Abstract
Intervertebral total disc replacements (TDR) are used in the treatment of degenerative spinal disc disease. There are, however, concerns that they may be subject to long-term failure due to wear. The adverse effects of TDR wear have the potential to manifest in the dura mater and surrounding tissues. The aim of this study was to investigate the physiological structure of the dura mater, isolate the resident dural epithelial and stromal cells and analyse the capacity of these cells to internalise model polymer particles. The porcine dura mater was a collagen-rich structure encompassing regularly arranged fibroblastic cells within an outermost epithelial cell layer. The isolated dural epithelial cells had endothelial cell characteristics (positive for von Willebrand factor, CD31, E-cadherin and desmoplakin) and barrier functionality whereas the fibroblastic cells were positive for collagen I and III, tenascin and actin. The capacity of the dural cells to take up model particles was dependent on particle size. Nanometer sized particles readily penetrated both types of cells. However, dural fibroblasts engulfed micron-sized particles at a much higher rate than dural epithelial cells. The study suggested that dural epithelial cells may offer some barrier to the penetration of micron-sized particles but not nanometer sized particles. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 102B: 1496–1505, 2014.
Highlights
Total intervertebral disc replacement (TDR) is used for the treatment of degenerative disc.[1,2,3,4,5] The implant materials are the same as those used in the hip and knee prostheses[2] either metal-on-polyethylene (Charite, De Puy-J&J; Prodisc L, SpineSolutions) or metal-on-metal (Maverick disc, Medtronic Sofamor Danek).[5]
The spinal cord with the meninges attached was dissected and incubated in a solution of Gentamicin (Sigma, UK) 50 ng mL21 and Nystatin (Sigma, UK) 100 U mL21 in phosphate buffered saline (PBS; Sigma, UK) for an hour at room temperature
This study is the first to analyze the components of the dural membrane in depth and enforces the hypothesis that the dura mater acts in defence against foreign body infiltration
Summary
Total intervertebral disc replacement (TDR) is used for the treatment of degenerative disc.[1,2,3,4,5] The implant materials are the same as those used in the hip and knee prostheses[2] either metal-on-polyethylene Solutions) or metal-on-metal (Maverick disc, Medtronic Sofamor Danek).[5] Between 1984 and 2004 around 9000 patients received Charite implants, mostly in Europe. The success of the Charite TDR remains controversial due to a broad range of outcomes.[6] Lemaire et al.[7] reported excellent or good clinical outcomes in 90% of cases at 10-years, Pultzier et al.[8] reported 60% ankylosis at 17 years. One case report indicated extensive metallosis and osteonecrosis at one year in a well-positioned device with no visible loosening on radiographic analysis.[12]
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