Comparison of Ultrasound-Guided Percutaneous and Open Surgery Approaches in The Animal Model of Tumor Necrosis Factor-Alpha-Induced Disc Degeneration

Document Type : Original Article


1 Department of Applied Cell Sciences, Faculty of Basic Sciences and Advanced Medical Technologies, Royan Institute, ACECR, Tehran, Iran

2 Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran

3 Department of Radiology and Surgery, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran

4 Animal Core Facility, Reproductive Biomedicine Research Center, Royan Institute for Animal Biotechnology, ACECR, Tehran, Iran

5 Department of Developmental Biology, School of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran

6 Advanced Therapy Medicinal Product Technology Development Center (ATMP-TDC), Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran

7 Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran


Objective: Animal models provide a deeper understanding about various complications and better demonstrate
the effect of therapeutic approaches. One of the issues in the low back pain (LBP) model is the invasiveness of
the procedure and it does not mimic actual disease conditions in humans. The purpose of the present study was
to compare the ultrasound-guided (US-guided) percutaneous approach with the open-surgery method in the tumor
necrosis factor-alpha (TNF-α)-induced disc degeneration model for the first time to showcase the advantages of this
recently developed, minimally invasive method.
Materials and Methods: In this experimental study, eight male rabbits were divided into two groups (open-surgery and
US-guided). Relevant discs were punctured by two approaches and TNF-α was injected into them. Magnetic resonance
imaging (MRI) was performed to assess the disc height index (DHI) at all stages. Also morphological changes (annulus
fibrosus, nucleus pulposus) were evaluated by assessing Pfirrmann grade and histological evaluation (Hematoxylin &
Results: The findings indicated targeted discs became degenerated after six weeks. DHI in both groups was significantly
reduced (P<0.0001), however the difference was not significant between the two groups. In the open-surgery group,
osteophyte formation was seen at six and eighteen weeks after the puncture. Pfirrmann grading revealed significant
differences between injured and adjacent uninjured discs (P<0.0001). The US-guided method indicated significantly
fewer signs of degeneration after six (P=0.0110) and eighteen (P=0.0328) weeks. Histological scoring showed
significantly lower degeneration in the US-guided group (P=0.0039).
Conclusion: The US-guided method developed a milder grade condition and such a model better mimics the chronic
characteristics of LBP and the procedure is more ethically accepted. Therefore, the US-guided method could be a merit
approach for future research in this domain as a safe, practical and low-cost method.


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