Biomechanical evaluation of annulus fibrosus repair with scaffold and soft anchors in an ex vivo porcine model

Introduction: Altered biomechanical properties, due to intervertebral disc (IVD) degeneration and missing nucleus fibrosus, could be thought as one of the reasons for the back pain many herniation patients experience after surgery. It has been suggested to repair annulus fibrosus (AF) to restore stability and allow nucleus pulposus (NP) replacement and furthermore prevent reherniation. The aim of this study was to evaluate a new method for closing a defect in AF for use in herniation surgery. Methods: Our repair method combines a polycaprolactone (PCL) scaffold plugging herniation and soft anchors to secure the plug. Ex vivo biomechanical testing was carried out in nine porcine lumbar motion segments. Flexion–extension, lateral bending and rotation were repeated three times: first in healthy specimens, second with a full thickness circular defect applied, and third time with the specimens repaired. Finally push out tests were performed to check whether the plug would remain in. Results: Tests showed that applying a defect to the AF increases the range of motion (ROM), neutral zone (NZ) and neutral zone stiffness (NZS). In flexion/extension it was found significant for ROM, NZ, and NZS. For lateral bending and rotation a significant increase in ROM occurred. After AF repair ROM, NZ and NZS were normalized. All plugs remained in the AF during push out test up until 4000 N, but NP was squeezed out through the pores of the scaffold. Discussion: A defect in the AF changes the biomechanical properties in the motion segment, changes that point to instability. Repairing the defect with a PCL plug and soft anchors brought the biomechanical behavior back to native state. This concept is promising and might be a viable way to repair the IVD after surgery.