Effect of loading rate and hydration on the mechanical properties of the disc

Effect of Hydration on Healthy Intervertebral Disk Mechanical Stiffness

The intervertebral disk has an excellent swelling capacity to absorb water, which is thought to be largely due to the high proteoglycan composition. Injury, aging, degeneration, and diurnal loading are all noted by a significant decrease in water content and tissue hydration. The objective of this study was to evaluate the effect of hydration, through osmotic loading, on tissue swelling and compressive stiffness of healthy intervertebral disks. The wet weight of nucleus pulposus (NP) and annulus fibrosus (AF) explants following swelling was 50% or greater, demonstrating significant ability to absorb water under all osmotic loading conditions (0.015 M-3.0 M phosphate buffered saline (PBS)). Estimated NP residual strains, calculated from the swelling ratio, were approximately 1.5 × greater than AF residual strains. Compressive stiffness increased with hyperosmotic loading, which is thought to be due to material compaction from osmotic-loading and the nonlinear mechanical behavior. Importantly, this study demonstrated that residual strains and material properties are greatly dependent on osmotic loading. The findings of this study support the notion that swelling properties from osmotic loading will be important for accurately describing the effect of degeneration and injury on disk mechanics. Furthermore, the tissue swelling will be an important consideration for developing biological repair strategies aimed at restoring mechanical behavior toward a healthy disk.

Preload substantially influences the intervertebral disc stiffness in loading-unloading cycles of compression

Disc hydration is controlled by fluid imbibition and exudation and hence by applied load magnitude and history, internal osmotic pressure and disc conditions. It affects both the internal load distribution and external load-bearing of a disc while variations therein give rise to the disc time-dependent characteristics. This study aimed to evaluate the effect of changes in compression preload magnitude on the disc axial cyclic compression stiffness under physiological loading. After 20h of free hydration, effects of various preload magnitudes (no preload, 0.06 and 0.28MPa, applied for eight hours) and disc-bone preparation conditions on disc height and axial stiffness were investigated using 36 disc-bone and 24 isolated disc (without bony endplates) bovine specimens. After preloading, specimens were subjected to ten loading/unloading cycles each of 7.5min compression at 0.5MPa followed by 7.5min at 0.06MPa. Under 0.06MPa preload, the specimen height losses during high loading periods of cyclic loading were greater than corresponding height recoveries during low loading phases. This resulted in a progressive reduction in the specimen height and increase in its stiffness. Differences between disc height losses in high cyclic loads and between stiffness in both load increase and release phases were significant for 0 and 0.06MPa vs. 0.28MPa preload. Results highlight the significant role of disc preload magnitude/history and hence disc height and hydration on disc stiffness in loading/unloading and disc height loss in loading periods. Proper preconditioning and hence hydration level should be achieved if recovery in height loss similar to in vivo conditions is expected.

Fundamental biomechanics of the spine--What we have learned in the past 25 years and future directions

Since the publication of the 2nd edition of White and Panjabi׳s textbook, Clinical Biomechanics of the Spine in 1990, there has been considerable research on the biomechanics of the spine. The focus of this manuscript will be to review what we have learned in regards to the fundamentals of spine biomechanics. Topics addressed include the whole spine, the functional spinal unit, and the individual components of the spine (e.g. vertebra, intervertebral disc, spinal ligaments). In these broad categories, our understanding in 1990 is reviewed and the important knowledge or understanding gained through the subsequent 25 years of research is highlighted. Areas where our knowledge is lacking helps to identify promising topics for future research. In this manuscript, as in the White and Panjabi textbook, the emphasis is on experimental research using human material, either in vivo or in vitro. The insights gained from mathematical models and animal experimentation are included where other data are not available. This review is intended to celebrate the substantial gains that have been made in the field over these past 25 years and also to identify future research directions.

Intervertebral disc internal deformation measured by displacements under applied loading with MRI at 3T

PURPOSE

Noninvasive assessment of tissue mechanical behavior could enable insights into tissue function in healthy and diseased conditions and permit the development of effective tissue repair treatments. Measurement of displacements under applied loading with MRI (dualMRI) has the potential for such biomechanical characterization on a clinical MRI system.

