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Annulus Fibrosus Tissue Engineering: Achievements and Future Development
Published in Gilson Khang, Handbook of Intelligent Scaffolds for Tissue Engineering and Regenerative Medicine, 2017
Bin Li, Jun Li, Pinghui Zhou, Huilin Yang
Lower back pain (LBP) is the most common cause of activity limitations in adults which severely affects the quality of life and significantly contributes to healthcare expenditures. In the United States, LBP permanently disables more than 5 million people and incurs more than US$40 billion of cost every year.1 Degenerative disc disease (DDD), or degeneration of the intervertebral disc (IVD) (Fig. 35.1A), is a leading cause of LBP.2,3 Current conservative treatments for DDD are effective only at an early stage and can hardly reverse the biological function of degenerated disc cells and tissue. Prevalent surgical interventions, including discectomy, spinal fusion, and total disc replacement, are highly invasive and may even aggravate existing damages or lead to degenerative changes in adjacent vertebrae.4,5 Moreover, the postsurgery recurrence rate is very high. Therefore, there is a need to develop new approaches to treat DDD. Recently, tissue engineering (TE) approaches have emerged as a promising therapy toward DDD using engineered disc replacements in order to alleviate LBP, while restoring the function and range of motion of spine.6,7
Expert review with meta-analysis of randomized and nonrandomized controlled studies of Barricaid annular closure in patients at high risk for lumbar disc reherniation
Published in Expert Review of Medical Devices, 2020
Larry E. Miller, R. Todd Allen, Brad Duhon, Kris E. Radcliff
Lumbar discectomy is the preferred method of surgical management for persistent sciatica arising from lumbar intervertebral disc herniation. Lumbar discectomy involves surgical removal of the intervertebral disc material that herniated through the annulus fibrosus into the extradiscal space. Traditional aggressive (or subtotal) lumbar discectomy involves near-complete excision of the intervertebral disc. While this procedure effectively reduces the risk of future reherniation, complete disc excision alters spinal kinematics and increases the risk of painful degenerative disc disease [6,7]. Consequently, lumbar disc surgery techniques have evolved over time to favor limited discectomy (or sequestrectomy), which aims to remove only the herniated disc material while leaving the intradiscal contents intact. While a limited surgical approach maintains disc height and spinal kinematics, the risk of reherniation of residual disc material is increased [8]. Reoperations for lumbar herniation are more costly [9] and less effective [10,11] than primary procedures. Therefore, identification of patient characteristics and surgical techniques that contribute to this excess risk is crucial to minimize patient morbidity due to symptomatic reherniation and associated reoperations.