Mechanical restoration and failure analyses of a hydrogel and scaffold composite strategy for annulus fibrosus repair
Résumé
Unrepaired defects in the annulus fibrosus of intervertebral discs are associated with degeneration and persistent back pain. A clinical need exists for a disc repair strategy that can seal annular defects, be easily delivered during surgical procedures, and restore biomechanics with low risk of herniation. Multiple annulus repair strategies were developed using poly(trimethylene carbonate) scaffolds optimized for cell delivery, polyurethane membranes designed to prevent herniation, and fibrin-genipin adhesive tuned to annulus fibrosus shear properties. This three-part study evaluated repair strategies for biomechanical restoration, herniation risk and failure mode in torsion, bending and compression at physiological and hyper-physiological loads using a bovine injury model. Fibrin-genipin hydrogel restored some torsional stiffness, bending ROM and disc height loss, with negligible herniation risk and failure was observed histologically at the fibrin-genipin midsubstance following rigorous loading. Scaffold-based repairs partially restored biomechanics, but had high herniation risk even when stabilized with sutured membranes and failure was observed histologically at the interface between scaffold and fibrin-genipin adhesive. Fibrin-genipin was the simplest annulus fibrosus repair solution evaluated that involved an easily deliverable adhesive
Mots clés
consultant and royalties from Zimmer Spine
surgical advisory board Zimmer Spine
consultant Medtronic Spine
editorial board of J. Spinal Disorders
Am J Orthopaedics
Spine Surgery Today
Orthopaedics Today JCI: Grant funding as listed annulus fibrosus repair
annular closure
intervertebral disc herniation
spine biomechanics
intervertebral disc degeneration
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