{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T02:26:03Z","timestamp":1788488763714,"version":"build-2803163510"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Percutaneous intradiscal hydrogel injection has been used to treat low-back pain (LBP) due to degenerative disc disease with or without mild radicular pain. Complications from these procedures are underreported. In this case lesson, the authors present a rare case of a patient with herniated intradiscal hydrogel following a minor trauma leading to neurological injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 36-year-old female who had been previously treated with L4\u20135 and L5\u2013S1 intradiscal hydrogel injections for LBP presented with painful, progressive right-sided lower-extremity weakness after experiencing a twisting trauma. Cross-sectional imaging results revealed a herniated hydrogel-based disc implant in the spinal canal. She underwent an urgent L4\u20135 laminectomy for decompression and removal of the herniated implant. A large annular defect was noted. Postoperatively, she had resolution of her right leg pain but experienced persistent right foot drop requiring an ankle-foot orthosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Herniated intradiscal hydrogel implants can lead to permanent neurological injury. While the risk factors for hydrogel herniation have not been elucidated, they can be related to pre-existing disruptions to the annulus and\/or posterior longitudinal ligament, excess volume of hydrogel injection, and insufficient fixation time. Further research is needed to determine the safety and efficacy of this technology.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24394\">https:\/\/thejns.org\/doi\/10.3171\/CASE24394<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24394","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T01:51:46Z","timestamp":1733104306000},"source":"Crossref","is-referenced-by-count":2,"title":["Delayed percutaneous intradiscal hydrogel herniation causing neurological injury after minor trauma: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Sowmya","family":"Gopalakrishnan","sequence":"first","affiliation":[{"name":"Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena","family":"Far","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Veilleux","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Swamy","sequence":"additional","affiliation":[{"name":"Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M. H.","family":"Yang","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department or Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"O\u2019Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Lancet Rheumatol","first-page":"e316","article-title":"Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","author":"Ferreira","year":"2023","unstructured":"Ferreira MLDe Luca KHaile LM. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329."},{"issue":"11","key":"bib2","series-title":"Spine (Phlia Pa 1976)","first-page":"1307","article-title":"Aging and degeneration of the human intervertebral disc","volume":"20","author":"Buckwalter","year":"1995","unstructured":"Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine (Phlia Pa 1976). 1995;20(11):1307-1314."},{"issue":"11","key":"bib3","series-title":"Eur Spine J","first-page":"1407","article-title":"Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain","volume":"17","author":"Jensen","year":"2008","unstructured":"Jensen TSKarppinen JSorensen JSNiinim\u00e4ki JLeboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407-1422."},{"issue":"11","key":"bib4","series-title":"Eur Spine J","first-page":"2791","article-title":"Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview","volume":"27","author":"Oliveira","year":"2018","unstructured":"Oliveira CBMaher CGPinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-2803."},{"issue":"4","key":"bib5","series-title":"Asian Spine J","first-page":"645","article-title":"Low back pain: current surgical approaches","volume":"9","author":"Baliga","year":"2015","unstructured":"Baliga STreon KCraig NJA. Low back pain: current surgical approaches. Asian Spine J. 2015;9(4):645-657."