Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces: a novel in vivo rat model

STUDY DESIGN

Establishment of a novel in vivo animal model of cervical spondylosis.

OBJECTIVE

To investigate apoptotic, degenerative, and inflammatory changes occurring in the cervical intervertebral discs of rats.

SUMMARY OF BACKGROUND DATA

Cervical degeneration occurs as the result of imbalance of both static and dynamic spinal stabilizers. The disc degeneration that occurs is characterized by increased local inflammation and increased apoptosis of intervertebral disc cells.

METHODS

By excising the paraspinal musculature and posterior cervical spinal ligaments of rats, both static and dynamic cervical stabilizers were disrupted. The resultant biomechanical imbalance resulted in biochemical and histologic changes, which were characterized by light microscopy, electron microscopy, immunostaining, enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization.

RESULTS

Histologic analysis showed characteristic degenerative changes of the intervertebral discs and vertebral endplates following surgery. Ultrastructural examination revealed apoptotic changes, which were verified by immunostaining. Instability also resulted in significant up-regulation of inflammatory factors, as shown by enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization.

CONCLUSIONS

By creating static and dynamic posterior instability of the cervical spine, this novel model of cervical spondylosis results in rapid intervertebral disc degeneration characterized by increased apoptosis and local inflammation, such as that seen clinically.

Strontium-containing hydroxyapatite (Sr-HA) bioactive cement for primary hip replacement: an in vivo study

The purpose of this study was to evaluate the strontium-containing hydroxyapatite (Sr-HA) cement in primary hip replacement, using a rabbit model, and to investigate the histological findings at the cement-implant and bone-cement interfaces under weight-bearing conditions. Unilateral hip replacement was performed with Sr-HA cement or polymethylmethacrylate (PMMA) cement in rabbits and observations were made after 6 months. Good fixation between the Sr-HA cement and implant was observed. Osseointegration of the Sr-HA cement with cancellous bone was widespread. Many multinucleus cells covered the surface of the cement, and resorbed the superficial layer of the cement. By scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analysis, high calcium and phosphorus levels were detected at the interface with a thickness of about 10 microm. Intimate contact was also observed between the Sr-HA cement and cortical bone without fibrous layer intervening. The overall affinity index of bone on Sr-HA cement was (85.06 +/- 5.40)%, which is significantly higher than that on PMMA cement (2.77%+/- 0.49%). On the contrary, a fibrous layer was consistently observed between PMMA cement and bone, and PMMA cement evoked an inflammatory response and foreign body reaction in the surrounding bony tissues. Results suggested good bioactivity and bone-bonding ability of the Sr-HA cement under weight-bearing conditions.

Nano-mechanics of bone and bioactive bone cement interfaces in a load-bearing model

Many bioactive bone cements were developed for total hip replacement and found to bond with bone directly. However, the mechanical properties at the bone/bone cement interface under load bearing are not fully understood. In this study, a bioactive bone cement, which consists of strontium-containing hydroxyapatite (Sr-HA) powder and bisphenol-alpha-glycidyl dimethacrylate (Bis-GMA)-based resin, was evaluated in rabbit hip replacement for 6 months, and the mechanical properties of interfaces of cancellous bone/Sr-HA cement and cortical bone/Sr-HA cement were investigated by nanoindentation. The results showed that Young's modulus (17.6+/-4.2 GPa) and hardness (987.6+/-329.2 MPa) at interface between cancellous bone and Sr-HA cement were significantly higher than those at the cancellous bone (12.7+/-1.7 GPa; 632.7+/-108.4 MPa) and Sr-HA cement (5.2+/-0.5 GPa; 265.5+/-39.2 MPa); whereas Young's modulus (6.3+/-2.8 GPa) and hardness (417.4+/-164.5 MPa) at interface between cortical bone and Sr-HA cement were significantly lower than those at cortical bone (12.9+/-2.2 GPa; 887.9+/-162.0 MPa), but significantly higher than Sr-HA cement (3.6+/-0.3 GPa; 239.1+/-30.4 MPa). The results of the mechanical properties of the interfaces were supported by the histological observation and chemical composition. Osseointegration of Sr-HA cement with cancellous bone was observed. An apatite layer with high content of calcium and phosphorus was found between cancellous bone and Sr-HA cement. However, no such apatite layer was observed at the interface between cortical bone and Sr-HA cement. And the contents of calcium and phosphorus of the interface were lower than those of cortical bone. The mechanical properties indicated that these two interfaces were diffused interfaces, and cancellous bone or cortical bone was grown into Sr-HA cement 6 months after the implantation.

