The effect of follower load on the intersegmental coupled motion characteristics of the human thoracic spine: An in vitro study using entire rib cage specimens

The mechanical coupling behaviour of the thoracic spine is still not fully understood. For the validation of numerical models of the thoracic spine, however, the coupled motions within the single spinal segments are of importance to achieve high model accuracy. In the present study, eight fresh frozen human thoracic spinal specimens (C7-L1, mean age 54 ± 6 years) including the intact rib cage were loaded with pure bending moments of 5 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) with and without a follower load of 400 N. During loading, the relative motions of each vertebra were monitored. Follower load decreased the overall ROM (T1-T12) significantly (p < 0.01) in all primary motion directions (extension: −46%, left LB: −72%, right LB: −72%, left AR: −26%, right AR: −26%) except flexion (−36%). Substantial coupled motion was found in lateral bending with ipsilateral axial rotation, which increased after a follower load was applied, leading to a dominant axial rotation during primary lateral bending, while all other coupled motions in the different motion directions were reduced under follower load. On the monosegmental level, the follower load especially reduced the ROM of the upper thoracic spine from T1-T2 to T4-T5 in all motion directions and the ROM of the lower thoracic spine from T9-T10 to T11-T12 in primary lateral bending. The facet joints, intervertebral disc morphologies, and the sagittal curvature presumably affect the thoracic spinal coupled motions depending on axial compressive preloading. Using these results, the validation of numerical models can be performed more accurately.     

Biomechanical Analysis of a Newly Developed Shape Memory Alloy Hook in a Transforaminal Lumbar Interbody Fusion (TLIF) In Vitro Model

Objective

The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model.

Methods

Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3–L4, L4–L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System.

Results

Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p<0.05). The USMAH slightly reduced the ROM in extension, right lateral bending and axial rotation (p>0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05).

Conclusions

Bilateral SMAH fixation can achieve immediate stability after L4–5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration.     

Finite element analysis of moment-rotation relationships for human cervical spine

A comprehensive, geometrically accurate, nonlinear C0-C7 FE model of head and cervical spine based on the actual geometry of a human cadaver specimen was developed. The motions of each cervical vertebral level under pure moment loading of 1.0 Nm applied incrementally on the skull to simulate the movements of the head and cervical spine under flexion, tension, axial rotation and lateral bending with the inferior surface of the C7 vertebral body fully constrained were analysed. The predicted range of motion (ROM) for each motion segment were computed and compared with published experimental data. The model predicted the nonlinear moment-rotation relationship of human cervical spine. Under the same loading magnitude, the model predicted the largest rotation in extension, followed by flexion and axial rotation, and least ROM in lateral bending. The upper cervical spines are more flexible than the lower cervical levels. The motions of the two uppermost motion segments account for half (or even higher) of the whole cervical spine motion under rotational loadings. The differences in the ROMs among the lower cervical spines (C3-C7) were relatively small. The FE predicted segmental motions effectively reflect the behavior of human cervical spine and were in agreement with the experimental data. The C0-C7 FE model offers potentials for biomedical and injury studies.     

脊柱-骨盆固定系统的生物力学研究

目的:研究髂骨钉在脊柱-骨盆固定系统中对腰骶稳定性及螺钉应力分布的影响。方法:6具成人腰椎-骨盆防腐标本,分别按照三种不同的固定方式完成置钉连接操作,制成3个实验组:单纯腰椎后路长节段固定组(L2-L5组)、腰骶固定组(L2-S1组)、髂骨钉固定组(L2-S1-I组)。生物力学测试采用8 N·m纯力矩执行前屈、后伸、左右侧弯、左右旋转6个工况运动,比较各固定组L2、L5水平活动度以及L5椎弓根钉、S1螺钉应力。结果:L2-S1组、L2-S1-I组内固定系统以及腰骶关节活动度均明显降低(P0.05),L2-S1-I组的优势更加显著,尤其在抵抗固定系统旋转活动以及腰骶关节前屈活动时作用更明显。L2-S1-I组、L2-S1组L5椎弓根钉应力均较L2-L5组明显减小(P0.05);L2-S1-I组S1螺钉应力较L2-S1组显著减小(P0.05)。结论:髂骨钉技术能够提供良好的脊柱-骨盆固定效果,在维持腰骶稳定性方面优势明显;对近端固定螺钉有保护作用,在与S1螺钉联合使用时,能有效分担S1螺钉所受应力,显著降低螺钉松动、拔出的风险。     

Novel Pedicle Screw and Plate System Provides Superior Stability in Unilateral Fixation for Minimally Invasive Transforaminal Lumbar Interbody Fusion: An In Vitro Biomechanical Study

Purpose

This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body.

