Le disque intervertébral est principalement composé de deux types de tissu : le nucleus pulposus au centre contenu par l'annulus fibrosus en périphérie.Le nucleus est relativement bien décrit dans la littérature contrairement à l'annulus dont la constitution bi-phasique couplée à une structure à fibres orientées reste délicate à modéliser. La caractérisation hydro-chimio-mécanique représente un point clé dans la compréhension des phénomènes qui régissent le comportement de l'organe.Pour répondre au manque d'information, deux axes de travail sont mis en place : expérimental et numérique.La réalisation de tests de traction cyclique associés à des techniques de corrélation d'images permet de fournir une base de données complète du comportement.Elle est ensuite utilisée pour identifier un modèle hydro-chimio-mécanique qui traduit le comportement non-linéaire, anisotrope, dissipatif ainsi que la sensibilité aux variations d'environnement chimique du tissu observés expérimentalement.L'intérêt majeur de cette méthode est l'identification simultanée de l'ensemble des paramètres du modèle au cours de sollicitations proches des conditions physiologiques sur chacune des éprouvettes.Ce protocole réduit ainsi les incertitudes liées aux variabilités inter-individus et inter-localisations pour obtenir des valeurs de paramètres plus fiables.La formulation identifiée permettra de proposer un modèle compréhensif des transferts de fluide impliqués dans les processus de nutrition cellulaire.Ce sujet s'intègre dans une réflexion plus large relative à la compréhension des couplages hydro-chimio-mécaniques dans les tissus biologiques.L'enjeu est de quantifier l'impact des stimuli mécaniques sur l'évolution des tissus humains et leur adaptation aux conditions environnementales. / Intervertebral disc is mainly divided into two parts : nucleus pulposus surrounding by annulus fibrosus.Nucleus is relatively well described in literature, on the other hand annulus remains difficult to model due to its bi-phasic constitution coupled with an oriented fibres structure.Hydro-chemo-mechanical characterization represent a key point to reach a better understanding of this organ.To overcome this lack of knowledge, two axes are developed in this work : experimental and numerical.Cyclic tensile tests associated to digital image correlation techniques allow to obtain a large amount of data on global tissue behaviour.It permit to identify a hydro-chemo-mechanical model which takes in account the non-linear, anisotropic and dissipative behaviours.It also highlights sensibility to chemical variations in tissue environment observed experimentally.The most important point of this work is the simultaneous parameter identification performed on each sample during solicitations similar to in vivo conditions.This protocol reduce inter-individuals and inter-localisations discrepancies and leads to an accurate bundle of parameters.The formulation aims to accurately model fluid motion inside intervertebral disc tissues which is related to cell nutrition, growth and homoeostasis.This work is involved in a larger problematic about hydro-chemo-mechanical coupling within biological tissues.It will allow to quantify mechanical stimuli influence on human tissues evolution and adaptation to environment conditions.