Surface characteristics, mechanical properties, and cytocompatibility of oxygen plasma-implanted porous nickel titanium shape memory alloy

Good surface properties and biocompatibility are crucial to porous NiTi shape memory alloys (SMA) used in medical implants, as possible nickel release from porous NiTi may cause deleterious effects in the human body. In this work, oxygen plasma immersion ion implantation (O-PIII) was used to reduce the amount of nickel leached from porous NiTi alloys with a porosity of 42% prepared by capsule-free hot isostatic pressing. The mechanical properties, surface properties, and biocompatibility were studied by compression tests, X-ray photoelectron spectroscopy (XPS), and cell culturing. The O-PIII porous NiTi SMAs have good mechanical properties and excellent superelasticity, and the amount of nickel leached from the O-PIII porous NiTi is much less than that from the untreated samples. XPS results indicate that a nickel-depleted surface layer predominantly composed of TiO(2) is produced by O-PIII and acts as a barrier against out-diffusion of nickel. The cell culturing tests reveal that both the O-PIII and untreated porous NiTi alloys have good biocompatibility.

An investigation on the physicochemical properties of chitosan/DNA polyelectrolyte complexes

In this work, to eliminate the effect of the hydrophobicity of N-acetyl groups in chitosan on the interaction between chitosan and DNA, a water soluble chitosan with molecular weight of 5000 and deacetylated degree of 99% was selected to complex with DNA at varied charged ratios. The physicochemical properties of chitoplexes were investigated by means of FTIR, circular dichroism (CD), static fluorescence spectroscopy, and atomic force microscopy (AFM). The results indicated that upon interacting with chitosan, the DNA molecules saved a B conformation, and the binding affinity of chitosan to DNA was dependent on pH of media. At pH 5.5, highly charged chitosan had a strong binding affinity with DNA; whereas in pH 12.0 medium, only weak interactions existed. The CD spectra of Hoechst 33258 competitive displacement revealed that chitosan was partially bound to the minor groove of DNA. The morphology of chitosan/DNA complexes was strongly dependent upon the charge ratios. At charge ratio (+/-) of 1:4, not all DNA could be entrapped in the complex; at ratio of 8:1, the spherical complexes with mean size of nanoscale were formed without free DNA, but no typical toroid patterns were observed, which might stem from the strong compact of DNA caused by highly charged chitosan. It was supposed that the strong interaction of chitosan with DNA possibly prevented gene unpacking from chitosan vector, consequently restraining gene expression in nucleus.

Genetic and environmental determinants of bone mineral density in Chinese women

BMD is a complex trait determined by genetic and lifestyle factors. To assess the genetic and environmental determinants of BMD in southern Chinese women, we studied a community-based cohort of 531 pre- and postmenopausal southern Chinese women and assessed the influence of 12 candidate gene loci and lifestyle risk factors on spine and hip BMD. The candidate genes studied include estrogen receptor alpha (ESR1) and beta (ESR2), calcium sensing receptor (CASR), vitamin D receptor (VDR), collagen type Ialpha1 (COLIA1), and LDL receptor-related protein 5 (LRP5). Social, medical, reproductive history, dietary habits and lifestyle factors were determined using a structured questionnaire. Single nucleotide polymorphisms (SNPs) of the COLIA1 and LRP5 gene in Chinese were determined by direct sequencing. Nucleotide (nt) -1363C/G and -1997 G/T of COLIA1, nt 266A/G, 2220C/T and 3989C/T of LRP5 gene were analyzed. Using stepwise multiple linear regression analyses, body weight was the strongest predictor for BMD in premenopausal women (n = 262), which accounted for 15.9% of the variance at the spine, 20% at femoral neck, 17.1% at trochanter, 24.3% at total hip and 10.9% at the Ward's triangle. Other significant predictors were ESR1 Ivs1-397T/C genotype (2.2% at the spine); LRP5 2220C/T genotype (1.3% at the spine, 1.6% at the trochanter); LRP5 266A/G genotype (1.1% at Ward's triangle); age at menarche (1.3% at trochanter) and age (2.0% at Ward's triangle). As for postmenopausal women (n = 269), body weight ( approximately 25% at various sites) and age (approximately 16% at femoral neck, trochanter, total hip and Ward's triangle sites) were the strongest predictors of BMD. Other significant predictors were age at menarche (4.4% at spine, 0.7% at femoral neck, 1.4% at trochanter, and 1.4% at Ward's triangle); weight bearing physical activity (2.1% at trochanter and 1% at total hip); calcium intake (1.1% at femoral neck, 0.9% at trochanter, and 1.7% at total hip) ; height (0.7% at trochanter); and ESR2 1082A/G genotype (0.8% at trochanter). We conclude that BMD at various sites and at different time span of a woman is modified by different genetic and lifestyle factors, suggesting that BMD is highly dependent on gene-environmental interactions.

