Human evolution and osteoporosis-related spinal fractures

The field of evolutionary medicine examines the possibility that some diseases are the result of trade-offs made in human evolution. Spinal fractures are the most common osteoporosis-related fracture in humans, but are not observed in apes, even in cases of severe osteopenia. In humans, the development of osteoporosis is influenced by peak bone mass and strength in early adulthood as well as age-related bone loss. Here, we examine the structural differences in the vertebral bodies (the portion of the vertebra most commonly involved in osteoporosis-related fractures) between humans and apes before age-related bone loss occurs. Vertebrae from young adult humans and chimpanzees, gorillas, orangutans, and gibbons (T8 vertebrae, n = 8–14 per species, male and female, humans: 20–40 years of age) were examined to determine bone strength (using finite element models), bone morphology (external shape), and trabecular microarchitecture (micro-computed tomography). The vertebrae of young adult humans are not as strong as those from apes after accounting for body mass (p<0.01). Human vertebrae are larger in size (volume, cross-sectional area, height) than in apes with a similar body mass. Young adult human vertebrae have significantly lower trabecular bone volume fraction (0.26±0.04 in humans and 0.37±0.07 in apes, mean ± SD, p<0.01) and thinner vertebral shells than apes (after accounting for body mass, p<0.01). Since human vertebrae are more porous and weaker than those in apes in young adulthood (after accounting for bone mass), even modest amounts of age-related bone loss may lead to vertebral fracture in humans, while in apes, larger amounts of bone loss would be required before a vertebral fracture becomes likely. We present arguments that differences in vertebral bone size and shape associated with reduced bone strength in humans is linked to evolutionary adaptations associated with bipedalism.     

Material changes in osteoporotic human cancellous bone following infiltration with acrylic bone cement for a vertebral cement augmentation

Bone cement infiltration can be effective at mechanically augmenting osteoporotic vertebrae. While most published literature describes the gain in mechanical strength of augmented vertebrae, we report the first measurements of viscoelastic material changes of cancellous bone due to cement infiltration. We infiltrated cancellous core specimen harvested from osteoporotic cadaveric spines with acrylic bone cement. Bone specimen before and after cement infiltration were subjected to identical quasi-static and relaxation loading in confined and free compression. Testing data were fitted to a linear viscoelastic model of compressible material and the model parameters for cement, native cancellous bone, and cancellous bone infiltrated (composite) with cement were identified. The fitting demonstrated that the linear viscoelastic model presented in this paper accurately describes the mechanical behaviour of cement and bone, before and after infiltration. Although the composite specimen did not completely adopt the properties of bulk bone cement, the stiffening of cancellous bone due to cement infiltration is considerable. The composite was, for example, 8.5 times stiffer than native bone. The local stiffening of cancellous bone in patients may alter the load transfer of the augmented motion segment and may be the cause of subsequent fractures in the vertebrae adjacent to the ones infiltrated with cement. The material model and parameters in this paper, together with an adequate finite-element model, can be helpful to investigate the load shift, the mechanism for subsequent fractures, and filling patterns for ideal cement infiltration.     

Biomechanical alterations in intact osteoporotic spine due to synthetic augmentation: finite element investigation

A three-dimensional nonlinear finite element model (FEM) was developed for a parametric study that examined the effect of synthetic augmentation on nonfractured vertebrae. The objective was to isolate those parameters primarily responsible for the effectiveness of the procedure; bone cement volume and bone density were expected to be highly important. Injection of bone cement was simulated in the FEM of a vertebral body that included a cellular model for the trabecular core. The addition of 10% and 20% cement by volume resulted in an increase in failure load, and the larger volume resulted in an increase in stiffness for the vertebral body. Placement of cement within the vertebral body was not as critical a parameter as cement amount. Simulated models of very poor bone quality saw the best therapeutic benefits.     

