TY - JOUR
T1 - Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations
AU - Chiang, Yueh Feng
AU - Chiang, Chang Jung
AU - Yang, Chih Hong
AU - Zhong, Zheng Cheng
AU - Chen, Chen Sheng
AU - Cheng, Cheng Kung
AU - Tsuang, Yang Hwei
PY - 2012/3
Y1 - 2012/3
N2 - 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.
AB - 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.
KW - annular repair
KW - annulotomy
KW - finite element analysis
KW - intradiscal pressure
KW - modified purse-string suture (MPSS)
KW - quantitative discomanometry
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U2 - 10.1016/j.clinbiomech.2011.09.008
DO - 10.1016/j.clinbiomech.2011.09.008
M3 - Article
C2 - 22000700
AN - SCOPUS:84858340179
SN - 0268-0033
VL - 27
SP - 241
EP - 248
JO - Clinical Biomechanics
JF - Clinical Biomechanics
IS - 3
ER -