The Transpedicular Approach As an Alternative Route for Intervertebral Disc Regeneration

Vadalà, Gianluca; Russo, Fabrizio; Pattappa, Girish; Schiuma, Damiano; Peroglio, Marianna; Benneker, Lorin Michael; Grad, Sibylle; Alini, Mauro; Denaro, Vincenzo

doi:10.1097/brs.0b013e318285bc4a

Cited by 45 publications

(46 citation statements)

References 31 publications

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“…Also, the risk of inducing IVD degeneration by puncturing of the IVD should be considered [175], although more recent studies describe alternative routes for molecule delivery [176]. Furthermore, given the predominantly avascular nature of IVD, systemic delivery of soluble molecules is unlikely to be effective in this situation.…”

Section: Injection Of Moleculesmentioning

confidence: 99%

Inflammation in intervertebral disc degeneration and regeneration

Molinos

Almeida

Caldeira

et al. 2015

J. R. Soc. Interface.

336

256

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Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain and hernia regression remains controversial. The inflammatory response may be involved in the onset of disease, but it is also crucial in maintaining tissue homeostasis. Furthermore, if properly balanced it may contribute to tissue repair/regeneration as has already been demonstrated in other tissues. In this review, we focus on how inflammation has been associated with IVD degeneration by describing observational and in vitro studies as well as in vivo animal models. Finally, we provide an overview of IVD regenerative therapies that target key inflammatory players.

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Section: Injection Of Moleculesmentioning

confidence: 99%

Inflammation in intervertebral disc degeneration and regeneration

Molinos

Almeida

Caldeira

et al. 2015

J. R. Soc. Interface.

336

256

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“…This pilot study on 12 sheep describes the technique in detail with the aim of investigating its in vivo feasibility and relevance in the preclinical field. Indeed, injections, nucleotomy and nucleoplasty are feasible through this approach as already described [7]. Even if some practice is required, the learning curve of the technique gets better over time.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the approach can be used to perform nucleotomy to trigger a degenerative cascade studying IDD or to allow successful delivery of cell/biomaterial constructs into the disc to study their effects [7]. Indeed, normal discs have a high swelling pressure in sheep and resist the injection of any volume of substance [6].…”

Section: Discussionmentioning

confidence: 99%

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The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

et al. 2013

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Purpose To characterize in vivo the transpedicular approach (TA) as an alternative route to study intervertebral disc (IVD) regeneration strategies in a sheep model. Methods 48 IVD of 12 sheep were used. TA was performed under fluoroscopy, followed by nucleotomy (2-mm shaver resector). A polyurethane scaffold was used to repair the end-plate. X-ray and MRI images were acquired pre-, intra-and post-operatively (1, 3, 6 months). Complications were recorded. Results TA was feasible in all animals; nucleus pulposus (NP) from L1 to L5 was accessible. Nucleotomy followed by end-plate repair was achieved. Loss of NP signal intensity was shown in MRI images of the nucleotomy group. Conclusions TA is feasible in vivo, repeatable after only a short learning period and safely performed without significant morbidity. This animal model allows the study of IVD degeneration physiopathology and investigation of IVD regeneration techniques in vivo.

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“…There is also evidence that discography procedures performed on non-degenerate discs can increase the risk of developing disc degeneration [65]. An alternative strategy consists in the delivery of therapeutics through the endplate via a transpedicular route [114]. This approach keeps the annulus intact, reducing the risk for mechanical destabilisation and leakage.…”

Section: Challenges For Msc Therapiesmentioning

confidence: 98%