Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength

This study investigated (1) the effect of screw diameter and insertion technique in lumbar vertebrae, and insertion site in the sacrum, on the axial pullout force and transverse bending stiffness of pedicle screws, and (2) the effect of bone cement augmentation using polymethylmethacrylate (PMMA) and the biodegradable composite, poly(propylene glycol-fumarate) on axial pullout force and transverse bending stiffness of pedicle screws inserted into lumbar vertebrae. The axial pullout force and transverse bending stiffness of a 6.25-mm Steffee screw and a 6-mm Kluger screw did not differ significantly in vertebral bodies of similar equivalent bone mineral density. The axial pullout force of Schanz screws was significantly increased with a 1-mm increase in screw diameter. However, there was no significant increase in transverse bending stiffness. In the sacrum, an approach through the S1 facet produced significantly higher axial pullout forces and transverse bending stiffness than the approach described by Harrington and Dickson. PMMA and a biodegradable composite bone cement poly(propylene glycol-fumarate) both increased the axial pullout force. PMMA also increased the transverse bending stiffness.

Cryogenic solvents inhibit the binding of the Escherichia coli heat-stable enterotoxin to intestinal brush border membranes

The cryogenic solvents ethylene glycol, glycerol, dimethyl sulfoxide (Me2SO) and dimethylformamide (Me2FM), with increasing potency, produced concentration-dependent inhibition of the binding of the Escherichia coli heat-stable enterotoxin (STa) to pig intestinal brush border membranes. Inhibition increased with time, and both Me2SO and Me2FM appeared to decrease both the affinity of the STa receptor and the effective receptor number. Both solvents stimulated the release of previously bound 125I-STa (Me2FM > Me2SO), 3 M Me2FM inducing 93% release by 120 min. These effects were reversible, and preincubation of membranes with up to 3 M Me2SO or Me2FM at 37 degrees C for 30 min, followed by washing, did not alter subsequent 125I-STa binding. Also, 125I-STa released from membranes by 3 M Me2FM was shown to rebind to the membranes after 10-fold dilution of Me2FM. Since pretreating membranes with the thiol reagent p-chloromercuribenzenesulfonate had no effect on the release of bound 125I-STa by Me2SO or Me2FM, and since neither of these can reduce disulfide bonds, the formation of mixed disulfides between STa and receptor is unlikely. Me2SO inhibition of 125I-STa binding was greater with membranes than with a partially purified receptor preparation, which may result from the substitution of detergent for the phospholipid normally associated with the receptor(s).

Rehabilitation of athletes following spine injury

We feel that the described system for staging cervical and lumbar spine injuries in the high-performance athlete affords a basic framework for the rehabilitation of those individuals. With spine injuries, one has to exercise care to rule out those injuries and additional pathologies presenting as neck or back pain that could result in catastrophic sequelae. We stress due diligence in the initial and continued follow-up of these patients with careful evaluation to rule out associated fractures, dislocations, and attendant disc pathology. The treatment of the "stinger" or "burner" is controversial. We suggest a conservative approach, although the orthopedic and neurologic literature reports that these individuals have been returned to full contact sports activity without documented subsequent neurologic sequelae. The final decision remains at the discretion of the treating physician. This program provides a rational approach to the rehabilitation of the spine-injured high-performance athlete that will provide for the return of him or her to preinjury activity level in an expeditious manner with the minimal period of interruption in training.

Biomechanics of pin and screw fixation of femoral neck fractures

Using an in vitro cadaveric femoral neck osteotomy model and a paired experimental design, we compared fixation stiffness and yield load for three- and four-pin configurations for both Knowles pins and Asnis screws and for three Asnis screws versus an AO-ASIF sliding hip screw. Repeat measure analyses of variance indicated a significant increase in stiffness (p < 0.05) with the use of three versus four pins; the yield load did not depend significantly on the number of pins. Fixation was significantly stiffer (p < 0.01) and stronger (p = 0.02) for Knowles pins if the osteotomy was oblique rather than transverse to the femoral neck; the opposite was found for Asnis screws. Femoral fixed with hip screws were significantly stiffer (p < 0.01) than the contralateral side fixed with three Asnis screws. No significant difference in yield load was observed, however. Clinically, it appears from these findings that the use of three Asnis screws or three Knowles pins provides modest increases (averaging 4%) in fixation stiffness with no degradation in strength when compared with four screws or pins. Parallel placement of Asnis screws also provides advantages over nonparallel Knowles pins by allowing controlled impaction of the femoral head. While three Asnis screws provide fixation stiffness approximately 40% less than that found with a sliding hip screw, there is no compromise in fixation strength.

