Thomas David Slater, Hans-Joachim Wilke, Gnanaprakash Gurusamy, Shanmuganathan Rajasekaran, Nicolas Newell
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引用次数: 0
Abstract
Purpose: Ex-vivo herniation models are essential for studying lumbar disc herniation mechanisms, but their morphological accuracy remains unclear due to limited validation against patient-derived clinical data. This review collates clinical lumbar disc herniation characteristics and evaluates whether existing models replicate real-world pathology. By identifying the most morphologically relevant models, this study provides a stronger foundation for improving mechanistic herniation models.
Methods: A systematic review following PRISMA guidelines identified clinical studies detailing herniation characteristics and experimental models of ex-vivo lumbar disc failure. Models were categorised by loading conditions (complex ultimate compression; cyclic; and intradiscal pressurisation), then compared to clinical data to assess their validity.
Results: In patients, extrusions (50%) and protrusions (34%) are the most common lumbar disc herniation types, with paracentral herniations (61%) predominantly occurring at L4-L5 (49%) and L5-S1 (42%). Structural failure patterns varied, with annulus fibrosus failure reported in 35-81% of cases and endplate junction failure in 19-68%. Among 25 analysed models, all loading types induced herniations, but often with different damage patterns. Complex ultimate compression caused abrupt failures and fractures, while cyclic led to progressive annular damage. Intradiscal pressurisation highlighted nucleus pulposus migration pathways. Within a single herniation model, the damage mechanisms seen were similar between discs.
Conclusions: Clinical herniation patterns show significant variability, while ex-vivo models yield more repeatable outcomes. Cyclic, complex ultimate compression, and intradiscal pressurisation models provide valuable mechanistic insights but differ in physiological relevance. Researchers must consider the physiological relevance of the applied load and the differences between animal and human discs when selecting a model. Future research should focus on understanding herniation progression and identifying initiating factors to improve prevention strategies.
期刊介绍:
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe