Effects of high-intensity focused ultrasound on the intervertebral disc: a potential therapy for disc herniations

PURPOSE

To determine the potential application of high-intensity focused ultrasound for the minimally invasive treatment of herniated intervertebral discs by developing a probe that produces sufficiently high temperature locally to shrink collagen fibers (65-75 degrees Celsius).

MATERIALS AND METHODS

A 5-mm ultrasound probe was produced with a geometric focal length of 15 mm. The probe produced 2.5 W of acoustic power and was operated at a frequency of 4.1 MHz. Measurements of temperature increase were performed in discs from bovine tails. In vivo experiments were performed to assess histologic changes in the disc as well as in nerve root and muscle.

RESULTS

Sufficient temperature increase to produce collagen shrinkage was observed close to the focus of the ultrasound. Temperature measurements in vertebral end plates showed a temperature increase of only 4 degrees Celsius after 60-second exposure of the disc. In vivo experiments revealed histologic changes in the disc consistent with collagen shrinkage, with no adverse effects seen in surrounding tissues.

CONCLUSIONS

The experiments demonstrated the feasibility of high-intensity focused ultrasound in the treatment of contained herniated discs. This technique has several advantages over other thermal treatment modalities.

Colour doppler ultrasound of the lumbar arteries: a novel application and reproducibility study in healthy subjects

Lumbar arteries are important because they are the main source of blood supply to the lumbar spine structures. However, these vessels and their flow characteristics have received little attention and their role in conditions such as low back pain remains unclear. The present study 1. describes the application of duplex ultrasonography in the assessment of lumbar artery blood flow and 2. evaluates the interobserver and intraobserver reproducibility of lumbar artery Doppler velocimetry. A total of 13 healthy volunteers were evaluated by two different examiners successively on the same day and measurements repeated by the same examiners 1 week later. Peak systolic velocities of lumbar arteries were recorded at an optimal angle below 60 degrees . Overall mean peak systolic velocity (+/-SD) for lumbar arteries was 0.158 +/- 0.051 m/s, and mean Doppler angle (+/-SD) was 24.6 +/- 14.5 degrees . For interobserver variability, the coefficient of variation was 23.4% and SD of differences 0.037 m/s. Reliable results of lumbar artery Doppler velocimetry demonstrate its applicability in future clinical investigations in patients with low back disorders. (E-mail: ).

Fluid shifts due to microgravity and their effects on bone: a review of current knowledge

Bone loss during long-term space flight is potentially a significant problem. Bone mineral density measurements show that bone is lost at a rate of about 1% per month from the lumbar spine, and 1.5% per month from the hip. Bone density changes are not uniform throughout the skeleton, and there is accumulating evidence that the distribution of bone density changes may be related to fluid shifts observed in microgravity. The paper summarises the data relating fluid shift of bone density changes in microgravity. In addition, microgravity and ground-based experiment were carried out to investigate the effects of interstitial fluid flow on bone formation. Data from these experiments were interpreted in light of the review data relating fluid shift to bone density changes in microgravity. Both experiments assessed the effect of an external pneumatic venous tourniquet on bone distal to the tourniquet. In the first experiment, a pneumatic tourniquet was designed to be placed around one ankle of a single astronaut on a 180-day mission on the MIR space station. Ultrasound measurements of both calcanei were made during the mission, and dual energy x-ray densitometry (x-ray absorption) measurements were performed at the start and end of the mission. In the second experiment, ground-based experiments have been performed to investigate possible mechanisms for the action of such a tourniquet on bone. A venous tourniquet was designed to be placed around the hind limb of a rat, proximal to the knee, applying a continuous pressure of 30 mmHg. The tourniquet increased significantly tibial fluid weight, periosteal bone formation and intracortical bone remodelling. Some of the effects appeared to due to a nitric oxide dependant pathway. It is proposed that tissue fluid pressures have an effect on bone that is independent of mechanical load, which may explain the variation in bone mineral density observed in space flight.

