Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations

Yueh Feng Chiang, Chang Jung Chiang, Chih Hong Yang, Zheng Cheng Zhong, Chen Sheng Chen, Cheng Kung Cheng, Yang Hwei Tsuang

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The adverse effects of annulotomy during lumbar discectomy have been increasingly recognized, and methods are developing to repair the annular defect. Biomechanically, the repair should retain the intra-nuclear pressure, which is doubtful using the current suture techniques. Therefore, a new suture technique was designed and tested to close a simpler type of annular incision. Methods: A new suture technique, the modified purse-string suture, was introduced into a re-validated nonlinear finite element human disk model after creating a standard transverse slit incision, as well as two other suture techniques: either two simple sutures, or a horizontal crossed suture, and compared their contact pressure on the cleft contact surface. Then, porcine lumbar endplate-disk-endplate complexes with transverse slit incisions were repaired using the three techniques. Quantitative discomanometry was then applied to compare their leakage pressure, as a parameter of disk integrity. Findings: In finite element model, the new technique created the greatest contact pressure along the suture range (the outer annulus), and generated a minimum contact pressure at the critical point, which was 68% and 55% higher than the other two suture techniques. In quantitative discomanometry, the new suture technique also had an average leakage pressure of 85% and 49% higher than the other two suture techniques. Interpretation: The modified purse-string suture can generate higher contact pressure than the other two techniques at finite element analysis and in realistic animal models, which aids in retaining intra-discal pressure, and should be encouraged in clinical practice.

Original languageEnglish
Pages (from-to)241-248
Number of pages8
JournalClinical Biomechanics
Volume27
Issue number3
DOIs
Publication statusPublished - Mar 2012

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Suture Techniques
Pressure
Sutures
Diskectomy
Finite Element Analysis
Swine
Animal Models

Keywords

  • annular repair
  • annulotomy
  • finite element analysis
  • intradiscal pressure
  • modified purse-string suture (MPSS)
  • quantitative discomanometry

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Biophysics

Cite this

Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations. / Chiang, Yueh Feng; Chiang, Chang Jung; Yang, Chih Hong; Zhong, Zheng Cheng; Chen, Chen Sheng; Cheng, Cheng Kung; Tsuang, Yang Hwei.

In: Clinical Biomechanics, Vol. 27, No. 3, 03.2012, p. 241-248.

Research output: Contribution to journalArticle

Chiang, Yueh Feng ; Chiang, Chang Jung ; Yang, Chih Hong ; Zhong, Zheng Cheng ; Chen, Chen Sheng ; Cheng, Cheng Kung ; Tsuang, Yang Hwei. / Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations. In: Clinical Biomechanics. 2012 ; Vol. 27, No. 3. pp. 241-248.
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AB - Background: The adverse effects of annulotomy during lumbar discectomy have been increasingly recognized, and methods are developing to repair the annular defect. Biomechanically, the repair should retain the intra-nuclear pressure, which is doubtful using the current suture techniques. Therefore, a new suture technique was designed and tested to close a simpler type of annular incision. Methods: A new suture technique, the modified purse-string suture, was introduced into a re-validated nonlinear finite element human disk model after creating a standard transverse slit incision, as well as two other suture techniques: either two simple sutures, or a horizontal crossed suture, and compared their contact pressure on the cleft contact surface. Then, porcine lumbar endplate-disk-endplate complexes with transverse slit incisions were repaired using the three techniques. Quantitative discomanometry was then applied to compare their leakage pressure, as a parameter of disk integrity. Findings: In finite element model, the new technique created the greatest contact pressure along the suture range (the outer annulus), and generated a minimum contact pressure at the critical point, which was 68% and 55% higher than the other two suture techniques. In quantitative discomanometry, the new suture technique also had an average leakage pressure of 85% and 49% higher than the other two suture techniques. Interpretation: The modified purse-string suture can generate higher contact pressure than the other two techniques at finite element analysis and in realistic animal models, which aids in retaining intra-discal pressure, and should be encouraged in clinical practice.

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