The effect of a new anular repair after discectomy in intervertebral disc degeneration: An experimental study using a porcine spine model

Study Design.: In vitro and in vivo studies to assess the effect of direct anular repair on subsequent degeneration of intervertebral discs (IVDs). Objective.: To assess whether a new suturing method could provide sealing effect on IVD after discectomy, and influence degenerative process of IVD. Summary OF Background Data.: Recurrent disc herniation and subsequent disc degeneration are major problems after discectomy. Anular repair can reduce the risk of recurrence, but its effect on disc degeneration needs more investigation. Methods.: A new suturing technique, the modified purse-string suture (MPSS), was designed for direct closure of anular incision. Intact motion segments of porcine lumbar spine were used to validate this technique in resisting disc pressure under mechanical loadings. A transverse slit incision was made in the anterior anulus of porcine cervical discs, with or without sealing of the anular defect by this suturing method. Magnetic resonance imaging grading was recorded before and after surgery. Anular healing was assessed histologically and gene expression of aggrecan, collagen type I, II, and matrix metalloproteinase-13 in nucleus pulposus were investigated. Results.: The average failure force of axial compression was 1150.3 ± 121.1 N for a simple suture, and 2917.9 ± 627.6 N for a MPSS. Cyclic loading test showed that the repaired discs succeeded against repeated compression forces. Magnetic resonance imaging and gross appearances showed lesser degenerative changes in repaired discs than in injured discs at each time period. In repaired discs, mRNA expression of aggrecan and type II collagen downregulated slightly with time, whereas it decreased rapidly and persistently in unrepaired discs. Histologic findings showed primary healing of outer anular tract in repaired discs. Conclusion.: In this pilot study, the MPSS can provide effectively sealing for damaged anulus to withstand stresses. Direct repair of anular incision by this suturing method does significantly slow down degenerative process within discs after discectomy.