Noninvasive prediction of vertebral body compressive strength using nonlinear finite element method and an image based technique

Noninvasive prediction of vertebral body strength under compressive loading condition is a valuable tool for the assessment of clinical fractures. This paper presents an effective specimen-specific approach for noninvasive prediction of human vertebral strength using a nonlinear finite element (FE) model and an image based parameter based on the quantitative computed tomography (QCT). Nine thoracolumbar vertebrae excised from three cadavers with an average age of 42 years old were used as the samples. The samples were scanned using the QCT. Then, a segmentation technique was performed on each QCT sectional image. The segmented images were then converted into three-dimensional FE models for linear and nonlinear analyses. A new material model was implemented in our nonlinear model being more compatible with real mechanical behavior of trabecular bone. A new image based MOS (Mechanic of Solids) parameter named minimum sectional strength ((σ_uA)_min) was used for the ultimate compressive strength prediction. Subsequently, the samples were destructively tested under uniaxial compression and their experimental ultimate compressive strengths were obtained. Results indicated that our new implemented FE model can predict ultimate compressive strength of human vertebra with a correlation coefficient (R² = 0.94) better than usual linear and nonlinear FE models (R² = 0.83 and 0.85 respectively). The image based parameter introduced in this study ((σ_uA)_min) was also correlated well with the experimental results (R² = 0.86). Although nonlinear FE method with new implemented material model predicts compressive strength better than the (σ_uA)_min, this parameter is clinically more feasible due to its simplicity and lower computational costs. This can make future applications of the (σ_uA)_min more justified for human vertebral body compressive strength prediction.     

Tensile strength of bovine trabecular bone

Data on the tensile and compressive properties of trabecular bone are needed to define input parameters and failure criteria for modeling total joint replacements. To help resolve differences in reports comparing tensile and compressive properties of trabecular bone, we have developed new methods, based on porous foam technology, for tensile testing of fresh/frozen trabecular bone specimens. Using bovine trabecular bone from an isotropic region from the proximal humerus as a model material, we measured ultimate strengths in tension and compression for two groups of 24 specimens each. The average ultimate strength in tension was 7.6 +/- 2.2 (95% C.I.) MPa and in compression was 12.4 +/- 3.2 MPa. This difference was statistically significant (p = 0.013) and was not related to density differences between the test groups (p = 0.28). Strength was related by a power-law function of the local apparent density, but, even accounting for density influences, isotropic bovine trabecular bone exhibits significantly lower strengths in tension than in compression.     

Microorbitalism: a technique for orbital rim expansion

A simple technique for orbital aperture expansion to facilitate placement of ocular prostheses is described. Both superolateral and inferolateral orbital margins are released by means of a single burr hole craniectomy of the frontosphenoid bone behind the orbital process of the frontal bone. Vertical and horizontal marginal lengthenings are performed by a rotatory displacement of one bone segment alongside the other. The expanded osseous aperture is secured with wire and plate-and-screw fixation following a supraorbital rim craniectomy to allow an adequate fit. The result provides for easier access of ocular prostheses and tissue expanders. The method has been applied to a series of patients with microorbitalism due to unilateral or bilateral congenital anophthalmia over the past 3 years without complication and with excellent results. Three-dimensional re-formatted CT reconstructions of the craniofacial skeleton are shown preoperatively and postoperatively.     

Parametric finite element analysis of vertebral bodies affected by tumors

The vertebral column is the most frequent site of metastatic involvement of the skeleton. Due to the proximity to the spinal cord, from 5% to 10% of all cancer patients develop neurologic manifestations. As a consequence, fracture risk prediction has significant clinical importance. In this study, we model the metastatically involved vertebra so as to parametrically investigate the effects of tumor size, material properties and compressive loading rate on vertebral strength. A two-dimensional axisymmetric finite element model of a spinal motion segment consisting of the first lumbar vertebral body (no posterior elements) and adjacent intervertebral disc was developed to allow the inclusion of a centrally located tumor in the vertebral body. After evaluating elastic, mixed, and poroelastic formulations, we concluded that the poroelastic representation was most suitable for modeling the metastatically involved vertebra's response to compressive load. Maximum principal strains were used to localize regions of potential vertebral trabecular bone failure. Radial and axial vertebral body displacements were used as relative indicators of spinal canal encroachment and endplate failure. Increased tumor size and loading rate, and reduced trabecular bone density all elevated axial and radial displacements and maximum tensile strains. The results of this parametric study suggest that vertebral tumor size and bone density contribute significantly to a patients risk for vertebral fracture and should be incorporated in clinical assessment paradigms.     

Compressive fatigue properties of a commercially available acrylic bone cement for vertebroplasty

Acrylic bone cements are widely used for fixation of joint prostheses as well as for vertebral body augmentation procedures of vertebroplasty and balloon kyphoplasty, with the cement zone(s) being subjected to repeated mechanical loading in each of these applications. Although, in vertebroplasty and balloon kyphoplasty, the cement zone is exposed to mainly cyclical compressive load, the compressive fatigue properties of acrylic bone cements used in these procedures are yet to be determined. The purposes of the present study were to determine the compressive fatigue properties of a commercially available cement brand used in vertebroplasty, including the effect of frequency on these properties; to identify the cement failure modes under compressive cyclical load; and to introduce a screening method that may be used to shorten the lengthy character of the standardized fatigue tests. Osteopal \({^\circledR } \mathrm{V}\) was used as the model cement in this study. The combinations of maximum stress and frequency used were 50.0, 55.0, 60.0, 62.5 and 75.5 MPa at 2 Hz; and of 40.0, 55.0, 60.0, 62.5 or 75.5 MPa at 10 Hz. Through analysis of nominal strain-number of loading cycles results, three cement failure modes were identified. The estimated mean fatigue limit at 2 Hz (55.4 MPa) was significantly higher than that at 10 Hz (41.1 MPa). The estimated fatigue limit at 2 Hz is much higher than stresses commonly found in the spine and also higher than that for other acrylic bone cements tested in a full tension–compression fatigue test, which indicates that tension–compression fatigue testing may substantially underestimate the performance of cements intended for vertebroplasty. A screening method was introduced which may be used to shorten the time spent in performing compressive fatigue tests on specimens of acrylic bone cement for use in vertebral body augmentation procedures.     

Lordotic vertebrae in sea bass (Dicentrarchus labrax L.) are adapted to increased loads

Lordosis in fish is an abnormal ventral curvature of the vertebral column, accompanied by abnormal calcification of the afflicted vertebrae. Incidences of lordosis are a major problem in aquaculture and often correlate with increased swimming activity. To understand the biomechanical causes and consequences of lordosis, we mapped the morphological changes that occur in the vertebrae of European sea bass during their development from larva to juvenile. Our micro-CT analysis of lordotic and non-lordotic vertebrae revealed significant differences in their micro-architecture. Lordotic vertebrae have a larger bone volume, flattened dorsal zygapophyses and extra lateral ridges. They also have a larger second moment of area (both lateral and dorso-ventral) than non-lordotic vertebrae. This morphology suggests lordotic vertebrae to be adapted to an increased bending moment, caused by the axial musculature during increased swimming activity. We hypothesize the increase in swimming activity to have a two-fold effect in animals that become lordotic. The first effect is buckling failure of the axial skeleton due to an increased compressive load. The second effect is extra bone deposition as an adaptive response of the vertebrae at the cellular level, caused by an increased strain and strain rate in these vertebrae. Lordosis thus comprises both a buckling failure of the vertebral column and a molecular response that adapts the lordotic vertebrae to a new loading regime.     

Finite element modeling of trabecular bone damage

This paper presents a finite element-based, computational model for analysis of structural damage to trabecular bone tissues. A modulus reduction method was formulated from elasto-plasticity theory, and was used to account for site-specific trabecular bone tissue damage. Trabecular bone tissue damage is illustrated using a large-scale, anatomically accurate, two-dimensional, microstructural finite element model of a human thoracic vertebral body. Four models with varying specifications for damage accumulation were subjected to compressive loading and unloading cycles. The numerical results and experimental validation demonstrated that the modulus reduction method reproduced the non-linear mechanical behaviour of vertebal trabecular bone. The iterative computational approach presented provides a methodology to study trabecular bone damage, and should provide researchers with a computational approach to study bone fracture and repair and to predict vertebral fragility.     

