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Ashish D Diwan - One of the best experts on this subject based on the ideXlab platform.
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do markers of inflammation and or muscle regeneration in lumbar multifidus muscle and fat differ between individuals with good or poor outcome following Microdiscectomy for lumbar disc herniation
Spine, 2021Co-Authors: Xiaolong Chen, Paul W Hodges, Gregory James, Ashish D DiwanAbstract:STUDY DESIGN Observational study. OBJECTIVE The aim of this study was to evaluate whether inflammatory and/or muscle regeneration markers in paraspinal tissues (multifidus muscle/fat) during Microdiscectomy surgery in patients with lumbar disc herniation (LDH) with radiculopathy, differ between individuals with good or poor outcome. SUMMARY OF BACKGROUND DATA Structural back muscle changes, including fat infiltration, muscle atrophy, and fiber changes, are ubiquitous with LBP and are thought to be regulated by inflammatory and regeneration processes. Muscle changes might be relevant for recovery after Microdiscectomy, but a link between expression of inflammatory and muscle regeneration genes in paraspinal tissues and clinical outcome has not been tested. METHOD Paraspinal tissues from deep multifidus muscles and fat (intramuscular, sub-cutaneous, epidural) were harvested from twenty-one patients with LDH undergoing Microdiscectomy surgery. Quantitative polymerase chain reaction (qPCR) measured expression of 10 genes. Outcome was defined as good (visual analogue scale (VAS) low back pain (LBP)+) or poor (VAS LBP-) by an improvement of >33% or ≤33% on the pain VAS, respectively. Good functional improvement was defined as 25% improvement on the physical functioning scale (PFS). RESULTS Brain-derived neurotrophic factor expression in deep multifidus was 91% lower (P = 0.014) in the VAS LBP- than VAS LBP+ group. Expression of interleukin-1β in subcutaneous fat was 48% higher (P = 0.026) in the VAS LBP- than VAS LBP+ group. No markers differed based on PFS. CONCLUSION Results show a relationship between impaired muscle regeneration profile in multifidus muscle and poor outcome following Microdiscectomy for LDH. Inflammatory dysregulation in subcutaneous fat overlying the back region might predict poor surgical outcome.Level of Evidence: 4.
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do markers of inflammation and or muscle regeneration in lumbar multifidus muscle and fat differ between individuals with good or poor outcome following Microdiscectomy for lumbar disc herniation
Spine, 2020Co-Authors: Xiaolong Chen, Paul W Hodges, Gregory James, Ashish D DiwanAbstract:Study design Observational study. Objective To evaluate whether inflammatory and/or muscle regeneration markers in paraspinal tissues (multifidus muscle/fat) during Microdiscectomy surgery in patients with lumbar disc herniation (LDH) with radiculopathy, differ between individuals with good or poor outcome. Summary of background data Structural back muscle changes, including fat infiltration, muscle atrophy and fiber changes, are ubiquitous with LBP and are thought to be regulated by inflammatory and regeneration processes. Muscle changes might be relevant for recovery after Microdiscectomy, but a link between expression of inflammatory and muscle regeneration genes in paraspinal tissues and clinical outcome has not been tested. Methods Paraspinal tissues from deep multifidus muscles and fat (intramuscular, sub-cutaneous, epidural) were harvested from twenty-one patients with LDH undergoing Microdiscectomy surgery. Quantitative polymerase chain reaction (qPCR) measured expression of 10 genes. Outcome was defined as good (VAS LBP+) or poor (VAS LBP-) by an improvement of >33% or ≤33% on the pain visual analogue scale (VAS), respectively. Good functional improvement was defined as 25% improvement on the physical functioning scale (PFS). Results Brain-derived neurotrophic factor expression in deep multifidus was 91% lower (P = 0.014) in the VAS LBP- than VAS LBP+ group. Expression of interleukin-1β in sub-cutaneous fat was 48% higher (P = 0.026) in the VAS LBP- than VAS LBP+ group. No markers differed based on PFS. Conclusion Results show a relationship between impaired muscle regeneration profile in multifidus muscle and poor outcome following Microdiscectomy for LDH. Inflammatory dysregulation in sub-cutaneous fat overlying the back region might predict poor surgical outcome. Level of evidence 4.