Damage accumulation in vertebral trabecular bone depends on loading mode and direction

Osteoporotic vertebral fractures constitute a major clinical problem in ageing societies. A third of all vertebral fractures is caused by falls, 15% by lifting heavy loads or traffic accidents and over 50% are not relatable to a traumatic event. In the latter case vertebrae show sinter processes which indicate the accumulation of damage and permanent deformation. Accumulated damage may not be visible on radiographs but increases the risk of fracture and could lead to vertebral collapse. Clear understanding of the accumulation of damage and residual strains and their dependence on loading mode and direction is important for understanding vertebral fractures. Altogether, 251 cylindrical samples (8×18-25mm) were obtained from 50 male and 54 female fresh frozen human vertebrae (T1-L3) of 65 (21-94) years. Vertebrae were randomly assigned to three groups cranial-caudal, anterior-posterior and latero-lateral. Specimens were mechanically loaded in compression, tension or torsion in five load steps at a strain rate of 0.2%/s. Three conditioning cycles were driven per load step. Stress-strain curves were reconstructed from the force-displacement or from the moment-twist angle curves. Damage accumulated from 0 to 86% in compression, from 0 to 76% in tension and from 0 to 86% in torsion through the five load steps. Residual strains accumulated from 0 to -0.008mm/mm in compression, 0 to 0.006mm/mm in tension and 0 to 0.026rad/rad in torsion. Significantly less damage (p<0.05) but not residual strains accumulated in transverse directions. This study provides detailed experimental insights into the damage behaviour of vertebral trabecular bone under various loads occurring in vivo. Damage but not residual strain evolution seems to be anisotropic. Both seem to evolve differently under different loading modes. The results could be of importance in understanding vertebral fractures.     

Material Changes in Osteoporotic Human Cancellous Bone Following Infiltration with Acrylic Bone Cement for a Vertebral Cement Augmentation

Bone cement infiltration can be effective at mechanically augmenting osteoporotic vertebrae. While most published literature describes the gain in mechanical strength of augmented vertebrae, we report the first measurements of viscoelastic material changes of cancellous bone due to cement infiltration. We infiltrated cancellous core specimen harvested from osteoporotic cadaveric spines with acrylic bone cement. Bone specimen before and after cement infiltration were subjected to identical quasi-static and relaxation loading in confined and free compression. Testing data were fitted to a linear viscoelastic model of compressible material and the model parameters for cement, native cancellous bone, and cancellous bone infiltrated (composite) with cement were identified. The fitting demonstrated that the linear viscoelastic model presented in this paper accurately describes the mechanical behaviour of cement and bone, before and after infiltration. Although the composite specimen did not completely adopt the properties of bulk bone cement, the stiffening of cancellous bone due to cement infiltration is considerable. The composite was, for example, 8.5 times stiffer than native bone. The local stiffening of cancellous bone in patients may alter the load transfer of the augmented motion segment and may be the cause of subsequent fractures in the vertebrae adjacent to the ones infiltrated with cement. The material model and parameters in this paper, together with an adequate finite-element model, can be helpful to investigate the load shift, the mechanism for subsequent fractures, and filling patterns for ideal cement infiltration.     

The relationship of whole human vertebral body creep to geometric,microstructural, and material properties

Creep, the time dependent deformation of a structure under load, is an important viscoelastic property of bone and may play a role in the development of permanent deformity of the vertebrae in vivo leading to clinically observable spinal fractures. To date, creep properties and their relationship to geometric, microstructural, and material properties have not been described in isolated human vertebral bodies. In this study, a range of image-based measures of vertebral bone geometry, bone mass, microarchitecture and mineralization were examined in multiple regression models in an effort to understand their contribution to creep behavior. Several variables, such as measures of mineralization heterogeneity, average bone density, and connectivity density persistently appeared as significant effects in multiple regression models (adjusted r²: 0.17–0.56). Although further work is needed to identify additional tissue properties to fully describe the portion of variability not explained by these models, these data are expected to help understand mechanisms underlying creep and improve prediction of vertebral deformities that eventually progress to a clinically observable fracture.     

Mechanical implications of pneumatic neck vertebrae in sauropod dinosaurs

The pre-sacral vertebrae of most sauropod dinosaurs were surrounded by interconnected, air-filled diverticula, penetrating into the bones and creating an intricate internal cavity system within the vertebrae. Computational finite-element models of two sauropod cervical vertebrae now demonstrate the mechanical reason for vertebral pneumaticity. The analyses show that the structure of the cervical vertebrae leads to an even distribution of all occurring stress fields along the vertebrae, concentrated mainly on their external surface and the vertebral laminae. The regions between vertebral laminae and the interior part of the vertebral body including thin bony struts and septa are mostly unloaded and pneumatic structures are positioned in these regions of minimal stress. The morphology of sauropod cervical vertebrae was influenced by strongly segmented axial neck muscles, which require only small attachment areas on each vertebra, and pneumatic epithelia that are able to resorb bone that is not mechanically loaded. The interaction of these soft tissues with the bony tissue of the vertebrae produced lightweight, air-filled vertebrae in which most stresses were borne by the external cortical bone. Cervical pneumaticity was therefore an important prerequisite for neck enlargement in sauropods. Thus, we expect that vertebral pneumaticity in other parts of the body to have a similar role in enabling gigantism.     