Biomechanics of the vertebrae and associated osteoderms of the Early Permian amphibian Cacops aspidephorus

Two series of osteoderms associated with the anterior three-quarters of the presacral vertebral column of the Early Permian temnospondylous amphibian Cacops aspidephorus have important implications for biomechanics of the axial skeleton. An internal series consists of an osteoderm fused to the distal tip of each neural spine. Lying dorsal to the internal series and overlapping each internal osteoderm is a second external series. The orientation of the zygapophyseal facets implies modest lateral flexion with limited coupled axial rotation of the column. However, the osteoderms restricted any possible lateral flexion through their inverted V-shape, strongly angled overlap between each external osteoderm and its neighbouring internal osteoderms, and the presence of a midsagittal flange on the ventral surface of each external osteoderm that fits into grooves on the anterior and posterior edges of the neighbouring internal osteoderms. This configuration allowed vertical flexion of the vertebral column with little lateral flexion. The rod-like nature of osteoderms with the anterior three-quarters of the presacral vertebrae suggests a restricted form of forward movement for Cacops unlike that of other early tetrapods.     

Rapid prototyping of scaphoid and lunate bones

In this study, a novel rapid prototyping technology was used to fabricate scaphoid and lunate bone prostheses, two carpal bones that are prone to avascular necrosis. Carpal prostheses were fabricated with an Envisiontec Perfactory® SXGA stereolithography system using Envisiontec eShell 200 photocurable polymer. Fabrication was guided using 3-D models, which were generated using Mimics software (Materialise NV, Leuven, Belgium) from patient computer tomography data. The prostheses were fabricated in a layer-by-layer manner; ∼ 50-μm thick layers were observed in the prostheses. Hardness and Young's modulus values of polymerized eShell 200 material were 93.8 ± 7.25 MPa and 3050 ± 90 MPa, respectively. The minimum compressive force required for fracture was 1360 N for the scaphoid prosthesis and 1248 N for the lunate prosthesis. Polymerized Envisiontec eShell material exhibited high human neonatal epidermal keratinocyte cell viability rate in an MTT assay. The results of this study indicate that small bone prostheses fabricated by stereolithography using eShell 200 polymer may have suitable geometry, mechanical properties, and cytocompatibility properties for in vivo use.     

Responses of jawbone to pressure

Objective: To provide a literature review of bone resorption of edentulous jaws focusing on responses to pressure. Background: After the extraction of all teeth in a jaw there is a continuous reduction of the residual ridge. The individual variation of bone resorption is great, and the aetiology is complex and not yet well understood. Materials and methods: A search of the literature published up to May 2003 on bone resorption and pressure was performed using PubMed/Medline. Results: Animal studies have demonstrated that excessive and constant pressure induces bone resorption. Recent experimental research has indicated that bone resorption is a pressure‐regulated phenomenon with a lower threshold for continuous than for intermittent pressure. Clinical studies have suggested that residual ridge resorption is due more to the effects of denture wearing than to disuse atrophy. However, the results of leaving out dentures at night are not conclusive. Nor does the literature offer any strong evidence for the so‐called combination syndrome, which has been described as a result of unfavourable loading. Clinical studies using multivariate analyses indicate that female gender and systemic factors may be of greater importance than oral and denture factors. Implant‐supported prostheses have a bone preserving effect rather than the continuing resorption under complete dentures. Conclusions: The best way to reduce bone resorption is to avoid total extraction, preserve a few teeth and fabricate overdentures. In edentulous jaws, placement of implant‐supported prostheses will lead to less bone loss and may even promote bone growth. To increase our knowledge of residual ridge resorption extended experimental, clinical and statistical methods will be needed, preferably including collaboration between dental and medical researchers.     

