Abstract
As a minimally invasive surgery, percutaneous cement discoplasty (PCD) is now contemplated to treat lumbar disc degeneration disease in elder population. Here, we investigated whether the osteogenic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) cement could be a suitable material in PCD surgery. Injectability, hydrophilicity and mechanical properties of the MC-modified PMMA (PMMA-MC) was characterized. The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation. Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress. Then, PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA. Three months after implantation, micro-computed tomography analysis revealed a 36.4% higher circumferential contact index between PMMA-MC and bone, as compared to PMMA alone. Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone, while the PMMA was covered by fibrous tissue. The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation. Therefore, the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro. We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages. Moreover, expressions of fibroblast-stimulating growth factors, insulin-like growth factor, basic fibroblast growth factor and tumor necrosis factor-β were significantly down-regulated in the macrophages cocultured with PMMA-MC. Together, the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.
Highlights
Lumbar degenerative disc disease (DDD), characterized by intervertebral lumbar disc narrowing, reduced disc height, and loss of disc signal intensity, is a condition associated with the degeneration of one or more of the discs in the spine [1, 2]
We investigated whether MCmodified PMMA bone cement could be adopted in the percutaneous cement discoplasty (PCD) surgery with a goat model
An injectable mineralized collagen (MC) incorporated PMMA-based composite have been successfully prepared as a material for percutaneous cement discoplasty surgery to treat lumbar DDD
Summary
Lumbar degenerative disc disease (DDD), characterized by intervertebral lumbar disc narrowing, reduced disc height, and loss of disc signal intensity, is a condition associated with the degeneration of one or more of the discs in the spine [1, 2]. Invasive surgeries are more suitable in elder population, since they reduce the risk of complication and the surgical morbidity As such a minimally invasive technique, percutaneous cement discoplasty (PCD) was first developed by Varga et al [7]. In order to restore segmental height, PMMA bone cement was later implanted into the intervertebral disc space, as part of further development [8]. Varga et al [6] demonstrated that after PCD surgery with KyphXVR bone cement, majority of the DDD elder patients reported a significant reduction in the lower back pain postoperatively. In 2016, Yamada et al [9] found that the 109 elderly patients with degenerative lumbar scoliosis had sustained clinical benefit for at least 2 years after percutaneous intervertebral PMMA bone cement injection. Sola et al [10] reported that a 78-year-old woman who had degenerative scoliosis with multiple pneumodisk was soon able to stand up and walk well after PCD surgery
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