Compressed vertebrae in Atlantic salmon Salmo salar: evidence for metaplastic chondrogenesis as a skeletogenic response late in ontogeny

Anterior/posterior (a/p) compression of the vertebral column, referred to as 'short tails', is a recurring event in farmed Atlantic salmon. Like other skeletal deformities, the problem usually becomes evident in a late life phase, too late for preventive measures, making it difficult to understand the aetiology of the disease. We use structural, radiological, histological, and mineral analyses to study 'short tail' adult salmon and to demonstrate that the study of adult fish can provide important insights into earlier developmental processes. 'Short tails' display a/p compressed vertebrae throughout the spine, except for the first post-cranial vertebrae. The vertebral number is unaltered, but the intervertebral space is reduced and the vertebrae are shorter. Compressed vertebrae are characterized by an unchanged central part, altered vertebral end plates (straight instead of funnel-shaped), an atypical inward bending of the vertebral edges, and structural alterations in the intervertebral tissue. The spongiosa is unaffected. The growth zones of adjacent vertebrae fuse and blend towards the intervertebral space into chondrogenic tissue. This tissue produces different types of cartilage, replacing the notochord. The correspondence in location of intervertebral cartilage and deformed vertebral end plates, and the clearly delimited, unaltered, central vertebral parts suggest that the a/p compression of vertebral bodies is a late developmental disorder that may be related to a metaplastic shift of osteogenic tissue into chondrogenic tissue in the vertebral growth zone. Given the lack of evidence for infections, metabolic disorders and/or genetic disorders, we propose that an altered mechanical load could have caused the transformation of the bone growth zones and the concomitant replacement of the intervertebral (notochord) tissue by cartilaginous tissues in the 'short tails' studied here. This hypothesis is supported by the role that notochord cells are known to play in spine development and in maintaining the structure of the intervertebral disk.     

A study of complaints and their relation to vertebral destruction in patients with osteoporosis

Patients with spinal osteoporosis suffer from vertebral deformation, loss of height and back pain, as well as from functional limitations and alterations of mood. So far little is known about the extent of these clinical symptoms at all and whether they are related in a predictable manner to the fractures or damages of bone structure. In the present study we investigated the relation between vertebral deformation and clinical symptoms in 70 patients with osteoporosis. Clinical data like pain, functional limitations and parameters of mood were examined by a standardized questionnaire. The numbers of vertebral fractures were determined, and the vertebral destruction was quantified using the Spine Deformity Index (SDI). The symptoms and functional limitations were graded and correlated to the SDI and the number of fractures. Our results underline a relation between the extent of vertebral deformation and the reduction in quality of life by pain, functional limitations and alterations of mood. This relationship was absent or less evident, if the number of fractures was taken into account. Besides the difficulties concerning the grading and quantification of clinical symptoms and outcome of disease, our study revealed that there is a causal relation between the extent of vertebral destruction measured by the SDI and the extent of these clinical parameters.     

Comparison of Cervical Spine Anatomy in Calves,Pigs and Humans

Background Context

Animals are commonly used to model the human spine for in vitro and in vivo experiments. Many studies have investigated similarities and differences between animals and humans in the lumbar and thoracic vertebrae. However, a quantitative anatomic comparison of calf, pig, and human cervical spines has not been reported.

Purpose

To compare fundamental structural similarities and differences in vertebral bodies from the cervical spines of commonly used experimental animal models and humans.

Study Design

Anatomical morphometric analysis was performed on cervical vertebra specimens harvested from humans and two common large animals (i.e., calves and pigs).

Methods

Multiple morphometric parameters were directly measured from cervical spine specimens of twelve pigs, twelve calves and twelve human adult cadavers. The following anatomical parameters were measured: vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), spinal canal width (SCW), spinal canal depth (SCD), pedicle width (PW), pedicle depth (PD), pedicle inclination (PI), dens width (DW), dens depth (DD), total vertebral width (TVW), and total vertebral depth (TVD).

