Lumbar disc herniation modelling: a review of ex-vivo mechanical models and a comparison with clinical data.

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
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.

腰椎间盘突出模型:离体力学模型的回顾和与临床数据的比较。
目的:离体腰椎间盘突出模型对于腰椎间盘突出机制的研究至关重要,但由于对患者临床数据的验证有限,其形态学准确性尚不清楚。这篇综述整理了临床腰椎间盘突出的特点,并评估了现有的模型是否能复制现实世界的病理。通过确定形态学上最相关的模型,本研究为完善机械性疝模型提供了更坚实的基础。方法:根据PRISMA指南进行系统综述,确定了详细描述腰椎间盘突出特征和离体腰椎间盘衰竭实验模型的临床研究。模型按加载条件(复杂极限压缩;循环;和椎间盘内加压),然后与临床数据进行比较,以评估其有效性。结果:在患者中,突出(50%)和突出(34%)是最常见的腰椎间盘突出类型,中心旁突出(61%)主要发生在L4-L5(49%)和L5-S1(42%)。结构破坏的类型各不相同,纤维环破坏在35-81%的病例中报道,终板连接破坏在19-68%。在分析的25个模型中,所有加载类型都引起了疝,但往往具有不同的损伤模式。复杂的极限压缩导致突发性破坏和破裂,而循环导致渐进式环空损伤。椎间盘内加压突出髓核的迁移路径。在单个突出模型中,椎间盘之间的损伤机制相似。结论:临床疝模式具有显著的可变性,而离体模型的结果可重复性更高。循环、复杂的极限压缩和椎间盘内加压模型提供了有价值的机制见解,但在生理相关性方面有所不同。在选择模型时,研究人员必须考虑所施加载荷的生理相关性以及动物和人类椎间盘之间的差异。未来的研究应侧重于了解疝的进展和确定启动因素,以改善预防策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Spine Journal
European Spine Journal 医学-临床神经学
CiteScore
4.80
自引率
10.70%
发文量
373
审稿时长
2-4 weeks
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
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