Methods

Seven fresh calf lumbar spines (L3-L6) were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM) was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB). After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR); unilateral pedicle screw and plate (UP); UR and transfacet pedicle screw (TFS); UP and TFS; UP and UR.

Results

All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP) reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR). The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs.

Conclusions

The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF.     

Abdominal muscles dominate contributions to vertebral joint stiffness during the push-up

The goal of this study was to quantify the relative contributions of each muscle group surrounding the spine to vertebral joint rotational stiffness (VJRS) during the push-up exercise. Upper-body kinematics, three-dimensional hand forces and lumbar spine postures, and 14 channels (bilaterally from rectus abdominis, external oblique, internal oblique, latissimus dorsi, thoracic erector spinae, lumbar erector spinae, and multifidus) of trunk electromyographic (EMG) activity were collected from 11 males and used as inputs to a biomechanical model that determined the individual contributions of 10 muscle groups surrounding the lumbar spine to VJRS at five lumbar vertebral joints (L1-L2 to L5-S1). On average, the abdominal muscles contributed 64.32 +/- 8.50%, 86.55 +/- 1.13%, and 83.84 +/- 1.95% to VJRS about the flexion/extension, lateral bend, and axial twist axes, respectively. Rectus abdominis contributed 43.16 +/- 3.44% to VJRS about the flexion/extension axis at each lumbar joint, and external oblique and internal oblique, respectively contributed 52.61 +/- 7.73% and 62.13 +/- 8.71% to VJRS about the lateral bend and axial twist axes, respectively, at all lumbar joints with the exception of L5-S1. Owing to changes in moment arm length, the external oblique and internal oblique, respectively contributed 55.89% and 50.01% to VJRS about the axial twist and lateral bend axes at L5-S1. Transversus abdominis, multifidus, and the spine extensors contributed minimally to VJRS during the push-up exercise. The push-up challenges the abdominal musculature to maintain VJRS. The orientation of the abdominal muscles suggests that each muscle primarily controls the rotational stiffness about a single axis.     

Effect of lumbar fasciae on the stability of the lower lumbar spine

The biomechanical effect of tensioning the lumbar fasciae (LF) on the stability of the spine during sagittal plane motion was analysed using a validated finite element model of the normal lumbosacral spine (L4-S1). To apply the tension in the LF along the direction of the fibres, a local coordinate was allocated using dummy rigid beam elements that originated from the spinous process. Up to 10 Nm of flexion and 7.5 Nm of extension moment was applied with and without 20 N of lateral tension in the LF. A follower load of 400 N was additionally applied along the curvature of the spine. To identify how the magnitude of LF tension related to the stability of the spine, the tensioning on the fasciae was increased up to 40 N with an interval of 10 N under 7.5 Nm of flexion/extension moment. A fascial tension of 20 N produced a 59% decrease in angular motion at 2.5 Nm of flexion moment while there was a 12.3% decrease at 10 Nm in the L5-S1 segment. Its decrement was 53 and 9.6% at 2.5 Nm and 10 Nm, respectively, in the L4-L5 segment. Anterior translation was reduced by 12.1 and 39.0% at the L4-L5 and L5-S1 segments under 10 Nm of flexion moment, respectively. The flexion stiffness shows an almost linear increment with the increase in fascial tension. The results of this study showed that the effect of the LF on the stability of the spine is significant.     

A technique for quantifying the bending moment acting on the lumbar spine in vivo

The bending properties of cadaveric lumbar spines were measured and used to convert in vivo measurements of lumbar flexion into bending moments ('stresses'). Forty-two lumbar motion segments were subjected to complex physiological loading and graphs were obtained of bending moment vs flexion angle. Variability was reduced by expressing both variables as a percentage of their values at the elastic limit. Data were averaged for each lumbar level, and a composite bending curve was compiled for the lumbar spine, L1-S1. A linear relationship was established between lumbar flexion measured in vitro and in vivo. This enabled values of 'per cent lumbar flexion' measured in vivo to be converted into 'per cent maximum bending moment' with a maximum likely error of about +/- 8%, which is equivalent to about +/- 5 Nm at L5-S1 for an average person. The technique was applied to 28 subjects, using dynamic measurements of lumbar flexion obtained with the '3-Space Isotrack' system. The bending moment at L5-S1 was 12 Nm on average when picking a pen up off the floor. Highly significant increases in bending moment were observed when heavier and bulkier objects were lifted.     

Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments—A finite element model study

The current study investigated mechanical predictors for the development of adjacent disc degeneration. A 3-D finite element model of a lumbar spine was modified to simulate two grades of degeneration at the L4–L5 disc. Degeneration was modeled by changes in geometry and material properties. All models were subjected to follower preloads of 800 N and moment loads in the three principal directions of motion using a hybrid protocol. Degeneration caused changes in the loading and motion patterns of the segments above and below the degenerated disc. At the level (L3–L4) above the degenerated disc, the motion increased due to moderate degeneration by 21% under lateral bending, 26% under axial rotation and 28% under flexion/extension. At the level (L5-S1) below the degenerated disc, motion increased only during lateral bending by 20% due to moderate degeneration. Both the L3–L4 and L5-S1 segment showed a monotonic increase in both the maximum von Mises stress and shear stress in the annulus as degeneration progressed for all loading directions, expect extension at L3–L4. The most significant increase in stress was observed at the L5-S1 level during axial rotation with nearly a ten-fold increase in the maximum shear stress and 103% increase in the maximum von Mises stress. The L5-S1 segment also showed a progressive increase in facet contact force for all loading directions with degeneration. Nucleus pressure did not increase significantly for any loading direction at either the caudal or cephalic adjacent segment. Results suggest that single-level degeneration can increase the risk for injury at the adjacent levels.     

Comparative stability of the "Internal Fixator" and the "Universal Spine System" and the effect of crosslinking transfixating systems. A biomechanical in vitro study.

In this study, the three-dimensional stabilizing capabilities of the AO-Internal Fixator (IF) and the new Universal Spine System (USS) were investigated. Both devices were tested without and with the cross-link system (IF, IFC, USS, USSC). To determine biomechanical characteristics, a human thoracolumbar spine instability model with resection of the vertebral body Th12 was created. The vertebral body was replaced by a spacer and transpedicular posterior stabilization was performed from Th11 to L1. All devices reduced the range of motion (ROM) significantly compared to the values of the intact specimen. In flexion the IFC showed the highest reduction of ROM (85% of intact), followed by the USSC, USS and IF (79% of intact). In extension the ROM was restored again most by the IFC (52% of intact), followed by the USSC, IF and USS (44% of intact). In lateral bending stability was provided by the USSC (right 78% and left 81% of intact), followed in right lateral bending by the IF, IFC and USS and in left lateral bending by the USS, IF and IFC. In axial rotation the ROM was reduced primary by the IFC (right 51% and left 46% of intact), followed in right axial rotation by the USS, USSC and IF, in left axial rotation by the USSC, USS and IF. Additional stability by crosslinking has been provided in the IF and the USS in flexion and extension, in the USS in lateral bending and in the IF in axial rotation nonsignificantly. The neutral zone (NZ) was reduced by posterior instrumentation in flexion/extension and right/left lateral bending significantly. In axial rotation only the USSC decreased the NZ below intact levels. The study showed no statistical significant differences in the stabilizing capabilities of the USS compared to the IF. For both implants the cross-link system increased stability in the chosen instability model insignificantly only.     

Biomechanical analysis of lumbar interbody fusion cages with various lordotic angles: a finite element study

Inappropriate lordotic angle of lumbar fusion cage could be associated with cage damage or subsidence. The biomechanical influence of cage lordotic angle on lumbar spine has not been fully investigated. Four surgical finite element models were constructed by inserting cages with various lordotic angles at L3-L4 disc space. The four motion modes were simulated. The range of motion (ROM) decreased with increased lordotic angle of cage in flexion, extension, and rotation, whereas it was not substantially changed in bending. The maximum stress in cage decreased with increased lordotic angle of cage in all motion modes. The maximum stress in endplate at surgical level increased with increased lordotic angle of cage in flexion and rotation, whereas it was not substantially changed in extension and bending. The facet joint force (FJF) was much smaller than that for the intact conditions in extension, bending, and rotation, while it was not substantially changed in flexion. In conclusion, the ROM, stresses in the cage and endplate at surgical level are sensitive to the lordotic angle of cage. The increased cage lordotic angle may provide better stability and reduce the risk of cage damage, whereas it may increase the risk of subsidence in flexion and rotation.     

Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study

Objective

For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective.

Method

We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position.

Results

The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa) and axial rotation (decrease from 1.639 to 1.307 MPa) after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree).

Conclusion

The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.     

Novel model to analyze the effect of a large compressive follower pre-load on range of motions in a lumbar spine

A 3-D finite element model (FEM) of the lumbar spine (L1-S1) was used to determine the effect of a large compressive follower pre-load on range of motions (ROM) in all three planes. The follower load modeled in the FEM produced minimal vertebral rotations in all the three planes. The model was validated by comparing the disc compression at all levels in the lumbar spine with the corresponding results obtained by compressing 10 cadevaric lumbar spines (L1-S1) using the follower load technique described by Patwardhan et al. [1999. A follower load increases the load-carrying capacity of the lumbar spine in compression. Spine 24(10), 1003-1009]. Further validation of the model was performed by comparing the lateral bending and torsion response without pre-load and the flexion-extension response without pre-load and with an 800 N follower pre-load with those obtained using cadaver lumbar spines. Following validation, the FEM was subjected to bending moments in all three planes with and without compressive follower pre-loads of up to 1200 N. Disc compression values and the flexion-extension range of motion under 800 N follower pre-load predicted by the FEM compared well with in vitro results. The current model showed that compressive follower pre-load decreased total as well as segmental ROM in flexion-extension by up to 18%, lateral bending by up to 42%, and torsion by up to 26%.     

The use of surface strain data and a neural networks solution method to determine lumbar facet joint loads during in vitro spine testing

A new method for determining facet loads during in vitro spine loading using strain gauges and a neural networks solution method was investigated. A test showed that the new solution method was more robust than and as accurate as a previously presented graphical solution method for computing facet loads using surface strain. The technique was subsequently utilized to assess facet loads at L1-L2 during flexibility testing [7.5Nm pure moments in flexion (FL), extension (EX), right and left axial rotation (AR), and right and left lateral bending (LB)], and stiffness testing (FL-EX with 400N compressive follower load) of six human lumbar spine segments (T12-L2). In contrast to other techniques, such as thin film sensors or pressure-sensitive film, the strain-gauge method leaves the facet joint capsule intact during data collection, presumably allowing more natural load transmission. During flexibility tests, the mean (+/-standard deviation) calculated facet loads (in N) were 46.1+/-41.3 (FL), 51.5+/-39.0 (EX), 70.3+/-43.2 (AR-contralateral side), 31.3+/-33.4 (AR-ipsilateral side), 30.6+/-29.1 (LB-contralateral side), and 32.0+/-44.4 (LB-ipsilateral side). During stiffness tests, the calculated facet loads were 45.5+/-40.4 (upright), 46.6+/-41.9 (full FL), and 75.4+/-39.0 (full EX), corresponding to an equivalent of 11.4%, 11.6%, and 18.8% of the compressive follower load (upright, full FL and EX, respectively). The error associated with this technique, which was below 11N for loads up to 125N, is comparable to that reported with other techniques. The new method shows promise for assessing facet load during in vitro spine testing, an important parameter when evaluating new implant systems and surgical techniques.     

