Abstract
Lumbar disc herniation (LDH) is the most common reason for low back pain in the working society. New regenerative approaches and novel implants are directed towards the restoration of the disc or its biomechanical properties. Aiming to investigate these new therapies under physiological conditions, in this study, a model for LDH was established by developing a new physiological in vitro test method. In 14 human lumbar motion segments, different daily-life and worst-case activities were simulated successfully by applying a physiological range of motion and axial loading in order to create physiological intradiscal pressure. An LDH could be provoked in 11 of the 14 specimens through vertical and round annular defects of different sizes. Interestingly, the defect and the LDH hardly influenced the biomechanical properties of the disc. For the investigation of regenerative approaches in further experiments, the recommendation based on the results of this study is to create an LDH in non-degenerated motion segments by the application of the new physiological in vitro test method after setting the round annular defects to a size of 4 mm in diameter.
Highlights
Lumbar disc herniation is the most common reason for low back pain in the working society [1]
In vivo motion values could be successfully replicated. By combining it with an axial compression, in vivo intradiscal pressure (IDP) could be created during the calibration cycle
A new physiological test method was developed that allows the replication of different physiological activities in vitro
Summary
Lumbar disc herniation is the most common reason for low back pain in the working society [1]. New regenerative approaches and novel implants are directed towards the restoration of the disc itself with the goal to improve the biomechanical properties [5,6,7] and the biological functions of an intact disc [8,9,10,11] This motivates the development of new materials as well as the use of innovative technologies such as 3D bioprinting which offers the opportunity to create highly complex and multidimensional biomaterials [12,13,14]. The investigation of such new treatment options requires biomechanical experiments where a lumbar disc herniation can be provoked under realistic conditions in order to challenge the new treatments under physiological worst-case scenarios
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