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complication rates of different discectomy techniques for the treatment of lumbar disc herniation a network meta analysis
European Spine Journal, 2019Co-Authors: Xiaolong Chen, Uphar Chamoli, Samuel Lapkin, Jose Vargas Castillo, Ashish D DiwanAbstract:The aim of this network meta-analysis (NMA) was to compare the complication rates of discectomy/Microdiscectomy, percutaneous laser disc decompression (PLDD), percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy (MED), and tubular discectomy for symptomatic lumbar disc herniation (LDH). We searched three online databases for randomized controlled trials (RCTs). Overall complication rates, complication rates per general and modified Clavien–Dindo classification schemes, and reoperation rates were considered as primary outcomes. Odds ratio with 95% confidence intervals for direct comparisons and 95% credible intervals for NMA results were reported. Surface under cumulative ranking curve (SUCRA) was used to estimate ranks for each discectomy technique based on the complication rates. In total, 18 RCTs with 2273 patients were included in this study. Our results showed that there was no significant difference in any of the pairwise comparisons. PELD (SUCRA: 0.856) ranked the lowest for overall complication rates. Discectomy/Microdiscectomy (SUCRA: 0.599) and PELD (SUCRA: 0.939) ranked the lowest for intraoperative and post-operative complication rates, respectively. Concerning modified Clavien–Dindo classification scheme, PELD (SUCRA: 0.803), MED (SUCRA: 0.730), and PLDD (SUCRA: 0.605) ranked the lowest for the occurrence of type I, II, and III complications, respectively. Tubular discectomy (SUCRA: 0.699) ranked the lowest for reoperation rates. The results of this NMA suggest that discectomy/Microdiscectomy and PELD are the safest procedures for LDH with minimal intraoperative and post-operative complications, respectively. PELD, MED, and PLDD are the safest procedures for LDH in terms of minimal rates for complications necessitating conservative, pharmacological, and surgical treatment, respectively. These slides can be retrieved under Electronic Supplementary Material.
Chris D Daly - One of the best experts on this subject based on the ideXlab platform.
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mesenchymal progenitor cells primed with pentosan polysulfate promote lumbar intervertebral disc regeneration in an ovine model of Microdiscectomy
The Spine Journal, 2017Co-Authors: Peter Ghosh, David Oehme, Graham Jenkin, Andrew C W Zannettino, Chris D Daly, Tanya Badal, Ronald Shimmon, Kanika JainAbstract:Abstract Background Context Neural compression associated with lumbar disc herniation is usually managed surgically by Microdiscectomy. However, 10%–20% of patients re-present with debilitating back pain, and approximately 15% require further surgery. Purpose Using an ovine model of Microdiscectomy, the present study investigated the relative potential of pentosan polysulfate-primed mesenchymal progenitor cells (pMPCs) or MPC alone implanted into the lesion site to facilitate disc recovery. Study Design An ovine model of lumbar Microdiscectomy was used to compare the relative outcomes of administering MPCs or pMPCs to the injury site postsurgery. Methods At baseline 3T magnetic resonance imaging (MRI) of 18 adult ewes was undertaken followed by annular Microdiscectomy at two lumbar disc levels. Sheep were randomized into three groups (n=6). The injured controls received no further treatment. Defects of the treated groups were implanted with a collagen sponge and MPC (5×105 cells) or pMPC (5×105 cells). After 6 months, 3T MRI and standard radiography were performed. Spinal columns were dissected, individual lumbar discs were sectioned horizontally, and nucleus pulposus (NP) and annulus fibrosus (AF) regions were assessed morphologically and histologically. The NP and AF tissues were dissected into six regions and analyzed biochemically for their proteoglycans (PGs), collagen, and DNA content. Results Both the MPC- and pMPC-injected groups exhibited less reduction in disc height (p Conclusions In an ovine model 6 months after administration of pMPCs to the injury site disc PG content and matrix organization were improved relative to controls, suggesting pMPCs' potential as a postsurgical adjunct for limiting progression of disc degeneration after Microdiscectomy.
