Fill of the Nucleus Cavity Affects Mechanical Stability in Compression, Bending, and Torsion of a Spine Segment, Which Has Undergone Nucleus Replacement

Arthur, Amy; Cannella, Marco; Keane, Michael; Singhatat, Wamis; Vresilovic, Edward J.; Marcolongo, Michele

doi:10.1097/brs.0b013e3181bdbb1a

Cited by 18 publications

(19 citation statements)

References 20 publications

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“…As described previously [26,[49][50][51], depressurization of the nucleus pulposus can destabilize disk mechanics. In our previous work [25], we showed that stabilization of the disk back to intact levels was accomplished from a fully denucleated state. As more volume was implanted in the nuclear cavity, correlated with higher injection pressures, the disk became more stable as determined by the decreased ROM, NZ, and increased disk height and stiffness through the NZ.…”

Section: Discussionmentioning

confidence: 92%

“…Thirteen IVDs were harvested from seven human cadaver lumbar spine sections within 18 h post mortem and kept at À20 C until testing. The IVDs were sectioned and isolated leaving the superior and inferior vertebral bodies attached and removing the posterior elements [25,26,44,45] (defined as an ACU). The intervertebral DH was measured by a calibrated X-ray imaging system (Fluoroscan Imaging Systems, Northbrook, IL) prior to testing, with the average DH from three locations on the disk used.…”

Section: Methodsmentioning

confidence: 99%

“…A list of anatomical measurements and physiological factors were obtained for each sample (Table 1). After a casting solution (Smooth-Cast 300, Smooth-On, Easton, PA) was used to pot adjacent vertebral bodies, the unit was placed on the mechanical testing machine (Model 8874, Instron, Norwood, MA) while hydration was maintained through continually spraying with phosphate-buffered physiological saline [25,26,46,47].…”

Section: Methodsmentioning

confidence: 99%

“…Interestingly, we also showed that fit and fill of the nucleus cavity was a dominant parameter in controlling the restoration of compressive biomechanics to the human lumbar anterior column units (ACU) [24]. In a separate study, we determined that by controlling the nucleus replacement material implantation pressure and volume, compressive, bending, and torsional stability were restored to the disk [25]. We also found that the compressive biomechanics were predictive of the bending and torsional biomechanics [25,26].…”

Section: Introductionmentioning

confidence: 97%

“…In a separate study, we determined that by controlling the nucleus replacement material implantation pressure and volume, compressive, bending, and torsional stability were restored to the disk [25]. We also found that the compressive biomechanics were predictive of the bending and torsional biomechanics [25,26]. However, we have not yet examined the role of the nucleus cavity size on the ability of the nucleus replacement to restore mechanics.…”

Section: Introductionmentioning

confidence: 98%

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Nucleus Implantation: The Biomechanics of Augmentation Versus Replacement With Varying Degrees of Nucleotomy

Cannella

Isaacs

Allen

et al. 2014

Journal of Biomechanical Engineering

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Nucleus pulposus replacement and augmentation has been proposed to restore disk mechanics in early stages of degeneration with the option of providing a minimally invasive procedure for pain relief to patients with an earlier stage of degeneration. The goal of this paper is to examine compressive stability of the intervertebral disk after either partial nucleus replacement or nuclear augmentation in the absence of denucleation. Thirteen human cadaver lumbar anterior column units were used to study the effects of denucleation and augmentation on the compressive mechanical behavior of the human intervertebral disk. Testing was performed in axial compression after incremental steps of partial denucleation and subsequent implantation of a synthetic hydrogel nucleus replacement. In a separate set of experiments, the disks were not denucleated but augmented with the same synthetic hydrogel nucleus replacement. Neutral zone, range of motion, and stiffness were measured. The results showed that compressive stabilization of the disk can be re-established with nucleus replacement even for partial denucleation. Augmentation of the disk resulted in an increase in disk height and intradiskal pressure that were linearly related to the volume of polymer implanted. Intervertebral disk instability, evidenced by increased neutral zone and ranges of motion, associated with degeneration can be restored by volume filling of the nucleus pulposus using the hydrogel device presented here.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

See 3 more Smart Citations

Nucleus Implantation: The Biomechanics of Augmentation Versus Replacement With Varying Degrees of Nucleotomy

Cannella

Isaacs

Allen

et al. 2014

Journal of Biomechanical Engineering

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New materials for hip and knee joint replacement: What's hip and what's in kneed?

Mihalko

Haider

Kurtz

et al. 2020

Journal Orthopaedic Research

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Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning adverse local tissue reactions, aseptic and septic loosening. The implants and the materials we utilize have improved over the last two decades and in knee and hip replacement there has been a decrease in the failures attributed to wear and osteolysis. Despite these advancements there are still issues with patient satisfaction and early revisions due to septic and aseptic loosening in knee replacement patients. This article reviews the state of current implant material technology in hip and knee replacement surgery, discusses some of the unmet needs we have in biomaterials, and reviews some of the current biomaterials and technology that may be able to solve the most common issues in the knee and hip replacement surgery.

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An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

et al. 2022

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Background Nuclectomy, also known as nucleotomy, is a percutaneous surgical procedure performed to remove nucleus material from the center of the disc. Multiple techniques have been considered to perform a nuclectomy, however, the advantages and disadvantages of each are not well understood. Aims This in vitro biomechanical investigation on human cadaveric specimens aimed to quantitatively compare three nuclectomy techniques performed using an automated shaver, rongeurs, and laser. Material & Methods Comparisons were made in terms of mass, volume and location of material removal, changes in disc height, and stiffness. Fifteen vertebra–disc–vertebra lumbar specimens were acquired from six donors (40 ± 13 years) and split into three groups. Before and after nucleotomy axial mechanical tests were performed and T2‐weighted 9.4T MRIs were acquired for each specimen. Results When using the automated shaver and rongeurs similar volumes of disc material were removed (2.51 ± 1.10% and 2.76 ± 1.39% of the total disc volume, respectively), while considerably less material was removed using the laser (0.12 ± 0.07%). Nuclectomy using the automated shaver and rongeurs significantly reduced the toe‐region stiffness (p = 0.036), while the reduction in the linear region stiffness was significant only for the rongeurs group (p = 0.011). Post‐nuclectomy, 60% of the rongeurs group specimens showed changes in the endplate profile while 40% from the laser group showed subchondral marrow changes. Discussion From the MRIs, homogeneous cavities were seen in the center of the disc when using the automated shaver. When using rongeurs, material was removed non‐homogeneously both from the nucleus and annulus regions. Laser ablation formed small and localized cavities suggesting that the technique is not suitable to remove large volumes of material unless it is developed and optimized for this application. Conclusion The results demonstrate that both rongeurs and automated shavers can be used to remove large volumes of NP material but the reduced risk of collateral damage to surrounding tissues suggests that the automated shaver may be more suitable.

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Fill of the Nucleus Cavity Affects Mechanical Stability in Compression, Bending, and Torsion of a Spine Segment, Which Has Undergone Nucleus Replacement

Abstract: Compliant nucleus replacement using inflation pressures of 20 to 40 psi resulted in restoration of intact mechanics. Mechanical function was dependent on the volume of implant injected into the nucleus cavity.

Cited by 18 publications

References 20 publications

Nucleus Implantation: The Biomechanics of Augmentation Versus Replacement With Varying Degrees of Nucleotomy

Nucleus Implantation: The Biomechanics of Augmentation Versus Replacement With Varying Degrees of Nucleotomy

New materials for hip and knee joint replacement: What's hip and what's in kneed?

An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra‐high resolution MRI study

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