Laser-induced thermal stress and the heat shock response in neural cells

BACKGROUND

The Ho: YAG laser is used extensively in orthopedic surgery. It offers a minimally invasive method of ablating tissue with precision. Previous studies have explored the effects of laser use on temperature during experimental foraminoplasty. To date, there has been limited work on the effects of thermal stress on cells in this context. Material and methods Cells were exposed either to heated medium or the Ho: YAG laser in the high-power mode. Heated medium was used as a stressor by (I) exposing groups of cells to a constant temperature of 45 degrees C for varying lengths of time: 5, 10, 15 and 20 min, and (II) exposing cells for a fixed length of time (5 min) to varying temperatures: 45 degrees C, 55 degrees C, 65 degrees C with a control treated at 37 degrees C. A third group was subjected to direct laser treatment. The effects of the treatments were assessed using trypan blue staining as a measure of viability and immunocytochemistry was used to measure changes in heat shock protein (HSP) expression.

RESULTS

There was a negative correlation between cell viability and HSP expression, and between cell viability and the severity of the treatment.

INTERPRETATION

Our findings suggest a possible role for the Ho: YAG laser in spinal foraminoplasty based on the high level of cell viability in the treatment regimen that most closely mirrored the clinical application of the laser.

Bone cement X-ray contrast media: A clinically relevant method of measuring their efficacy

It is important to compare different contrast media used in bone cement according to their ability to attenuate X-rays and thereby produce image contrast between bone cement and its surroundings in clinical applications. The radiopacity of bone cement is often evaluated by making radiographs of cement in air at an X-ray tube voltage of 40 kV. We have developed a method for ranking contrast media in bone cement simulating the clinical situation, by (1) choosing the same X-ray tube voltage as used in clinical work, and (2) using a water phantom to imitate the effects of the patients' soft tissue on the X-ray photons. In clinical work it is desirable to have low radiation dose, but high image contrast. The voltage chosen is a compromise, because both dose and image contrast decrease with higher voltage. Three contrast media (ZrO(2), BaSO(4), and Iodixanol) have been compared for degree of "image contrast." Comparing 10 wt % contrast media samples at an X-ray tube voltage of 40 kV, ZrO(2) produced higher image contrast than the other media. However, at 80 kV, using a water phantom, the results were reversed, ZrO(2) produced lower image contrast than both BaSO(4) and Iodixanol. We conclude that evaluations of contrast media should be made with voltages and phantoms imitating the clinical application.

Water uptake and release from iodine-containing bone cement

Water uptake and release characteristics of PMMA cement containing the water-soluble contrast media iohexol or iodixanol have been investigated. The water uptake study revealed that iohexol had the highest uptake of water (3.7%) and that iodixanol had an uptake close to that of Palacos R (2.3% and 1.9%). The curves obtained showed the materials to follow classic diffusion theory, with an initial linearity with respect to t(1/2) making it possible to calculate the diffusion coefficients. This showed iohexol to have the lowest diffusion coefficient, Palacos R the highest, and iodixanol close to that of Palacos R. The release study showed that more iohexol than iodixanol was released from the bone cement; the long-term release was above 25 microg/mL for iohexol compared to slightly above 10 microg/mL for iodixanol. A microCT investigation showed that the risk of developing an observable radiolucent zone is negligible.

Compressive and Shear Properties of Commercially Available Polyurethane Foams

Background: The shear properties of rigid polyurethane (PU-R) foams, routinely used to simulate cancellous bone, are not well characterized. Method of approach: The present assessment of the shear and compressive properties of four grades of Sawbones “Rigid cellular” PU-R foam tested 20 mm gauge diameter dumb-bell specimens in torsion and under axial loading. Results: Shear moduli ranged from 13.3 to 99.7 MPa, shear strengths from 0.7 MPa to 4.2 MPa. Compressive yield strains varied little with density while shear yield strains had peak values with “200 kgm−3” grade. Conclusions: PU-R foams may be used to simulate the elastic but not failure properties of cancellous bone.

Ablation of bone, cartilage, and facet joint capsule using Ho:YAG laser

OBJECTIVE

The objective of this study was to determine of the efficiency of holmium:YAG laser for bone ablation, compared to cartilage and soft tissue of the intervertebral foramen of the lumbosacral spine.

