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A Novel, Minimally-Invasive Approach to Repair Degenerative Disk Disease in an Ovine Model Using Injectable Polymethyl-Methacrylate and Bovine Collagen (PMMA/BC)

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ABSTRACT

Background :

The natural, inflammatory repair processes of an injured intervertebral degenerative disc can propagate further injury and destruction. While there are many different treatment modalities of the pain related to degenerative disc disease, none are actually reparative in nature. Treatment strategies to repair a degenerative disc without inducing a destructive inflammatory milieu have been elusive. 

Purpose:

The purpose of this experiment is to discover the feasibility of reconstructing an injured intervertebral disc using an injected, inert polymer as the foundation for endogenous collagen growth.

Study Design:

In this ovine model of six subjects in total, we introduce a modality where a large inert polymer, polymethyl methacrylate (PMMA), in conjunction bovine collagen (BC) is injected into the intervertebral disc. Following six months of observation, histologic specimens were evaluated macroscopically and microscopically for evidence of a benefit of the injectable PMMA/BC.

Methods:

We obtained six merino sheep for this study. Concentric injuries were made to four of their lumbar intervertebral discs. Two of those levels were treated with a percutaneous injection of 0.3 cc of PMMA/BC. The remaining lumbar levels were left untreated and were our controls. After six months, all subjects were sacrificed. Their four levels were extracted and were examined macroscopically and microscopically.

Results:

All subjects tolerated the lumbar injury and percutaneous injection of PMMA/BC well. After the six month interval, all subjects have demonstrated an intact architecture of their lumbar disc height at the macroscopic and microscopic level. Microscopically, there was no evidence of external migration of the PMMA/BC microspheres, nor was there any evidence of an inflammatory response by its presence. Notably, the PMMA/BC microspheres were well-incorporated into the concentric disc tears and had undergone endogenous collagen formation in its environment. Treatment levels were revealing for maintenance of disc height without evidence of an ongoing degeneration. The controlled levels were revealing for continued disc degeneration with loss of disc height and evolving injury at the level of the concentric tear.

Conclusions:

This ovine model demonstrates a novel and promising technique for prevention and arrest of lumbar intervertebral disc degeneration.

No MeSH data available.


Related in: MedlinePlus

Three weeks post PMMA/BC implantation (Left: 10x magnification, H&E stain), (Right: 40x magnification, H&E stain). Histologic H&E sections revealed maintenance of the PMMA/BC microspheres without migration beyond the lamellar injury. Healing of the annular defect occurred with early signs of the formation of new collagen without an inflammatory response. Most of the microspheres were lost during histologic preparation, and blue material observed within the voids is likely proteinaceous fluids or retained collagen from the injected PMMA/BC. There is a minor amount of fibrous tissue smoothing the internal layer of the voids. 
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FIG2: Three weeks post PMMA/BC implantation (Left: 10x magnification, H&E stain), (Right: 40x magnification, H&E stain). Histologic H&E sections revealed maintenance of the PMMA/BC microspheres without migration beyond the lamellar injury. Healing of the annular defect occurred with early signs of the formation of new collagen without an inflammatory response. Most of the microspheres were lost during histologic preparation, and blue material observed within the voids is likely proteinaceous fluids or retained collagen from the injected PMMA/BC. There is a minor amount of fibrous tissue smoothing the internal layer of the voids. 

Mentions: At the three-week mark, from the early-deceased subject, it was noted that the PMMA/BC microspheres were well incorporated within the annular lamellae, as demonstrated through microscopic histologic examination seen in Figure 2. 


A Novel, Minimally-Invasive Approach to Repair Degenerative Disk Disease in an Ovine Model Using Injectable Polymethyl-Methacrylate and Bovine Collagen (PMMA/BC)
Three weeks post PMMA/BC implantation (Left: 10x magnification, H&E stain), (Right: 40x magnification, H&E stain). Histologic H&E sections revealed maintenance of the PMMA/BC microspheres without migration beyond the lamellar injury. Healing of the annular defect occurred with early signs of the formation of new collagen without an inflammatory response. Most of the microspheres were lost during histologic preparation, and blue material observed within the voids is likely proteinaceous fluids or retained collagen from the injected PMMA/BC. There is a minor amount of fibrous tissue smoothing the internal layer of the voids. 
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016043&req=5

FIG2: Three weeks post PMMA/BC implantation (Left: 10x magnification, H&E stain), (Right: 40x magnification, H&E stain). Histologic H&E sections revealed maintenance of the PMMA/BC microspheres without migration beyond the lamellar injury. Healing of the annular defect occurred with early signs of the formation of new collagen without an inflammatory response. Most of the microspheres were lost during histologic preparation, and blue material observed within the voids is likely proteinaceous fluids or retained collagen from the injected PMMA/BC. There is a minor amount of fibrous tissue smoothing the internal layer of the voids. 
Mentions: At the three-week mark, from the early-deceased subject, it was noted that the PMMA/BC microspheres were well incorporated within the annular lamellae, as demonstrated through microscopic histologic examination seen in Figure 2. 

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background :

The natural, inflammatory repair processes of an injured intervertebral degenerative disc can propagate further injury and destruction. While there are many different treatment modalities of the pain related to degenerative disc disease, none are actually reparative in nature. Treatment strategies to repair a degenerative disc without inducing a destructive inflammatory milieu have been elusive. 

Purpose:

The purpose of this experiment is to discover the feasibility of reconstructing an injured intervertebral disc using an injected, inert polymer as the foundation for endogenous collagen growth.

Study Design:

In this ovine model of six subjects in total, we introduce a modality where a large inert polymer, polymethyl methacrylate (PMMA), in conjunction bovine collagen (BC) is injected into the intervertebral disc. Following six months of observation, histologic specimens were evaluated macroscopically and microscopically for evidence of a benefit of the injectable PMMA/BC.

Methods:

We obtained six merino sheep for this study. Concentric injuries were made to four of their lumbar intervertebral discs. Two of those levels were treated with a percutaneous injection of 0.3 cc of PMMA/BC. The remaining lumbar levels were left untreated and were our controls. After six months, all subjects were sacrificed. Their four levels were extracted and were examined macroscopically and microscopically.

Results:

All subjects tolerated the lumbar injury and percutaneous injection of PMMA/BC well. After the six month interval, all subjects have demonstrated an intact architecture of their lumbar disc height at the macroscopic and microscopic level. Microscopically, there was no evidence of external migration of the PMMA/BC microspheres, nor was there any evidence of an inflammatory response by its presence. Notably, the PMMA/BC microspheres were well-incorporated into the concentric disc tears and had undergone endogenous collagen formation in its environment. Treatment levels were revealing for maintenance of disc height without evidence of an ongoing degeneration. The controlled levels were revealing for continued disc degeneration with loss of disc height and evolving injury at the level of the concentric tear.

Conclusions:

This ovine model demonstrates a novel and promising technique for prevention and arrest of lumbar intervertebral disc degeneration.

No MeSH data available.


Related in: MedlinePlus