Manufacture of small calibre quadruple lamina vascular bypass grafts using a novel automated extrusion-phase-inversion method and nanocomposite polymer

Long-term patency of expanded polytetrafluoroethylene (ePTFE) small calibre cardiovascular bypass prostheses (<6 mm) is poor because of thrombosis and intimal hyperplasia due to low compliance, stimulating the search for elastic alternatives. Wall porosity allows effective post-implantation graft healing, encouraging endothelialisation and a measured fibrovascular response. We have developed a novel poly (carbonate) urethane-based nanocomposite polymer incorporating polyhedral oligomeric silsesquioxane (POSS) nanocages (UCL-NANO?) which shows anti-thrombogenicity and biostability.We report an extrusion-phase-inversion technique for manufacturing uniform-walled porous conduits using UCL-NANO?. Image analysis-aided wall measurement showed that two uniform wall-thicknesses could be specified. Different coagulant conditions revealed the importance of low-temperature phase-inversion for graft integrity. Although minor reduction of pore-size variation resulted from the addition of ethanol or N,N-dimethylacetamide, high concentrations of ethanol as coagulant did not provide uniform porosity throughout the wall. Tensile testing showed the grafts to be elastic with strength being directly proportional to weight. The ultimate strengths achieved were above those expected from haemodynamic conditions, with anisotropy due to the manufacturing process. Elemental analysis by energy-dispersive X-ray analysis did not show a regional variation of POSS on the lumen or outer surface. In conclusion, the automated vertical extrusion–phase-inversion device can reproducibly fabricate uniform-walled small calibre conduits from UCL-NANO?. These elastic microporous grafts demonstrate favourable mechanical integrity for haemodynamic exposure and are currently undergoing in-vivo evaluation of durability and healing properties.     

Effects of suppression of bone turnover on cortical and trabecular load sharing in the canine vertebral body

The relative biomechanical effects of antiresorptive treatment on cortical thickness vs. trabecular bone microarchitecture in the spine are not well understood. To address this, T-10 vertebral bodies were analyzed from skeletally mature female beagle dogs that had been treated with oral saline (n=8 control) or a high dose of oral risedronate (0.5 mg/kg/day, n=9 RIS-suppressed) for 1 year. Two linearly elastic finite element models (36-μm voxel size) were generated for each vertebral body—a whole-vertebra model and a trabecular-compartment model—and subjected to uniform compressive loading. Tissue-level material properties were kept constant to isolate the effects of changes in microstructure alone. Suppression of bone turnover resulted in increased stiffness of the whole vertebra (20.9%, p=0.02) and the trabecular compartment (26.0%, p=0.01), while the computed stiffness of the cortical shell (difference between whole-vertebra and trabecular-compartment stiffnesses, 11.7%, p=0.15) was statistically unaltered. Regression analyses indicated subtle but significant changes in the relative structural roles of the cortical shell and the trabecular compartment. Despite higher average cortical shell thickness in RIS-suppressed vertebrae (23.1%, p=0.002), the maximum load taken by the shell for a given value of shell mass fraction was lower (p=0.005) for the RIS-suppressed group. Taken together, our results suggest that—in this canine model—the overall changes in the compressive stiffness of the vertebral body due to suppression of bone turnover were attributable more to the changes in the trabecular compartment than in the cortical shell. Such biomechanical studies provide an unique insight into higher-scale effects such as the biomechanical responses of the whole vertebra.     

Constraints and fixation for implanted joint replacements

Observations made on both cemented and uncemented joint prostheses after about two years of use show a layer of fibrous tissue next to the bone. This fibrous layer smooths over surface features up to l mm in size, and must be assumed to be weak in tension and shear. Prosthesis-bone interfaces should therefore be designed to transmit all forces acting on the prosthesis as compressive stresses. The forces acting across prostheses are controlled by the constraints exerted by the articulating surfaces; if the useful ligaments present are allowed to do their job of transmitting tension, the articulating surfaces can be designed to transmit only such forces and moments as can safely be transmitted across the prosthesis-bone interfaces.     