Orientador: João Batista de Miranda / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:02:57Z (GMT). No. of bitstreams: 1 Pasqualini_Wagner_D.pdf: 1157517 bytes, checksum: f927ba791a4b318be74e60bad2138135 (MD5) Previous issue date: 2012 / Resumo: Modelo de Estudo: Estudo diagnóstico Transversal de caso controle. Objetivos: comparar pacientes com estenose do canal lombar com indicação de cirurgia e um grupo controle, assintomáticos para esta doença, levando em consideração imagens de ressonância magnética (RM) e o questionário de Oswestry. Material e Método: Vinte e três pacientes com estenose do canal lombar foram comparados com um grupo controle de 17 indivíduos. Todos foram submetidos a RM e responderam ao questionário de Oswestry. Medidas qualitativas foram descritas segundo os grupos com uso de frequências absolutas e relativas e, verificada a existência de associação dessas medidas com uso do teste exato de Fisher. Medidas quantitativas foram descritas e comparadas entre os grupos com uso do teste Mann-Whitney. O teste de Spearman foi utilizado para avaliar a correlação entre os grupos. Resultados: Lombalgia foi a queixa mais frequente nos dois grupos. O índice de Oswestry mostrou média de percentual de invalidez de 45,69% no Grupo Estenose e 11,60% no Grupo Controle. A RM mostrou que a área de secção transversa do saco dural, o diâmetro do canal e a avaliação dos forames e recesso lateral estavam alterados em ambos os grupos. Conclusões: Não houve relação entre o grau de estenose do canal lombar mensurado em exame de RM com o índice de Oswestry em ambos os grupos / Abstract: Study design: Transversal Case-control, diagnostic study. Objectives: To verify the relationship between the degree of lumbar spinal canal stenosis (LCS), as seen in magnetic resonance imaging (MRI), and the severity of disability as seen in the Oswestry Index, in patients with LCS compared to controls without a diagnosed LCS. Methods: Twenty-three patients with a previous diagnosis of LCS were compared with a control group of 17 volunteers. All participants underwent MRI and answered the Oswestry questionnaire. Qualitative data were described according to the groups with the use of absolute and relative frequencies, and the association of these measures was checked by using the Fisher exact test. Quantitative measures were described and compared between groups using the Mann-Whitney test. Spearman's test was used as well. Results: Low back pain was the most frequent complaint in both groups. The Oswestry index showed average percentage of disability of 45.69% in patients with stenosis and 11.60% in the control group. MRI revealed that the dural sac cross-sectional area (DCSA), the diameter of the canal and the evaluation of lateral recesses and foramina were equally changed in both groups. Conclusions: There was no correlation between the degree of lumbar canal stenosis measured on MRI with the Oswestry Disability Index in both groups / Doutorado / Cirurgia / Doutor em Cirurgia

La dégénérescence des disques intervertébraux (DD) est un processus naturel qui touche une grande partie de la population. Toutefois, elle peut devenir pathologique et ainsi être accélérée par de multiples facteurs et conduire à un dysfonctionnement précoce des disques lombaires. La DD est un phénomène asymptomatique, ce qui le rend délicat à diagnostiquer précocement. Dans ce cadre, le présent travail vise à développer une méthodologie de diagnostic de la DD utilisant imagerie médicale et modélisation biomécanique.Les disques intervertébraux (DIV) sont des articulations fibro-cartilagineuses qui lient les vertèbres du rachis entre elles. Ils ont pour rôle de supporter et redistribuer les chargements appliqués au rachis tout en assurant sa mobilité. Le DIV peut être assimilé d’un point de vue mécanique à un milieu poreux biologique dont le squelette est formé par la matrice extracellulaire (MEC) et la phase fluide par son contenu hydrique. C’est un milieu hétérogène et anisotrope. Possédant une pression osmotique interne élevée, les DIV ne sont pas vascularisés et possèdent un contenu hydrique important dans lesquels les nutriments cellulaires diffusent à partir des vertèbres adjacentes. Cette particularité rend le fonctionnement des disques très dépendant de la régulation en eau en particulier lorsque ces derniers sont soumis à des sollicitations mécaniques non physiologiques.L’une des clés dans l’élaboration d’un diagnostic fiable de la DD peut être de déterminer de manière objective certaines des caractéristiques internes au disque relatives à son hydratation. Dans le présent travail, une méthodologie de diagnostic quantitatif de la viabilité discale et plus largement de la DD est ainsi proposée. Cette méthodologie se base sur un couplage entre l’imagerie