},{"issue":"8","key":"bib6","series-title":"Glob Spine J","first-page":"1676","article-title":"Lumbar fusion surgery for patients with back pain and degenerative disc disease: an observational study from the Canadian spine outcomes and research network","volume":"12","author":"Evaniew","year":"2022","unstructured":"Evaniew NSwamy GJacobs WB, et al. Lumbar fusion surgery for patients with back pain and degenerative disc disease: an observational study from the Canadian spine outcomes and research network. Glob Spine J. 2022;12(8):1676-1686."},{"issue":"1","key":"bib7","series-title":"Can J Neurol Sci","first-page":"96","article-title":"Patient predictors of surgical candidacy in elective spine disorders","volume":"46","author":"Yang","year":"2019","unstructured":"Yang MMHSt-Pierre GHDuPlessis S. Patient predictors of surgical candidacy in elective spine disorders. Can J Neurol Sci. 2019;46(1):96-101."},{"issue":"5","key":"bib8","series-title":"Can J Neurol Sci","first-page":"687","article-title":"Validation of the Calgary postoperative pain after spine surgery score for poor postoperative pain control after spine surgery","volume":"50","author":"Yang","year":"2023","unstructured":"Yang MMHRiva-Cambrin JCunningham JCasha S. Validation of the Calgary postoperative pain after spine surgery score for poor postoperative pain control after spine surgery. Can J Neurol Sci. 2023;50(5):687-693."},{"issue":"1","key":"bib9","series-title":"J Neurosurg Spine","first-page":"3","article-title":"Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery","volume":"34","author":"Yang","year":"2021","unstructured":"Yang MMHRiva-Cambrin JCunningham J, et al. Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery. J Neurosurg Spine. 2021;34(1):3-12."},{"issue":"8","key":"bib10","series-title":"Medicina (Kaunas)","first-page":"471","article-title":"Overview on percutaneous therapies of disc diseases","volume":"55","author":"Masala","year":"2019","unstructured":"Masala SSalimei FLacch\u00e8 AMarcia SMassari F. Overview on percutaneous therapies of disc diseases. Medicina (Kaunas). 2019;55(8):471."},{"key":"bib11","series-title":"J Pain Res","first-page":"1171","article-title":"Perspective on intradiscal therapies for lumbar discogenic pain: state of the science, knowledge gaps, and imperatives for clinical adoption","volume":"17","author":"Lorio","year":"2024","unstructured":"Lorio MPTate JLMyers TJBlock JEBeall DP. Perspective on intradiscal therapies for lumbar discogenic pain: state of the science, knowledge gaps, and imperatives for clinical adoption. J Pain Res. 2024;17:1171-1182."},{"key":"bib12","series-title":"Carbohydr Polym","first-page":"342","article-title":"Thermo-sensitive injectable glycol chitosan-based hydrogel for treatment of degenerative disc disease","volume":"184","author":"Li","year":"2018","unstructured":"Li ZShim HCho MO, et al. Thermo-sensitive injectable glycol chitosan-based hydrogel for treatment of degenerative disc disease. Carbohydr Polym. 2018;184:342-353."},{"key":"bib13","series-title":"Biomaterials","first-page":"12","article-title":"An interpenetrating network-strengthened and toughened hydrogel that supports cell-based nucleus pulposus regeneration","volume":"136","author":"Gan","year":"2017","unstructured":"Gan YLi PWang L, et al. An interpenetrating network-strengthened and toughened hydrogel that supports cell-based nucleus pulposus regeneration. Biomaterials. 2017;136:12-28."},{"key":"bib14","series-title":"Acta Biomater","first-page":"201","article-title":"Translation of an injectable triple-interpenetrating-network hydrogel for intervertebral disc regeneration in a goat model","volume":"60","author":"Gullbrand","year":"2017","unstructured":"Gullbrand SESchaer TPAgarwal P, et al. Translation of an injectable triple-interpenetrating-network hydrogel for intervertebral disc regeneration in a goat model. Acta Biomater. 2017;60:201-209."},{"issue":"4","key":"bib15","series-title":"J Tissue Eng Regen Med","first-page":"299","article-title":"Recent advances of hydrogel-based biomaterials for intervertebral disc tissue treatment: a literature review","volume":"15","author":"Zheng","year":"2021","unstructured":"Zheng KDu D. Recent advances of hydrogel-based biomaterials for intervertebral disc tissue treatment: a literature review. J Tissue Eng Regen Med. 2021;15(4):299-321."