BACKGROUND DATA

The holmium:YAG (Ho:YAG) laser has been used for ablation of bulging or prolapsed discs and also has the potential for decompression of the nerve root when there is narrowing of the foraminae (foraminoplasty). It is proposed that laser ablation of bone and ligament of the intervertebral foramen for nerve root decompression using the Ho:YAG laser is able to produce sufficient bone ablation without inducing significant thermal necrosis in surrounding tissues due to its short absorption length, which could result in significant clinical advantages.

MATERIALS AND METHODS

Experiments were performed on samples of laminar bone, facet joint capsule, and cartilage for quantitative and qualitative determination of the effect of Ho:YAG ablation on tissue mass loss using a range of pulse energies from 0.5 to 1.5 J/P at 15 pulses/sec.

RESULTS

The results showed a significant linear correlation between the mass loss and pulse energy, and between the mass loss and radiant exposure. Electron microscopy and histology showed that the Ho:YAG ablation resulted in a very sharp and clear border with little charring. Applying 0.01 k.J of total energy at two different settings (1.5 J/p, high power, and 0.5 J/p, low power) at 15 pulses/sec, the cross-sectional area/mm(2) of the ablated bone was measured, using light microscopy and the Scion Image analysis program. The ablated areas were 2.28 +/- 0.87 and 1.16 +/- 0.43 mm(2) at high and low power, respectively (p = 0.008).

The effect of irrigation on peak temperatures in nerve root, dura, and intervertebral disc during laser-assisted foraminoplasty

BACKGROUND AND OBJECTIVE

The Holmium: YAG (Ho: YAG) laser has been used for the ablation of prolapsed discs but alternative techniques are available, and this application remains controversial. It also has potential for the decompression of nerve roots within narrowed foraminae with the technique of endoscopic laser foraminoplasty. Traditional methods of decompression necessitate a major surgical procedure with potential destabilisation of the lumbar spinal segment. Nevertheless, minimally invasive techniques are attractive only if serious complications can be avoided. This study reports the peak temperatures reached in surrounding tissues with and without saline irrigation.

STUDY DESIGN/MATERIALS AND METHODS

Investigation of the hypothesis was carried out in excised sheep lumbar spines. T-type thermocouples were used for the measurement of tissue temperatures during laser ablation of nerve root foraminae. The temperature was assessed in the nerve root, dura mater, and disc space.

RESULTS

The Ho: YAG laser was effective in widening the foraminae by approximately 1.5 mm with a total energy of 4.60 kJ. This was statistically significant in both vertical and horizontal directions (P < 0.0003 and P < 0.00005, respectively). The mean temperature of the nerve root, dura, and disc space during the procedure was 44 +/- 3.1 degrees C, 42.8 +/- 4.7 degrees C, and 41 +/- 3.4 degrees C respectively. There were transient high peaks seen in the temperature profiles. Using saline irrigation at 27 ml/minutes these temperatures were reduced to 34.1 +/- 1.8 degrees C (P = 0.0002), 34.9 +/- 1.5 degrees C (P = 0.002), and 37.2 +/- 1.2 degrees C (P < 0.014), for nerve roots, dura, and disc space respectively.

CONCLUSIONS

Laser ablation of bone and ligament for nerve root decompression using the Ho: YAG laser may offer substantial advantages, but the risk of serious complication may only be avoided if the technique is combined with saline irrigation.

Identifying migratory Salmo trutta using carbon and nitrogen stable isotope ratios

