Jean-Philippe Deneuville, Maxime Billot, Alexandra Cervantes, Sylvain Peterlongo, Martin Meyer, Mezika Kolder, Marie Escande, Mathilde Bourgeois, Adrien Pallot, Romain David, Manuel Roulaud, Amine Ounajim, Mark Laslett, Mathieu Sarracanie, Najat Salameh, Arnaud Germaneau, Philippe Rigoard
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These predictions are regularly used as a theoretical basis for explaining certain disc pathologies, such as disc herniation.</p><p><strong>Methods: </strong>We screened seven databases (CENTRAL, Embase, MEDLINE, CINAHL, ScienceDirect, Google Scholar, and HAL) up to July 2024, identifying studies through a PRISMA-guided approach that detailed the mechanical transformation (displacement and deformation) of the <i>nucleus pulposus</i> under bending load on the intervertebral disc. We conducted a double-blind data extraction and quality assessment of the body of evidence. Finally, we performed a meta-analysis of proportions.</p><p><strong>Results: </strong>From the 9,269 articles screened, 14 studies were included in the systematic review and meta-analysis. Magnetic Resonance Imaging (MRI) was employed in 92.8% of the studies, revealing four strategies for assessing <i>nucleus pulposus</i> transformation. The meta-analysis of asymptomatic subjects' data demonstrated that the <i>nucleus pulposus</i> behavior aligned with dynamic disc model predictions in 85.4% (95% CI = [79.4-91.4]) across spinal regions and bending directions. However, significant heterogeneity and low study quality were noted. Only one study used discography to assess the DDM in a discogenic pain population, identifying discrepancies in <i>nucleus pulposus</i> transformation and contrast agent leakage.</p><p><strong>Conclusion: </strong>Evidence for the dynamic disc model for intact discs is of low strength, whereas very limited evidence challenges the dynamic disc model for fissured discs. New multiparametric MRI studies may help guiding future clinical assessment protocols.</p><p><strong>Systematic review registration: </strong>CRD42022331774.</p>","PeriodicalId":12444,"journal":{"name":"Frontiers in Bioengineering and Biotechnology","volume":"13 ","pages":"1582438"},"PeriodicalIF":4.3000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179537/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dynamic behavior of the nucleus pulposus within the intervertebral disc loading: a systematic review and meta-analysis exploring the concept of dynamic disc model.\",\"authors\":\"Jean-Philippe Deneuville, Maxime Billot, Alexandra Cervantes, Sylvain Peterlongo, Martin Meyer, Mezika Kolder, Marie Escande, Mathilde Bourgeois, Adrien Pallot, Romain David, Manuel Roulaud, Amine Ounajim, Mark Laslett, Mathieu Sarracanie, Najat Salameh, Arnaud Germaneau, Philippe Rigoard\",\"doi\":\"10.3389/fbioe.2025.1582438\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The dynamic disc model (DDM) is a theoretical framework in spine mechanics that theorizes the behavior of the <i>nucleus pulposus</i> within the intervertebral disc under various loads. 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引用次数: 0
摘要
动态椎间盘模型（DDM）是脊柱力学中的一个理论框架，它理论化了椎间盘内髓核在各种载荷下的行为。该模型预测了在弯曲载荷作用下髓核的位移，例如在弯曲载荷作用下髓核的向后位移。这些预测通常被用作解释某些椎间盘病理的理论基础，如椎间盘突出。方法：截至2024年7月，我们筛选了7个数据库（CENTRAL, Embase， MEDLINE， CINAHL, ScienceDirect，谷歌Scholar和HAL），通过prism引导的方法识别研究，这些研究详细描述了椎间盘弯曲载荷下髓核的机械转变（位移和变形）。我们对大量证据进行了双盲数据提取和质量评估。最后，我们进行了比例的荟萃分析。结果：在筛选的9269篇文章中，14项研究被纳入系统评价和荟萃分析。92.8%的研究采用磁共振成像（MRI），揭示了评估髓核转化的四种策略。对无症状受试者数据的荟萃分析表明，髓核的行为在85.4% （95% CI =[79.4-91.4]）的脊柱区域和弯曲方向上与动态椎间盘模型预测一致。然而，异质性显著，研究质量较低。只有一项研究使用椎间盘造影术评估椎间盘源性疼痛人群的DDM，发现髓核转化和造影剂泄漏的差异。结论：完整椎间盘的动态椎间盘模型证据不足，而对裂隙椎间盘的动态椎间盘模型提出质疑的证据非常有限。新的多参数MRI研究可能有助于指导未来的临床评估方案。系统评价注册：CRD42022331774。
Dynamic behavior of the nucleus pulposus within the intervertebral disc loading: a systematic review and meta-analysis exploring the concept of dynamic disc model.
