Stiffness: a key mechanical factor in normal, degenerate and artificial lumbar intervertebral discs

Intervertebral disk;Intervertebral disk prostheses;Intervertebral disk--Diseases;Backache;Backache--Treatment;Lumbar vertebrae--Movements

Ross, Edward R. S.

University:University of St Andrews

Department:Medicine (School of)

关键词: Intervertebral disk;    Intervertebral disk prostheses;    Intervertebral disk--Diseases;    Backache;    Backache--Treatment;    Lumbar vertebrae--Movements;   

Others  :  https://research-repository.st-andrews.ac.uk/bitstream/handle/10023/3213/EdwardRossMDThesis.pdf?sequence=3&isAllowed=y

来源: DR-NTU

【 摘 要 】

This thesis describes the development of artificial disc technology for the replacement of intervertebral discs in the human lumbar spine. The clinicalproblem is back pain. There may be a relationship between certain forms ofback pain and disc degeneration. The mechanical properties of human intervertebral discs are examined in detail. The genetic basis of disc degeneration ispresented. The hypothesis is that such degeneration leads to a loss of normalstiffness in the segments affected leading to abnormal mechanical behaviourwhich in turn leads to pain. The evidence for this is presented. The development of surgical solutions to relieve back pain, from fusion through firstgeneration mechanical artificial discs to elastomeric designs, is traced. Theauthor‘s personal contributions to this area of knowledge are set out. Theappreciation of the requirement for a restoration of physiological stiffness isargued throughout, showing where fusion and first generation discs have notmet the clinical aim of pain relief, because they have not restored physiological stiffness. The path to an elastomeric, viscoelastic, polyhydrocarbon, rubbersolution in the form of the “Freedom“ disc has filled 17 years of the author‘sacademic pursuits. It will be shown that this technology may represent a possible solution to the clinical problem. Failure is part of all new advancementand this too is presented, to show how that has influenced thinking, producingoriginal ideas to overcome these failures. Providing lessons are learned fromthese failures then our patients in the future will benefit.