Histological and Molecular Structure Characterization of Annular Collagen after Intradiskal Electrothermal Annuloplasty

HSS Journal


Gregory E. Lutz, MD

Gregory E. Lutz, MD

Physiatrist-in-Chief Emeritus, Hospital for Special Surgery
Associate Attending Physiatrist, Hospital for Special Surgery
Associate Professor of Clinical Rehabilitation Medicine, New York-Presbyterian Hospital

Stephen Doty, PhD

Senior Scientist, Hospital for Special Surgery

Daniel Southern, MD
Physiatry Department
Hospital for Special Surgery

Ana Bracilovic, MD
Physiatry Department
Hospital for Special Surgery

Paul West, PhD
Research Division
Mineralized Tissue Section
Hospital for Special Surgery

Mila Spevak, PhD
Research Division
Mineralized Tissue Section
Hospital for Special Surgery

Nancy Pleshko Camacho, PhD

Abstract
The mechanism of pain relief of intradiskal electrothermal annuloplasty (IDET) in the treatment of lumbar diskogenic pain is uncertain. Theories include sealing of annular fissures via collagen denaturation and contraction. Prior studies offer conflicting qualitative data on the ability of IDET to denature collagen. The objective of the present study is to evaluate IDET treatment effect onannular collagen using quantitative data supplied by Fourier-transform infrared imaging spectroscopy.

The posterior annulus of disks (n = 3) from an intact human cadaveric spine at room temperature were treated with two different radiothermal catheters using standard intradiskal electrothermal annuloplasty (IDET) heating protocols. Disks were dissected free with catheters in place and fixed in formalin. Channels created by the catheters were marked and catheters were removed. Tissue samples of treated areas adjacent to the channels and internal control areas from the same disk were stained for light microscopy and placed on barium sulfate windows for Fourier transform infrared imaging spectroscopy (FT-IRIS) analysis.
Treated areas showed evidence of disruption in the fibrillar organization of annular collagen by light microscopy compared to intact stroma from control areas. Quantitative FT-IRIS analysis compared ratios of wavenumber regions known to be sensitive to collagen denaturation. Mean values for the ratios amide II/1,338 cm-1 (137.21 ± 25.84 treated, 76.94 ± 16.77 control) and 1,640/1,660 cm-1 (0.98 ± 0.03 treated, 0.89 ± 0.03 control) were significantly different between treated and control samples (p < 0.001), indicating a breakdown in collagen integrity. Separate analysis by catheter type suggests that catheter design may impact treatment effect.

This article appears in HSS Journal: Volume 2, Number 1.
View the full article at springerlink.com.


About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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