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  • Annular Repair Using High-density Collagen Gel Seeded with Fibrochondrocytes in a Rat Model

    Final Number:
    115

    Authors:
    Brenton Pennicooke MD, MS; Yu Moriguchi MD PhD; Roger Hartl MD; Lawrence J Bonassar PhD; Brandon Borde

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: Discectomy of herniated intervertebral discs (IVDs) successfully alleviates associated neurological symptoms but fails to repair the underlying degenerative disc process. Persistent annular defect post discectomy is associated with increased risk of reherniation, progressive IVD degeneration, and chronic low back pain [1-7]. Recently, we demonstrated the ability of riboflavin crosslinked high-density collagen gels (HDC) to facilitate annular repair in vivo [8,9]. In this study, AF fibrochondrocytes were seeded in the HDC gel to enhance the reparative process at the site of annular defect.

    Methods: 36 athymic rats, punctured with an 18-gauge needle in the tail disc, were divided into three groups: 1) untreated (n=6); 2) injected with crossliked HDC (n=15); 3) injected with fibrochondrocyte-laden crosslinked HDC (n=15). Sheep AF fibrochondrocytes at a concentration of 106 cells/ml were mixed with HDC gels prior to injection. Quantitative analysis using X rays and MRIs [10] as well as qualitative histological assessments were performed.

    Results: 36 athymic rats, punctured with an 18-gauge needle in the tail disc, were divided into three groups: 1) untreated (n=6); 2) injected with crossliked HDC (n=15); 3) injected with fibrochondrocyte-laden crosslinked HDC (n=15). Sheep AF fibrochondrocytes at a concentration of 106 cells/ml were mixed with HDC gels prior to injection. Quantitative analysis using X rays and MRIs [10] as well as qualitative histological assessments were performed.

    Conclusions: In vivo studies on the cell-based annular repair are few in number. Our preliminary findings suggest that fibrochondrocytes can potentially improve HDC gel-based annular repair. Long term study with sufficient sample size are necessary to confirm these results.

    Patient Care: By the conclusion of this session, participants should be able to: 1) Describe the importance of developing a novel treatment for annular defect, 2) Discuss, in small groups, therapeutic strategies using cells and scaffolds 3) Identify an effective treatment for lumbar disc hernia and subsequent degenerative disc diseases.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of developing a novel treatment for annular defect, 2) Discuss, in small groups, therapeutic strategies using cells and scaffolds 3) Identify an effective treatment for lumbar disc hernia and subsequent degenerative disc diseases.

    References: 1) Bruske-Hohlfeld I, Merritt JL, Onofrio BM, et al. Incidence of lumbar disc surgery. A population-based study in Olmsted County, Minnesota, 1950-1979. Spine (Phila Pa 1976) 1990;15:31-5. 2) Carragee EJ, Han MY, Suen PW, Kim D. Clinical out- comes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 2003 85-A(1):102–108 3) Laus M, Bertoni F, Bacchini P, Alfonso C, Giunti A Recurrent lumbar disc herniation: what recurs? (A morpholog- ical study of recurrent disc herniation). Chir Organi Mov 1993 78(3):147–154 4) Barth M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine (Phila Pa 1976 ) 33: 265-272 5) O’Connell GD, Malhotra NR, Vresilovic EJ, Elliott DM. The effect of nuleotomy and the dependence of the degeneration of human intervertebral disc strain in axial compression. Spine (Philla Pa 1976) Oct 1; 36(21):1765-71 6) Frei H, Oxland TR, Rathonyi GC, Nolte LP. The effect of nucleotomy on lumbar spine mechanics in compression and shear loading. Spine (Philla Pa 1976) 2001 Oct 1;26(19):2080-9 7) DePalma MJ, Ketchum JM, Saullo TR, Laplante BL. Is the history of a surgical discectomy related to the source of chronic low back pain? Pain Physician. 2012; 15:E53–E58 Grunert P1, Borde BH2, Towne SB1, Moriguchi Y1, Hudson KD2, Bonassar LJ3, Härtl R4. Riboflavin crosslinked high-density collagen gel for the repair of annular defects in intervertebral discs: An in vivo study. Acta Biomater. 2015 Jun 23. pii: S1742-7061(15)00271-8. doi: 10.1016/j.actbio.2015.06.006. [Epub ahead of print] 8) Grunert P1, Borde BH, Hudson KD, Macielak MR, Bonassar LJ, Härtl R. Annular repair using high-density collagen gel: a rat-tail in vivo model. Spine (Phila Pa 1976). 2014 Feb 1;39(3):198-206. doi: 10.1097/BRS.0000000000000103. 9) Borde B1, Grunert P2, Härtl R2, Bonassar LJ1,3. Injectable, high-density collagen gels for annulus fibrosus repair: An in vitro rat tail model. J Biomed Mater Res A. 2015 Aug;103(8):2571-81. doi: 10.1002/jbm.a.35388. Epub 2014 Dec 29. 10) Grunert P, Hudson KD, Macielak MR, Aronowitz E, Borde BH, Alimi M, Njoku I, Ballon D, Tsiouris AJ, Bonassar LJ, Härtl R. Assessment of intervertebral disc degeneration based on quantitative magnetic resonance imaging analysis: an in vivo study. Spine (Phila Pa 1976). 2014 Mar 15;39(6):E369-78.

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