Strengthening mechanisms of bone bonding to crystalline hydroxyapatite in vivo

The formation and strengthening mechanisms of bone bonding of crystalline hydroxyapatite (HA) has been investigated using high-resolution transmission electron microscope (HRTEM) and energy-dispersive X-ray (EDX) analysis. A series of results were obtained: (i) a layer of amorphous HA, which has almost the same chemistry as the implanted HA, was formed on the surface of crystalline HA particles prior to dissolution; (ii) at 3 months a bone-like tissue formed a bonding zone between mature bone and the HA implant, composed of nanocrystalline and amorphous apatite; and (iii) at 6 months, mature bone was in direct contact with HA particles, and collagen fibres were perpendicularly inserted into the surface layer of implanted HA crystals. Findings (i) and (ii) indicated the following dissolution-precipitation process. (i) The crystalline HA transforms into amorphous HA; (ii) the amorphous HA dissolves into the surrounding solution, resulting in over-saturation; and (iii) the nanocrystallites are precipitated from the over-saturated solution in the presence of collagen fibres. A preliminary analysis indicated several conclusions: (i) the transition from crystalline to amorphous HA might be the controlling step in the bone bonding of crystalline HA; (ii) biological interdigitation (or incorporation) of collagen fibres with HA and chemical bonding of a apatite layer were both necessary to strengthen and toughen a bone bond, not only for the bonding between bone and HA at 6 months, but also for the bonding zone at 3 months, which would otherwise be very fragile due to the inherited brittleness of polycrystalline ceramics; and (iii) perpendicular interdigitation is an effective way for collagen fibres to impart their unique combination of flexibility and strength to the interface which they are keying.

Modelling and simulation of the intervertebral movements of the lumbar spine using an inverse kinematic algorithm

An inverse kinematic model is presented that was employed to determine the optimum intervertebral joint configuration for a given forward-bending posture of the human trunk. The lumbar spine was modelled as an open-end, kinematic chain of five links that represented the five vertebrae (L 1-L5). An optimisation equation with physiological constraints was employed to determine the intervertebral joint configuration. Intervertebral movements were measured from sagittal X-ray films of 22 subjects. The mean difference between the X-ray measurements of intervertebral rotations in the sagittal plane and the values predicted by the kinematic model was less than 1.6 degrees. Pearson product-moment correlation R was used to measure the relationship between the measured and predicted values. The R-values were found to be high, ranging from 0.83 to 0.97, for prediction of intervertebral rotation, but poor for intervertebral translation (R= 0.08-0.67). It is concluded that the inverse kinematic model will be clinically useful for predicting intervertebral rotation when X-ray or invasive measurements are undesirable. It will also be useful to biomechanical modelling, which requires accurate kinematic information as model input data.