METHODS

dualMRI was translated from high-field research systems to a 3T clinical system. Precision was calculated using repeated tests of a silicone phantom. dualMRI was demonstrated by visualizing displacements and strains in an intervertebral disc and compared to T2 measured during cyclic loading.

RESULTS

The displacement and strain precisions were 24 µm and 0.3% strain, respectively, under the imaging parameters used in this study. Displacements and strains were measured within the intervertebral disc, but no correlations were found with the T2 values.

CONCLUSION

The translation of dualMRI to a 3T system unveils the potential for in vivo studies in a myriad of tissue and organ systems. Because of the importance of mechanical behavior to the function of a variety of tissues, it's expected that dualMRI implemented on a clinical system will be a powerful tool in assessing the interlinked roles of structure, mechanics, and function in both healthy and diseased tissues.

ISSLS Prize Winner: Dynamic Loading-Induced Convective Transport Enhances Intervertebral Disc Nutrition

STUDY DESIGN

Experimental animal study of convective transport in the intervertebral disc.

OBJECTIVE

To quantify the effects of mechanical loading rate on net transport into the healthy and degenerative intervertebral disc in vivo.

SUMMARY OF BACKGROUND DATA

Intervertebral disc degeneration is linked with a reduction in transport to the avascular disc. Enhancing disc nutrition is, therefore, a potential strategy to slow or reverse the degenerative cascade. Convection induced by mechanical loading is a potential mechanism to augment diffusion of small molecules into the disc.

METHODS

Skeletally mature New Zealand white rabbits with healthy discs and discs degenerated via needle puncture were subjected to low rate axial compression and distraction loading for 2.5, 5, 10, 15, or 20 minutes after a bolus administration of gadodiamide. Additional animals with healthy discs were subjected to high-rate loading for 10 minutes or no loading for 10 minutes. Transport into the disc for each loading regimen was quantified using post-contrast-enhanced magnetic resonance imaging.

RESULTS

Low-rate loading resulted in the rapid uptake and clearance of gadodiamide in the disc. Low-rate loading increased net transport into the nucleus by a mean 16.8% and 12.6% in healthy and degenerative discs, respectively. The kinetics of small molecule uptake and clearance were accelerated in both healthy and degenerative discs with low-rate loading. In contrast, high-rate loading reduced transport into nucleus by a mean 16.8%.

CONCLUSION

These results illustrate that trans-endplate diffusion can be enhanced by forced convection in both healthy and degenerative discs in vivo. Mechanical loading-induced convection could offer therapeutic benefit for degenerated discs by enhancing uptake of nutrients and clearance of by-products.

LEVEL OF EVIDENCE

4.

The region-dependent biomechanical and biochemical properties of bovine cartilaginous endplate

Regional biomechanical and biochemical properties of bovine cartilaginous endplate (CEP) and its role in disc mechanics and nutrition were determined. The equilibrium aggregate modulus and hydraulic permeability between the central and lateral regions were examined by confined compression testing. Biochemical assays were conducted to quantify the amount of water, collagen, and glycosaminoglycan (GAG). The equilibrium aggregate modulus of the CEP in the central region (0.23 ± 0.15 MPa) was significantly lower than for the lateral region (0.83 ± 0. 26 MPa). No significant regional difference was found for the permeability of the CEP (central region: 0.13 ± 0.07×10(-15)m(4)/Ns and lateral region: 0.09 ± 0.03 × 10(-15)m(4)/Ns). CEPs were an average of 75.6% water by wet weight, 41.1% collagen, and 20.4% GAG by dry weight in the central region, as well as an average of 70.2% water by wet weight, 73.8% collagen, and 11.7% GAG by dry weight in the lateral region. Regional differences observed for the equilibrium aggregate modulus were likely due to the regional variation in biochemical composition. The lateral bovine endplate is much stiffer and may share a greater portion of the load. Compared with the nucleus pulposus (NP) and annulus fibrosus (AF), a smaller hydraulic permeability was found for the CEP in both the central and lateral regions, which could be due to its lower water content and higher collagen content. Our results suggest that the CEP may block rapid fluid exchange and solute convection, allow pressurization of the interstitial fluid, and play a significant role in nutrient supply in response to loading.

