The effect of intervertebral disc damage on the mechanical strength of the annulus fibrosus in the adjacent segment

Abstract

BACKGROUND CONTEXTA herniated intervertebral disc (IVD) is a common injury in the human population. Despite the injury being isolated to a singular IVD in the spine, it is important to look at the biomechanical effects that a damaged IVD has on the entire spine, specifically the IVD adjacent to the injury. PURPOSEThis study examined the effects of a damaged IVD on the mechanical properties of the annulus fibrosus (AF) in the adjacent cranial IVD. STUDY DESIGNBasic science study using an in-vitro porcine model. METHODSSixteen porcine cervical spines were used; specifically spinal levels C3/4/5 were assigned to one of two experimental groups: 1) a control group that was not subjected any injuries (n=8); 2) an experimental group that experienced an injury to the anterolateral part of the disc, reaching the nucleus pulposus but without affecting the posterior portion of the AF in the C4/5 functional spine unit (FSU) (n=8). Each specimen underwent a previously published precondition compression protocol of 300 N of compression for 15 minutes followed by a cyclical compression protocol of compression protocol of 0.5 Hz sinusoidal waveform at 300 to 1200 N for 2 hours (3600 cycles). Post compression, the C3/4 AF was dissected to obtain two multilayer samples (one anterior and one posterior) as well as a peel sample (from the posterolateral region). A tensile strength test was conducted to examine the strength of the interlamellar matrix (peel sample) and the overall strength of the AF (multilayer samples). RESULTSSignificant results were found in the peel test samples. Specifically, experimental specimens were less stiff compared than control specimens (p<.01). In addition, experimental specimens also had a lower average strength then control specimens (p<.01). This reduction in both interlamellar strength and stiffness increases the risk of delamination in the experimental samples. In contrast, there were no differences found between the two groups when examining the AF as a whole through the multilayer tests (p>.05). CONCLUSIONSIt appears that a damaged IVD impacts the biomechanics of the spine and specifically the mechanical properties of the adjacent IVD. Specifically, the observed weakening of the interlamellar matrix in these adjacent IVDs may predispose it to delamination and subsequently degeneration or herniation. CLINICAL SIGNIFICANCEThese findings may help clinicians when treating patients who have experienced a disc herniation or severe degeneration, as they may potentially experience accelerated adjacent disc degeneration.