• Cyrille Decante, Johann Clouet, Antoine Hamel, Luc Le Fournier, Olivier Gauthier, Dominique Rouleau, Julie Lesoeur, Boris Halgand, Catherine Le Visage, Jérôme Guicheux, and Marion Fusellier.
• INSERM UMR 1229, RMeS, Regenerative Medicine and Skeleton, School of Dental Surgery, ONIRIS, Université de Nantes, 1-Place Alexis Ricordeau, 44042, Nantes Cedex I, France.
• Eur Spine J. 2021 Feb 1; 30 (2): 585-595.

PurposeIn the context of regenerative medicine strategies, based in particular on the injection of regenerative cells, biological factors, or biomaterials into the nucleus pulposus (NP), two main routes are used: the transpedicular approach (TPA) and the transannular approach (TAA). The purpose of our study was to compare the long-term consequences of the TPA and the TAA on intervertebral disc (IVD) health through a longitudinal follow-up in an ovine model.MethodsThe TPA and the TAA were performed on 12 IVDs from 3 sheep. Six discs were left untreated and used as controls. The route and injection feasibility, as well as the IVD environment integrity, were assessed by MRI (T2-weighted signal intensity), micro-CT scan, and histological analyses (Boos' scoring). The sheep were assessed at 1, 3, and 7 months.ResultsBoth the TPA and the TAA allowed access to the NP. They both induced NP degeneration, as evidenced by a decrease in the T2wsi and an increase in the Boos' scores. The TPA led to persistent end-plate defects and herniation of NP tissue (Schmorl's node-like) after 7 months as well as the presence of osseous fragments in the NP.ConclusionsThe TPA induced more severe lesions in IVDs and vertebrae compared to the TAA. The lesions induced by the TPA are reason to consider whether or not this route is optimal for studying IVD regenerative medicine approaches.

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