Strength reductions from trabecular destruction within thoracic vertebrae

An in vitro model of metastatic lesions in thoracic vertebrae was used to determine if the reduction in vertebral cross-sectional area could be used to predict the associated strength reduction. Defects, entirely within the trabecular bone, were created in alternating vertebrae of unembalmed human thoracic spines. The adjacent vertebrae were tested intact and served as controls. Defect size was determined as the cross-sectional area of the defect divided by the nominal cross-sectional area of the vertebral body midplane. Vertebrae were tested to failure using combined axial-flexion loads. For each spine, a linear regression was determined between the cross sectional area of the superior endplate and the load at failure for the intact vertebrae. The intact strength of bodies with defects was estimated from this regression. The normalized strength of thoracic vertebrae with trabecular defects was linearly related to the reduction in cross-sectional area (normalized failure load = 1.0-Ad/Ai, r2 = 0.51; Ad = cross-sectional area of defect; and Ai = intact cross-sectional area at midplane). The data suggest that the strength reduction due to lytic defects within the centrum of thoracic vertebrae is proportional to the cross-sectional area of bone resorbed.

Cervical injuries under flexion and compression loading

Cervical spine segmental tests were performed to determine the specific patterns of initial cervical injury in response to loading just beyond the point of structural failure. Well-defined combinations of flexion rotation and compression translation were applied to segments with varying degrees of disc and facet degeneration. Twelve cervical spine specimens (from human cadavers ages 52-91 years), each consisting of three vertebrae (two motion segments) from the middle (C2-C5) or lower (C5-T1) regions, were subjected to pure flexion rotation (seven specimens) or to combined flexion rotation and axial compression translation (five specimens). Specimens were sectioned and dissected to determine the patterns of structural failure. Pure flexion, and combined flexion and compression produced similar patterns of injuries. The disc was the most commonly injured structure, with annular injuries noted in 8 of the 12 specimens, and with anterior herniation of the nucleus occurring in two specimens. Wedge fractures and posterior ligament injuries were noted in both specimen groups and with both modes of loading. We conclude that similar patterns of initial anterior bony compressive failure and posterior ligamentous failure can occur with both flexion and with combined flexion-compression, without axial or lateral rotation, at low rates of loading. Anterior cervical disc herniations were produced in both middle and lower cervical segments.

Magnetic resonance imaging analysis of percutaneous discectomy. A preliminary report

Twenty-one consecutive patients (27 lumbar discs) were treated by percutaneous discectomy for lumbar herniated disc disease from July 1988 through March 1989. Twenty-six discs in 20 patients were evaluated with preoperative and postoperative magnetic resonance images graded by a neuroradiologist blinded to the clinical and prior imaging results. Fifteen patients were treated by one-level percutaneous discectomy and six patients by two-level percutaneous discectomy. The disc herniations were graded with respect to size, type, location, and hydration status on the magnetic resonance image scans. The postoperative magnetic resonance images were obtained 2-6 months after percutaneous discectomy. Early clinical outcomes after percutaneous discectomy were compared with the various magnetic resonance imaging parameters. Overall, treatment for thirteen patients (62%) was considered clinically successful (decrease or elimination of pain) after percutaneous discectomy, whereas treatment for eight (38%) patients was considered to clinically fail (persistence of pain) with follow-up ranging from 1 to 6 months postoperatively. Three of the patients in whom treatment failed have been subsequently treated successfully by laminotomy and discectomy. On the average, there is a small absolute decrease (5% of the anteroposterior diameter of the spinal canal) in the size of disc herniations when treated by percutaneous discectomy. Although this study is limited by a small sample size and lacks statistical significance, it appears that an early clinical success after percutaneous discectomy may be related to a few magnetic resonance imaging parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical spondylotic myelopathy: a review of surgical indications and decision making

Cervical spondylotic myelopathy (CSM) is frequently underdiagnosed and undertreated. The key to the initial diagnosis is a careful neurologic examination. The physical findings may be subtle, thus a high index of suspicion is helpful. Poor prognostic indicators and, therefore, absolute indications for surgery are: 1. Progression of signs and symptoms. 2. Presence of myelopathy for six months or longer. 3. Compression ratio approaching 0.4 or transverse area of the spinal cord of 40 square millimeters or less. Improvement is unusual with nonoperative treatment and almost all patients progressively worsen. Surgical intervention is the most predictable way to prevent neurologic deterioration. The recommended decompression is anterior when there is anterior compression at one or two levels and no significant developmental narrowing of the canal. For compression at more than two levels, developmental narrowing of the canal, posterior compression, and ossification of the posterior longitudinal ligament, we recommend posterior decompression. In order for posterior decompression to be effective there must be lordosis of the cervical spine. If kyphosis is present, anterior decompression is needed. Kyphosis associated with a developmentally narrow canal or posterior compression may require combined anterior and posterior approaches. Fusion is required for instability.

