Replacing the Nucleus Pulposus for Degenerative Disc Disease and Disc Herniation: Disc Preservation Following Discectomy

Chamoli, U; Lam, M; Diwan, A

Replacing the Nucleus Pulposus for Degenerative Disc Disease and Disc Herniation: Disc Preservation Following Discectomy

Chamoli, U

Lam, M Diwan, A

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Publisher:: Springer
Publication Type:: Chapter
Citation:: Handbook of Spine Technology, 2021, pp. 1111-1129
Issue Date:: 2021-04-13

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Field	Value	Language
dc.contributor.author	Chamoli, U https://orcid.org/0000-0002-8396-5814
dc.contributor.author	Lam, M
dc.contributor.author	Diwan, A
dc.date.accessioned	2022-06-20T22:58:39Z
dc.date.available	2022-06-20T22:58:39Z
dc.date.issued	2021-04-13
dc.identifier.citation	Handbook of Spine Technology, 2021, pp. 1111-1129
dc.identifier.isbn	3319444239
dc.identifier.isbn	9783319444239
dc.identifier.uri	http://hdl.handle.net/10453/158279
dc.description.abstract	Low back pain is the leading cause of years lived with disability worldwide and thus a significant burden on the economy and healthcare systems. Degenerative changes and/or repetitive abnormal loading in the lumbar spine could lead to structural failures of the intervertebral disc and herniation of the nucleus pulposus, all of which may manifest as chronic back and/or leg pain. Although lumbar discectomy is a clinically beneficial procedure for appropriately selected disc herniation patients, revision discectomy rates range from 2% to 18% within the first decade of the primary discectomy, especially in patients younger than 65 years. Discectomy being a tissue discarding procedure may compromise the biomechanical integrity of the disc and accelerate its degeneration. Nucleus replacement (NR) implants present a promising option to address some of the challenges surrounding lumbar discectomy. An NR implant may be used as an adjunct to discectomy to preserve the biomechanical integrity of the disc and minimize recurrent herniation of the nuclear tissue. Nonetheless, a systematic review of the literature on clinical outcomes for NR implants revealed high rates for endplate remodeling and implant subsidence. A detailed multiscale understanding of the mechanisms of disc herniation and reherniation, closure of the annular defect, and the ability to tailor geometry and material properties for individual patients are needed to develop the next generation of NR implants.
dc.format.extent	69
dc.language	en
dc.publisher	Springer
dc.relation.ispartof	Handbook of Spine Technology
dc.relation.isbasedon	10.1007/978-3-319-44424-6_94
dc.rights	info:eu-repo/semantics/closedAccess
dc.title	Replacing the Nucleus Pulposus for Degenerative Disc Disease and Disc Herniation: Disc Preservation Following Discectomy
dc.type	Chapter
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-06-20T22:58:37Z
pubs.place-of-publication	Switzerland
pubs.publication-status	Published
dc.location	Switzerland

Abstract:

Low back pain is the leading cause of years lived with disability worldwide and thus a significant burden on the economy and healthcare systems. Degenerative changes and/or repetitive abnormal loading in the lumbar spine could lead to structural failures of the intervertebral disc and herniation of the nucleus pulposus, all of which may manifest as chronic back and/or leg pain. Although lumbar discectomy is a clinically beneficial procedure for appropriately selected disc herniation patients, revision discectomy rates range from 2% to 18% within the first decade of the primary discectomy, especially in patients younger than 65 years. Discectomy being a tissue discarding procedure may compromise the biomechanical integrity of the disc and accelerate its degeneration. Nucleus replacement (NR) implants present a promising option to address some of the challenges surrounding lumbar discectomy. An NR implant may be used as an adjunct to discectomy to preserve the biomechanical integrity of the disc and minimize recurrent herniation of the nuclear tissue. Nonetheless, a systematic review of the literature on clinical outcomes for NR implants revealed high rates for endplate remodeling and implant subsidence. A detailed multiscale understanding of the mechanisms of disc herniation and reherniation, closure of the annular defect, and the ability to tailor geometry and material properties for individual patients are needed to develop the next generation of NR implants.

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http://hdl.handle.net/10453/158279