"Surprise" Loading in Flexion Increases the Risk of Disc Herniation Due to Annulus-Endplate Junction Failure: A Mechanical and Microstructural Investigation

STUDY DESIGN

Microstructural investigation of compression-induced herniation of the flexed lumbar disc.

OBJECTIVE

To provide a microstructural analysis of the mechanisms of annular wall failure in healthy discs subjected to flexion and a rate of compression comparable with the maximum rate at which the muscles of the spinal column can generate a force.

SUMMARY OF BACKGROUND DATA

Clinical evidence indicates the involvement of the endplate in herniation. It is known that both an elevated rate of compression and a flexed posture are necessary to cause disc failure either within the midspan of the annulus or at the annular-endplate interface. However, the question of what effect a sudden or "surprise" loading might have on the mode of failure is, as yet, unanswered.

METHODS

Twenty-four healthy mature ovine lumbar motion segments were compressed to failure in high physiological flexion (10º). This occurred over approximately 5 mm of crosshead displacement in 0.75 seconds that resulted in a displacement rate of 400 mm/min (defined as a "surprise" rate) and was intended to simulate the maximum rate at which the muscles of the spinal column can generate a force. The damaged discs were then analyzed microstructurally.

RESULTS

Fifty-eight percent of discs suffered annular-endplate junction rupture, 25% suffered midspan annular rupture, and the balance of 17% endplate fracture. Microstructural analysis indicated that annular rupture initiated at the endplate apical ridge in the mid-to-outer region of the annulus in both annular-endplate and midspan annulus rupture.

CONCLUSION

Motion segments subjected to a "surprise" loading rate are likely to fail via some form of annular rupture. Failure under such sudden loading occurs mostly via rupture of the annular-endplate junction and is thought to arise from a rate-induced mechanostructural imbalance between the annulus and the endplate.

LEVEL OF EVIDENCE

N/A.

Low rate loading-induced convection enhances net transport into the intervertebral disc in vivo

BACKGROUND CONTEXT

The intervertebral disc primarily relies on trans-endplate diffusion for the uptake of nutrients and the clearance of byproducts. In degenerative discs, diffusion is often diminished by endplate sclerosis and reduced proteoglycan content. Mechanical loading-induced convection has the potential to augment diffusion and enhance net transport into the disc. The ability of convection to augment disc transport is controversial and has not been demonstrated in vivo.

PURPOSE

To determine if loading-induced convection can enhance small molecule transport into the intervertebral disc in vivo.

STUDY DESIGN

Net transport was quantified via postcontrast enhanced magnetic resonance imaging (MRI) into the discs of the New Zealand white rabbit lumbar spine subjected to in vivo cyclic low rate loading.

METHODS

Animals were administered the MRI contrast agent gadodiamide intravenously and subjected to in vivo low rate loading (0.5 Hz, 200 N) via a custom external loading apparatus for either 2.5, 5, 10, 15, or 20 minutes. Animals were then euthanized and the lumbar spines imaged using postcontrast enhanced MRI. The T1 constants in the nucleus, annulus, and cartilage endplates were quantified as a measure of gadodiamide transport into the loaded discs compared with the adjacent unloaded discs. Microcomputed tomography was used to quantify subchondral bone density.

RESULTS

Low rate loading caused the rapid uptake and clearance of gadodiamide in the nucleus compared with unloaded discs, which exhibited a slower rate of uptake. Relative to unloaded discs, low rate loading caused a maximum increase in transport into the nucleus of 16.8% after 5 minutes of loading. Low rate loading increased the concentration of gadodiamide in the cartilage endplates at each time point compared with unloaded levels.

CONCLUSIONS

Results from this study indicate that forced convection accelerated small molecule uptake and clearance in the disc induced by low rate mechanical loading. Low rate loading may, therefore, be therapeutic to the disc as it may enhance the nutrient uptake and waste product clearance.

