The direction of progressive herniation in porcine spine motion segments is influenced by the orientation of the bending axis

Abstract

Background. It has been shown that disc herniations are a cumulative injury created by repetitive flexion motion while under modest compressive loads. There is a lack of data linking the direction of nucleus tracking to the orientation of the bending motion axis. Our purpose was to determine if the direction that the nucleus tracks through the annulus during progressive herniation is predictable from the direction of bending motion (i.e. a specific side with posterio-lateral herniation). Methods. Matched cohorts (nu = 16) of porcine cervical spine (C3/4 and C5/6) motion segments were potted in aluminum cups and bent at an angle of 30° to the sagittal plane flexion axis while under a sustained compressive load of 1472 N. Findings. The direction of bending motion affected the tracking pattern of the nucleus through the annular fibres in a predictable pattern. Specifically, bending the motion segments at an angle of 30° to the left of the sagittal plane flexion axis biased the movement of the nucleus toward the posterior right side of the disc in 15 of the 16 specimens. Interpretation. Based on this animal model, shown to have similar biomechanical behaviour to humans, the direction that the nucleus tracks through the annular fibres appears to be dependent upon the direction of bending motion. This may have implications on both herniation prevention and rehabilitation of posterio-lateral bulges and herniations.