For anybody who has ever suffered the pain caused by a herniated disc, a new treatment approach announced in the pages of Science Translational Medicine will make perfect sense. According to lead researcher professor Lawrence Bonassar of Cornell University in Ithaca, New York, he and his colleagues have developed a process for repairing herniation that he compares to fixing a flat tire.
To understand the new approach, all that is needed is a simple understanding of what happens when one of our intervertebral discs is damaged. These discs have a rubbery exterior with a soft center, and when the exterior develops a crack or is in some other way damaged, the soft center pushes through. Though some people can suffer a herniated disc without having any symptoms, in others the center comes into contact with nearby nerves, leading to pain, numbness or weakness in the extremities.
For some people, nothing but rest or other conservative treatments are effective and no further intervention is required, but others require minimally invasive surgical procedures. The new approach, called combined nucleus pulposus augmentation and annulus fibrosus repair, would be incorporated into those surgeries, offering improved outcomes.
As described in the published article, Dr. Bonassar’s team found that they could inject hyaluronic acid into the soft inner center of a herniated disc in order to reinflate and restore the internal pressure that was lost during the herniation. Following this injection, a specialized collagen patch would be placed on the crack or tear on the disc’s exterior. A photoactive vitamin B derivative incorporated into the patch makes it sensitive to light, which the surgeon applies following the procedure so that the patch bonds to the surface of the disc. The entire procedure adds only ten minutes to the surgery, and the patch provides a medium on which new tissue can grow and strengthen the disc’s surface.
According to Dr. Bonassar, “This is really a new avenue and a whole new approach to treating people who have herniated discs. We now have potentially a new option for them, other than walking around with a big hole in their intervertebral disc and hoping that it doesn’t re-herniate or continue to degenerate. And we can fully restore the mechanical competence of the disc.”
“The idea is, if you have a herniation and you’ve lost some material from the nucleus, now we can re-inflate the disc with this hyaluronic acid gel and put the collagen cross-linking seal on the outside. Now we’ve refilled the tire and sealed it. What the paper shows is that both of those things are critical.”
So far, Dr. Bonassar and his colleague Roger Härtl, a neurosurgeon at New York-Presbyterian Hospital, have tested the procedure on sheep and have found it successful. They say that it can be used in conjunction with discectomy and other spinal procedures and therapies.
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