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Lumbar Microdiscectomy and post-operative activity restrictions: a protocol for a single blinded randomised controlled trial
'Springer Science and Business Media LLC', 2017Co-Authors: Chris D Daly, Kai Zheong Lim, Jennifer Lewis, Kelly Saber, Mohammed Molla, Naor Bar-zeev, Tony GoldschlagerAbstract:Abstract Background Lumbar Microdiscectomy is the most commonly performed spinal surgery procedure, with over 300,000 cases performed annually in the United States alone. Traditionally, patients were advised to restrict post-operative activity as this was believed to reduce the risk of disc reherniation and progressive instability. However, this practice would often delay patients return to work. In contemporary practice many surgeons do not restrict patient post-operative activity due to the perception this practice is unnecessary. We describe a randomised controlled trial to assess the impact of activity restrictions on clinical outcome following lumbar discectomy. Methods/Design The lumbar Microdiscectomy and post-operative activity restriction trial is a multi-centre, randomised, controlled single blinded trial. Two hundred ten patients due to undergo single level lumbar Microdiscectomy without a history of previous spine surgery, infection or fracture are randomised to be advised either restricted or unrestricted activity for a period of 30 days following lumbar Microdiscectomy. Actual adherence with trial allocation will be monitored bioelectronically via a wearable device. Outcome assessment at follow up will occur at 1, 3, 6 and 12 months. The primary outcome will be a composite endpoint comprising changes in Visual Analogue Scale (Leg and Back), Oswestry Disability Index and the absence of intervertebral disc reherniation or secondary intervention. Discussion This randomised controlled trial will directly compare post-operative protocols of activity restrictions and no restrictions following lumbar discectomy with adherence monitored bioelectronically. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12616001360404 (retrospectively registered 30/09/2016)
Simon Clark - One of the best experts on this subject based on the ideXlab platform.
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Microdiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by prolapsed intervertebral disc the nerves rct
Health Technology Assessment, 2021Co-Authors: Martin Wilby, A Best, Eifiona Wood, Girvan Burnside, Emma Bedson, Hannah Short, Dianne Wheatley, Daniel Hillmcmanus, Manohar Sharma, Simon ClarkAbstract:BACKGROUND Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. Microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of Microdiscectomy with transforaminal epidural steroid injection for the management of radicular pain secondary to lumbar prolapsed intervertebral disc for non-emergency presentation of sciatica of < 12 months' duration. INTERVENTIONS Patients were randomised to either (1) Microdiscectomy or (2) transforaminal epidural steroid injection. DESIGN A pragmatic, multicentre, randomised prospective trial comparing Microdiscectomy with transforaminal epidural steroid injection for sciatica due to prolapsed intervertebral disc with < 1 year symptom duration. SETTING NHS services providing secondary spinal surgical care within the UK. PARTICIPANTS A total of 163 participants (aged 16-65 years) were recruited from 11 UK NHS outpatient clinics. MAIN OUTCOME MEASURES The primary outcome was participant-completed Oswestry Disability Questionnaire score at 18 weeks post randomisation. Secondary outcomes were visual analogue scores for leg pain and back pain; modified Roland-Morris score (for sciatica), Core Outcome Measures Index score and participant satisfaction at 12-weekly intervals. Cost-effectiveness and quality of life were assessed using the EuroQol-5 Dimensions, five-level version; Hospital Episode Statistics data; medication usage; and self-reported cost data at 12-weekly intervals. Adverse event data were collected. The economic outcome was incremental cost per quality-adjusted life-year gained from the perspective of the NHS in England. RESULTS Eighty-three participants were allocated to transforaminal epidural steroid injection and 80 participants were allocated to Microdiscectomy, using an online randomisation system. At week 18, Oswestry Disability Questionnaire scores had decreased, relative to baseline, by 26.7 points in the Microdiscectomy group and by 24.5 points in the transforaminal epidural steroid injection. The difference between the treatments was not