eCM (Eur Cell Mater / e Cells & Materials) Not-for-profit Open Access
Created by Scientists, for Scientists
 ISSN:1473-2262         NLM:100973416 (link)         DOI:10.22203/eCM

2013   Volume No 25 – pages 1-21

Title: Challenges and strategies in the repair of ruptured annulus fibrosus

Author: CC Guterl, EY See, SBG Blanquer, A Pandit, SJ Ferguson, LM Benneker, DW Grijpma, D Sakai, D Eglin, M Alini, JC Iatridis, S Grad

Address: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland

E-mail: sibylle.grad at aofoundation.org

Key Words: Annulus fibrosus rupture; disc herniation; disc biomechanics; biomaterial scaffold; pre-clinical model; interdisciplinary approach; annulus fibrosus tissue engineering; annulus fibrosus regeneration.

Publication date: January 2nd 2013

Abstract: Lumbar discectomy is the surgical procedure most frequently performed for patients suffering from low back pain and sciatica. Disc herniation as a consequence of degenerative or traumatic processes is commonly encountered as the underlying cause for the painful condition. While discectomy provides favourable outcome in a majority of cases, there are conditions where unmet requirements exist in terms of treatment, such as large disc protrusions with minimal disc degeneration; in these cases, the high rate of recurrent disc herniation after discectomy is a prevalent problem. An effective biological annular repair could improve the surgical outcome in patients with contained disc herniations but otherwise minor degenerative changes. An attractive approach is a tissue-engineered implant that will enable/stimulate the repair of the ruptured annulus. The strategy is to develop three-dimensional scaffolds and activate them by seeding cells or by incorporating molecular signals that enable new matrix synthesis at the defect site, while the biomaterial provides immediate closure of the defect and maintains the mechanical properties of the disc. This review is structured into (1) introduction, (2) clinical problems, current treatment options and needs, (3) biomechanical demands, (4) cellular and extracellular components, (5) biomaterials for delivery, scaffolding and support, (6) pre-clinical models for evaluation of newly developed cell- and material-based therapies, and (7) conclusions. This article highlights that an interdisciplinary approach is necessary for successful development of new clinical methods for annulus fibrosus repair. This will benefit from a close collaboration between research groups with expertise in all areas addressed in this review.

Article download: Pages 1-21 (PDF file)
DOI: 10.22203/eCM.v025a01