Many Salmo trutta populations consist of non-anadromous (freshwater-resident) brown trout and anadromous (sea-run migratory) sea trout. Although adult brown trout and sea trout can usually be identified using differences in size and body colouration, it is not possible to easily identify eggs/alevins as the progeny of brown trout or sea trout. In this study we show that delta(13)C and delta(15)N, measured using a continuous flow isotope ratio mass spectrometer (CF-IRMS), can accurately identify fish eggs as the progeny of freshwater-resident (delta(13)C(egg) = -25.7 +/- 1.9 per thousand,delta(15)N(egg) = 9.2 +/- 1.8 per thousand) or migratory (delta(13)C(egg) = -19.9 +/- 1.1 per thousand, delta(15)N(egg) = 14. 3 +/- 1.5 per thousand) adult female Salmo trutta. Case studies show that stable isotope analysis is a more reliable technique for distinguishing anadromous adult fish than differentiation using morphological characteristics. For example, stable isotope analysis of brown trout from Loch Eck, Scotland, revealed that some individuals possessed delta(13)C and delta(15)N signatures indicative of marine feeding despite visual identification as freshwater-resident fish. It is most likely that these fish are misidentified sea trout although it possible that these fish may be brown trout that have adopted an estuarine feeding strategy to avoid interspecific competition for food within Loch Eck with salmon, powan and Arctic charr. Most stable isotope studies of fish ecology use terminal tissue sampling to provide sufficient biological material for isotopic analysis; however, our study suggests that adipose fin tissue could provide a comparable measure of delta(13)C and delta(15)N. Such a strategy would be invaluable when studying the trophic ecology or migration patterns of fish of high conservation value.

Nitric oxide mediated vasoreactivity during fracture repair

An experimental model of fracture healing has been used to investigate whether nitric oxide mediated vascular reactivity, determined using laser Doppler flowmetry, is present in bone after a fracture. Times corresponding to Days 0, 1, 3, 7, 14, and 28 after fracture were used to study the injured and contralateral limbs in response to bolus intravenous administration of nitric oxide inhibitor, N-nitro-L-arginine methyl ester, and nitric oxide stimulator, acetylcholine. N-nitro-L-arginine methyl ester administration (1 mumol/kg, 10 mumol/kg, and 100 mumol/kg) caused a dose dependent increase in systemic blood pressure in each of the assessment groups; however, there was no statistical difference between the groups. Doppler flow readings at the fracture site showed measurable changes in local vascular reactivity after drug administration. At Day 1 after fracture, the magnitude of unit change in vascular reactivity in response to N-nitro-L-arginine methyl ester (1 mumol/kg, 10 mumol/kg, and 100 mumol/kg) was significantly higher in the fractured limb compared with the contralateral limb and also when compared with other points of assessment. These results show that nitric oxide mediated vasoreactivity is present about a fracture site and is maximal in the early healing phase, before returning to basal levels as healing progresses. This is compatible with an initial restoration of blood flow at a fracture site by nitric oxide dependent vasodilation of preexisting blood vessels, followed by ingrowth of less nitric oxide dependent angiogenic vessels during the later phase of repair.

Nitric oxide in fracture repair. Differential localisation, expression and activity of nitric oxide synthases

Our aim was to investigate whether nitric oxide synthase (NOS) isoforms, responsible for the generation of NO, are expressed during the healing of fractures. To localise the sites of expression compared with those in normal bone we made standardised, stabilised, unilateral tibial fractures in male Wistar rats. Immunostaining was used to determine the precise tissue localisation of the different NOS isoforms. Western blotting was used to assess expression of NOS isoform protein and L-citrulline assays for studies on NOS activity. Control tissue was obtained from both the contralateral uninjured limb and limbs of normal rats. Immunohistochemistry showed increased expression of endothelial NOS (eNOS) to be strongest in the cortical blood vessels and in osteocytes in the early phase of fracture repair. Western blot and image analysis confirmed this initial increase. Significantly elevated calcium-dependent NOS activity was observed at day 1 after fracture. Inducible NOS (iNOS) was localised principally in endosteal osteoblasts and was also seen in chondroblasts especially in the second week of fracture healing. Western blotting showed a reduction in iNOS during the early healing period. Significantly reduced calcium-independent NOS activity was also seen. No neuronal NOS was seen in either fracture or normal tissue. Increased eNOS in bone blood vessels is likely to mediate the increased blood flow recognised during fracture healing. eNOS expression in osteocytes may occur in response to changes in either mechanical or local fluid shear stress. The finding that eNOS is increased and iNOS reduced in early healing of fractures may be important in their successful repair.

