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Biological and biomechanical effects of fibrin injection into porcine intervertebral discs.
MedLine Citation:
PMID:  21325992     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
STRUCTURED ABSTRACT: Study Design: Surgically-denucleated porcine intervertebral discs (IVD) were injected with BIOSTAT BIOLOGX® Fibrin Sealant (FS), and the in vivo effects were assessed over time by histological, biochemical and mechanical criteria.Objectives: The objectives were to test whether the intradiscal injection of FS stimulates disc healing.Summary of background data: Disc avascularity prevents the deposition of a provisional fibrin scaffold that typically facilitates soft tissue repair. Poor disc wound healing leads to disc damage accumulation and chronic inflammation characterized by over production of pro-inflammatory cytokines and proteolytic enzymes.Methods: Four lumbar IVDs from each of 31 Yucatan mini-pigs were randomized to: untreated controls; degenerative injury (nucleotomy); and nucleotomy plus FS injection. Animals were sacrificed at 1, 2, 3, 6 and 12 weeks post surgery. IVDs were harvested to quantify: 1) architecture using morphological and histological grading; 2) proteoglycan composition using DMMB assay; 3) cytokine content using ELISA; and 4) mechanical properties using quantitative pressure/volume testing.Results: There was progressive invasion of annular tissue into the nucleus of nucleotomy discs and concomitant reduction in proteoglycan content. By contrast, FS supplementation inhibited nuclear fibrosis and facilitated proteoglycan content recovery over time. FS discs synthesized significantly less TNFα than degenerate discs (66% vs 226%, p<0.05) and had upregulation of IL-4 (310% vs 166%) and TGF-β (400% vs 117%) at 2-3 weeks post-treatment. At 3 weeks post surgery the denucleated discs were less stiff than controls (pressure modulus 779.9 psi versus 2754.8 psi, p<0.05), and failed at lower pressures (250.5 psi versus 492.5 psi; p<0.05). The stiffness and leakage pressure of the FS-treated discs recovered to control values after 6 and 12 weeks, respectively.Conclusions: Fibrin sealant facilitated structural, compositional, and mechanical repair of the surgically damaged IVD. These FS-derived benefits are likely due to its conductive scaffold properties, and metabolically active constituents such as thrombin, Factor XIII, and aprotinin acetate.
Authors:
Zorica Buser; Fabrice Kuelling; Jane Liu; Ellen Liebenberg; Kevin J Thorne; Dezba Coughlin; Jeffrey C Lotz
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-15
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA 2 Spinal Restoration, Austin, TX USA.
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