statistically significant (estimated treatment effect -4.25 points, 95% confidence interval -11.09 to 2.59 points). Nor were there significant differences between treatments in any of the secondary outcomes: Oswestry Disability Questionnaire scores, visual analogue scores for leg pain and back pain, modified Roland-Morris score and Core Outcome Measures Index score up to 54 weeks. There were four (3.8%) serious adverse events in the Microdiscectomy group, including one nerve palsy (foot drop), and none in the transforaminal epidural steroid injection group. Compared with transforaminal epidural steroid injection, Microdiscectomy had an incremental cost-effectiveness ratio of £38,737 per quality-adjusted life-year gained and a probability of 0.17 of being cost-effective at a willingness to pay threshold of £20,000 per quality-adjusted life-year. LIMITATIONS Primary outcome data was invalid or incomplete for 24% of participants. Sensitivity analyses demonstrated robustness to assumptions made regarding missing data. Eighteen per cent of participants in the transforaminal epidural steroid injection group subsequently received Microdiscectomy prior to their primary outcome assessment. CONCLUSIONS To the best of our knowledge, the NErve Root Block VErsus Surgery trial is the first trial to evaluate the comparative clinical effectiveness and cost-effectiveness of Microdiscectomy and transforaminal epidural steroid injection. No statistically significant difference was found between the two treatments for the primary outcome. It is unlikely that Microdiscectomy is cost-effective compared with transforaminal epidural steroid injection at a threshold of £20,000 per quality-adjusted life-year for sciatica secondary to prolapsed intervertebral disc. FUTURE WORK These results will lead to further studies in the streamlining and earlier management of discogenic sciatica. TRIAL REGISTRATION Current Controlled Trials ISRCTN04820368 and EudraCT 2014-002751-25. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 24. See the NIHR Journals Library website for further project information.
Mark P Arts - One of the best experts on this subject based on the ideXlab platform.
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annular closure in lumbar Microdiscectomy for prevention of reherniation a randomized clinical trial
The Spine Journal, 2018Co-Authors: Claudius Thome, Mark P Arts, Martin Barth, Peter Douglas Klassen, Gerrit J Bouma, Adisa Kursumovic, Javier Fandino, Wimar Van Den Brink, Richard Bostelmann, Aldemar Andres HegewaldAbstract:Abstract Background Context Patients with large annular defects after lumbar discectomy for disc herniation are at high risk of symptomatic recurrence and reoperation. Purpose The present study aimed to determine whether a bone-anchored annular closure device, in addition to lumbar Microdiscectomy, resulted in lower reherniation and reoperation rates plus increased overall success compared with lumbar Microdiscectomy alone. Design This is a multicenter, randomized superiority study. Patient Sample Patients with symptoms of lumbar disc herniation for at least 6 weeks with a large annular defect (6–10 mm width) after lumbar Microdiscectomy were included in the study. Outcome Measures The co-primary end points determined a priori were recurrent herniation and a composite end point consisting of patient-reported, radiographic, and clinical outcomes. Study success required superiority of annular closure on both end points at 2-year follow-up. Methods Patients received lumbar Microdiscectomy with additional bone-anchored annular closure device (n=276 participants) or lumbar Microdiscectomy only (control; n=278 participants). This research was supported by Intrinsic Therapeutics. Two authors received study-specific support morethan $10,000 per year, 8 authors received study-specific support less than $10,000 per year, and 11 authors received no study-specific support. Results Among 554 randomized participants, 550 (annular closure device: n=272; control: n=278) were included in the modified intent-to-treat efficacy analysis and 550 (annular closure device: n=267; control: n=283) were included in the as-treated safety analysis. Both co-primary end points of the study were met, with recurrent herniation (50% vs. 70%, P Conclusions In patients at high risk of herniation recurrence after lumbar Microdiscectomy, annular closure with a bone-anchored implant lowers the risk of symptomatic recurrence and reoperation. Additional study to determine outcomes beyond 2 years with a bone-anchored annular closure device is warranted.