Are subjective clinical findings and objective clinical tests related to the motion characteristics of low back pain subjects?

Many authors have demonstrated that low back pain sufferers have impaired spinal motion. However, it is not known to what degree the patient's signs and symptoms influence this impairment in motion. The aim of this study was therefore to conduct an explorative study to investigate the relationship between low back pain patients' signs and presenting symptoms and objective measurements of motion. One hundred thirty-eight patients with low back pain completed a questionnaire detailing their signs and symptoms and underwent a full clinical examination. A potentiometric motion analysis system of known accuracy and repeatability was used to measure their spinal motion during a flexion-extension test. The effects of a variety of subjective and clinical findings on the motion characteristics were examined, which revealed that certain factors, such as diagnosis, pain characteristics, symptom severity, and level of disruption, were related to the resulting motion measurements. The strength of these relationships were not as strong as anticipated (accounting for 16-45% of the variability). This suggests that routine objective assessments cannot be used as a substitute for a thorough physical and subjective examination.

Quantitative assessment of the motion of the lumbar spine in the low back pain population and the effect of different spinal pathologies of this motion

There are few objective means by which disability caused by low back pain (LBP) can be quantified. The purpose of this study was to investigate the usefulness of motion measurements in the assessment of LBP. The motion characteristics of 138 LBP subjects were investigated, and the data compared with a previously published database of normal subjects. Values of range of motion and angular velocity were obtained for all subjects in each plane of motion. Analysis of these motion characteristics demonstrated significant differences (P < 0.0001) between the two populations; however both populations demonstrated considerable intersubject variation. Multiple regression analysis revealed that some of the variance in the LBP population was attributable to the underlying diagnosis. Patients with a spondylolisthesis tended to be hypermobile whilst those with spinal stenosis, disc prolapse or degenerative disc disease tended to be hypomobile. All diagnostic groups showed impairments in their velocity characteristics.

Endothelium-dependent vasodilatation produced by the L-arginine/nitric oxide pathway in normal and ischemic bone

We used an experimental model of the perfused isolated rabbit tibia to investigate the vasodilatation produced by nitric oxide in the circulation of bone. Tibiae were perfused at a constant flow rate while the perfusion pressure was monitored continuously. Perfusion pressure was raised by the addition of noradrenaline to the perfusate, and dose responses were measured for bolus doses of acetylcholine and sodium nitroprusside. N omega-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthesis, was then added to the perfusate at a concentration of 10(-4) M, and the dose responses to acetylcholine and sodium nitroprusside were repeated. Measurements were performed on groups of bones after 0, 6, 12, and 24 hours of normothermic ischemia (n 5, 4, 6, and 9, respectively). Both acetylcholine and sodium nitroprusside produced significant vasodilatation after 0 and 6 hours' ischemia, but no significant response was observed after 12 or 24 hours of ischemia. The vasodilatation produced by acetylcholine was significantly attenuated when L-NAME was added to the perfusate, but the vasodilatation produced by sodium nitroprusside remained unchanged. These findings confirm endothelial production of NO by stimulation of muscarinic receptors on the endothelial cells in bone and indicate that vasodilatation via the L-arginine/NO pathway remains viable for 6 hours after normothermic ischemia.

Aseptic loosening of total hip replacement. Macrophage expression of inducible nitric oxide synthase and cyclo-oxygenase-2, together with peroxynitrite formation, as a possible mechanism for early prosthesis failure

