Disc height loss and restoration via injectable hydrogel influences adjacent segment mechanics in-vitro

• Disc height loss is a severe pathological change to the intervertebral disc.
• Injectable hydrogels could potentially restore height and kinematics.
• Disc height loss reduced motion at an affected spine segment.
• Disc height loss increased motion at a segment adjacent to the affected level.
• Hydrogel injection restored height and kinematics of multi-articulated spine specimens.

BackgroundHeight loss can have a profound influence on the local mechanical environment of the disc. While disc height loss is incorporated into scales of degeneration, its direct influence on spine kinematics is unclear. Further, there is a need for minimally invasive techniques to restore disc height; injectable hydrogels are a potential solution. Tandem investigation of disc height loss and subsequent restoration will enhance understanding of spine dysfunction and aberrant movement.MethodsTwenty porcine spine specimens with two functional segments were tested in repeated flexion and extension. Relative angular displacement of each segment was measured with full specimen disc height, disc height loss in one of the segments (superior or inferior), and disc height restoration via hydrogel injection.FindingsDisc height loss decreased the range of motion at the affected segment and increased the range of motion at the adjacent segment. Relative angular displacement decreased at the affected segment by 13.8% (SD = 5.3%) and 4.5% (SD = 2.1%) for specimens with height loss in the superior and inferior discs respectively. Hydrogel injection was able to restore segmental kinematics to the pre-injury state, with 12.7% (SD = 5.5%) and 6.4% (SD = 4.2%) of motion regained at the affected segment for superior and inferior disc height loss specimens respectively.InterpretationAcute disc height loss reduces motion at an affected segment, while increasing motion at an adjacent segment in-vitro; relative motion appears to be governed by local stiffness. Injectable hydrogels show promise in their ability to restore kinematics to segments with disc height loss.