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  • Title: Degenerative anular changes induced by puncture are associated with insufficiency of disc biomechanical function.
    Author: Hsieh AH, Hwang D, Ryan DA, Freeman AK, Kim H.
    Journal: Spine (Phila Pa 1976); 2009 May 01; 34(10):998-1005. PubMed ID: 19404174.
    Abstract:
    STUDY DESIGN: In vivo experiments to examine physiologic consequences and in vitro tests to determine immediate biomechanical effects of anular injury by needle puncture. OBJECTIVE: To determine whether a relationship exists between induction of degenerative changes in anulus fibrosus (AF) and compromised disc biomechanical function according to injury size. SUMMARY OF BACKGROUND DATA: Various studies in intervertebral disc mechanics, degeneration, and regeneration involve the creation of a defect in the anulus fibrosus (AF). However, the impact of the puncture, itself, on biomechanical function and disc health are not understood. METHODS: For in vivo experiments, rat caudal discs subjected to percutaneous anular punctures using different gauge size hypodermic needles (18, 22, 26 g) and nonpunctured controls were examined histologically up to 4 weeks postsurgery. For in vitro biomechanical testing, healthy motion segments were isolated and their creep compression response assessed immediately after needle puncture. RESULTS: We found that needle size-dependence of creep compression behavior paralleled the size-dependence of degenerative changes in the AF. Specifically, 18-g punctures resulted in inward bulging of the AF, lamellar disorganization, and cellular changes. These changes were not seen in 22- and 26-g punctured discs. Biomechanical tests showed that only 18-g needle punctures led to significant changes in disc mechanics. Importantly, a statistically significant association was found between needle sizes that caused biomechanical changes and induction of degenerative changes in the AF. CONCLUSION: Our findings suggest that injury sizes large enough to disrupt biomechanical function are needed to drive degenerative changes in rat caudal disc AF. Based on the data, we believe that small anular defects become sealed, allowing the disc to function normally and the AF to heal. Larger defects appear to require longer wound closure times, and may prolong the duration of impaired disc function.
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