title: A biodegradable glue for annulus closure: evaluation of strength and endurance.
abstract: METHODS
  A biodegradable glue was biomechanically tested for annulus closure using nondegenerated goat intervertebral discs. Ultimate strength and endurance tests were performed using native and punctured discs as positive and negative controls, respectively.
  
  
  OBJECTIVE
  The aim of this study was to investigate the feasibility and biomechanical properties of a biodegradable glue for annulus closure.
  
  
  BACKGROUND
  There is an unmet clinical need for annulus closure techniques. Isocyanate-terminated tissue glues show potential because they adhere to annulus tissue, have an elastic modulus similar to the annulus, and show limited cytotoxicity to human annulus fibrosus cells.
  
  
  METHODS
  Three biomechanical tests were performed divided in 2 parts: part 1: ultimate strength tests comparing native, punctured (2.4-mm needle), and glued caprine intervertebral discs (n = 11 per group); part 2: 10 discs per group were subjected to a 10-day ex vivo endurance test of 864,000 load cycles, followed by ultimate strength tests. Outcome parameters include the restoration of strength after puncture, reduction of herniation in the endurance test, and conservation of glue strength after endurance testing.
  
  
  RESULTS
  Part 1: The glue partially restored subsidence to failure and yield strength/ultimate strength ratio of intervertebral discs. Part 2: During endurance testing, 40% of punctured discs failed compared with none of the glued discs. Endurance testing did not affect glue strength, and pooling of ultimate strength tests showed that the glue restored ultimate strength, work to failure, and yield strength/ultimate strength to 79%, 75%, and 119% of native values, respectively.
  
  
  CONCLUSIONS
  A biodegradable isocyanate-terminated glue increases the force at which nucleus protrusion occurs, and it limits herniations during endurance or ultimate strength tests. Biomechanical tests in a bioreactor provide a low-cost assessment for annulus repair strategies; however, the clinical efficacy needs to be further addressed using long-term in vivo studies.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, the Netherlands †MOVE Research Institute Amsterdam, Amsterdam, the Netherlands ‡Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands §Department of Orthopedics, Orthopedic Research Laboratory, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands ¶Department of Biomedical Engineering, University of Groningen, University Medical Centre Groningen, W.J. Kolff Institute, Groningen, the Netherlands; and ‖Department of Human Movement Sciences, VU University, Amsterdam, the Netherlands.
authors.forename: Pieter-Paul A
authors.initials: PP
authors.lastname: Vergroesen
authors.forename: Agnieszka I
authors.initials: AI
authors.lastname: Bochyn Ska
authors.forename: Kaj S
authors.initials: KS
authors.lastname: Emanuel
authors.forename: Shahriar
authors.initials: S
authors.lastname: Sharifi
authors.forename: Idsart
authors.initials: I
authors.lastname: Kingma
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Grijpma
authors.forename: Theodoor H
authors.initials: TH
authors.lastname: Smit
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry / Q000494:pharmacology; D001696:Biomechanical Phenomena; D017586:Diskectomy; D006041:Goats; D007403:Intervertebral Disc / Q000187:drug effects / Q000502:physiology / Q000601:surgery; D008954:Models, Biological; D014014:Tissue Adhesives / Q000737:chemistry / Q000494:pharmacology; D058106:Wound Closure Techniques
chemical_list: D001672:Biocompatible Materials; D014014:Tissue Adhesives