Compressive fatigue behavior of human vertebral trabecular bone

Damage accumulation under compressive fatigue loading is believed to contribute significantly to non-traumatic, age-related vertebral fractures in the human spine. Only few studies have explored trabecular bone fatigue behavior under compressive loading and none examined the influence of trabecular architecture on fatigue life. In this study, trabecular bone samples of human lumbar and thoracic vertebrae (4 donors from age 29 to 86, n=29) were scanned with a microCT system prior to compressive fatigue testing to determine morphology-mechanical relationships for this relevant loading mode. Inspired from previous fabric-based relationships for elastic properties and quasi-static strength of trabecular bone, a simple power relationship between volume fraction, fabric eigenvalue, applied stress and the number of cycles to failure is proposed. The experimental results demonstrate a high correlation for this relationship (R2=0.95) and detect a significant contribution of the degree of anisotropy towards prediction of fatigue life. Step-wise regression for total and residual strains at failure suggested a weak, but significant correlation with volume fraction. From the obtained results, we conclude that the applied stress normalized by volume fraction and axial fabric eigenvalue can estimate fatigue life of human vertebral trabecular bone in axial compressive loading.     

Mid-sagittal dimensions of cervical vertebral bodies.

A series of lateral radiographs of the cervical spinal column was evaluated in order to determine vertebral body dimensions. The sample included males (N=30) and females (N=31) 18 to 24 years old, comprising three stature percentile ranges (1-20; 40-60; 80-99) of the U.S. adult population. A two-dimensional analysis of vertebral body height (average distance between superior-inferior surgaces), depth (average distance between anteriorposterior surfaces), and area (average height X average depth) revealed minimal effects due to stature. In all subjects, average depth exceeded average height for vertebral bodies C3 through C7. Upon combining stature groups, both sexes revealed maximum average values for these dimensions at the seventh cervical vertebral body. Minimum average height occurred at C5 whereas minimum average depth was found at C3. Significant correlation (alpha greater than 0.05) was found for males between ponderal index and height and depth of the C7 vertebra. Male head weight correlated significantly with C3, C4, C5 and C6 vertebral body height and with C3, C5 and C6 vertebral body depth. For females, C7 height and C6 depth correlated significantly with ponderal index and head weight respectively. Probable biomechanical relationships of specific cervical vertebral bodies are noted     

Analysis of compressive creep behavior of the vertebral unit subjected to a uniform axial loading using exact parametric solution equations of Kelvin-solid models--Part II. Rhesus monkey intervertebral joints

The simulation of long-term creep response behavior, observed on 54 Rhesus monkey intervertebral joints subjected to a constant axial compressive stress, is attempted by two- and three-parameter-solid models utilizing the Burns- Kaleps 'exact analysis scheme'. Model parameters identified by the analysis of each specimen's experimental strain data were optimized via a computer program and the mechanical properties (Young's moduli and the viscosity coefficient) appropriate to each model were calculated for individual spinal segments. Simulation results for the two-parameter-solid (one- Kelvin -unit) model demonstrate its general ineptness in predicting the observed strain-time behavior of normal spinal sements . The three-parameter-solid model yielded excellent results in the simulation of observed spinal segment compressive creep phenomena. It produced an average error between the model predicted and experimental strain values that ranged from a low of 0.4000% to a high of 3.290% for the 54 Rhesus monkey intervertebral joints, with a collective average error for all specimens of only 1.363%.     

椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的临床分析

目的分析老年骨质疏松脊柱压缩骨折行椎体后凸成形术的治疗方法及临床效果,为临床提供依据。方法回顾性分析我院2014年10月~2015年10月收治的老年骨质疏松脊柱压缩骨折患者40例的临床资料,全部患者均为椎体后壁完整疼痛性骨质疏松脊柱压缩骨折,均接受椎体后凸成形术治疗,经双侧椎弓根、椎弓根旁置入可扩张球囊,将骨折塌陷椎体进行复位,采取骨水泥填充球囊扩张产生的椎体内空腔,术后观察患者症状改善和骨折复位情况。结果 40例患者手术均顺利完成,术后48h内患者疼痛显著缓解,骨折椎体前缘以及中部高度丢失,从手术前的(12.5±2.2)mm、(9.1±1.3)mm减少到手术后的(4.6±1.4)mm、(3.3±1.0)mm;后凸畸形Cobb角从手术前的(22.2±5.1)°矫正到手术后的(9.1±4.6)°,其中1例患者术后出现少量骨水泥渗漏,1例患者手术过程中一侧穿刺管中出现脑脊液,即停止该侧手术。结论老年骨质疏松脊柱压缩骨折行椎体后凸成形术治疗效果显著,可以快速缓解患者的疼痛,使患者脊柱序列得到恢复,值得临床推广使用。     