médicale et l’analyse par modélisation du comportement biomécanique du DIV. Un modèle physique biphasique du DIV est développé à l’aide de données déduites d’images IRM. Ce modèle tient compte de l’anisotropie du DIV et des effets induits par les déformations mécaniques sur le processus de transport nutritif.La partie mécanique du modèle est tout d’abord validée en utilisant des résultats d’essais de relaxation réalisés précédemment par l’équipe de biomécanique d’IRPHE. Le modèle est à même de reproduire la distribution de la porosité à l’intérieur du DIV et la perte d’eau suite à un effort mécanique. Cela permet de confirmer la fiabilité de la méthodologie de diagnostic développée pour les cas étudiés. En intégrant le couplage mécano-métabolique, la réponse biomécanique du DIV à des chargements quasi statiques et cycliques est ensuite analysée. / Intervertebral disc degeneration (DD) is a natural process affecting a large part of the population. However, it can be accelerated by several factors and then become associated to lumbar disc pathologies. Given that the DD is symptomless, it is complicated to diagnostic it early. In this context, the present work aims to develop a new methodology of DD diagnostic based on medical imaging and biomechanical modeling.The intervertebral discs (IVD) are fibro-cartilaginous joints that connect vertebrae together ensuring their relative motion. They support and distribute loads applied on the spine. Mechanically, the IVD can be assimilated to a biological porous media in which the solid phase is composed of the extracellular matrix (MEC) and the fluid phase is formed by water content. It is a non-homogeneous and anisotropic component. The IVD is nonvascularized and characterized by a high water content in which cell nutrients diffuses from the adjacent vertebrae. Given this latter particularity, the porosity of the IVD presents a key factor in in its functioning especially when exposed to mechanical non-physiological loads. One of the main keys in the elaboration of a reliable DD diagnostic is to determine objectively some of the IVD interne properties related to its water content. In the present work, a new quantitative methodology of DD diagnostic is proposed. This method is based on a coupling between the medical imaging and the IVD biomechanical behavior modeling. A biphasic IVD model is developed using data from MRI imaging. This model takes into account the anisotropy of the IVD and the effect of the mechanical deformation on the nutrient transport process.The mechanical part of the developed model was firstly validated using results of relaxation tests previously performed by the biomechanics staff of IRPHE. The model is able to predict water distribution within the IVD and the water loss as response to a mechanical load. These results confirm the reliability of the developed diagnostic methodology for the studied cases. The biomechanical response to quasi-static and cyclic loads is then analyzed. The present work proposes and evaluates a new methodology of DD quantitative diagnostic. It also analyzes and compares mechanical and metabolic responses to quasi-static and cyclic loads.

Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The extrusion of the intervertebral disc is the most common cause of neurological disorders in dogs. Extrusion (Hansen type I) or protrusion (Hansen type II) of the disc may occur and consequent compression of the spinal cord and / or nerve roots. The objective of this thesis was, in a first step, to carry out a retrospective study for the epidemiological survey of the disease and to evaluate dogs in different degrees of neurological dysfunction after surgical decompression of the spinal cord. In article 1, of the 110 dogs with thoracolumbar DDIV submitted to surgical decompression, 74 (67.3%) improved clinical signs, 54 (49.1%) considered satisfactory and 20 (18.2%) were partially satisfactory. In article 2, of the 17 dogs with extrusion (Hansen type I) of thoracolumbar intervertebral disc without perception to deep pain (PDP) submitted to clinical treatment, nine (52.9%) presented satisfactory functional recovery, one (5.9%) satisfactory recovery without pain (Spinal walk) and seven (41.2%) were unsatisfactory. Of the 20 dogs submitted to surgical treatment, 10 (50%) presented satisfactory functional recovery, three (15%) satisfactory recovery without deep pain (spinal gait) and seven (35%) were unsatisfactory. There was no significant difference in functional recovery between dogs undergoing clinical or surgical treatment. In view of the results, the surgical treatment promotes a satisfactory functional recovery in the most of dogs with thoracolumbar disc extrusion, being the percentage of relapse in animals submitted to this type of