In vitro hyperextension injuries in the human cadaveric cervical spine

To investigate the relationship between the type of hyperextension injuries and the conditions producing them, nine cervical specimens (occiput to T1) were loaded to failure in tension at a fixed extension angle of 30 degrees. Under these loading conditions, specimens failed at average tensile loads and extension moments of 499 +/- 148 (SD) N and 4.0 +/- 3.1 Nm, respectively. Failure occurred at an average tensile displacement of 18.8 +/- 7.7 mm. The anterior longitudinal ligament ruptured and the intervertebral disc failed in at least one level in all specimens. In four specimens, the disc failed at an additional level, leaving the anterior longitudinal ligament intact at that site. With one exception, all injuries occurred in the lower cervical spine (C5-C6 and C6-C7), the region most often injured in vivo. The location of the injuries was associated with the degree of degeneration of the facet joints and the discs. The discs of the lower cervical spine were significantly more degenerated than those at the C2-C3 level. In addition, the degree of disc degeneration in the noninjured discs was significantly less than in the injured discs. These data help quantify the threshold of injury and the patterns of tissue damage resulting from hypertension loading of the cervical spine.

Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation

Forty-seven patients who had lumbar or lumbosacral fusion with or without pedicle screw internal fixation by one surgeon for treatment of degenerative lumbar disease with clinical instability were retrospectively reviewed by an independent observer. Eighteen of the 21 patients whose fusions were internally fixed with the Variable Spinal Plating (VSP) system were available for review. A control group consisted of 27 patients who had fusion without internal fixation. The rate of pseudarthrosis did not significantly differ between the two groups (VSP group, 22%; versus control group, 26%). Twelve (67%) of the 18 patients treated with fusion and VSP instrumentation were considered to have had a good or excellent outcome, whereas 19 (70%) of the 27 patients treated by fusion without internal fixation had good or excellent results. Two VSP-instrumented patients had postoperative leg dysesthesias, whereas this complication was not observed in the control group. Bilateral posterolateral lumbar or lumbosacral fusion without internal fixation is as effective as and safer than fusion with pedicle screw instrumentation.

Presence of functional receptors for the Escherichia coli heat-stable enterotoxin in the gastrointestinal tract of the chicken

Receptors for the Escherichia coli heat-stable enterotoxin (STa) were shown to be present throughout the digestive tract of the chicken, with binding activity present not only in the intestinal epithelium but also in the intestinal smooth muscle. Brush border membrane vesicles (BBMV) purified from chicken enterocyte homogenates and plasma membranes (SMPM) purified from intestinal smooth muscle homogenates were compared with pig enterocyte BBMV. All had similar 125I-STa binding affinities, but the 50% effective concentration for STa activation of guanylate cyclase was higher in SMPM than in BBMV. Maximal STa-stimulated guanylate cyclase activities were similar in chicken and pig BBMV and were seven- to eightfold higher than in SMPM, and the STa receptor density was five- to sixfold higher. Patterns unique to each membrane were demonstrated after affinity labelling of STa receptors with 125I-STa, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and autoradiography. The results demonstrated STa-stimulated guanylate cyclase activity in birds as well as mammals and suggested that there are different functional STa receptors in chicken BBMV and SMPM.

Nucleotide regulation of heat-stable enterotoxin receptor binding and of guanylate cyclase activation