In vivo cancellous bone remodeling on a strontium-containing hydroxyapatite (sr-HA) bioactive cement

The purpose of this study was to investigate the in vivo bone response to the strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement injected into the cancellous bone. Sr-HA cement was injected into the iliac crest of rabbits for 1, 3, and 6 months. Active bone formation and remodeling were observed after 1 month. Newly formed bone was observed to grow onto the bone cement after 3 months. Thick osteoid layer with osteoblasts formed along the bone and guided over the bone cement surface reflected the stimulating effect of Sr-HA. From scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analysis, high calcium and phosphorus levels were detected at the interface with a thick layer of 70 microm in width, and fusion of Sr-HA with the bone was observed. Blood vessels were found developing in remodeling sites. The affinity of bone on Sr-HA cement was increased from 73.55 +/- 3.50% after 3 months up to 85.15 +/- 2.74% after 6 months (p < 0.01). In contrast to Sr-HA cement, poly(methyl methacrylate) (PMMA) bone cement was neither osteoconductive nor bioresorbable. Results show that the Sr-HA cement is biocompatible and osteoconductive, which is suitable for use in treating osteoporotic vertebral fractures.

The flexion-extension profile of lumbar spine in 100 healthy volunteers

STUDY DESIGN

Dynamic lumbar flexion-extension motions were assessed by an electrogoniometer and a videofluoroscopy unit simultaneously.

OBJECTIVES

The aims of this study were to assess the motion profile of lumbar spine in different genders and age groups and to assess their differences. SUMMARY OF BACKGROUNDS DATA: The dynamic lumbar flexion-extension motions analysis method has been developed and validated. However, data profile of the spinal motions of healthy volunteers has not been established. METHODS.: A total of 100 healthy volunteers, including 50 men and 50 women, were recruited. They were then divided into four equal groups, following their age ranges of 21 to 30 years, 31 to 40 years, 41 to 50 years, and 51 years and older. Lumbar flexion-extension motion was assessed with an electrogoniometer and videofluoroscopy simultaneously. Radiologic images of the lumbar spine were captured during flexion-extension in 10 degrees intervals. Intervertebral flexion-extension (IVFE) of each vertebral level was calculated. The spinal motion of different genders was compared segment by segment with independent t test. The spinal motion of different age groups was compared with one-way analysis of variance.

RESULTS

A linear-liked pattern of the IVFE curves was observed in different genders and age groups. No statistically significant difference in the pattern of motion was found between genders. However, statistically significant difference in the slope of IVFE curves was found at all lumbar levels in subjects whose age was 51 years or older (P < 0.05).

CONCLUSIONS

Assessment of motion profile was found to be helpful for the identification of spinal disorders in clinical practice. Because of the normal variation of spinal motion of subjects in different age ranges, interpretation of spinal motion disorders should be careful. Although the sample size in this study was limited, the database generated might be useful to assist the diagnosis of spinal "instability" in the future.

Microfracture and changes in energy absorption to fracture of young vertebral cancellous bone following physiological fatigue loading

STUDY DESIGN

Fifty-five human thoracolumbar vertebrae were randomly fatigue loaded and analyzed.

OBJECTIVES

The purpose of this study was to explore the relationship between fatigue loading, trabecular microfracture, and energy absorption to fracture in human cadaveric thoracolumbar vertebrae.

BACKGROUND

Although trabecular microfractures are found in vivo and have been produced by fatigue loading in vitro, the effect of the level of physiologic fatigue loading on microfracture and energy absorption has not been investigated.

METHODS

Fifty-five human thoracolumbar vertebrae (T11-L4) were randomly divided into 5 groups: 1) control (no loading, n = 6); 2) axial compression to yield (n = 7); and 3-5) 20,000 cycles of fatigue loading at 2 Hz (each n = 14). The level of fatigue loading was determined as a proportion of the yield load of Group 2 as follows: 10% (Group 3), 20% (Group 4), and 30% (Group 5). Half of the specimens in groups 3 to 5 were used for radiographic and histomorphometric analysis to determine microfracture density and distribution, whereas the other half were tested to determine the energy absorption to yield failure.

RESULTS

No radiographic evidence of gross fracture was found in any of the groups following fatigue loading. A mean 7.5% increase in stiffness was found in specimens subject to cyclic loading at 10% of yield stress (Group 3). Fatigue at 20% (Group 4) and 30% of yield stress (Group 5) caused significantly higher (P < 0.05) increases in mean stiffness of 23.6% and 24.2%, respectively. Microfracture density increased from 0.46/mm in Group 3 to 0.66/mm in Group 4 and 0.94/mm in Group 5 (P < 0.05). The energy absorbed to failure decreased from 21.9 J in Group 3 to 18.1 J and 19.6 J in Groups 4 and 5, respectively (P < 0.05).

