022331774。