},{"key":"bib16","series-title":"Biomedical Hydrogels","first-page":"103","article-title":"Spinal disc implants using hydrogels","author":"Borzacchiello","year":"2011","unstructured":"Borzacchiello AGloria ADe Santis RAmbrosio L. Spinal disc implants using hydrogels. In: Biomedical Hydrogels. Elsevier; 2011:103-117."},{"key":"bib17","series-title":"Osteoarthr Cartil","first-page":"S424","article-title":"An open label study to evaluate safety and efficacy of a novel hydrogel (hyalodisc) in patients with degenerative disc disease","volume":"26","author":"Mazza","year":"2018","unstructured":"Mazza EMondaini FMarcia STorri TBarbanti Brodano GGiordan N. An open label study to evaluate safety and efficacy of a novel hydrogel (hyalodisc) in patients with degenerative disc disease. Osteoarthr Cartil. 2018;26:S424-S425."},{"issue":"1","key":"bib18","series-title":"J Vasc Interv Radiol","first-page":"51","article-title":"Hydrogel augmentation of the lumbar intervertebral disc: an early feasibility study of a treatment for discogenic low back pain","volume":"35","author":"Beall","year":"2024","unstructured":"Beall DPAmirdelfan KNunley PDPhillips TRImaz Navarro LCSpath A. Hydrogel augmentation of the lumbar intervertebral disc: an early feasibility study of a treatment for discogenic low back pain. J Vasc Interv Radiol. 2024;35(1):51-58.e1."},{"key":"bib19","series-title":"Injectable Gel for Regenerative Discs","author":"ReGelTec","unstructured":"ReGelTec. Injectable Gel for Regenerative Discs. Accessed April 6, 2024. https:\/\/regeltec.com."},{"key":"bib20","series-title":"ClinicalTrials.gov.","article-title":"HYDRAFIL-D: HYDRogel augmentation for intervertebral lumbar discs (HYDRAFIL-D)","author":"Beall","unstructured":"Beall DAmirdelfan K. HYDRAFIL-D: HYDRogel augmentation for intervertebral lumbar discs (HYDRAFIL-D). ClinicalTrials.gov. Accessed February 26, 2024. https:\/\/clinicaltrials.gov\/study\/NCT06011551."},{"issue":"6","key":"bib21","series-title":"IEEE Pulse","first-page":"36","article-title":"Noninvasive injectables for chronic low back pain","volume":"14","author":"Mertz","year":"2023","unstructured":"Mertz L. Noninvasive injectables for chronic low back pain. IEEE Pulse. 2023;14(6):36-41."},{"issue":"3","key":"bib22","series-title":"BMJ Open","first-page":"e053772","article-title":"Efficacy of the Gelstix nucleus augmentation device for the treatment of chronic discogenic low back pain: protocol for a randomised, sham-controlled, double-blind, multicentre trial","volume":"12","author":"Koetsier","year":"2022","unstructured":"Koetsier Evan Kuijk SMJMaino P, et al. Efficacy of the Gelstix nucleus augmentation device for the treatment of chronic discogenic low back pain: protocol for a randomised, sham-controlled, double-blind, multicentre trial. BMJ Open. 2022;12(3):e053772."},{"issue":"6","key":"bib23","series-title":"Turk J Med Sci","first-page":"1634","article-title":"Clinical results of intradiscal hydrogel administration (GelStix) in lumbar degenerative disc disease","volume":"49","author":"Ceylan","year":"2019","unstructured":"Ceylan AA\u015fik I\u00d6zgencil GEErken B. Clinical results of intradiscal hydrogel administration (GelStix) in lumbar degenerative disc disease. Turk J Med Sci. 2019;49(6):1634-1639."},{"issue":"4","key":"bib24","series-title":"J Neurosurg Spine","first-page":"614","article-title":"Migration of fragments into the spinal canal after intervertebral polyethylene glycol implantation: an extremely rare adverse effect: case report","volume":"21","author":"Akgun","year":"2014","unstructured":"Akgun BOzturk SCakin HKaplan M. Migration of fragments into the spinal canal after intervertebral polyethylene glycol implantation: an extremely rare adverse effect: case report. J Neurosurg Spine. 2014;21(4):614-616."},{"issue":"4","key":"bib25","series-title":"Turk Neurosurg","first-page":"602","article-title":"Fragmentation to epidural space: first documented complication of Gelstix(TM)","volume":"24","author":"Durdag","year":"2014","unstructured":"Durdag EAyden OAlbayrak SAtci IBArmagan E. Fragmentation to epidural space: first documented complication of Gelstix(TM). Turk Neurosurg. 2014;24(4):602-605."