Certain nucleotides were found to regulate the binding of the Escherichia coli heat-stable enterotoxin (STa) to its receptor in pig intestinal brush border membranes. ATP and adenine nucleotide analogues inhibited 125I-STa binding, while guanine nucleotide analogues stimulated binding, with maximal effects at 0.5-1.0 mM. The strongest inhibitors were adenosine 5'-[beta gamma-imido]triphosphate (App[NH]p) (36%) and adenosine 5'-[beta-thio]diphosphate (ADP[S]) (41%). Inhibition did not require Mg2+, and was blocked by p-chloromercuribenzenesulphonate (PCMBS). Stimulation of binding required Mg2+, was not prevented by PCMBS and was maximal with GDP[S] (41%). While App[NH]p and MgGDP[S] appeared to be acting at different sites, they also interfered with each other. These nucleotides exerted only inhibitory effects on STa-stimulated guanylate cyclase activity, in contrast with the stimulatory effects of adenine nucleotides on atrial natriuretic peptide (ANP)-stimulated guanylate cyclase. Inhibition by low concentrations of MgApp[NH]p and MgATP was weaker above 0.1 mM, while MgGDP[S] and magnesium guanosine 5'-[gamma-thio]triphosphate (MgGTP[S]) inhibited in a single phase. Inhibition by MgApp[NH]p, at all concentrations, was competitive with the substrate (MgGTP), as was that by MgGDP[S] and MgGTP[S]. Whereas membrane guanylate cyclases usually show positively co-operative kinetics with respect to the substrate, STa-stimulated activity exhibited Michaelis-Menten kinetics with respect to MgGTP. This changed to positive co-operativity when Lubrol PX was the activator, or when the substrate was MnGTP. These results suggest the presence of both a regulatory and a catalytic nucleotide-binding site, which do not interact co-operatively with STa activation.

A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model

Clinical failures of internal fixation implants for the treatment of the thoracolumbar spine are generally attributed to fatigue. Few studies, however, have characterized changes in fixation rigidity with time or subjected spine-implant fixation constructs to fatigue loading until failure. Fatigue characteristics of five dorsally applied spinal fixation implants were determined using lumbosacral calf spines, with an L3 vertebrectomy, loaded cyclically in combined compression (maximum 605 N) and flexion (maximum 16 Nm) for up to 100,000 cycles. Displacement transducers monitored motion at the site of instability and at the segment above the implants. Flexibility and strain at these segments were then calculated. A one-way analysis of variance showed that there were no significant differences in flexibility of the five fixation constructs (P greater than .05). A multiple Bonferroni test revealed that the AO and Kluger fixateur interne and Steffee plates, with fixation at L2 and L4, allowed significantly more strain (P less than .01) across the site of instability than did Harrington rods and Luque plates with fixation at L1, L2, L4, and L5. There were no significant differences between fixation constructs in initial strain above the implants. After 10,000 cycles, however, there were significant increases in strain across the segment above the Luque and Harrington implants (P less than .05). Failure of the AO Schanz screw occurred in three of six constructs at a mean of 73,300 cycles. The Steffee screws failed in four of five constructs at a mean of 20,800 cycles. The rods of the Kluger fixateur interne broke in four of five constructs at a mean of 47,800 cycles, and one screw slipped at 11,000 cycles. There were no metal failures in the Harrington or Luque implants.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional load displacement properties of posterior lumbar fixation

Pedicular fixation devices for the posterior treatment of segmental spinal instability are thought to offer enhanced stabilization compared with sublaminar wire systems, while avoiding the immobilization of multiple normal motion segments. We compared the performance of three dissimilar stabilization systems: the Hartshill rectangle, the Acromed/Steffee interpedicular screw and plate, and the Synthes/Dick fixateur interne. Human cadaveric lumbosacral specimens were first tested intact, then after a laminectomy and a facetectomy at the L3/L4 level, and finally after the fixation devices were sequentially attached. Constructs spanning two to four vertebral levels were compared for stabilization of the resected lumbar spine segments. When tested in compression, the Acromed/Steffee system with pedicular screws at L2-L5 allowed significantly less intersegmental distraction than the Synthes/Dick construct with screws at L2 and L5 only, and less than the intact and the destabilized uninstrumented spine. When sagittally rotated, the Acromed/Steffee construct with screws at L2-L5, or at L2 and L5, allowed significantly less distraction than the intact or destabilized segments, and the construct with screws at L2 through L5 allowed less distraction than the Synthes/Dick constructs with screws at L3/L4 or L2/L5. With the exception of the Acromed/Steffee system with screws at four levels, there were no significant differences in distraction allowed between the Synthes/Dick and Acromed/Steffee constructs, or between the multisegment and single segment constructs. There were no significant differences in stiffness across levels L3/L4 with the various implants. Results indicate that the use of posterior spine constructs significantly augment the stability of posterior segmental defects. Pedicular fixation immediately cephalad and caudad to the defect provided stable fixation in this application.