Results

The atlantoaxial (C1–2) joint in pigs is similar to that in humans and could serve as a human substitute. The pig cervical spine is highly similar to the human cervical spine, except for two large transverse processes in the anterior regions ofC4–C6. The width and depth of the calf odontoid process were larger than those in humans. VBW and VBD of calf cervical vertebrae were larger than those in humans, but the spinal canal was smaller. Calf C7 was relatively similar to human C7, thus, it may be a good substitute.

Conclusion

Pig cervical vertebrae were more suitable human substitutions than calf cervical vertebrae, especially with respect to C1, C2, and C7. The biomechanical properties of nerve vascular anatomy and various segment functions in pig and calf cervical vertebrae must be considered when selecting an animal model for research on the spine.     

The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

PurposeVertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment.MethodsA Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments.ResultsThe results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture.ConclusionsWe conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.     

Gender specific LRP5 influences on trabecular bone structure and strength

A mutation in LRP5 (low-density lipoprotein receptor-related protein 5) has been shown to increase bone mass and density in humans and animals. Transgenic mice expressing the LRP5 mutation (G171V) demonstrate an increase in bone mass as compared to non-transgenic (NTG) littermates. This study evaluated LRP5 gene and gender-related influences on the structural and biomechanical strength properties of trabecular and cortical bone in femurs and vertebrae (L5) of 17-week-old mice. Micro-computed tomography was used to evaluate the trabecular bone structure of distal femurs and vertebrae ex vivo. Mechanical testing of the trabecular bone in the distal femur was done to determine biomechanical strength. Differences due to genotype and gender were tested using two-way ANOVA at a significance level of p<0.05. Trabecular bone structural parameters (BV/TV, trabecular thickness, number, etc.) at the distal femur, femoral neck, and vertebral body sites were greater in the transgenic as compared to the NTG mice. In addition, vertebral cortical thickness and trabecular strength parameters (ultimate and yield loads, stiffness, ultimate and yield stresses) in the distal femur were greater in the transgenic mice as compared to NTG. The increasing trends of cortical thickness were also noted in the transgenic mice as compared to NTG. Within LRP5 (G171V) mutant mice, there were significant gender-related differences in some of the trabecular bone structural parameters at all the sites (distal femur, femoral neck, and vertebral body). However, unlike trabecular structural parameters, the gender-specific differences were not found in the trabecular strength of LRP5 transgenic mice. In summary, these findings suggest that the LRP5 (G171V) mutation results in greater trabecular bone structure and strength at both the distal femurs and vertebral bodies as compared to NTG. In addition, only the trabecular structure parameters were affected by gender within the LRP5 (G171V) mutation.     

Removal of the cortical endplates has little effect on ultimate load and damage distribution in QCT-based voxel models of human lumbar vertebrae under axial compression

Every year, 500,000 osteoporotic vertebral compression fractures occur in Europe. Quantitative computed tomography (QCT)-based finite element (FE) voxel models predict ultimate force whether they simulate vertebral bodies embedded in polymethylmethacrylate (PMMA) or vertebral sections with both endplates removed. To assess the effect of endplate removal in those predictions, non-linear FE analyses of QCT-based voxel models of human vertebral bodies were performed. High resolution pQCT images of 11 human lumbar vertebrae without posterior elements were coarsened to clinical resolution and bone volume fraction was used to determine the elastic, plastic and damage behavior of bone tissue. Three model boundary conditions (BCs) were chosen: the endplates were cropped (BC1, BC2) or voxel layers were added on the intact vertebrae to mimic embedding (BC3). For BC1 and BC3, the bottom nodes were fully constrained and the top nodes were constrained transversely while both node sets were freed transversely for BC2. Axial displacement was prescribed to the top nodes. In each model, we compared ultimate force and damage distribution during post-yield loading. The results showed that ultimate forces obtained with BC3 correlated perfectly with those computed with BC1 (R(2)=0.9988) and BC2 (R(2)=0.9987), but were in average 3.4% lower and 6% higher respectively. Moreover, good correlation of damage distribution calculated for BC3 was found with those of BC1 (R(2)=0.92) and BC2 (R(2)=0.73). This study demonstrated that voxel models of vertebral sections provide the same ultimate forces and damage distributions as embedded vertebral bodies, but with less preprocessing and computing time required.     

