The Effect of Degeneration on Internal Strains and the Mechanism of Failure in Human Intervertebral Discs Analyzed Using Digital Volume Correlation (DVC) and Ultra-High Field MRI

Tavana, Saman; Masouros, Spyros D.; Baxan, Nicoleta; Freedman, Brett A.; Hansen, Ulrich; Newell, Nicolas

doi:10.3389/fbioe.2020.610907

Cited by 17 publications

(15 citation statements)

References 58 publications

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“…During disc degradation, the concentration of proteoglycans decreases, causing a drop in stiffness 146 . This increases the risk of AF bulging, increases the compressive strain on the AF (Figure 4b), and increases the chances of peripheral failure of the end plates 148 . Therefore, a potential treatment of DDD would be to repair the NP.…”

Section: Applicationsmentioning

confidence: 99%

Design and clinical application of injectable hydrogels for musculoskeletal therapy

Øvrebø

Perale

Wojciechowski

et al. 2022

Bioengineering & Transla Med

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Musculoskeletal defects are an enormous healthcare burden and source of pain and disability for individuals. With an aging population, the proportion of individuals living with these medical indications will increase. Simultaneously, there is pressure on healthcare providers to source efficient solutions, which are cheaper and less invasive than conventional technology. This has led to an increased research focus on hydrogels as highly biocompatible biomaterials that can be delivered through minimally invasive procedures. This review will discuss how hydrogels can be designed for clinical translation, particularly in the context of the new European Medical Device Regulation (MDR). We will then do a deep dive into the clinically used hydrogel solutions that have been commercially approved or have undergone clinical trials in Europe or the United States. We will discuss the therapeutic mechanism and limitations of these products. Due to the vast application areas of hydrogels, this work focuses only on treatments of cartilage, bone, and the nucleus pulposus. Lastly, the main steps toward clinical translation of hydrogels as medical devices are outlined. We suggest a framework for how academics can assist small and medium MedTech enterprises conducting the initial clinical investigation and post‐market clinical follow‐up required in the MDR. It is evident that the successful translation of hydrogels is governed by acquiring high‐quality pre‐clinical and clinical data confirming the device mechanism of action and safety.

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Section: Applicationsmentioning

confidence: 99%

Design and clinical application of injectable hydrogels for musculoskeletal therapy

Øvrebø

Perale

Wojciechowski

et al. 2022

Bioengineering & Transla Med

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show abstract

“…Another image modality that was recently explored in combination to DVC is magnetic resonance imaging (MRI). MRI-based DVC application has been successfully used to obtain the full-field strain in human intervertebral disc (IVD) ex vivo ( Tavana et al, 2020b ). However, due to the limitations in volume imaged with confocal or availability/cost/resolution of MRI, the main input image for DVC is still from X-ray CT which is inherently less suitable to resolve soft tissues.…”

Section: Open Challenges and Current/future Developmentsmentioning

confidence: 99%

Digital volume correlation for the characterization of musculoskeletal tissues: Current challenges and future developments

Dall’Ara

Tozzi

2022

Front. Bioeng. Biotechnol.

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Biological tissues are complex hierarchical materials, difficult to characterise due to the challenges associated to the separation of scale and heterogeneity of the mechanical properties at different dimensional levels.The Digital Volume Correlation approach is the only image-based experimental approach that can accurately measure internal strain field within biological tissues under complex loading scenarios. In this minireview examples of DVC applications to study the deformation of musculoskeletal tissues at different dimensional scales are reported, highlighting the potential and challenges of this relatively new technique.The manuscript aims at reporting the wide breath of DVC applications in the past 2 decades and discuss future perspective for this unique technique, including fast analysis, applications on soft tissues, high precision approaches, and clinical applications.

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“…The bottom PMMA holder was fixed using screws and the sample was positioned so that the center of the top endplate was aligned with the actuator. The stiffness of each segment was estimated in the linear range, corresponding also to human disc axial strains during physiological loading (2%-5%) (Tsantrizos et al, 2005;Tavana et al, 2021).…”

Section: Mechanical Testingmentioning

confidence: 99%

An ex-vivo model for the biomechanical assessment of cement discoplasty

Ghandour

Pazarlis

Lewin

et al. 2022

Front. Bioeng. Biotechnol.

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Percutaneous Cement Discoplasty (PCD) is a surgical technique developed to relieve pain in patients with advanced degenerative disc disease characterized by a vacuum phenomenon. It has been hypothesized that injecting bone cement into the disc improves the overall stability of the spinal segment. However, there is limited knowledge on the biomechanics of the spine postoperatively and a lack of models to assess the effect of PCD ex-vivo. This study aimed to develop a biomechanical model to study PCD in a repeatable and clinically relevant manner. Eleven ovine functional spinal units were dissected and tested under compression in three conditions: healthy, injured and treated. Injury was induced by a papain buffer and the treatment was conducted using PMMA cement. Each sample was scanned with micro-computed tomography (CT) and segmented for the three conditions. Similar cement volumes (in %) were injected in the ovine samples compared to volumes measured on clinical PCD CT images. Anterior and posterior disc heights decreased on average by 22.5% and 23.9% after injury. After treatment, the anterior and posterior disc height was restored on average to 98.5% and 83.6%, respectively, of their original healthy height. Compression testing showed a similar stiffness behavior between samples in the same group. A decrease of 51.5% in segment stiffness was found after injury, as expected. The following PCD treatment was found to result in a restoration of stiffness—showing only a difference of 5% in comparison to the uninjured state. The developed ex-vivo model gave an adequate representation of the clinical vacuum phenomena in terms of volume, and a repeatable mechanical response between samples. Discoplasty treatment was found to give a restoration in stiffness after injury. The data presented confirm the effectiveness of the PCD procedure in terms of restoration of axial stiffness in the spinal segment. The model can be used in the future to test more complex loading scenarios, novel materials, and different surgical techniques.

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The Effect of Degeneration on Internal Strains and the Mechanism of Failure in Human Intervertebral Discs Analyzed Using Digital Volume Correlation (DVC) and Ultra-High Field MRI

Cited by 17 publications

References 58 publications

Design and clinical application of injectable hydrogels for musculoskeletal therapy

Design and clinical application of injectable hydrogels for musculoskeletal therapy

Digital volume correlation for the characterization of musculoskeletal tissues: Current challenges and future developments

An ex-vivo model for the biomechanical assessment of cement discoplasty

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