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tubular discectomy versus conventional Microdiscectomy for the treatment of lumbar disc herniation long term results of a randomised controlled trial
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Gijsbert M Overdevest, Wilco C Peul, R Brand, Bart W Koes, Ronald H M A Bartels, Wee Fu Tan, Mark P ArtsAbstract:Background The reference surgical procedure for the treatment of lumbar disc herniation is open Microdiscectomy. Minimal invasive discectomy with tubular retractors is hypothesised to cause less tissue damage and result in lower blood loss, less postoperative pain and faster recovery. We previously reported our 1 and 2-year results, and found no better outcomes of tubular discectomy compared with open Microdiscectomy. Until now, no studies on tubular discectomy have reported results with more than 2 years of follow-up. Studies with long-term follow-up are required to determine if clinical outcomes are sustained and to assess specific long-term outcomes such as reoperation rate and iatrogenic low back pain due to impaired spinal integrity. The aim of this study is to evaluate the 5-year results of tubular discectomy compared with conventional Microdiscectomy. Methods The study was designed as a double-blind randomised controlled trial. 325 patients with a symptomatic lumbar disc herniation were randomly allocated to tubular discectomy (166 patients) or conventional Microdiscectomy (159 patients). Repeated standardised follow-up measurements were performed at 2, 4, 6, 8, 12, 26, 38, 52, 78, 104, 156, 208 and 260 weeks after randomisation. Main outcomes are the Roland-Morris Disability Questionnaire for Sciatica (RDQ), Visual Analogue Scale for leg pain and low back pain, self-perceived recovery and reoperation incidence. Results There was no clinically significant difference between tubular discectomy and conventional Microdiscectomy regarding the main clinical outcomes at any time point during the 5 years of follow-up. RDQ scores at 5 years were 4.3 (95% CI 3.3 to 5.2) in the tubular discectomy group and 3.4 (95% CI 2.4 to 4.5) in the conventional Microdiscectomy group. The mean difference of 0.9 (95% CI −0.6 to 2.2) was not significant. Mean differences for leg pain and back pain were 0.2 (95% CI −5.5 to 6.0) and 0.4 (95% CI −5.9 to 6.7), respectively. 77% of patients allocated to conventional discectomy reported complete or near-complete recovery of symptoms compared with 74% of patients allocated to tubular discectomy (p=0.79). The reoperation rate was 18% in the tubular discectomy group and 13% in the conventional discectomy group (p=0.29). Conclusions Long-term functional and clinical outcome did not differ between patients allocated to tubular discectomy and conventional Microdiscectomy. Primary and secondary outcome measures did not support the hypothesised advantages of tubular discectomy over conventional Microdiscectomy. Trial registration number ISRCTN51857546.