therapy low. The functional clinical recovery in dogs with paraplegic thoracolumbar intervertebral disc extrusion and without perception to deep pain over 48 hours can occur independently of the treatment instituted. Other studies are needed with more cases to reinforce the evidence found. / A extrusão do disco intervertebral é uma das causas mais comuns de alterações neurológicas em cães, sendo provocada pela degeneração do disco intervertebral. Pode ocorrer extrusão (Hansen tipo I) ou protrusão (Hansen tipo II) do disco e consequente compressão da medula espinhal e/ou raízes nervosas. O objetivo desta tese foi, em uma primeira etapa, realizar um estudo retrospectivo para levantamento epidemiológico da doença e avaliar clinicamente os cães submetidos a descompressão cirúrgica da medula espinhal em diferentes graus de disfunção neurológica. Na segunda etapa avaliou, mediante estudo prospectivo, a recuperação funcional de cães paraplégicos e sem percepção à dor profunda por mais de 48 horas em decorrência de extrusão de disco intervertebral toracolombar (Hansen tipo I) submetidos ao tratamento clínico ou cirúrgico. No artigo 1, dos 110 cães com DDIV toracolombar submetidos a descompressão cirúrgica, 74 (67,3%) tiveram melhora dos sinais clínicos, sendo 54 (49,1%) considerados satisfatórios e 20 (18,2%) parcialmente satisfatórios. No artigo 2, dos 17 cães com extrusão (Hansen tipo I) de disco intervertebral toracolombar sem percepção à dor profunda (PDP) submetidos ao tratamento clínico, nove (52,9%) apresentaram recuperação funcional satisfatória, um (5,9%) recuperação satisfatória sem dor profunda (andar espinhal) e sete (41,2%) insatisfatória. Já, dos 20 cães submetidos ao tratamento cirúrgico, 10 (50%) apresentaram recuperação funcional satisfatória, três (15%) recuperação satisfatória sem dor profunda (andar espinhal) e sete (35%) insatisfatória. Não houve diferença significativa em relação a recuperação funcional entre em cães submetidos ao tratamento clínico ou cirúrgico. Diante dos resultados, o tratamento cirúrgico promove recuperação funcional satisfatória na maioria dos cães com extrusão de disco toracolombar, sendo baixo o percentual de recidiva em animais submetidos a este tipo de terapia. A recuperação clínica funcional em cães com extrusão de disco intervertebral toracolombar paraplégicos e sem percepção à dor profunda superior a 48 horas pode ocorrer independente do tratamento instituído. Outros estudos são necessários com maior número de casos para reforçar as evidências encontradas.

Abstract Earlier studies on lumbar degenerative imaging findings in magnetic resonance imaging (MRI) have been done mainly in adult populations and the associations of degenerative findings with low back pain (LBP) are controversial. Only a few studies have involved adolescents and young adults. Heritability has been acknowledged as the only explicit risk factor of disc degeneration (DD). This study investigated the prevalence and environmental determinant of lumbar degenerative findings in MRI and their association with low back symptoms among young adults. The data were based on two physical assessments, three questionnaires and one lumbar MRI that were executed on members of the Oulu Back Study (n=558), a subsample of Northern Finland Birth Cohort 1986, between 16 and 21 years of age. Prevalences of lumbar DD (54%), bulging (25%), protrusion (18%) and Schmorl’s node (17%) were high, whereas other degenerative findings were rare among young adults. Males had higher prevalence of DD and Schmorl’s nodes than females. DD and herniations were associated with low back symptoms. On the other hand, symptoms were present among subjects without DD or other abnormal findings on MRI. Of the environmental determinants, high body mass index and MRI-based obesity measurements of visceral adiposity were associated with lumbar DD among males. Waist circumference and smoking showed a comparable association with DD among males, but the level of physical activity was not associated with DD in either gender. Low back symptoms are more common among young adults with a higher degree of DD or presence of disc herniation. Smoking and overweight are associated with lumbar DD among young male adults. / Tiivistelmä Aikaisempia tutkimuksia magneettikuvantamisella (MK) todetuista lannerangan rappeumamuutoksista ja niiden yhteyksistä alaselkäkipuun on tehty lähinnä aikuisväestöllä ja tulokset ovat ristiriitaisia. Vain muutamia tutkimuksia on tehty alle 25-vuotiailla. Välilevyrappeuman mahdollisista riskitekijöistä vain perimästä on vahvaa näyttöä. Tässä tutkimuksessa tarkasteltiin MK:lla todettujen lannerangan rappeumamuutosten esiintyvyyttä, niihin vaikuttavia ympäristötekijöitä ja yhteyttä alaselkäoireisiin nuorilla aikuisilla. Tutkimuksen aineisto