},{"issue":"3","key":"bib26","series-title":"Bagcilar Med Bull","first-page":"71","article-title":"Hydrogel implant causing lumbar radiculopathy: a case report","volume":"2","author":"Tufan","year":"2017","unstructured":"Tufan ATas AKaragoz Guzey F, et al. Hydrogel implant causing lumbar radiculopathy: a case report. Bagcilar Med Bull. 2017;2(3):71-74."},{"issue":"4","key":"bib27","series-title":"Int J Mol Sci","first-page":"1483","article-title":"Lumbar degenerative disease Part 1: Anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature","volume":"21","author":"Kim","year":"2020","unstructured":"Kim HSWu PHJang IT. Lumbar degenerative disease Part 1: Anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature. Int J Mol Sci. 2020;21(4):1483."},{"issue":"9","key":"bib28","series-title":"Spine J","first-page":"1632","article-title":"Back pain improves significantly following discectomy for lumbar disc herniation","volume":"18","author":"Owens","year":"2018","unstructured":"Owens RKCarreon LYBisson EFBydon MPotts EAGlassman SD. Back pain improves significantly following discectomy for lumbar disc herniation. Spine J. 2018;18(9):1632-1636."},{"issue":"6","key":"bib29","series-title":"J Neurosurg Spine","first-page":"715","article-title":"Low-back pain after lumbar discectomy for disc herniation: what can you tell your patient?","volume":"35","author":"Iorio-Morin","year":"2021","unstructured":"Iorio-Morin CFisher CGAbraham E, et al. Low-back pain after lumbar discectomy for disc herniation: what can you tell your patient? J Neurosurg Spine. 2021;35(6):715-721."},{"key":"bib30","series-title":"BioMed Res Int","first-page":"2818624","article-title":"Applications of functionalized hydrogels in the regeneration of the intervertebral disc","volume":"2021","author":"Yan","year":"2021","unstructured":"Yan CWang XXiang C, et al. Applications of functionalized hydrogels in the regeneration of the intervertebral disc. BioMed Res Int. 2021;2021:2818624."},{"issue":"9","key":"bib31","series-title":"Spine J","first-page":"S84","article-title":"168. Minimally invasive hydrogel nucleoplasty in a goat model of moderate severity disc degeneration","volume":"21","author":"Fusco","year":"2021","unstructured":"Fusco ABoorman SEngiles J, et al. 168. Minimally invasive hydrogel nucleoplasty in a goat model of moderate severity disc degeneration. Spine J. 2021;21(9):S84."},{"issue":"1","key":"bib32","series-title":"Chiropr Man Therapap","first-page":"33","article-title":"The natural course of low back pain: a systematic critical literature review","volume":"20","author":"Lemeunier","year":"2012","unstructured":"Lemeunier NLeboeuf-Yde CGagey O. The natural course of low back pain: a systematic critical literature review. Chiropr Man Therapap. 2012;20(1):33."},{"issue":"6","key":"bib1","series-title":"Lancet Rheumatol","first-page":"e316","article-title":"Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","author":"Ferreira","year":"2023","unstructured":"Ferreira MLDe Luca KHaile LM. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329."},{"issue":"11","key":"bib2","series-title":"Spine (Phlia Pa 1976)","first-page":"1307","article-title":"Aging and degeneration of the human intervertebral disc","volume":"20","author":"Buckwalter","year":"1995","unstructured":"Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine (Phlia Pa 1976). 1995;20(11):1307-1314."},{"issue":"11","key":"bib3","series-title":"Eur Spine J","first-page":"1407","article-title":"Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain","volume":"17","author":"Jensen","year":"2008","unstructured":"Jensen TSKarppinen JSorensen JSNiinim\u00e4ki JLeboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407-1422."},{"issue":"11","key":"bib4","series-title":"Eur Spine J","first-page":"2791","article-title":"Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview","volume":"27","author":"Oliveira","year":"2018","unstructured":"Oliveira CBMaher CGPinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-2803."},{"issue":"4","key":"bib5","series-title":"Asian Spine J","first-page":"645","article-title":"Low back pain: current surgical approaches","volume":"9","author":"Baliga","year":"2015","unstructured":"Baliga STreon KCraig NJA. Low back pain: current surgical approaches. Asian Spine J. 2015;9(4):645-657."