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tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk herniation 2 year results of a double blind randomized controlled trial
Neurosurgery, 2011Co-Authors: Mark P Arts, Bart W Koes, Ronald H M A Bartels, Ronald Brand, M E Van Den Akker, Wilco C PeulAbstract:BACKGROUND: Transmuscular tubular diskectomy has been introduced to increase the rate of recovery, although evidence is lacking. OBJECTIVE: To evaluate the 2-year results of tubular diskectomy compared with conventional microdiskectomy. METHODS: Three hundred twenty-eight patients with persistent leg pain caused by lumbar disk herniation were randomly assigned to undergo tubular diskectomy (167 patients) or conventional microdiskectomy (161 patients). Main outcome measures were scores from Roland-Morris Disability Questionnaire for Sciatica, Visual Analog Scale for leg pain and low-back pain, and Likert self-rating scale of global perceived recovery. RESULTS: On the basis of intention-to-treat analysis, there was no significant difference between tubular diskectomy and conventional microdiskectomy in Roland-Morris Disability Questionnaire for Sciatica scores during 2 years after surgery (between-group mean difference [Delta] = 0.6; 95% confidence interval [CI], -0.3-1.6). Patients treated with tubular diskectomy reported more leg pain (Delta = 3.3 mm; 95% CI, 0.2-6.2) and more low-back pain (Delta = 3.0 mm; 95% CI, -0.2-6.3) than those patients treated with conventional microdiskectomy. At 2 years, 71% of patients assigned to tubular diskectomy documented a good recovery vs 77% of patients assigned to conventional microdiskectomy (odds ratio, 0.76; 95% CI, 0.45-1.28; P = .35). Repeated surgery rates within 2 years after tubular diskectomy and conventional microdiskectomy were 15% and 10%, respectively (P = .22). CONCLUSION: Tubular diskectomy and conventional microdiskectomy resulted in similar functional and clinical outcomes. Patients treated with tubular diskectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.
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tubular diskectomy vs conventional microdiskectomy for sciatica a randomized controlled trial
JAMA, 2009Co-Authors: Mark P Arts, R Brand, Bart W Koes, Ronald H M A Bartels, Elske M Van Den Akker, Wilco C PeulAbstract:Context Conventional microdiskectomy is the most frequently performed surgery for patients with sciatica due to lumbar disk herniation. Transmuscular tubular diskectomy has been introduced to increase the rate of recovery, although evidence is lacking of its efficacy. Objective To determine outcomes and time to recovery in patients treated with tubular diskectomy compared with conventional microdiskectomy. Design, Setting, and Patients The Sciatica Micro-Endoscopic Diskectomy randomized controlled trial was conducted among 328 patients aged 18 to 70 years who had persistent leg pain (>8 weeks) due to lumbar disk herniations at 7 general hospitals in the Netherlands from January 2005 to October 2006. Patients and observers were blinded during the follow-up, which ended 1 year after final enrollment. Interventions Tubular diskectomy (n = 167) vs conventional microdiskectomy (n = 161). Main Outcome Measures The primary outcome was functional assessment on the Roland-Morris Disability Questionnaire (RDQ) for sciatica (score range: 0-23, with higher scores indicating worse functional status) at 8 weeks and 1 year after randomization. Secondary outcomes were scores on the visual analog scale for leg pain and back pain (score range: 0-100 mm) and patient's self-report of recovery (measured on a Likert 7-point scale). Results Based on intention-to-treat analysis, the mean RDQ score during the first year after surgery was 6.2 (95% confidence interval [CI], 5.6 to 6.8) for tubular diskectomy and 5.4 (95% CI, 4.6 to 6.2) for conventional microdiskectomy (between-group mean difference, 0.8; 95% CI, −0.2 to 1.7). At 8 weeks after surgery, the RDQ mean (SE) score was 5.8 (0.4) for tubular diskectomy and 4.9 (0.5) for conventional microdiskectomy (between-group mean difference, 0.8; 95% CI, −0.4 to 2.1). At 1 year, the RDQ mean (SE) score was 4.7 (0.5) for tubular diskectomy and 3.4 (0.5) for conventional microdiskectomy (between-group mean difference, 1.3; 95% CI, 0.03 to 2.6) in favor of conventional microdiskectomy. On the visual analog scale, the 1-year between-group mean difference in improvement was 4.2 mm (95% CI, 0.9 to 7.5 mm) for leg pain and 3.5 mm (95% CI, 0.1 to 6.9 mm) for back pain in favor of conventional microdiskectomy. At 1 year, 107 of 156 patients (69%) assigned to tubular diskectomy reported a good recovery vs 120 of 151 patients (79%) assigned to conventional microdiskectomy (odds ratio, 0.59 [95% CI, 0.35 to 0.99]; P = .05). Conclusions Use of tubular diskectomy compared with conventional microdiskectomy did not result in a statistically significant improvement in the Roland-Morris Disability Questionnaire score. Tubular diskectomy resulted in less favorable results for patient self-reported leg pain, back pain, and recovery. Trial Registration isrctn.org Identifier: ISRCTN51857546
Graham Jenkin - One of the best experts on this subject based on the ideXlab platform.