CONCLUSIONS

Fatigue loading at physiologic levels produced microfractures that are not detectable by radiography. Increased fatigue load results in an increase in microfracture density and decrease energy absorbed to fracture, indicating a reduced resistance to further fatigue loading.

Transforming growth factor-beta1 gene polymorphisms and bone turnover, bone mineral density and fracture risk in southern Chinese women

Genetic contributions play an important role in determining bone mineral density (BMD) and bone turnover. Transforming growth factor-beta (TGF-beta) is abundant in bone and has been implicated as an important regulator of both bone formation and resorption. Several polymorphisms of the TGF-beta1 gene have recently been suggested to be associated with BMD and susceptibility to osteoporotic spine fractures. To determine the relationship between TGF-beta1 polymorphisms and BMD in southern Chinese women, three SNPs at C(-1348) -T, T29 -C, and T(861-20) -C of TGF-beta1 gene were analyzed in 237 postmenopausal southern Chinese women by RFLP and direct sequencing. BMD at the lumbar spine and hip region, biochemical markers of bone turnover, as well as serum levels of TGF-beta1 were measured. Only the T29 -C polymorphism of TGF-beta1 gene was associated with BMD and fracture risk. The prevalence of fragility fractures was significantly higher in individuals with TC genotype (P < 0.05). Serum alkaline phosphatase and osteocalcin levels as well as urinary N-telopeptide excretion were significantly higher in women with TC than with TT or CC genotypes, and the difference remained significant after adjusting for age and BMI (all P < 0.05). Women with TC genotype had lower BMD at the trochanteric (P < 0.03) and total hip region (P = 0.05). No difference was observed in the serum TGF-beta1 levels among the three genotypes. In conclusion, an association between T29 -C polymorphisms of TGF-beta1 gene and BMD, bone turnover as well as fragility fractures were demonstrated in postmenopausal southern Chinese women.

A prospective comparison of the coronal deformity correction in thoracic scoliosis using four different instrumentations and the fulcrum-bending radiograph

STUDY DESIGN

A prospective study on comparing coronal deformity correction in thoracic scoliosis using four different instrumentations.

OBJECTIVES

To compare the ability of four different instrumentation systems in correcting thoracic scoliosis based on the curve flexibility as reviewed by the fulcrum-bending radiograph.

SUMMARY OF BACKGROUND DATA

The fulcrum-bending radiograph has been shown to be able to accurately reflect the flexibility of thoracic curves, and the fulcrum bending correction index (FBCI) predicts the amount of correction achieved by current surgical techniques. By recruiting curves of known flexibility, the efficacy of the different instrumentations in correcting coronal deformity can be truly compared.

METHODS

A consecutive series of 127 patients with idiopathic scoliosis were treated by one of four implants: CD-Horizon (CD-H), Moss Miami (MM), TSRH, and ISOLA. All surgeries were performed by the same group of surgeons using the respective recommended techniques. FBCI was used to compare the correction achieved by these implants.

RESULTS

The mean FBCI/correction rate was 101.0%/57.9% in the TSRH group, 103.5%/58.5% in ISOLA, 109.1%/67.6% in CD-H, and 100.2%/62.7% in the MM group. The correction rate was significantly (P < 0.05) higher in the CD-H group than those in the TSRH and ISOLA groups, while the differences in the FBCI between the four implants were not statistically significant.

CONCLUSIONS

When curve flexibility is taken into account, despite differences in material and design of four commonly used instrumentations, their ability to correct thoracic scoliosis is the same. Future studies describing surgical correction results should be based on the FBCI.

Spinal flexibility increase after chymopapain injection is dose dependent: a possible alternative to anterior release in scoliosis

STUDY DESIGN

Experimental animal study.

OBJECTIVES

To investigate whether the increase in spinal flexibility after chymopapain injection is dose dependent and determine the "optimal" dosage of chymopapain to increase spinal flexibility in a rabbit model.

SUMMARY OF BACKGROUND DATA

Spinal instability after chymopapain injection may result in severe back pain. However, this undesired mechanical effect in treating disc herniation may provide a safe minimally invasive approach for anterior spinal release in scoliosis correction.