perustui kahteen kliiniseen tutkimukseen, kolmeen kyselyyn ja yhteen MK:een, jotka toteutettiin Pohjois-Suomen syntymäkohortti 1986:een kuuluville Oulun selkätutkimuksen koehenkilöille (n=558) 16-21 vuoden iässä. Lannerangan välilevyrappeumalla (54 %), välilevyn pullotuksilla (bulge; 25 %), sellaisilla välilevyn pullistumilla jotka eivät läpäisseet selkärangan takimmaista pitkittäissidettä (protruusio; 18 %) sekä päätelevyn läpi suuntautuvilla välilevyn pullistumilla (Schmorlin keräset; 17 %) oli korkea esiintyvyys nuorilla aikuisilla, kun taas muut kuvantamislöydökset olivat harvinaisia. Välilevyrappeuma ja Schmorlin keräset olivat yleisempiä miehillä. Sekä välilevyrappeuma että pullistumat olivat yhteydessä alaselkäoireisiin molemmilla sukupuolilla, mutta kaikilla oireisilla ei todettu poikkeavia löydöksiä MK:ssa. Ympäristötekijöistä korkea kehon painoindeksi ja MK:sta mitatut rasvan määrää mittaavat muuttujat olivat miehillä yhteydessä välilevyrappeumaan. Miehillä vyötärönympärys ja tupakointi olivat heikommin yhteydessä välilevyrappeumaan, kun taas liikunta-aktiivisuus ei ollut kummallakaan sukupuolella yhteydessä rappeumaan. Alaselkäoireet ovat yleisempiä nuorilla aikuisilla, joilla on vaikea-asteisempi välilevyrappeuma tai välilevyn pullistuma. Tupakointi ja ylipaino ovat yhteydessä lannerangan välilevyrappeumaan nuorilla aikuisilla miehillä.

The intervertebral disc (IVD), situated between adjoining vertebrae, consists of the gelatinous nucleus pulposus (NP) in the centre surrounded by the tougher annulus fibrosus (AF). Its main roles are to distribute loads and to act as joints. With aging, degenerative disc disease (DDD) occurs due to an imbalance in anabolic and catabolic events in the IVD, which results in a loss of function. Lower back pain (LBP) affects 84% of people at some point in their lifetime and is strongly associated with DDD. Current LBP treatments have limited long term efficacy and are symptomatic rather than curative. Cell-based therapies are regarded to hold great potential for the treatment of DDD as it has been hypothesised that they could regenerate the damaged tissue and alleviate LBP. A number of natural and synthetic biomaterials have been investigated as NP tissue engineering scaffolds with varying results. In this study, a self assembling peptide hydrogel (SAPH) was investigated for its potential as a cell carrier and/or scaffold for NP tissue engineering. SAPHs display the advantages of natural polymer hydrogels such as biocompatibility and biodegradability whilst combining the advantages of synthetic materials such as controlled structural and mechanical propertiesCharacterisation determined that the SAPH nanofibrous architecture had features that were of similar scale to extracellular matrix (ECM) components of the human NP. The mechanical properties of the SAPH could be optimised to closely match the native tissue. The system could shear thin and self-heal making the system ideally suited to delivery via minimally invasive procedure. The three dimensional (3D) culture of bovine NP cells (bNPCs) in the SAPH demonstrated that the NP phenotype could be restored after de-differentiation during monolayer culture. Gene expression results demonstrated that ‘traditional’ and ‘novel’ NP markers were highly expressed throughout in vitro culture. Cell viability was high, cell population remained stable and bNPCs adopted the characteristic rounded morphology of native NPCs. Finally, type II collagen and aggrecan, the main ECM components of the NP, were deposited with increasing production over culture period. Growth differentiation factor 6 (GDF-6) has been identified as the most promising current growth factor for inducing discogenic differentiation from human bone marrow mesenchymal stem cell (h-BMMSCs). After samples were stimulated with GDF-6, gene expression results confirmed that a NP-like phenotype could be induced with high expression of ‘traditional’ and ‘novel’ NP markers. Cell viability was high, cell population remained stable and NP associated ECM components were deposited with cells displaying a rounded morphology. Interestingly, when h-BMMSCs were cultured without GDF-6, it was strongly suggested that spontaneous discogenic differentiation occurred after culture in the SAPHs as ‘traditional’ and ‘novel’ NP markers were highly expressed, morphology was comparable to native NPCs and type II collagen and aggrecan were deposited extracellularly. If these findings were accurate then this is the first study to demonstrate that a NP-like phenotype could be induced from MSCs without use of an exogenous growth factor or a discogenic bioactive motif. Despite exciting and novel results, further work is required to confirm the potential of SAPHs for NP tissue engineering scaffolds.