Introduction: The dynamic disc model (DDM) is a theoretical framework in spine mechanics that theorizes the behavior of the nucleus pulposus within the intervertebral disc under various loads. The model predicts displacement of the nucleus pulposus away from the bending loads, for example backward displacement of the nucleus pulposus with a flexion load. These predictions are regularly used as a theoretical basis for explaining certain disc pathologies, such as disc herniation.
Methods: We screened seven databases (CENTRAL, Embase, MEDLINE, CINAHL, ScienceDirect, Google Scholar, and HAL) up to July 2024, identifying studies through a PRISMA-guided approach that detailed the mechanical transformation (displacement and deformation) of the nucleus pulposus under bending load on the intervertebral disc. We conducted a double-blind data extraction and quality assessment of the body of evidence. Finally, we performed a meta-analysis of proportions.
Results: From the 9,269 articles screened, 14 studies were included in the systematic review and meta-analysis. Magnetic Resonance Imaging (MRI) was employed in 92.8% of the studies, revealing four strategies for assessing nucleus pulposus transformation. The meta-analysis of asymptomatic subjects' data demonstrated that the nucleus pulposus behavior aligned with dynamic disc model predictions in 85.4% (95% CI = [79.4-91.4]) across spinal regions and bending directions. However, significant heterogeneity and low study quality were noted. Only one study used discography to assess the DDM in a discogenic pain population, identifying discrepancies in nucleus pulposus transformation and contrast agent leakage.
Conclusion: Evidence for the dynamic disc model for intact discs is of low strength, whereas very limited evidence challenges the dynamic disc model for fissured discs. New multiparametric MRI studies may help guiding future clinical assessment protocols.
期刊介绍：
The translation of new discoveries in medicine to clinical routine has never been easy. During the second half of the last century, thanks to the progress in chemistry, biochemistry and pharmacology, we have seen the development and the application of a large number of drugs and devices aimed at the treatment of symptoms, blocking unwanted pathways and, in the case of infectious diseases, fighting the micro-organisms responsible. However, we are facing, today, a dramatic change in the therapeutic approach to pathologies and diseases. Indeed, the challenge of the present and the next decade is to fully restore the physiological status of the diseased organism and to completely regenerate tissue and organs when they are so seriously affected that treatments cannot be limited to the repression of symptoms or to the repair of damage. This is being made possible thanks to the major developments made in basic cell and molecular biology, including stem cell science, growth factor delivery, gene isolation and transfection, the advances in bioengineering and nanotechnology, including development of new biomaterials, biofabrication technologies and use of bioreactors, and the big improvements in diagnostic tools and imaging of cells, tissues and organs.
In today`s world, an enhancement of communication between multidisciplinary experts, together with the promotion of joint projects and close collaborations among scientists, engineers, industry people, regulatory agencies and physicians are absolute requirements for the success of any attempt to develop and clinically apply a new biological therapy or an innovative device involving the collective use of biomaterials, cells and/or bioactive molecules. “Frontiers in Bioengineering and Biotechnology” aspires to be a forum for all people involved in the process by bridging the gap too often existing between a discovery in the basic sciences and its clinical application.
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