Fusion of the cervical vertebrae of mammals

Morphogenesis of the cervical vertebrae has been investigated in Dipis sagitt. and in Rattus norvegicus. The main distinctive feature of the Dipis embryos at the mesenchymal stage is their very thin perichordal intervertebral rings. As a result, short cartilaginous vertebral bodies and thin intervertebral discs develop, cervical segments lengthen more slowly than those of the Rattus. Because of the small length of the Dipis cervical segments, the cartilaginous neural arches and the transverse processes of 2-6 vertebrae draw nearer and fuse. Owing to the insufficient development of the Dipis intervertebral discs and the nuclei pulposae, the normal formation of the vertebral epiphyses is disturbed, this results in fusion of the neighbouring osseous vertebral bodies.     

Long-term use of polyurethane breast prostheses: a 14-year experience

I have used polyurethane prostheses for the past 14 years, implanting 220 implants into 130 patients who desired breast reconstruction after subcutaneous mastectomy or cancer ablation or simply breast augmentation. I theorize that a polyurethane-covered implant resists contracture, retaining its compressibility because the fibroblasts proliferate into the polyurethane in many different directions. When the fibrils contract, the forces of contracture counterbalance one another, resisting contracture. However, when smooth prostheses are implanted, fibrils are directed in a circular fashion around the implant and naturally contract, leading to firmer breasts. There were 115 prostheses inserted following subcutaneous mastectomy, and 22 percent developed contracted capsules. Seven implants became exposed because of skin necroses; one was removed because of a Staphylococcus infection; and two patients developed a combination of polyurethane and silicone granulomas. These developed only with the earlier implant, where there was shedding of the polyurethane sponge layer and silicone bled from the low-viscosity silicone used in the earlier implants. No granulomas were noted with the currently used Surgitek Replicon implant. Eighty-five breasts were reconstructed after cancer ablation with polyurethane implants, and the contracture rate was 2.3 percent. Other complications were minimal. A smaller group of patients had augmentation mammaplasty, and 20 prostheses were placed in 10 patients. A 15 percent contracture rate was noted in this group. In this study, 82 percent of patients were followed for up to 14 years. Capsular contractures occurred in 30 implants between 1 and 11 years, for an average recurrence at 6.3 years. The overall contracture rate was 13 percent. Other complications were minimal. All implants were placed subcutaneously or subglandularly, and all were drained.     

Do patients with diabetic neuropathy use a higher proportion of their maximum strength when walking?

Diabetic patients have an altered gait strategy during walking and are known to be at high risk of falling, especially when diabetic peripheral neuropathy is present. This study investigated alterations to lower limb joint torques during walking and related these torques to maximum strength in an attempt to elucidate why diabetic patients are more likely to fall. 20 diabetic patients with moderate/severe peripheral neuropathy (DPN), 33 diabetic patients without peripheral neuropathy (DM), and 27 non-diabetic controls (Ctrl) underwent gait analysis using a motion analysis system and force plates to measure kinetic parameters. Lower limb peak joint torques and joint work done (energy expenditure) were calculated during walking. The ratio of peak joint torques and individual maximum joint strengths (measured on a dynamometer) was then calculated for 59 of the 80 participants to yield the ‘operating strength’ for those participants. During walking DM and DPN patients showed significantly reduced peak torques at the ankle and knee. Maximum joint strengths at the knee were significantly less in both DM and DPN groups than Ctrls, and for the DPN group at the ankle. Operating strengths were significantly higher at the ankle in the DPN group compared to the Ctrls. These findings show that diabetic patients walk with reduced lower limb joint torques; however due to a decrement in their maximum ability at the ankle and knee, their operating strengths are higher. This allows less reserve strength if responding to a perturbation in balance, potentially increasing their risk of falling.