Natural variation and differential diagnosis of skeletal changes in tuberculosis

Twenty-six documented cases (17 blacks, 9 whites) of skeletal tuberculosis from the Hamann-Todd Osteological Collection, Cleveland Museum of Natural History, were analyzed for lesion variability and patterns of multiple site involvement. In addition, several documented cases of pathologic conditions (osteomyelitis, vertebral fractures, and malignant bone tumors) that resemble skeletal tuberculosis were photographed and described for use in differential diagnosis. The range of variation of tuberculous lesions was found to be considerable. Thirty-eight percent (10/26) of the cases display skeletal lesions in two or more regions concomitantly. The average number of vertebrae affected, as well as the incidence of multiple bone involvement, were found to be higher in blacks. Certain combinations of skeletal lesions (e. g., spine-rib, spine-rib-sternum, and spine-hip) may be useful in the diagnosis of tuberculosis in dry bone material.     

Variogram-based evaluations of DXA correlate with vertebral strength,but do not enhance the prediction compared to aBMD alone

Ancillary evaluation of spinal Dual-energy X-ray Absorptiometry (DXA) via variogram-based texture evaluation (e.g., Trabecular Bone Score) is used for improving the fracture risk assessment, despite no proven relationship with vertebral strength. The purpose of this study was thus to determine whether classical variogram-based parameters (sill variance and correlation length) evaluated from simulated DXA scans could help predicting the in vitro vertebral strength.Experimental data of thirteen human full vertebrae (i.e., with posterior elements) and twelve vertebral bodies were obtained from two existing studies. Areal bone mineral density (aBMD) was calculated from 2D projection images of the 3D HR-pQCT scan of the specimens mimicking clinical DXA scans. Stochastic predictors, sill variance and correlation length, were calculated from their experimental variogram. Vertebral strength was measured as the maximum failure load of human vertebrae and vertebral bodies from mechanical tests.Vertebral strength correlated significantly with sill variance (r = 0.727) and correlation length (r = 0.727) for the vertebral bodies, and with correlation length (r = 0.593) for full vertebrae. However, the stochastic predictors improved the strength prediction made by aBMD alone by only 11% for the vertebral bodies while no improvement was observed for the full vertebrae.Despite a correlation, classical variogram parameters such as sill variance and correlation length do not enhance the prediction of in vitro vertebral strength beyond aBMD. It remains unclear why some variogram-based evaluations of DXA improve fracture prediction without a proven relationship with vertebral strength.     

Biomechanics of vertebral level, geometry, and transcortical tumors in the metastatic spine

Metastatic involvement can disrupt the mechanical integrity of the spine, rendering vertebrae susceptible to burst fracture and neurologic damage. Fracture risk assessment for patients with spinal metastases is important in considering prophylactic treatment options. Stability of thoracic vertebrae affected by metastatic disease has been shown to be dependent on tumor size and bone density, but additional structural and geometric factors may also play a role in fracture risk assessment. The objective of this study was to use parametric finite element modeling to determine the effects of vertebral level, geometry, and metastatic compromise to the cortical shell on the risk of burst fracture in the thoracic spine. Analysis of vertebral level and geometry was assessed by investigation of seven scenarios ranging in geometry from T2-T4 to T10-T12. The effects of cortical shell compromised were assessed by comparison of four transcortical scenarios to a fully contained central vertebral body tumor scenario. Results demonstrated that upper thoracic vertebrae are at greater risk of burst fracture and that kyphotic motion segments are at decreased risk of burst fracture. Vertebrae with transcortical lesions are up to 30% less likely to lead to burst fracture initiation. The findings of this study are important for improving the understanding of burst fracture mechanics in metastatically involved vertebrae and guiding future modeling efforts.     

Three-dimensional topology optimization model to simulate the external shapes of bone

Elucidation of the mechanism by which the shape of bones is formed is essential for understanding vertebrate development. Bones support the body of vertebrates by withstanding external loads, such as those imposed by gravity and muscle tension. Many studies have reported that bone formation varies in response to external loads. An increased external load induces bone synthesis, whereas a decreased external load induces bone resorption. This relationship led to the hypothesis that bone shape adapts to external load. In fact, by simulating this relationship through topology optimization, the internal trabecular structure of bones can be successfully reproduced, thereby facilitating the study of bone diseases. In contrast, there have been few attempts to simulate the external structure of bones, which determines vertebrate morphology. However, the external shape of bones may be reproduced through topology optimization because cells of the same type form both the internal and external structures of bones. Here, we constructed a three-dimensional topology optimization model to attempt the reproduction of the external shape of teleost vertebrae. In teleosts, the internal structure of the vertebral bodies is invariable, exhibiting an hourglass shape, whereas the lateral structure supporting the internal structure differs among species. Based on the anatomical observations, we applied different external loads to the hourglass-shaped part. The simulations produced a variety of three-dimensional structures, some of which exhibited several structural features similar to those of actual teleost vertebrae. In addition, by adjusting the geometric parameters, such as the width of the hourglass shape, we reproduced the variation in the teleost vertebrae shapes. These results suggest that a simulation using topology optimization can successfully reproduce the external shapes of teleost vertebrae. By applying our topology optimization model to various bones of vertebrates, we can understand how the external shape of bones adapts to external loads.     

