SYSTEMATIC REVIEW article

Front. Bioeng. Biotechnol.

Sec. Biomechanics

Volume 13 - 2025 | doi: 10.3389/fbioe.2025.1582438

Dynamic behavior of the nucleus pulposus within the intervertebral disc loading : a systematic review and metaanalysis exploring the concept of Dynamic Disc Model

Provisionally accepted
Jean-Philippe  DeneuvilleJean-Philippe Deneuville1,2,3*Maxime  BillotMaxime Billot1Alexandra  CervantesAlexandra Cervantes2Sylvain  PeterlongoSylvain Peterlongo2Martin  MeyerMartin Meyer2Mesika  KolderMesika Kolder2Marie  EscandeMarie Escande4Mathilde  BourgeoisMathilde Bourgeois4Adrien  PallotAdrien Pallot4,5Romain  DavidRomain David1,3,6Manuel  RoulaudManuel Roulaud1Amine  OunajimAmine Ounajim1Mark  LaslettMark Laslett7Mathieu  SarracanieMathieu Sarracanie8Najat  SalamehNajat Salameh8Arnaud  GermaneauArnaud Germaneau3Philippe  RigoardPhilippe Rigoard1,3,6
  • 1Laboratoire de Recherche Prismatics, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
  • 2Association Francophone McKenzie (AFMcK – McKenzie Francophonic Association), Paris, France, Paris, France
  • 3UPR3346 Institut P' Recherche et Ingénierie en Matériaux, Mécanique et Energétique (Pprime), Poitiers, Poitou-Charentes, France
  • 4Centre Européen d’Enseignement en Rééducation et Réadaptation Fonctionnelle (CEERRF – European Center for Education in Rehabilitation and Functional Rehabilitation), Saint Denis, France., Saint-Denis, France
  • 5Institut d’Ingénierie de la Santé, Université de Picardie Jules Verne, 80000 Amiens, France, Amiens, France
  • 6Department of Spine, Pain and Disability Neurosurgery, Poitiers University Hospital, Poitiers, France., Poitiers, France
  • 7The Sports Clinic, 156 Bealey Ave., Christchurch, New Zealand., Christchurch, New Zealand
  • 8Center for Adaptable MRI Technology, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom, Aberdeen, United Kingdom

The final, formatted version of the article will be published soon.

Introduction: The dynamic disc model (DDM) is a theoretical framework in spine mechanics that theorizes the behavior of the nucleus pulposus within the intervertebral disc under various loads. The model predicts displacement of the nucleus pulposus away from the bending loads, for example backward displacement of the nucleus pulposus with a flexion load. These predictions are regularly used as a theoretical basis for explaining certain disc pathologies, such as disc herniation.Methods: We screened seven databases (CENTRAL, Embase, MEDLINE, CINAHL, ScienceDirect, Google Scholar, and HAL) up to July 2024, identifying studies through a PRISMA-guided approach that detailed the mechanical transformation (displacement and deformation) of the nucleus pulposus under bending load on the intervertebral disc. We conducted a double-blind data extraction and quality assessment of the body of evidence. Finally, we performed a meta-analysis of proportions.Results: From the 9,269 articles screened, 14 studies were included in the systematic review and meta-analysis. Magnetic Resonance Imaging (MRI) was employed in 92.8% of the studies, revealing four strategies for assessing nucleus pulposus transformation. The meta-analysis of asymptomatic subjects’ data demonstrated that the nucleus pulposus behavior aligned with dynamic disc model predictions in 85.4% (95% CI = [79.4 – 91.4]) across spinal regions and bending directions. However, significant heterogeneity and low study quality were noted. Only one study used discography to assess the DDM in a discogenic pain population, identifying discrepancies in nucleus pulposus transformation and contrast agent leakage.Conclusion: Evidence for the dynamic disc model for intact discs is of low strength, whereas very limited evidence challenges the dynamic disc model for fissured discs. New multiparametric MRI studies may help guiding future clinical assessment protocols.

Keywords: Dynamic disc mode, Intervertebral disc biomechanics, Systematic review/meta-analysis, Mow back pain, Directional preference. (Min.5-Max. 8)

Received: 24 Feb 2025; Accepted: 01 May 2025.

Copyright: © 2025 Deneuville, Billot, Cervantes, Peterlongo, Meyer, Kolder, Escande, Bourgeois, Pallot, David, Roulaud, Ounajim, Laslett, Sarracanie, Salameh, Germaneau and Rigoard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jean-Philippe Deneuville, Laboratoire de Recherche Prismatics, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France

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