Disc prolapse: evidence of reversal with repeated extension

A basic science study that used a porcine cervical spine model to produce disc prolapse subsequently exposed to an extension protocol.

This study investigated whether extension or combined extension and side flexion could move the displaced portion of nucleus from the anulus towards the nucleus.

Previous research has established that repeated flexion can create disc prolapse, the question here is whether repeated extension can reverse the process.

The C3/4 segments of 18 porcine cervical spines were dissected and potted in cups. Specimens were preloaded, then axially compressed (1472 N), and repeatedly rotated in either pure flexion or combined flexion and side flexion at a rate of 0.5 degrees /s. Specimens that prolapsed were axially compressed and repeatedly and rotated into extension.

Based on a blinded radiologist's review of the radiograph images, all 18 specimens contained healthy discs before testing, but after testing 2 of the 18 specimens had endplate fractures, whereas 11 of the 18 specimens had prolapsed. Prolapsed nucleus was reduced in 5 of the 11 prolapsed specimens after the reversal testing, whereas the remaining 6 did not change. Subclassification analysis revealed that the prolapsed discs that centralized had significantly less disc height loss (P < 0.01). Neither the classification of the herniation (circumferential or radial) nor the angle of lordosis of the specimens was linked to the behavior of the specimens.

This study showed that with repeated flexion, in porcine cervical spines, disc prolapse was initiated and that the displaced portion of nucleus can be directed back towards the center of the disc in response to particular active and passive movements/positions.