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J Neurol Surg A Cent Eur Neurosurg 2017; 78(01): 46-52
DOI: 10.1055/s-0035-1570344
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effect of Annular Defects on Intradiscal Pressures in the Lumbar Spine: An in Vitro Biomechanical Study of Diskectomy and Annular Repair

Richard Bostelmann
1   Department of Neurosurgery, University Hospital, Düsseldorf, Germany
,
Hans-Jakob Steiger
1   Department of Neurosurgery, University Hospital, Düsseldorf, Germany
,
Jan Frederick Cornelius
1   Department of Neurosurgery, University Hospital, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

23 April 2015

22 October 2015

Publication Date:
28 April 2016 (online)

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Abstract

Background Integrity of intervertebral disks may influence, and be influenced by, the maintenance of hydrostatic pressures inside the nucleus pulposus. Disk degeneration causes decreased pressures, leading to overload and injury of the annulus fibrosus, increasing the risk of disk herniation. Diskectomies to treat disk herniation can cause further loss of hydrostatic pressures resulting in worsening degeneration. This study investigated the impact of opening the annulus on intradiscal pressure and whether implantation of an annular closure device (ACD) can restore physiologic pressures.

Methods The pressure responses under unconstrained moments in concert with axial compressive loads of nine human cadaver lumbar disks were biomechanically tested at baseline, immediately following posterior annulotomy, and immediately following implantation of the ACD.

Results The analysis of variance indicated a significant difference in the pressure response (p = 0.0001) among the three rounds of testing. Specifically, the post hoc Bonferroni test revealed that the pressure response after diskectomy was significantly different when compared with baseline (p < 0.001) and after ACD implantation (p = 0.001). However, baseline and ACD pressure responses were insignificantly different (p = 1.000).

Conclusion Our findings suggest that restoration of annular integrity during diskectomy with implantation of the tested ACD may restore pressures closer to preoperative levels. Whether or not restoring pressures to preoperative levels has any clinical benefit or effect on the rate of degeneration is an area for further clinical research.

Keywords

annulus closure device - biomechanics - disk degeneration - intradiscal pressure - lumbar diskectomy
 

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