Age-dependent changes in affinity-labeled receptors for Escherichia coli heat-stable enterotoxin in the swine intestine

Intestinal brush border membranes from 1-day-old and 4-week-old (day of weaning) pigs were affinity labeled with an Escherichia coli heat-stable enterotoxin (STa) by cross-linking 125I-STa to receptor proteins with disuccinimidyl suberate. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography revealed that a radioactive protein with a relative molecular weight of 137,000 to 145,000 was present in both age groups. A strongly radioactive protein with an apparent Mr of 90,000 was present in the 1-day-old animals but not in those that were 4 weeks old. The major radioactive protein present in the older pigs had an Mr of 64,000 to 67,000, but this protein was missing or very weakly radioactive in the younger pigs. There was no significant difference between the groups in receptor affinity for STa, although the receptor density in the older animals was marginally significantly greater. STa-stimulated guanylate cyclase activity in membranes from 1-day-old pigs was only one-sixth that in 4-week-old pigs, although the basal and Lubrol PX-stimulated activities were similar.

Prevalence of idiopathic vertebral sclerosis, Zöetermeer, Rotterdam, 1975-1978

In order better to define the prevalence and characteristics of idiopathic vertebral sclerosis, we evaluated the roentgenograms of 1,391 individuals greater than or equal to 35 years of age) for the presence or absence of idiopathic vertebral sclerosis. One hundred two radiographs showed evidence of idiopathic vertebral sclerosis, a prevalence rate of 5% in this population. For the first time, a roentgenographic classification is offered. These "cases" were then classified into Types I-IV, based on the pattern and location of the sclerosis. The radiologic and demographic characteristics of Type I correlate most closely with previous studies that have investigated the association of vertebral sclerosis with chronic back pain. Women predominated in age-specific classifications; the female-to-male ratio in Type I was 4:1, a reproducible finding in previous studies. The large sample available for study supports the conclusion that this is an accurate estimate of the prevalence rate of idiopathic vertebral sclerosis.

Solubilization and reprecipitation from intestinal brush border membranes of a complex containing guanylate cyclase activatable by the heat-stable enterotoxin

Extraction of pig intestinal brush border membranes with the zwitterionic detergent 3-[(3-cholamidopropyl)-dimethylammonio]-1-propanesulfonate (Chaps) in the presence of 0.5 M KCl yielded a solution which contained 60-70% of the receptor for the Escherichia coli heat-stable enterotoxin (STa) and of the Lubrol PX-activated guanylate cyclase activity present in the membrane. When the supernatant solution was diluted fivefold with 10 mM Hepes buffer (pH 7.4) and kept at 4 degrees C overnight, a precipitate formed. Centrifugation yielded a pellet (P2) which contained 25-30% of both the cyclase and the receptor in the original membranes, with a 2.5- to 3-fold enrichment of both. The process could be repeated for further enrichment (P4). The addition of MgCl2 to the diluted extract affected both basal and STa-stimulated activity of P2; 1 mM was optimal. P2 resembled membranes with respect to competitive inhibition of 125I-STa binding by STa, and the concentration-dependent activation of cyclase by STa. Guanylate cyclase in resolubilized P2 was also activated by STa. Most of the enzymes interfering with guanylate cyclase determinations were removed, as were the brush border marker enzymes sucrase and gamma-glutamyltransferase, and a GTP-binding protein that is a pertussis toxin substrate. Specific cross-linking of 125I-STa to receptors in the membrane was preserved in P2 and P4, the three proteins showing the strongest radioactivity having relative molecular masses of 55,000-60,000, 70,000-80,000, and 135,000-140,000. P2 and P4 appear to contain a complex of membrane proteins with certain functional properties intact.

Importance of bone mineral density in instrumented spine fusions

The effect of equivalent mineral density on pedicular screw fixation strength was investigated. The equivalent mineral density of human vertebral bodies was correlated highly with the pullout force of Kluger screws (r2 = 0.61, P less than 0.02). A moderate to high correlation existed between density and vertical force (r2 = 0.42 for Kluger screws, r2 = 0.55 for Steffee screws, P less than 0.02). In calf vertebral bodies of higher density (146 +/- 14 mg/cc), the forces were significantly higher than in the human vertebral bodies (P less than 0.05). Human lumbosacral spines were instrumented with three different fixators: Steffee plates, AO fixateur interne, and Kluger fixateur interne. Of five specimens with a mean density of 88 +/- 11 mg/cc, one screw loosened. More than one screw loosened in six specimens with a mean density of 63 +/- 12 mg/cc, and no screw loosened in four specimens with a mean density of 114 +/- 38 mg/cc. Measurement of equivalent mineral density correlates with the fixation strength of the intrapedicular screws in vitro and should be considered in patients with signs of osteopenia before using pedicular screws for spinal fusions. It is also concluded that calf spines are a good model for testing implants because they tend to focus failure processes in the implant rather than in the implant-bone interface.