THE EFFECTS OF BACK EXTENSION TRAINING ON BACK MUSCLE STRENGTH AND SPINAL RANGE OF MOTION IN YOUNG FEMALES

The objective of this study was to determine the effects of a 10-week dynamic back extension training programme and its effects on back muscle strength, back muscle endurance and spinal range of motion (ROM) for healthy young females. Seventy-three young females (age: 19.32±1.80 years, height: 158.89±4.71 cm, body weight: 55.67±6.30 kg) volunteered for the study. Prior to the training period, all participants completed anthropometric measurements, back muscle strength and endurance test, lateral bending and spinal ROM measurements. After measurements, the participants were divided into two groups. The exercise group (N:35) performed the dynamic back extension exercise 3 days per week for 10 weeks. The control group (N:38) did not participate in any type of exercise. The mixed design ANOVA (group x time) was used to determine the difference in pre- and post-training values. The present findings show that there were significant differences between pre-training and post-training values for back muscle strength and spinal ROM in the exercise group. Following the dynamic strength training programme, back muscle strength and spine ROM values except flexion of the lumbar 5-sacrum 1 (L5-S1) segment of the exercise group showed a significant increase when compared with the pre test values. The control group did not show any significant changes when compared with the pre-training values. The results demonstrate that the 10-week dynamic strength training programme was effective for spinal extension ROM and back muscle strength, but there was no change in back muscle endurance. In this context, this programme could potentially be used to prevent the decrease of spinal ROM as well as provide an increase in the fitness parameters of healthy individuals.     

Finite Element Analysis of a New Pedicle Screw-Plate System for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Purpose

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly popular for the surgical treatment of degenerative lumbar disc diseases. The constructs intended for segmental stability are varied in MI-TLIF. We adopted finite element (FE) analysis to compare the stability after different construct fixations using interbody cage with posterior pedicle screw-rod or pedicle screw-plate instrumentation system.

Methods

A L3–S1 FE model was modified to simulate decompression and fusion at L4–L5 segment. Fixation modes included unilateral plate (UP), unilateral rod (UR), bilateral plate (BP), bilateral rod (BR) and UP+UR fixation. The inferior surface of the S1 vertebra remained immobilized throughout the load simulation, and a bending moment of 7.5 Nm with 400N pre-load was applied on the L3 vertebra to recreate flexion, extension, lateral bending, and axial rotation. Range of motion (ROM) and Von Mises stress were evaluated for intact and instrumentation models in all loading planes.

Results

All reconstructive conditions displayed decreased motion at L4–L5. The pedicle screw-plate system offered equal ROM to pedicle screw-rod system in unilateral or bilateral fixation modes respectively. Pedicle screw stresses for plate system were 2.2 times greater than those for rod system in left lateral bending under unilateral fixation. Stresses for plate were 3.1 times greater than those for rod in right axial rotation under bilateral fixation. Stresses on intervertebral graft for plate system were similar to rod system in unilateral and bilateral fixation modes respectively. Increased ROM and posterior instrumentation stresses were observed in all loading modes with unilateral fixation compared with bilateral fixation in both systems.

Conclusions

Transforaminal lumbar interbody fusion augmentation with pedicle screw-plate system fixation increases fusion construct stability equally to the pedicle screw-rod system. Increased posterior instrumentation stresses are observed in all loading modes with plate fixation, and bilateral fixation could reduce stress concentration.     

A new in vivo technique for 3-dimensional analysis of the translation of femoral condyles and the menisci responding to antagonistic muscle forces]

The aim of our study was to develop a 3-D MR-based technique for the analysis of meniscal and femoral translations during flexion of the knee, and under the influence of antagonistic muscle forces in healthy subjects. In an open MR system, 5 knees were examined at 30 degrees and 90 degrees flexion using a T1-weighted 3-D gradient echo sequence. A force of 30 Newtons, first in the extending and then in the flexing direction, was applied to the distal lower leg. After three-dimensional reconstruction, the minimal distances between the centre of the tibial plateau and the posterior edge of the menisci and femoral condyles were determined. At 30 degrees flexion, the minimum distance for the meniscus was larger medially than laterally (23.2 +/- 1.8 mm vs. 16.2 +/- 3.3 mm), and this also applied to the condyles (25.1 +/- 1.5 vs. 19.0 +/- 3.0 mm). During flexion to 90 degrees, a posterior translation of 0.5 +/- 0.2 mm was observed for the lateral, and of 3.4 +/- 1.2 mm for the medial, meniscus. The condyles demonstrated a different posterior translation (lateral 2.2 +/- 0.56 mm; medial 1.8 +/- 1.9 mm). No obvious differences were found between extension and flexion muscle activity for the different positions of the knee. In the present study, a new 3-D technique is presented for the analysis of the femoral and meniscal translation at various positions of the knee, and under muscle activity. The results suggest different translation for the menisci and condyles.     