},{"issue":"8","key":"bib6","series-title":"Glob Spine J","first-page":"1676","article-title":"Lumbar fusion surgery for patients with back pain and degenerative disc disease: an observational study from the Canadian spine outcomes and research network","volume":"12","author":"Evaniew","year":"2022","unstructured":"Evaniew NSwamy GJacobs WB, et al. Lumbar fusion surgery for patients with back pain and degenerative disc disease: an observational study from the Canadian spine outcomes and research network. Glob Spine J. 2022;12(8):1676-1686."},{"issue":"1","key":"bib7","series-title":"Can J Neurol Sci","first-page":"96","article-title":"Patient predictors of surgical candidacy in elective spine disorders","volume":"46","author":"Yang","year":"2019","unstructured":"Yang MMHSt-Pierre GHDuPlessis S. Patient predictors of surgical candidacy in elective spine disorders. Can J Neurol Sci. 2019;46(1):96-101."},{"issue":"5","key":"bib8","series-title":"Can J Neurol Sci","first-page":"687","article-title":"Validation of the Calgary postoperative pain after spine surgery score for poor postoperative pain control after spine surgery","volume":"50","author":"Yang","year":"2023","unstructured":"Yang MMHRiva-Cambrin JCunningham JCasha S. Validation of the Calgary postoperative pain after spine surgery score for poor postoperative pain control after spine surgery. Can J Neurol Sci. 2023;50(5):687-693."},{"issue":"1","key":"bib9","series-title":"J Neurosurg Spine","first-page":"3","article-title":"Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery","volume":"34","author":"Yang","year":"2021","unstructured":"Yang MMHRiva-Cambrin JCunningham J, et al. Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery. J Neurosurg Spine. 2021;34(1):3-12."},{"issue":"8","key":"bib10","series-title":"Medicina (Kaunas)","first-page":"471","article-title":"Overview on percutaneous therapies of disc diseases","volume":"55","author":"Masala","year":"2019","unstructured":"Masala SSalimei FLacch\u00e8 AMarcia SMassari F. Overview on percutaneous therapies of disc diseases. Medicina (Kaunas). 2019;55(8):471."},{"key":"bib11","series-title":"J Pain Res","first-page":"1171","article-title":"Perspective on intradiscal therapies for lumbar discogenic pain: state of the science, knowledge gaps, and imperatives for clinical adoption","volume":"17","author":"Lorio","year":"2024","unstructured":"Lorio MPTate JLMyers TJBlock JEBeall DP. Perspective on intradiscal therapies for lumbar discogenic pain: state of the science, knowledge gaps, and imperatives for clinical adoption. J Pain Res. 2024;17:1171-1182."},{"key":"bib12","series-title":"Carbohydr Polym","first-page":"342","article-title":"Thermo-sensitive injectable glycol chitosan-based hydrogel for treatment of degenerative disc disease","volume":"184","author":"Li","year":"2018","unstructured":"Li ZShim HCho MO, et al. Thermo-sensitive injectable glycol chitosan-based hydrogel for treatment of degenerative disc disease. Carbohydr Polym. 2018;184:342-353."},{"key":"bib13","series-title":"Biomaterials","first-page":"12","article-title":"An interpenetrating network-strengthened and toughened hydrogel that supports cell-based nucleus pulposus regeneration","volume":"136","author":"Gan","year":"2017","unstructured":"Gan YLi PWang L, et al. An interpenetrating network-strengthened and toughened hydrogel that supports cell-based nucleus pulposus regeneration. Biomaterials. 2017;136:12-28."},{"key":"bib14","series-title":"Acta Biomater","first-page":"201","article-title":"Translation of an injectable triple-interpenetrating-network hydrogel for intervertebral disc regeneration in a goat model","volume":"60","author":"Gullbrand","year":"2017","unstructured":"Gullbrand SESchaer TPAgarwal P, et al. Translation of an injectable triple-interpenetrating-network hydrogel for intervertebral disc regeneration in a goat model. Acta Biomater. 2017;60:201-209."},{"issue":"4","key":"bib15","series-title":"J Tissue Eng Regen Med","first-page":"299","article-title":"Recent advances of hydrogel-based biomaterials for intervertebral disc tissue treatment: a literature review","volume":"15","author":"Zheng","year":"2021","unstructured":"Zheng KDu D. Recent advances of hydrogel-based biomaterials for intervertebral disc tissue treatment: a literature review. J Tissue Eng Regen Med. 2021;15(4):299-321."