The goal of this research study was to create an artificial annulus fibrosus similar to that of the natural intervertebral disc, as well as find preliminary results for vertebral endplate connection and nucleus pulposus internal pressure, for the correction of disc degeneration in the spine. The three-part composite samples needed to demonstrate good shock absorption and load distribution while maintaining strength and flexibility, and removing the need for metal in the body, something of which no current total disc replacement or spinal fusion surgery can offer. For this study, the spinal disc was separated into its three different components, the annulus fibrosus, the nucleus pulposus, and the vertebral endplates, each playing a vital role in the function of the disc. Two low-cost materials were selected, a Covestro polyurethane and cellulose nanocrystals, for the purpose of creating a polymer composite spinal disc implant. A methodology was established for creating the cast composite material for use as an annulus fibrosus, while also investigating its mechanical properties. The same composite material was used to acquire preliminary results for vertebral endplate connection to the synthesized annulus, however no additional material was used to determine or mimic the mechanical properties of these endplates, due to time constraints. Also because of time constraints, the nucleus used in this study was only comprised of water with no other additives for preliminary testing since the natural nucleus is comprised of about 80-90% water. These properties were then compared to the mechanical properties of the natural disc, so that they could be finely tuned to emulate the natural disc. It is shown in this study that the composite material, when swelled in water, was able to mimic the annulus fibrosus in tensile strength and modulus, however showed higher compressive strength and modulus than ideal. The samples also did not undergo any permanent deformation within the realm of force actually introduced to the natural disc. The vertebral endplates showed decent adhesion to the synthesized annulus, however there were slight defects that became failure concentrators during compression testing. The nucleus showed promising results maintaining good internal pressure to the system causing better compressive load distribution, with barreling of the samples. / Master of Science / Spinal disc degeneration is a very prevalent problem in today’s society, effecting anywhere from 12% to 35% of a given population. It usually occurs in the lumbar section of the spine, and when severe enough, can cause bulging and herniation of the intervertebral disc itself. This can cause immense lower back pain in individual’s stricken with this disease, and in the US, medical costs associated with lower back pain to exceed $100 billion. Current solutions to this problem include multiple different treatment options of which, spinal fusion surgery and total disc replacement (TDR) are among the most common. Although these treatments cause pain relief for the majority of patients, there are multiple challenges that come with these options. For example, spinal fusion surgery severely limits the mobility of its patients by fusing two vertebrae together, disallowing any individual movement, and TDR can cause hypermobility in among the vertebrae and offer little to no shock absorption of loads. Therefore, a better treatment option is needed to relieve the pain of the patients, as well as maintain equal motion, shock absorption, and load cushioning to that of the normal intervertebral disc and remaining biocompatible. The goal of this research study was to create a three-component system, like that of the natural intervertebral disc, for the use of spinal disc replacement and to replace current options. The fabricated system was comprised of the three components found in the natural intervertebral disc; the annulus fibrosus, the nucleus pulposus, and the vertebral endplates. Because the system will need to go in-body, the materials used were all characterized as biocompatible materials; the polyurethane currently being used in medical devices and implants, and the cellulose nanocrystals (CNCs) coming from natural cellulose in sources such as wood and plants. The results determined that the mechanical properties of the system can be fine-tuned in order to mimic the natural strength and cushioning capabilities of the natural disc, based on CNC content added to the polyurethane, and when all three components of the system are added together, the compressive stress-strain is most similar to the natural disc in compression. However, the system did show failure in the connection between the annulus fibrosus and vertebral endplates, causing herniation of the nucleus similar to the initial problem attempting to be solved. For this, more ideal fabrication methods should be researched in the future including 3D printing techniques, injection molding, and roll milling. As well as alternate fabrication techniques, cell grow and viability should be determined to show that cells don’t die once the system in implanted.

It is possible that interruption of nociceptive input from intervertebral discs can be modulated through bilateral L1 and L2 dorsal root ganglia (DRG) blockade. In order to test this hypothesis, we prospectively collected data from patients with low-lumbar pain, accurately diagnosed as discogenic using provocation discography. Methods Twelve patients were recruited with a mean (SD) symptom duration of 13.7 (8.2) years. Bilateral DRG blocks of L1 and L2 were performed using methylprednisolone 80 mg, clonidine 75 µg and 0.5% bupivacaine 4 ml in each patient. Results Analysis of Brief Pain Inventories showed no significant change in pain scores. Conclusion We conclude that blocks of this nociceptive pathway in humans using bilateral DRG blocks has no therapeutic value.