METHODS

A total of 138 lumbar intervertebral discs from 46 New Zealand white rabbits were randomly injected with chymopapain at 6.25, 12.5, 25, 50, 75, and 100 picokatals (pKats)/0.05 mL/disc. The rabbits were killed 1 week after the injection, and the lateral bending stiffness of the spinal segments without posterior elements was determined.

RESULTS

The lateral bending spinal stiffness showed no significant change after injection of 6.25 and 12.5 pKats/0.05 mL/disc but reduced significantly following chymopapain injection of 25, 50, 75, and 100 pKats (all P < 0.05 by post hoc least significant difference tests). While the lateral bending stiffness was lowest at the 100-pKats dose, there were no significant differences between the four higher dosages.

CONCLUSION

The reduction in the lateral bending spinal stiffness after chymopapain injection is dose dependent, and an optimal dosage for spinal release existed; doses greater than the optimal dosage did not result in further significant decrease in lateral bending spinal stiffness.

Surface treatment of injectable strontium-containing bioactive bone cement for vertebroplasty

A novel injectable bioactive bone-bonding cement (SrHAC) composed of strontium-containing hydroxyapatite (Sr-HA) as the inorganic filler and bisphenol A diglycidylether dimethacrylate (Bis-GMA) as the organic matrix for vertebroplasty was developed previously. In this study, the Sr-HA powders were surface treated with methyl methacrylate (MMA) to improve the interface integration of the two phases. After surface treatment, the compression strength and Young's modulus, which were tested after immersion in distilled water at 37 degrees C for 24 h according to ISO 5833, were increased by 68.65 % (p <.001) and 31.02% (p <.001), respectively. The bending strength and bending stiffness of the bioactive bone cement were significantly improved by 54.44% (p <.001) and 83.90% (p <.001). In addition, the handling property of the cement was also enhanced. In vitro biomechanical testing showed that the stiffness of the fractured spine recovered to 82.5% (p <.01) of the intact condition after cementation with surface-treated SrHAC. The failure load of the spine cemented with original and MMA-treated SrHAC improved by 14.25% (p <.05) and 46.91% (p <.05) in comparison with the fractured spines. Results from this study revealed that the MMA-treated SrHAC has a better mechanical effect for orthopedic applications.

Ultrastructural study of mineralization of a strontium-containing hydroxyapatite (Sr-HA) cementin vivo

The purpose of this study was to investigate the mineralization leading to osseointegration of strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement injected into cancellous bone in vivo. Sr-HA cement was injected into the ilium of rabbits for 1, 3, and 6 months. The bone mineralization area was found to be largest at 3 months, then at 1 month, and smallest at 6 months (p < 0.01) measured with tetracycline labeling. Osseointegration of Sr-HA cement was achieved at 3 months as observed by scanning electron microscopy. A high calcium and phosphorus area was observed at the interface of bone-Sr-HA cement determined by energy-dispersive X-ray analysis. Transmission electron microscopy gave evidence of the mechanism of bone formation. Dissolution of Sr-HA into debris by the bone remodeling process was thought to increase the concentration of calcium and phosphorus at the interface of bone-Sr-HA cement and stimulate bone formation. Crystalline Sr-HA formed an amorphous layer and dissolved into the surrounding solution, then apatite crystallites were precipitated and formed new bone at 3 months. This young bone then becomes mature bone, which bonds tightly to the Sr-HA cement with collagen fibers inserted perpendicularly after 6 months.

Controllable porosity hydroxyapatite ceramics as spine cage: fabrication and properties evaluation

A procedure was designed to prepare porosity-graded hydroxyapatite (HA) ceramics simulating the bimodal structure of natural bone, which could be used to build a cage that would promote the reconstruction of the anterior column after vertebrectomy or corpectomy in tumor and trauma surgery. HA ceramics with controllable pore size distribution and porosity were developed by using chitosan and Poly(vinyl alcohol) (PVA) as the pore-forming agents. HA ceramics with worthwhile properties such as a wide range of volume porosity (10-50%) and pore size (nanometer to 400 microm) can be obtained from this method, which allows the fabrication of HA ceramics with desirable porous characteristics simulating the bimodal natural bone architecture expected to provide advantages for bony fusion in the intervertebral foramina. When coated with chitosan-gelatin network, the bending strength of the porous HA ceramics significantly improved. The polymer network coated porous HA have potential application in the construction of cages for spinal operations.