},{"key":"bib16","series-title":"Biomedical Hydrogels","first-page":"103","article-title":"Spinal disc implants using hydrogels","author":"Borzacchiello","year":"2011","unstructured":"Borzacchiello AGloria ADe Santis RAmbrosio L. Spinal disc implants using hydrogels. In: Biomedical Hydrogels. Elsevier; 2011:103-117."},{"key":"bib17","series-title":"Osteoarthr Cartil","first-page":"S424","article-title":"An open label study to evaluate safety and efficacy of a novel hydrogel (hyalodisc) in patients with degenerative disc disease","volume":"26","author":"Mazza","year":"2018","unstructured":"Mazza EMondaini FMarcia STorri TBarbanti Brodano GGiordan N. An open label study to evaluate safety and efficacy of a novel hydrogel (hyalodisc) in patients with degenerative disc disease. Osteoarthr Cartil. 2018;26:S424-S425."},{"issue":"1","key":"bib18","series-title":"J Vasc Interv Radiol","first-page":"51","article-title":"Hydrogel augmentation of the lumbar intervertebral disc: an early feasibility study of a treatment for discogenic low back pain","volume":"35","author":"Beall","year":"2024","unstructured":"Beall DPAmirdelfan KNunley PDPhillips TRImaz Navarro LCSpath A. Hydrogel augmentation of the lumbar intervertebral disc: an early feasibility study of a treatment for discogenic low back pain. J Vasc Interv Radiol. 2024;35(1):51-58.e1."},{"key":"bib19","series-title":"Injectable Gel for Regenerative Discs","author":"ReGelTec","unstructured":"ReGelTec. Injectable Gel for Regenerative Discs. Accessed April 6, 2024. https:\/\/regeltec.com."},{"key":"bib20","series-title":"ClinicalTrials.gov.","article-title":"HYDRAFIL-D: HYDRogel augmentation for intervertebral lumbar discs (HYDRAFIL-D)","author":"Beall","unstructured":"Beall DAmirdelfan K. HYDRAFIL-D: HYDRogel augmentation for intervertebral lumbar discs (HYDRAFIL-D). ClinicalTrials.gov. Accessed February 26, 2024. https:\/\/clinicaltrials.gov\/study\/NCT06011551."},{"issue":"6","key":"bib21","series-title":"IEEE Pulse","first-page":"36","article-title":"Noninvasive injectables for chronic low back pain","volume":"14","author":"Mertz","year":"2023","unstructured":"Mertz L. Noninvasive injectables for chronic low back pain. IEEE Pulse. 2023;14(6):36-41."},{"issue":"3","key":"bib22","series-title":"BMJ Open","first-page":"e053772","article-title":"Efficacy of the Gelstix nucleus augmentation device for the treatment of chronic discogenic low back pain: protocol for a randomised, sham-controlled, double-blind, multicentre trial","volume":"12","author":"Koetsier","year":"2022","unstructured":"Koetsier Evan Kuijk SMJMaino P, et al. Efficacy of the Gelstix nucleus augmentation device for the treatment of chronic discogenic low back pain: protocol for a randomised, sham-controlled, double-blind, multicentre trial. BMJ Open. 2022;12(3):e053772."},{"issue":"6","key":"bib23","series-title":"Turk J Med Sci","first-page":"1634","article-title":"Clinical results of intradiscal hydrogel administration (GelStix) in lumbar degenerative disc disease","volume":"49","author":"Ceylan","year":"2019","unstructured":"Ceylan AA\u015fik I\u00d6zgencil GEErken B. Clinical results of intradiscal hydrogel administration (GelStix) in lumbar degenerative disc disease. Turk J Med Sci. 2019;49(6):1634-1639."},{"issue":"4","key":"bib24","series-title":"J Neurosurg Spine","first-page":"614","article-title":"Migration of fragments into the spinal canal after intervertebral polyethylene glycol implantation: an extremely rare adverse effect: case report","volume":"21","author":"Akgun","year":"2014","unstructured":"Akgun BOzturk SCakin HKaplan M. Migration of fragments into the spinal canal after intervertebral polyethylene glycol implantation: an extremely rare adverse effect: case report. J Neurosurg Spine. 2014;21(4):614-616."},{"issue":"4","key":"bib25","series-title":"Turk Neurosurg","first-page":"602","article-title":"Fragmentation to epidural space: first documented complication of Gelstix(TM)","volume":"24","author":"Durdag","year":"2014","unstructured":"Durdag EAyden OAlbayrak SAtci IBArmagan E. Fragmentation to epidural space: first documented complication of Gelstix(TM). 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