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mesenchymal progenitor cells primed with pentosan polysulfate promote lumbar intervertebral disc regeneration in an ovine model of Microdiscectomy
The Spine Journal, 2017Co-Authors: Peter Ghosh, David Oehme, Graham Jenkin, Andrew C W Zannettino, Chris D Daly, Tanya Badal, Ronald Shimmon, Kanika JainAbstract:Abstract Background Context Neural compression associated with lumbar disc herniation is usually managed surgically by Microdiscectomy. However, 10%–20% of patients re-present with debilitating back pain, and approximately 15% require further surgery. Purpose Using an ovine model of Microdiscectomy, the present study investigated the relative potential of pentosan polysulfate-primed mesenchymal progenitor cells (pMPCs) or MPC alone implanted into the lesion site to facilitate disc recovery. Study Design An ovine model of lumbar Microdiscectomy was used to compare the relative outcomes of administering MPCs or pMPCs to the injury site postsurgery. Methods At baseline 3T magnetic resonance imaging (MRI) of 18 adult ewes was undertaken followed by annular Microdiscectomy at two lumbar disc levels. Sheep were randomized into three groups (n=6). The injured controls received no further treatment. Defects of the treated groups were implanted with a collagen sponge and MPC (5×105 cells) or pMPC (5×105 cells). After 6 months, 3T MRI and standard radiography were performed. Spinal columns were dissected, individual lumbar discs were sectioned horizontally, and nucleus pulposus (NP) and annulus fibrosus (AF) regions were assessed morphologically and histologically. The NP and AF tissues were dissected into six regions and analyzed biochemically for their proteoglycans (PGs), collagen, and DNA content. Results Both the MPC- and pMPC-injected groups exhibited less reduction in disc height (p Conclusions In an ovine model 6 months after administration of pMPCs to the injury site disc PG content and matrix organization were improved relative to controls, suggesting pMPCs' potential as a postsurgical adjunct for limiting progression of disc degeneration after Microdiscectomy.
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mesenchymal progenitor cells combined with pentosan polysulfate mediating disc regeneration at the time of Microdiscectomy a preliminary study in an ovine model
Journal of Neurosurgery, 2014Co-Authors: David Oehme, Peter Ghosh, Susan Shimmon, Courtney Mcdonald, John Troupis, Tony Goldschlager, Jeffrey V Rosenfeld, Graham JenkinAbstract:Object Following Microdiscectomy, discs generally fail to undergo spontaneous regeneration and patients may experience chronic low-back pain and recurrent disc prolapse. In published studies, formulations of mesenchymal progenitor cells combined with pentosan polysulfate (MPCs+PPS) have been shown to regenerate disc tissue in animal models, suggesting that this approach may provide a useful adjunct to Microdiscectomy. The goal of this preclinical laboratory study was to determine if the transplantation of MPCs+PPS, embedded in a gelatin/fibrin scaffold (SCAF), and transplanted into a defect created by Microdiscectomy, could promote disc regeneration. Methods A standardized Microdiscectomy procedure was performed in 18 ovine lumbar discs. The subsequent disc defects were randomized to receive either no treatment (NIL), SCAF only, or the MPC+PPS formulation added to SCAF (MPCs+PPS+SCAF). Necropsies were undertaken 6 months postoperatively and the spines analyzed radiologically (radiography and MRI), biochem...