Effect of different casting methods on adolescent idiopathic scoliosis

Scoliosis is a three-dimensional spinal deformity. Although orthotic treatment for moderate adolescent idiopathic scoliosis (AIS) has been well recognized, there are few studies documenting the effectiveness of different casting methods in the fabrication of thoracolumbo-sacral orthoses (TLSO). The current study was a retrospective clinical evaluation of the effectiveness of two commonly used casting methods namely, the frame casting method and the supine with traction casting method in the treatment of AIS. Eighty (80) female patients with AIS were recruited and they were all treated by TLSOs. The frame casting method was used in 37 patients while the remaining 43 patients were under the supine with traction casting method. The responses of spinal deformities under the two different casting methods were analyzed for the period from pre-brace to 2 years after bracing. The studied parameters included the AP Cobb's angle, the apical vertebral rotation and the trunk listing (cervico-sacral lateral offset). The results of the current study showed that the orthoses manufactured from the two casting methods could provide an effective control of AIS (change of Cobb's angle within (+/- 5 degrees). For the frame casting, the Cobb's angles at pre-brace and 2 years after off-brace were 36.0 degrees and 33.8 degrees respectively while for the supine with traction casting, the corresponding Cobb's angles were 32.7 degrees and 34.0 degrees. The frame casting method could give a better control of the apical vertebral rotation at the early stage of treatment (pre-brace = 18.2 degrees and the 4th month = 13.8 degrees while the supine with traction casting method was more effective in the long-term control of the trunk listing (pre-brace = 10mm and 2 years after off-brace = 3.3mm).

Gene therapy for new bone formation using adeno-associated viral bone morphogenetic protein-2 vectors

Previous reports have suggested that bone morphogenetic protein (BMP) gene therapy could be applied for in vivo bone regeneration. However, these studies were conducted either using immunodeficient animals because of immunogenicity of adenovirus vectors, or using ex vivo gene transfer technique, which is much more difficult to handle. Adeno-associated virus (AAV) is a replication-defective virus without any association with immunogenicity and human disease. This study was conducted to investigate whether orthotopic new bone formation could be induced by in vivo gene therapy using AAV-based BMP2 vectors. To test the feasibility of this approach, we constructed an AAV vector carrying human BMP2 gene. Mouse myoblast cells (C2C12) transduced with this vector could produce and secrete biologically active BMP2 protein and induce osteogenic activity, which was confirmed by ELISA and alkaline phosphatase activity assay. For in vivo study, AAV-BMP2 vectors were directly injected into the hindlimb muscle of immunocompetent Sprague-Dawley rats. Significant new bone under X-ray films could be detected as early as 3 weeks postinjection. The ossification tissue was further examined by histological and immunohistochemical analysis. This study is, to our knowledge, the first to establish the feasibility of AAV-based BMP2 gene therapy for endochondral ossification in immunocompetent animals.

Isokinetic and isometric lifting capacity of Chinese in relation to the physical demand of job

The aim of the study was to formulate normative data for the lifting capacities of a normal Chinese population, in order to establish a basic foundation for further studies and to investigate the relationship between individual attributes including age, gender, height, weight, job physical demand and each type of lifting capacity. Isokinetic and isometric lifting strength at low, waist and shoulder assessment levels were measured using the LIDO Workset II based on a sample of 93 normal Chinese adults (63 men and 30 women) between the ages of 21-51. The 50th percentile score for adult Chinese female's lifting strength was 17.71% lower than the American female while the adult Chinese male's lifting strength was 14.94% lower than the American male. Lifting forces were higher in the 20-40 year age group. The isometric work mode had considerable impact on the lifting capacities, with shoulder level having the highest lifting capacities. The gender and body weight had a significant positive correlation to lifting capacity while job physical demand had a moderate correlation. Age and body heights were weakly correlated to lifting capacity.

Application of time-frequency analysis to somatosensory evoked potential for intraoperative spinal cord monitoring

OBJECTIVE

To investigate the improvement in the reliability of intraoperative spinal cord monitoring by applying time-frequency analysis to somatosensory evoked potentials (SEP).