This thesis deals with stress strain analysis of an aortic abdominal aneurysm (AAA) and the influence of its contact with the spine on the extreme wall stress. The influence was tested on the idealized geometry, as well as on ten patient specific geometries obtained from computer tomography (CT-A) scans. Hyperelastic constitutive models were used for the AAA wall and intraluminal thrombus (ILT) tissue description. The prestress algorithm was used for reconstruction of the unloaded geometry to get more trustworthy results against the geometry from CT which was obtained under the blood pressure. Statistical analysis was used for the results evaluation. The maximal increase of peak wall stress was as high as 81 %.

Le travail présenté dans le manuscrit concerne la conception d'un dispositif médical de classe III pour des applications en ingénierie tissulaire du derme et du disque intervertébral.Il s'agit d'une solution aqueuse de chitosane, stérilisée par autoclave, et dont le pH et l'osmolarité ont été ajustés selon un procédé de dialyse classique. Cette solution possède des propriétés de gélification in situ innovantes, ce qui lui confère de très bonnes propriétés mécaniques quelques minutes après l'injection, sans l'utilisation d'agents de réticulation mais de façon modulable en fonction de la concentration en polymère. De plus, cette solution possède une bonne injectabilité favorisant le développement d'une technique d'implantation mini-invasive pour la régénération du derme et du disque intervertébral. Un critère de performance rhéologique a notamment été mis au point afin de relier l'injectabilité aux propriétés mécaniques de l'injectât (dermal filler).Les propriétés mécaniques de l'injectât gélifié doivent être comparables au tissu natif en particulier pour le dermal filler mais aussi pour le disque intervertébral. Le comportement mécanique viscoélastique du disque intervertébral a été évalué par des essais de relaxation de contraintes et modélisé avec un modèle de Maxwell solide à trois branches. Ces essais ont été conduits sur des disques sains, ayant subi une altération de structure (fenestration) et après l'injection de biopolymères.La solution de chitosane a été injectée (i) dans le tissu cutané de deux modèles animaux : le porc et le rat et (ii) dans le disque intervertébral de deux modèles animaux : le porc et le lapin. La biocompatibilité ainsi que la réponse biologique de solutions/gels physique de chitosane in vivo ont été validées pour tous ces modèles animaux / This work deals with the conception of a class III medical device for applications in tissue engineering of dermis and intervertebral disc.This device consists in an aqueous chitosan solution, sterilized by autoclaving, with pH and osmolality adjusted by a dialysis process. This chitosan solution shows in situ gelation ability with a post-injection increase of mechanical properties. This feature is related to polymer concentration, gelation time, and is performed without external cross-linking agent. In addition, the solution exhibits a good injectability allowing the development of minimally invasive techniques to treat dermis and intervertebral disc diseases. A rheological performance criterion was defined linking injectability to mechanical properties of the implant (dermal filler).Mechanical properties of gel implant formed in contact with body fluids, in situ, have to be similar to that of native tissues. The viscoelastic behavior characterization of intervertebral disc was performed using stress relaxation and was modeled using a generalized solid Maxwell model (composed of three Maxwell elements). The tests were performed on healthy disc, fenestrated discs and after biopolymers injection.Chitosan solutions were injected into (i) porcine and rat cutaneous tissue and (ii) porcine and rabbit intervertebral discs. The biocompatibility and biofunctionality of chitosan solutions and physical hydrogels was evidenced in vivo for all animals