Assessment of non-invasive intervertebral motion measurements in the lumbar spine

This study compared the accuracy of new, FDA-approved, image-analysis software to conventional radiographic assessment techniques for the measurement of intervertebral motion. Six adult human cadaveric lumbar spines (L1-S1) were individually mounted in a custom Plexiglas device and electromagnetic sensors were rigidly mounted to the spinous processes of L3, L4, and L5. Lateral radiographs of the spines in neutral, full flexion, and full extension were digitized and analyzed both using the software and manually by three orthopedic surgeons. Compared to intervertebral rotations determined from the electromagnetic device, the errors in rotations reported by the software and surgeons were 0.47+/-0.24 degrees and 2.16+/-0.78 degrees , respectively. Rotations measured by the surgeons were significantly less accurate and more variable than that of the software (p<0.05).     

Validation of lumbar spine loading from a musculoskeletal model including the lower limbs and lumbar spine

Low back mechanics are important to quantify to study injury, pain and disability. As in vivo forces are difficult to measure directly, modeling approaches are commonly used to estimate these forces. Validation of model estimates is critical to gain confidence in modeling results across populations of interest, such as people with lower-limb amputation. Motion capture, ground reaction force and electromyographic data were collected from ten participants without an amputation (five male/five female) and five participants with a unilateral transtibial amputation (four male/one female) during trunk-pelvis range of motion trials in flexion/extension, lateral bending and axial rotation. A musculoskeletal model with a detailed lumbar spine and the legs including 294 muscles was used to predict L4-L5 loading and muscle activations using static optimization. Model estimates of L4-L5 intervertebral joint loading were compared to measured intradiscal pressures from the literature and muscle activations were compared to electromyographic signals. Model loading estimates were only significantly different from experimental measurements during trunk extension for males without an amputation and for people with an amputation, which may suggest a greater portion of L4-L5 axial load transfer through the facet joints, as facet loads are not captured by intradiscal pressure transducers. Pressure estimates between the model and previous work were not significantly different for flexion, lateral bending or axial rotation. Timing of model-estimated muscle activations compared well with electromyographic activity of the lumbar paraspinals and upper erector spinae. Validated estimates of low back loading can increase the applicability of musculoskeletal models to clinical diagnosis and treatment.     

Application of a stand-alone interbody fusion cage based on a novel porous TiO2/glass ceramic--2: Biomechanical evaluation after implantation in the sheep cervical spine]

Animals are becoming more and more common as in vivo models for the human spine. Especially the sheep cervical spine is stated to be of good comparability and usefulness in the evaluation of in vivo radiological, biomechanical and histological behaviour of new bone replacement materials, implants and cages for cervical spine interbody fusion. In preceding biomechanical in vitro examinations human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or polymethylmethacrylate (PMMA) after discectomy. Following our first experience with the use of the new material and its influence on the primary stability after in vitro application we carried out fusions of 20 sheep cervical spines levels with either PMMA or an Ecopore-cage, and performed radiological examinations during the following 2-4 months. In this second part of the study we intended the biomechanical evaluation of the spine segments with reference to the previously determined morphological findings, like subsidence of the implants, significant increase of the kyphosis angle and degree of the bony fusion along with the interpretation of the results. 20 sheep cervical spines segments with either PMMA- or Ecopore-fusion in the levels C2/3 and C4/5 were tested, in comparison to 10 native corresponding sheep cervical spine segments. Non-destructive biomechanical testing was performed, including flexion/extension, lateral bending and axial rotation using a spine testing apparatus. Three-dimensional range of motion (ROM) was evaluated using an ultrasound measurement system. In the native spine segments C2/3 and C4/5 the ROM increased in cranio-caudal direction particulary in flexion/extension, less pronounced in lateral flexion and axial rotation (p < 0.05). The overall ROM of both tested segments was greatest in lateral flexion, reduced to 52% in flexion/extension and to 16% in axial rotation. After 2 months C2/3- and C4/5-segments with PMMA-fusion and C2/3-segments with Ecopore-interposition showed decrease of ROM in lateral flexion in comparison to the native segments, indicating increasing stiffening. However, after 4 months all operated segments, independent from level or implanted material, were stiffer than the comparable native segments. The decrease of the ROM correlated with the radiological-morphological degree of fusion. Our evaluation of the new porous TiO2/glass composite as interbody fusion cage has shown satisfactory radiological results as well as distinct biomechanical stability and fusion of the segments after 4 months in comparison to PMMA. After histological analysis of the bone-biomaterial-interface, further examinations of this biomaterial previous to an application as alternative to other customary cages in humans are necessary.