Regeneration of a spinal ligament after total lumbar disk arthroplasty in primates.
Total disk arthroplasty (TDA) is a new procedure that replaces the intervertebral disk space with an artificial motion segment and necessitates the resection of the anterior longitudinal ligament (ALL). We assessed whether a collagen-based graft made from porcine small-intestine submucosa (SIS) can be used as a regenerative scaffold to restore the function and structure of the ALL in the lumbar spine. A total of 10 mature male baboons underwent TDA at L5-L6 using one of two treatments: (1) TDA only (n = 5) or (2) TDA combined with SIS (n = 5). Six months postoperatively, mock revision surgery was performed to assess tissue adhesions followed by non-destructive multidirectional flexibility testing of the spinal segment. The vertebral segments were then processed for histology. The tissue adhesion score was 2.8 +/- 0.8 in the TDA only group and 1.8 +/- 1.4 in the TDA-SIS group (p = 0.2). Segmental range of motion and the length of the neutral zone were similar in both groups. Histology showed that the SIS scaffold led to an organized ligamentous structure with a significantly (p = 0.027) higher thickness (2.18 +/- 0.25 mm) compared to the connective tissue structure in the TDA-only group (1.66 +/- 0.33 mm). We concluded that using a SIS bioscaffold after TDA did not lead to increased great vessel adhesion while its use facilitated the formation of highly organized ligamentous tissues. However, the SIS- induced and newly formed ligamentous tissue anterior to the spinal segment did not lead to a measurable limitation of spinal extension.
Department of Orthopedic Surgery, Union Memorial Hospital, Baltimore, MD, USA.
Bryan W
BW
Cunningham
Sigurd H
SH
Berven
Nianbin
N
Hu
Helen J
HJ
Beatson
Patrick G
PG
De Deyne
Paul C
PC
McAfee
D000818:Animals; D001178:Arthroplasty / Q000379:methods*; D001672:Biocompatible Materials; D007403:Intervertebral Disc; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007421:Intestine, Small; D017846:Longitudinal Ligaments / Q000502:physiology*; D008159:Lumbar Vertebrae; D048548:Papio cynocephalus; D016059:Range of Motion, Articular; D012038:Regeneration; D013552:Swine; D000267:Tissue Adhesions; D054457:Tissue Scaffolds
D001672:Biocompatible Materials