Aseptic loosening is a major cause of failure of total hip arthroplasty. The adverse tissue response to prosthetic wear particles, with activation of cytokine and prostanoid production, contributes to bone loss around the implants. We have investigated the possibility that inducible nitric oxide synthase (iNOS) and cyclo-oxygenase-2 (COX-2) are expressed in macrophages in the pseudomembrane at the bone-implant interface, thereby contributing to the periprosthetic bone resorption. We also assessed whether peroxynitrite, a nitric oxide (NO)-derived oxidant associated with cellular injury, is generated in the membrane. Enzymatic activity of iNOS was measured using the arginine-citrulline assay technique and prostaglandin E2 (PGE2), as an indicator of COX-2 activity, was measured using an enzyme immunoassay. Cellular immunoreactivity for iNOS, nitrotyrosine (a marker of peroxynitrite-induced cellular injury) and COX-2 was assessed by quantitative peroxidase immunocytochemistry while immunofluorescence methods were used for subsequent co-localisation studies with CD68+ macrophages. The presence of calcium-independent iNOS activity and PGE2 production was confirmed in the homogenised interface membrane. Immunocytochemistry showed that periprosthetic CD68+ wear-debris-laden macrophages were the most prominent cell type immunoreactive for iNOS, nitrotyrosine and COX-2. Other periprosthetic inflammatory and resident cell types were also found to immunolocalise nitrotyrosine thereby suggesting peroxynitrite-induced protein nitrosylation and cellular damage not only in NO-producing CD68+ macrophages, but also in their neighbouring cells. These data indicate that both iNOS and COX-2 are expressed by CD68+ macrophages in the interface membrane and peroxynitrite-induced cellular damage is evident in such tissue. If high-output NO and peroxynitrite generation were to cause macrophage cell death, this would result in the release of phagocytosed wear debris into the extracellular matrix. A detrimental cycle of events would then be established with further phagocytosis by newly-recruited inflammatory cells and subsequent NO, peroxynitrite and prostanoid synthesis. Since both NO and PGE2 have been implicated in the induction and maintenance of chronic inflammation with resulting loss of bone, and peroxynitrite in the pathogenesis of disease states, they may be central to the pathogenesis of aseptic loosening.

Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease

We obtained intervertebral discs with cartilage endplates and underlying cancellous bone at operation from patients with degenerative disc disease and then used immunohistochemical techniques to localise the nerves and nerve endings in the specimens. We used antibodies for the ubiquitous neuronal protein gene product 9.5 (PGP 9.5). Immunoreactivity to neuropeptide Y was used to identify autonomic nerves and calcitonin gene-related peptide (CGRP) and substance P to identify sensory nerves. Blood vessels were identified by immunoreactivity with platelet-endothelial cell-adhesion molecule (CD31; PECAM). In a control group with no known history of chronic back pain, nerve fibres immunoreactive to PGP 9.5 and neuropeptide Y were most closely related to blood vessels, with occasional substance P and CGRP immunoreactivity. In patients with severe back pain and markedly reduced disc height, proliferation of blood vessels and accompanying nerve fibres was observed in the endplate region and underlying vertebral bodies. Many of these nerves were immunoreactive to substance P or CGRP, and in addition, substance P- and CGRP-immunoreactive nociceptors were seen unrelated to blood vessels. Quantification by image analysis showed a marked increase in CGRP-containing sensory nerve fibres compared with normal control subjects. We speculate that a chemotactic response to products of disc breakdown is responsible for the proliferation of vascularity and CGRP-containing sensory nerves found in the endplate region and vertebral body adjacent to degenerate discs. The neuropeptides substance P and CGRP have potent vasodilatory as well as pain-transmitting effects. The increase in sensory nerve endings suggests increase in blood flow, perhaps as an attempt to augment the nutrition of the degenerate disc. The increase in the density of sensory nerves, and the presence of endplate cartilage defects, strongly suggest that the endplates and vertebral bodies are sources of pain; this may explain the severe pain on movement experienced by some patients with degenerative disc disease.