Structural parameters determining the strength of the porcine vertebral body affected by tumours

Spinal metastatic disease could lead to catastrophic consequences for the patient. However, the structural parameters that explain the weakening of vertebrae affected by tumours are not fully understood. In this study, we developed a specimen-specific finite element model to predict the strength of the porcine vertebra with simulated tumours and used it to find the structural parameters determining the strength. We validated our model with mechanical testing and then we analysed the compressive strength of intact vertebrae and seven defects with different size and shape. The results showed that the minimum bone mineral mass of the cross section and areal defect fraction were the best predictors of the normalized strength. We also found that areal parameters appeared to be better predictors than the volumetric ones. In conclusion, reduction in bone strength for vertebrae weakened by metastatic tumours is mostly associated with decrease in the mechanical properties of the cross section.     

Contribution of vertebral [corrected] bodies, endplates, and intervertebral discs to the compression creep of spinal motion segments

Spinal segments show non-linear behavior under axial compression. It is unclear to what extent this behavior is attributable to the different components of the segment. In this study, we quantified the separate contributions of vertebral bodies and intervertebral discs to creep of a segment. Secondly, we investigated the contribution of bone and osteochondral endplate (endplates including cartilage) to the deformation of the vertebral body. From eight porcine spines a motion segment, a disc and a vertebral body were dissected and subjected to mechanical testing. In an additional test, cylindrical samples, machined from the lowest thoracic vertebrae of 11 porcine spines, were used to compare the deformation of vertebral bone and endplate. All specimens were subjected to three loading cycles, each comprising a loading phase (2.0 MPa, 15 min) and a recovery phase (0.001 MPa, 30 min). All specimens displayed substantial time-dependent height changes. Average creep was the largest in motion segments and smallest in vertebral bodies. Bone samples with endplates displayed substantially more creep than samples without. In the early phase, behavior of the vertebra was similar to that of the disc. Visco-elastic deformation of the endplate therefore appeared dominant. In the late creep phase, behavior of the segment was similar to that of isolated discs, suggesting that in this phase the disc dominated creep behavior, possibly by fluid flow from the nucleus. We conclude that creep deformation of vertebral bodies contributes substantially to creep of motion segments and that within a vertebral body endplates play a major role.     

Simulated influence of osteoporosis and disc degeneration on the load transfer in a lumbar functional spinal unit

As life expectancy increases, age-related disorders and the search for related medical care will expand. Osteoporosis is the most frequent skeletal disease in this context with the highest fracture risk existing for vertebrae. The aging process is accompanied by systemic changes, with the earliest degeneration occurring in the intervertebral discs. The influence of various degrees of disc degeneration on the load transfer was examined using the finite element method. The effect of different possible alterations of the bone quality due to osteoporosis was simulated by adjusting the corresponding material properties and their distribution and several loadings were applied. An alteration of the load transfer, characterised by changed compression stiffness and strain distributions as well as magnitudes, due to osteoporotic bone and degenerated discs was found. When osteoporosis was simulated, the stiffness was substantially decreased, larger areas of the cancellous bone were subjected to higher strains and strain maxima were increased. Increasing ratios of transverse isotropy in the osteoporotic bone yielded smaller effects than reduced bone properties. Including a degenerated disc mainly altered the strain distribution. Combining osteoporosis and degenerated discs reduced the areas of cancellous bone subjected to substantial strain. Based on these results, it can be concluded that the definition of a healthy disc in osteoporotic spines might be considered as a worst-case scenario. One attempt to evaluate the progress of osteoporosis can be made by introducing increasing degrees of anisotropy. If several parameters in a model are changed to simulate degeneration, it should be pointed out how each individual definition influences the overall result.