Activation of intestinal brush border guanylate cyclase by aromatic disulphide compounds

Guanylate cyclase in pig intestinal brush border membranes was stimulated by certain aromatic disulphides. The most effective were 6-thioguanine disulphide [(TGS)2], 6-mercaptopurine disulphide, 6,6'-dithiodinicotinic acid, 5,5'-dithiobis-(2-nitrobenzoic acid) and 5-carboxy-2-thiouracil disulphide. (TGS)2 stimulated activity 15-fold when present at 0.1 mM. The optimum concentration for each disulphide was different, and higher concentrations were inhibitory. There was no activation by alkyl disulphides or by N-ethylmaleimide. Activation by 50 microM-(TGS)2 was partially reversed by later addition of 0.1 mM-dithiothreitol, whereas activation by the Escherichia coli heat-stable enterotoxin STa was relatively unaffected. Pretreatment of the membranes with (TGS)2 produced a concentration-dependent inhibition of STa-stimulated activity, while stimulating basal activity, until the activities were equal at 50 microM. Activity was [Mg2+]-dependent, the optimal [Mg2+] progressively increasing as the enzyme was stimulated by (TGS)2, STa and Lubrol PX respectively. However, (TGS)2 pretreatment prevented the shift to higher [Mg2+]optima induced by STa or Lubrol alone. Substitution of Mn2+ for Mg2+ in the reaction elevated basal activity and eliminated by activation (TGS)2. (TGS)2 only inhibited Mn2(+)-dependent activity (both basal and stimulated). The affinity of 125I-STa for its receptor was slightly increased by (TGS)2. We propose that (TGS)2 undergoes thiol-disulphide exchange with at least three different protein thiols of decreasing reactivity. The first is associated with Mg2(+)-dependent activation, the second is associated with a tonic inhibition of activity and the third is associated with the catalytic activity, although probably not at the active site.

Physical and mechanical properties of calf lumbosacral trabecular bone

The physical and mechanical properties of calf lumbar and sacral trabecular bone were determined and compared with those of human trabecular bone. The mean tissue density (1.66 +/- 0.12 g cm-3), equivalent mineral density (169 +/- 36 mg cm-3), apparent density (453 +/- 89 mg cm-3), ash density (194 +/- 59 mg cm-3), ash content (0.6 +/- 0.05%), compressive strength (7.1 +/- 3.0 MPa) and compressive modulus (173 +/- 97 MPa) of calf trabecular bone are similar to those of young human. There were moderate, positive linear correlations between apparent density and equivalent mineral density, ash density, and compressive strength; and between compressive strength and equivalent mineral density (R2 ranging from 0.35 to 0.48, p less than 0.001). Apparent density, ash density, and equivalent mineral density did not differ significantly in different regions. In contrast to humans, the compressive strength increased from posterior, near the facet, to the anterior vertebral body. These comparisons of physical and mechanical properties, as well as anatomical comparisons by others, indicate that the calf spine is a good model of the young non-osteoporotic human spine and thus useful for the testing of spinal instrumentation.

Variations of stiffness and strength along the human cervical spine

The load-displacement response and strength of the mid (C2-C5) and lower (C5-T1) cervical regions were determined for combinations of sagittal loads, in vitro. In unpaired t-test comparisons, the mid cervical region was significantly stiffer in compression and extension than the lower region. In tests to failure, failure in six out of seven mid cervical specimens resulted from flexion alone, while combined compression-flexion was required to fail five of the eight lower cervical specimens. Post-test dissections revealed no regional differences in the pattern of failure. In addition to sagittal tests, the load-displacement responses of three-vertebrae cervical specimens were measured with the upper body axially rotated with respect to the lower body. The effect of this pre-torsion was to diminish the zone of low slope near zero load for axial, shear, and flexion motion. Three of the four axially rotated specimens failed in flexion without added compression. These controlled load-displacement measurements of cervical spine specimens describe for the first time the continuous flexion-compression response up to failure, and suggest that consideration of the biomechanics of three apparently distinct mobile regions of the cervical spine (C1-C2, C2-C5, C5-T1) may facilitate the interpretation of hazardous conditions and the diagnosis of injury. These data also provide basic information for the in vitro investigation of passive cervical spine protection such as helmets and head-rests, suggesting that the head should be kept in a non-rotated position to reduce risk of injury.