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Intervertebral Disc Degeneration:
Studies in the Loaded Disc Culture System
C.P.L. Paul
Colophon
Research funding:
The research presented in this thesis was supported by the Dutch Government ZonMw Program
‘‘Alternatives for life animal testing’’: grant number 11400090. The development of the Loaded
Disc Culture System (LDCS) was supported by the government led consortium for the
development of BioMedical Materials, BMM: grant number P2.01 IDiDAS. The funders had
no role in study design, data collection and analysis, decision to publish, or preparation of the
thesis or individual manuscript.
Publication of this thesis was supported by:
Amsterdam Movement Sciences
Nederlandse Orthopaedische Vereniging
Graduate school, AMC
Stichting Beroepsopleiding Huisarts (SBOH)
Stichting Proefdiervrij
Dutch Spine Society
Anna Fonds | NOREF
The funders had no role in study design, data collection and analysis, decision to publish, or
preparation of the thesis or individual manuscripts.
Cover illustration: “Kneeling Atlas” by FMP Westerhuis – Paul
© 2017, Gouda, The Netherlands. All rights reserved.
Lay-out and printing: Loes Kema, GVO drukkers & vormgevers B.V. Ede, The
Netherlands.
ISBN: 978-94-6332-293-5
Digital version available@: http://hdl.handle.net/11245.1/9411a201-59b9-479d-b777-
e60eaf0e42af
Copyright © 2017 CPL Paul, Amstelveen, The Netherlands. All rights reserved. No part of this
publication, cover illustration, text or figures may be reproduced, stored or transmitted in any
poart or means, without written permission of the author.
Colophon
Intervertebral Disc Degeneration: Studies in
Research funding: the Loaded Disc Culture System
The research presented in this thesis was supported by the Dutch Government ZonMw
Program ‘‘Alternatives for life animal testing’’: grant number 11400090. The
development of the Loaded Disc Culture System (LDCS) was supported by the ACADEMISCH PROEFSCHRIFT
government led consortium for the development of BioMedical Materials, BMM: grant
ter verkrijging van de graad van doctor
number P2.01 IDiDAS. The funders had no role in study design, data collection and
analysis, decision to publish, or preparation of the thesis or individual manuscript. aan de Universiteit van Amsterdam
op gezag van de Rector Magnificus
Publication of this thesis was supported by:
prof. dr. ir. K.I.J. Maex
Nederlandse Orthopedie Vereniging
ten overstaan van een door het College voor Promoties ingestelde commissie,
Amsterdam Movement Sciences
Stichting Beroepsopleiding Huisarts (SBOH) in het openbaar te verdedigen in de Agnietenkapel
Stichting Proefdiervrij
Dutch Spine Society op 7 februari 2018, te 14:00 uur
Anna Fonds | NOREF
door Cornelis Pieter Louis Paul
The funders had no role in study design, data collection and analysis, decision to
geboren te Beverwijk
publish, or preparation of the thesis or individual manuscripts.
Cover illustration: “Kneeling Atlas” by FMP Westerhuis – Paul
© 2017, Gouda, The Netherlands. All rights reserved.
Lay-out and printing: Loes Kema, GVO drukkers & vormgevers B.V. Ede, The
Netherlands.
ISBN: 978-94-6332-293-5
Digital version available@: http://hdl.handle.net/11245.1/9411a201-59b9-479d-
b777-e60eaf0e42af
Copyright © 2017 CPL Paul, Amstelveen, The Netherlands. All rights reserved. No part
of this publication, cover illustration, text or figures may be reproduced, stored or
transmitted in any poart or means, without written permission of the author.
Promotiecommissie:
Promotor: Prof. dr. ir. T.H. Smit AMC-Universiteit van Amsterdam
Copromotoren: Dr. M.N. Helder VU medisch centrum
Dr. M.G. Mullender VU medisch centrum
Overige leden: Prof. dr. G.M.M.J. Kerkhoffs AMC-Universiteit van Amsterdam
Prof. Dr. Ir. G.J. Strijkers AMC-Universiteit van Amsterdam
“All thanks to sis’, I can do that!”
Dr. M.J.B. van den Hoff AMC-Universiteit van Amsterdam
Mike Cass (Charles McGown), A chorus line, 1985
Prof. dr. W.F. Lems Vrije Universiteit Amsterdam
Dr. A.D. Bakker Vrije Universiteit Amsterdam
Faculteit der geneeskunde
5 6
Promotiecommissie:
Promotor: Prof. dr. ir. T.H. Smit AMC-Universiteit van Amsterdam
Copromotoren: Dr. M.N. Helder VU medisch centrum
Dr. M.G. Mullender VU medisch centrum
Overige leden: Prof. dr. G.M.M.J. Kerkhoffs AMC-Universiteit van Amsterdam
Prof. Dr. Ir. G.J. Strijkers AMC-Universiteit van Amsterdam
“All thanks to sis’, I can do that!”
Dr. M.J.B. van den Hoff AMC-Universiteit van Amsterdam
Mike Cass (Charles McGown), A chorus line, 1985
Prof. dr. W.F. Lems Vrije Universiteit Amsterdam
Dr. A.D. Bakker Vrije Universiteit Amsterdam
Faculteit der geneeskunde
5 6
Contents
Page
Chapter 1 General introduction 10
Chapter 2 Simulated-physiological loading conditions preserve 36
biological and mechanical properties of caprine lumbar
intervertebral discs in ex vivo culture.
Chapter 3 Dynamic and static overloading induce early degenerative 66
processes in caprine lumbar intervertebral discs
Chapter 4 Static axial overloading primes lumbar caprine intervertebral 100
discs for posterior herniation
Chapter 5 Changes in Intervertebral Disc Mechanical Behavior during 136
Early Degeneration
Chapter 6 Quantitative MRI in early intervertebral disc degeneration: 160
T1rho correlates better than T2 with biomechanics and
matrix content
Chapter 7 General discussion 188
Chapter 8 Summary 206
Addendum Dutch summary / Nederlandse samenvatting 216
Acknowledgements 236
LDCS articles 239
Curriculum Vitae 241
7
Contents
Page
Chapter 1 General introduction 10
Chapter 2 Simulated-physiological loading conditions preserve 36
biological and mechanical properties of caprine lumbar
intervertebral discs in ex vivo culture.
Chapter 3 Dynamic and static overloading induce early degenerative 66
processes in caprine lumbar intervertebral discs
Chapter 4 Static axial overloading primes lumbar caprine intervertebral 100
discs for posterior herniation
Chapter 5 Changes in Intervertebral Disc Mechanical Behavior during 136
Early Degeneration
Chapter 6 Quantitative MRI in early intervertebral disc degeneration: 160
T1rho correlates better than T2 with biomechanics and
matrix content
Chapter 7 General discussion 188
Chapter 8 Summary 206
Addendum Dutch summary / Nederlandse samenvatting 216
Acknowledgements 236
LDCS articles 239
Curriculum Vitae 241
7
Chapter 1.
General Introduction
C.P.L. Paul
10
Description:Adams MA, Lama P, Zehra U, Dolan P. Why do some intervertebral discs degenerate, when others (in the same spine) do not? Clin Anat 2015 Mar;28(2):195-204. 115. Lotz JC, Colliou OK, Chin JR, Duncan NA, Liebenberg E. Compression-induced degeneration of the intervertebral disc: an in vivo
