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Collateral effects of targeting the nucleus pulposus via a transpedicular or transannular surgical route: a combined X-ray, MRI, and histological long-term descriptive study in sheep

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Abstract

Purpose

In the context of regenerative medicine strategies, based in particular on the injection of regenerative cells, biological factors, or biomaterials into the nucleus pulposus (NP), two main routes are used: the transpedicular approach (TPA) and the transannular approach (TAA). The purpose of our study was to compare the long-term consequences of the TPA and the TAA on intervertebral disc (IVD) health through a longitudinal follow-up in an ovine model.

Methods

The TPA and the TAA were performed on 12 IVDs from 3 sheep. Six discs were left untreated and used as controls. The route and injection feasibility, as well as the IVD environment integrity, were assessed by MRI (T2-weighted signal intensity), micro-CT scan, and histological analyses (Boos’ scoring). The sheep were assessed at 1, 3, and 7 months.

Results

Both the TPA and the TAA allowed access to the NP. They both induced NP degeneration, as evidenced by a decrease in the T2wsi and an increase in the Boos’ scores. The TPA led to persistent end-plate defects and herniation of NP tissue (Schmorl’s node-like) after 7 months as well as the presence of osseous fragments in the NP.

Conclusions

The TPA induced more severe lesions in IVDs and vertebrae compared to the TAA. The lesions induced by the TPA are reason to consider whether or not this route is optimal for studying IVD regenerative medicine approaches.

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Acknowledgements

This study was supported by grants from the Société Française de Neurochirurgie, the Société Française de Chirurgie du Rachis, the Agence de la Biomédecine, the Institut National de la Santé et de la Recherche Médicale (INSERM), the Région des Pays de la Loire, ANR générique 2014 (REMEDIV project), the Fondation pour la Recherche Médicale FRM Bioingénierie (DBS20131128442), the Région des Pays de la Loire Research Program "Longévité Mobilité Autonomie" (LMA). The authors gratefully acknowledge the technical assistance that they received from the personnel of the CRIP (i.e. Patrice Roy, Christian Raphael, Stéphane Madec, Ingrid Leborgne, and Gildas Vaillant) and the SC3M platform (Service Commun de Microscopie électronique, Microcaractérisation et Morpho-histologie-imagerie fonctionnelle of the INSERM UMS016-SFR François Bonamy), as well as Sophie Domingues (Longdom publishing) for editing the manuscript.

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Author notes

  1. Cyrille Decante, Johann Clouet: Co-first author

Authors and Affiliations

  1. INSERM UMR 1229, RMeS, Regenerative Medicine and Skeleton, School of Dental Surgery, ONIRIS, Université de Nantes, 1-Place Alexis Ricordeau, 44042, Nantes Cedex I, France

    Cyrille Decante, Johann Clouet, Antoine Hamel, Olivier Gauthier, Dominique Rouleau, Julie Lesoeur, Boris Halgand, Catherine Le Visage, Jérôme Guicheux & Marion Fusellier

  2. CHU Nantes, PHU5 HME Chirurgie Infantile, 44093, Nantes, France

    Cyrille Decante & Antoine Hamel

  3. UFR Odontologie, Université de Nantes, 44042, Nantes, France

    Johann Clouet, Julie Lesoeur, Boris Halgand & Jérôme Guicheux

  4. UFR Sciences Biologiques et Pharmaceutiques, Université de Nantes, 44035, Nantes, France

    Johann Clouet

  5. CHU Nantes, Pharmacie Centrale, PHU11, 44093, Nantes, France

    Johann Clouet

  6. Department of Neurosurgery, CHU Angers, 49033, Angers, France

    Luc Le Fournier

  7. Department of Surgery,CRIP, Oniris College of Veterinary Medicine, Food Science and Engineering, 44307, Nantes, France

    Olivier Gauthier

  8. Department of Diagnostic Imaging, CRIP, Oniris College of Veterinary Medicine, Food Science and Engineering, 44307, Nantes, France

    Dominique Rouleau & Marion Fusellier

  9. CHU Nantes, 44093, Nantes, France

    Boris Halgand

  10. CHU Nantes, PHU4 OTONN, 44093, Nantes, France

    Jérôme Guicheux

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  1. Cyrille Decante
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Correspondence to Jérôme Guicheux.

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All applicable international, national, and/or institutional guidelines for the care and use of animals were adhered to. All procedures involving animals performed in this study were in accordance with the ‘‘3Rs’’ rule (Replacement, Reduction, and Refinement), the ethics standards of the institution and the practice at which the study was performed.

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Decante, C., Clouet, J., Hamel, A. et al. Collateral effects of targeting the nucleus pulposus via a transpedicular or transannular surgical route: a combined X-ray, MRI, and histological long-term descriptive study in sheep. Eur Spine J 30, 585–595 (2021). https://doi.org/10.1007/s00586-020-06602-5

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