METHODS

34 patients undergoing scoliosis surgery were studied. SEP were recorded during different stages of scoliosis surgery. Averaged SEP signals were analysed intraoperatively by short time Fourier transform (STFT). The time-frequency characteristics of SEP were observed during surgery. The main peak in the time-frequency interpretation of SEP was measured in peak time, peak frequency, and peak power. The changes in these variables were compared with the changes in latency and amplitude during different surgical stages.

RESULTS

During different surgical stages, changes in peak times and peak powers were found to correlate with the changes in latency and amplitude, respectively. Peak time showed more variability than latency (p < 0.01), while peak power showed less variability than amplitude (p < 0.01). The peak frequency of SEP appeared to be unchanged during surgery. SEP signals were found to have specific time-frequency characteristics, with the time-frequency distribution of the signals being located in a particular time-frequency space.

CONCLUSIONS

Time-frequency analysis of SEP waveforms reveals stable and easily identifiable characteristics. Peak power is recommended as a more reliable monitoring parameter than amplitude, while peak time monitoring was not superior to latency measurement. Applying time-frequency analysis to SEP can improve the reliability of intraoperative spinal cord monitoring.

An autologous blood donation program for paediatric scoliosis patients in Hong Kong

A retrospective audit was conducted to determine the safety, efficacy and patient satisfaction related to a preoperative autologous blood donation program for children and teenagers undergoing corrective surgery for scoliosis. Forty-five of the 77 patients donated the requested amount of blood. These 45 compliant patients had been requested to donate fewer units of blood than noncompliant patients (mean 4.0 vs 4.6 respectively, P = 0.02). Twelve patients required allogeneic blood transfusion. Two patients had surgery delayed making the collected autologous blood unavailable. The extent of the operation was associated with the need for allogeneic blood transfusion. Six and a half percent of all donated units of blood were discarded. No major complications were reported. Overall, 93% of patients were satisfied with the program. With careful patient selection, good inter-departmental coordination and teamwork, preoperative autologous blood donation in paediatric patients undergoing extensive corrective surgery for scoliosis is safe and effective.

A comparison of deconvolution techniques for stress relaxation

Stress relaxation (or equivalently creep) allows a large range of the relaxation (retardation) spectrum of materials to be examined, particularly at lower frequencies. However, higher frequency components of the relaxation curves (typically of the order of Hertz) are attenuated due to the finite time taken to strain the specimen. This higher frequency information can be recovered by deconvolution of the stress and strain during the loading period. This paper examines the use of three separate deconvolution techniques: numerical (Fourier) deconvolution, semi-analytical deconvolution using a theoretical form of the strain, and deconvolution by a linear approximation method. Both theoretical data (where the exact form of the relaxation function is known) and experimental data were used to assess the accuracy and applicability of the deconvolution methods. All of the deconvolution techniques produced a consistent improvement in the higher frequency data up to the frequencies of the order of Hertz, with the linear approximation method showing better resolution in high-frequency analysis of the theoretical data. When the different deconvolution techniques were applied to experimental data, similar results were found for all three deconvolution techniques. Deconvolution of the stress and strain during loading is a simple and practical method for the recovery of higher frequency data from stress-relaxation experiments.

Effect of using prismatic eye lenses on the posture of patients with adolescent idiopathic scoliosis measured by 3-d motion analysis

This is a preliminary investigation to detect the body sway and postural changes of patients with AIS under different spatial images. Two pairs of low-power prismatic eye lenses (Fresnel prisms) with 5 dioptre and 10 dioptre were used. In the experiment, the apices of the prisms were orientated randomly at every 22.5 degrees from 0 degrees to 360 degrees to test changes. Four patients with mean age of 11 and Cobb's angle of 30 degrees were recruited and the results showed that the low-power prisms at specific orientations (157.5 degrees and 180 degrees) could cause positive postural changes (2.1 degrees-2.7 degrees reduction of angle of trunk mis-alignment) measured by 3-D motion analysis. This might be used for controlling their scoliotic curves by induced visual bio-feedback. Apart from this laboratory test, a longitudinal study is necessary to investigate the long-term effect of the prisms at different powers and orientations (under both static and dynamic situations) on the patient's posture, spinal muscular activities, vision, eye-hand coordination, psychological state and other daily activities before it becomes an alternative management of AIS.