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Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations.
MedLine Citation:
PMID:  22000700     Owner:  NLM     Status:  Publisher    
BACKGROUND: The adverse effects of annulotomy during lumbar discectomy have been increasingly recognized, and methods are developing to repair the annular defect. Biomechanically, the repair should retain the intra-nuclear pressure, which is doubtful using the current suture techniques. Therefore, a new suture technique was designed and tested to close a simpler type of annular incision. METHODS: A new suture technique, the modified purse-string suture, was introduced into a re-validated nonlinear finite element human disk model after creating a standard transverse slit incision, as well as two other suture techniques: either two simple sutures, or a horizontal crossed suture, and compared their contact pressure on the cleft contact surface. Then, porcine lumbar endplate-disk-endplate complexes with transverse slit incisions were repaired using the three techniques. Quantitative discomanometry was then applied to compare their leakage pressure, as a parameter of disk integrity. FINDINGS: In finite element model, the new technique created the greatest contact pressure along the suture range (the outer annulus), and generated a minimum contact pressure at the critical point, which was 68% and 55% higher than the other two suture techniques. In quantitative discomanometry, the new suture technique also had an average leakage pressure of 85% and 49% higher than the other two suture techniques. INTERPRETATION: The modified purse-string suture can generate higher contact pressure than the other two techniques at finite element analysis and in realistic animal models, which aids in retaining intra-discal pressure, and should be encouraged in clinical practice.
Yueh-Feng Chiang; Chang-Jung Chiang; Chih-Hong Yang; Zheng-Cheng Zhong; Chen-Sheng Chen; Cheng-Kung Cheng; Yang-Hwei Tsuang
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-13
Journal Detail:
Title:  Clinical biomechanics (Bristol, Avon)     Volume:  -     ISSN:  1879-1271     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8611877     Medline TA:  Clin Biomech (Bristol, Avon)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ltd. All rights reserved.
Department of Orthopaedic Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, No. 66, Sec. 1, Fongsing Road, Tanzih Township. Taichung County, Taiwan; Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang Ming University, No.155, Sec.2, Linong Street, Taipei City, Taiwan.
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