Article

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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Langue : ANGLAIS