Clearance of albumin by cortical bone and marrow

Male Sprague-Dawley rats, approximately 300 g, were anesthetized. The jugular vein and carotid artery were cannulated and the left femoral vein was exposed. The femoral vein was then ligated, and 2 minutes later albumin, labeled with 125I, was injected. The albumin was allowed to equilibrate in the vascular system for 3 minutes, and then 1 group of animals was euthanized. Further groups of animals were euthanized after 15, 30, and 60 minutes. Tibias were removed from both legs together with samples of muscle and liver. The tibias were separated into diaphyseal cortex, marrow, and proximal and distal ends. All tissue samples and terminal blood samples were counted for radioactivity, and volumes of distribution were calculated. In cortical bone the volume distribution increased from an initial value of 12.9 +/- 1.1 microL/g to 18.6 +/- 2.5 microL/g at 30 minutes in the control leg (mean +/- standard error of the mean, n = 5). In the congested leg, the volume of distribution increased from 10.6 +/- 0.6 to 19.6 +/- 2.1 microL/g during the same time interval. The difference in rate of increase between the congested and control leg was not statistically significant. Albumin seemed to equilibrate within 3 minutes within the marrow. The data are consistent with the hypothesis that macromolecular transport in the interstitial fluid of cortical bone is coupled to convectional flow from endosteal to periosteal surface. This data may help to understand mechanisms by which venous hypertension has been shown to stimulate bone growth and fracture repair, and also the distribution of bone density changes observed after prolonged exposure to microgravity.

Motion characteristics of the lumbar spine in the normal population

STUDY DESIGN

The present study investigated the dynamic motion characteristics of the lumbar spine in the normal population using a potentiometric analysis system.

OBJECTIVES

To assess the ability of a triaxial potentiometric analysis system to measure dynamic motion in the lumbar spine, and to use this system to form a database of dynamic motion characteristics from which normal parameters of motion and the factors affecting this motion could be defined.

SUMMARY OF BACKGROUND DATA

Spinal motion has been studied using a variety of different methods, the majority of which have been limited either in terms of reliability, accuracy, or invasiveness and many have been only of a static nature. There has been no previous study into the normal dynamic motion characteristics of the lumbar spine.

METHODS

The accuracy of the system was determined by a series of tests against a calibrated engineering mill, and the reliability of the system was assessed on 10 subjects with repeated measurements over a 3-day period. Values of range of motion and angular velocity were obtained from 203 normal subjects during flexion and extension, lateral flexion, and rotation.

RESULTS

The results of the calibration testing revealed excellent accuracy, and it was shown that the system was repeatable. Initial analysis of the results indicated that sex differences did exist with men having 58.4 degrees of flexion and women having 53.4 degrees. Age appeared to have an influence on motion, and a gradual reduction was seen with each decade (P < 0.001), with the 20-29-year age range having 59.5 degrees mean flexion, the 30-39-year group having 58.1 degrees, the 40-49-year group having 53.7 degrees, the 50-60-year group having 57.5 degrees, and the 60-70-year group having 45.9 degrees. Multiple regression techniques revealed that only a few factors are important with respect to motion and that these varied according to the characteristic being defined.

CONCLUSIONS

Range of motion tended to be affected by age and sex, whereas velocity was only affected by distance moved, with occupation and body mass index having little or no influence on the motion. The factors identified could only account for a small proportion of the variation seen, suggesting that it is difficult to predict the motion characteristics with any degree of sensitivity.

A new in-vitro model to investigate antibiotic penetration of the intervertebral disc

We have studied the ability of a range of antibiotics to penetrate intervertebral disc tissue in vitro, using a mouse disc model. Equilibrium concentrations of antibiotics incorporated into the entire disc were determined by bioassay using a microbial growth-inhibition method. Uptake was significantly higher with positively-charged aminoglycosides compared with negatively-charged penicillins and cephalosporins. Uncharged ciprofloxacin showed an intermediate degree of uptake. Our results support the hypothesis that electrostatic interaction between charged antibiotics and negatively-charged glycosaminoglycans in the disc is an important factor in antibiotic penetration, and may explain their differential uptake.

A new in-vitro model to investigate antibiotic penetration of the intervertebral disc

We have studied the ability of a range of antibiotics to penetrate intervertebral disc tissue in vitro, using a mouse disc model. Equilibrium concentrations of antibiotics incorporated into the entire disc were determined by bioassay using a microbial growth-inhibition method. Uptake was significantly higher with positively-charged aminoglycosides compared with negatively-charged penicillins and cephalosporins. Uncharged ciprofloxacin showed an intermediate degree of uptake. Our results support the hypothesis that electrostatic interaction between charged antibiotics and negatively-charged glycosaminoglycans in the disc is an important factor in antibiotic penetration, and may explain their differential uptake.