Previous studies have reported that combination of electroacupuncture (EA) and mesenchymal stem/stromal cells (MSC) promoted survival, differentiation and functional recovery in spinal cord-transected rats. In this study, it was examined the therapeutic effects of stem cells from canine exfoliated dental pulp (SCED) combined with EA treatment in dogs with chronic naturally occurred spinal cord injury due to intervertebral disc herniation (IVDH). Dogs were randomly assigned to four experimental groups (n=4 for each group; total of 16 animals): SCED, EA, SCED + EA) and control. Mild increase in the neurological scoring was found in one animal from SCED group (1/4; 2 points gained), one from EA group (1/4; 8 points gained), three from SCED+EA group (3/4; 16 points gained) and one from control group (1/4; 2 points gained). Functional outcome improvements were observed two animals from SCED group (2/4; 3 points gained), two from EA group (2/4; 4 points gained), one from SCED+EA group (1/4; 1 point gained) and two were from control group (2/4; 6 points gained). However no statistical differences were observed. Magnetic resonance imaging (MRI) findings did not suggest improvement comparing pre- and post-treatment within groups, excepted from one animal from SCED group (1/4), and 10 animals from all groups (10/16) presented signs of injury progression in the SCI in post-treatment exam, which could not be associated to the procedures from study, but could be related to the natural evolution of the disease. Limitation such as number of transplanted stem cells, delivery route, injury chronicity and intrinsic variation among naturally spinal cord injured dogs could have influence outcomes negatively. Moreover, canine deciduous exfoliated teeth were easily obtained and SCED were simply isolated, and no mortality followed up 7 month from procedure were observed. / Estudos anteriores demonstraram que a associação da eletroacupuntura e células-tronco mesenquimais/estromais (CTMs) pode promover a sobrevivência e diferenciação das CTMs, assim como recuperação funcional em ratos com transecção da medula espinal. Neste estudo, foram avaliados os efeitos terapêuticos da associação de células-tronco derivadas de polpa de dente decíduo esfoliado de cães (CPDEc) e eletroacupuntura (EAP) em cães com lesão de medula espinhal crônica causada de forma natural por herniação do disco interververtebral. Os cães foram divididos aleatoriamente em quatro grupos experimentais (n=4 para cada grupo; total de 16 animais): CPDEc, EAP, CPDEc+EAP e grupo controle. Foram encontradas pequenas melhoras na pontuação do exame neurológico em um animal do grupo CPDEc (1/4; 2 pontos ganhos), um do grupo EAP (1/4; 8 pontos ganhos), três do grupo CPDEc+EAP (3/4; 16 pontos ganhos) e um do grupo controle (1/4; 2 pontos ganhos). Na avaliação funcional, pequenas melhoras também foram observadas em dois animais do grupo CPDEc (2/4; 3 pontos ganhos), dois do grupo EAP (2/3; 4 pontos ganhos), um do grupo CPDEc+EAP (1/4; 1 ponto ganho) e dois do grupo controle (2/4; 6 pontos ganhos). No entanto, não foram encontradas diferenças estatísticas entre os grupos. Os achados ressonância magnética não sugeriram melhoras comparando os exames pré e pós tratamento entre os grupos, com exceção de um animal do grupo CPDEc (1/4), e 10 animais dentre todos os grupos (10/16) apresentaram sinais de progressão na lesão da medula espinhal, que não puderam ser associados com os procedimentos do estudo, mas podem estar relacionados à progressão natural da doença. Além disso, os dentes decíduos esfoliados foram obtidos facilmente e as CPDEc foram isoladas de forma simples, ademais, não foi observada nenhuma mortalidade foi observada até 7 meses após o procedimento.

INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO: Os resultados indicam que a estabilização é efetiva na melhora da dor, incapacidade funcional, e capacidade da ativação do TrA, e a TENS apenas na dor. A estabilização foi superior à TENS em todas as variáveis / INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain (p < 0.001), functional disability (p < 0.001), and ability to contract the TrA (p < 0.001). CONCLUSION: The results indicate that stabilization is effective in improving pain, functional disability, and the ability to contract the TrA in individuals with LDH. In the TENS group, the only improvement after treatment was in terms of pain. Stabilization was superior to TENS in all outcomes