Abstract
Introduction: This abstract describes the development of an effective procedure for removing as much nucleus as possible from an intervertebral disc with minimal disruption to the annulus. The procedure was developed on cadaveric sheep discs which are well established as a model for human discs in studies of this kind. The purpose of the study was to develop a method for removing the nucleus as part of a laboratory study of nucleus replacement; however, it is also intended to guide the development of procedures for the removal of residual nucleus when indicated in surgical procedures that involve replacing the nucleus with synthetic materials.
Methods: All procedures were performed via a 3 mm trocar. Four procedures were compared: (I) unilateral approach using rongeurs alone, (II) bilateral approach using rongeurs alone, (III) unilateral approach using rongeurs followed by chymopapain and (IV) bilateral approach using rongeurs followed by chymopapain. Chymopapain was administered as a solution (30 units in 0.1 cm3 de-ionised water) to a disc at 37oC. For each procedure (I–IV) 14 discs were used.
Results: The percentages of nucleus removed were: (I) 34 ± 2%, (II) 41 ± 2%, (III) 52 ± 3% and (IV) 75 ± 8%; ANOVA showed a significant differences between the four sets of results (P < 0.05).
Conclusions: Significantly more nucleus is removed using a bilateral than a unilateral approach; significantly more nucleus is removed if chymopapain is used in addition to rongeurs.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