Glucosamine loaded injectable silk-in-silk integrated system modulate mechanical properties in bovine ex-vivo degenerated intervertebral disc model

Injectable hydrogels offer a tremendous potential for treatment of degenerated intervertebral disc due to their ability to withstand complex loading, conforming precisely to the defect spaces and eliminating the need for invasive surgical procedures. We have developed an injectable hydrogel platform of N-acetyl-glucosamine (GlcNAc) loaded silk hollow spheres embedded in silk hydrogel for in situ therapeutic release and enhanced mechanical strength. The assembled silk hydrogel provided adequate structural support to the ex vivo degenerated disc model in a cyclic compression test at par with the native tissue. Spatiotemporal release of GlcNAc in a controlled manner from the silk hollow microspheres trigger enhanced proteoglycan production from ADSCs embedded in the composite system. Role of MAPK and SMAD pathways in increasing proteoglycan production have been explored by immunohistological analysis as a result of the action of GlcNAc on the cells, elucidating the potential of injectable silk microsphere-in-silk hydrogel for the regeneration of degenerated disc tissue.

Effect of potting technique on the measurement of six degree-of-freedom viscoelastic properties of human lumbar spine segments

Polymethyl methacrylate (PMMA) and Wood's Metal are fixation media for biomechanical testing; however, the effect of each potting medium on the measured six degree-of-freedom (DOF) mechanical properties of human lumbar intervertebral discs is unknown. The first aim of this study was to compare the measured 6DOF elastic and viscoelastic properties of the disc when embedded in PMMA compared to repotting in Wood's Metal. The second aim was to compare the surface temperature of the disc when potted with PMMA and Wood's Metal. Six human lumbar functional spinal units (FSUs) were first potted in PMMA, and subjected to overnight preload in a saline bath at 37 °C followed by five haversine loading cycles at 0.1 Hz in each of 6DOF loading directions (compression, left/right lateral bending, flexion, extension, left/right axial rotation, anterior/posterior, and lateral shear). Each specimen was then repotted in Wood's Metal and subjected to a 2-h re-equilibrating preload followed by repeating the same 6DOF tests. Outcome measures of stiffness and phase angle were calculated from the final loading cycle in each DOF and were expressed as normalized percentages relative to PMMA (100%). Disc surface temperatures (anterior, left/right lateral) were measured during potting. Paired t-tests (with alpha adjusted for multiple DOF) were conducted to compare the differences in each outcome parameter between PMMA and Wood's Metal. No significant differences in stiffness or phase angle were found between PMMA and Wood's Metal. On average, the largest trending differences were found in the shear DOFs for both stiffness (approximately 35% greater for Wood's Metal compared to PMMA) and phase angle (approximately 15% greater for Wood's Metal). A significant difference in disc temperature was found at the anterior surface after potting with Wood's Metal compared to PMMA, which did not exceed 26 °C. Wood's Metal is linear elastic, stiffer than PMMA and may reduce measurement artifact of potting medium, particularly in the shear directions. Furthermore, it is easier to remove than PMMA, reuseable, and cost effective.

Finite element based nonlinear normalization of human lumbar intervertebral disc stiffness to account for its morphology

Disc degeneration, usually associated with low back pain and changes of intervertebral stiffness, represents a major health issue. As the intervertebral disc (IVD) morphology influences its stiffness, the link between mechanical properties and degenerative grade is partially lost without an efficient normalization of the stiffness with respect to the morphology. Moreover, although the behavior of soft tissues is highly nonlinear, only linear normalization protocols have been defined so far for the disc stiffness. Thus, the aim of this work is to propose a nonlinear normalization based on finite elements (FE) simulations and evaluate its impact on the stiffness of human anatomical specimens of lumbar IVD. First, a parameter study involving simulations of biomechanical tests (compression, flexion/extension, bilateral torsion and bending) on 20 FE models of IVDs with various dimensions was carried out to evaluate the effect of the disc's geometry on its compliance and establish stiffness/morphology relations necessary to the nonlinear normalization. The computed stiffness was then normalized by height (H), cross-sectional area (CSA), polar moment of inertia (J) or moments of inertia (Ixx, Iyy) to quantify the effect of both linear and nonlinear normalizations. In the second part of the study, T1-weighted MRI images were acquired to determine H, CSA, J, Ixx and Iyy of 14 human lumbar IVDs. Based on the measured morphology and pre-established relation with stiffness, linear and nonlinear normalization routines were then applied to the compliance of the specimens for each quasi-static biomechanical test. The variability of the stiffness prior to and after normalization was assessed via coefficient of variation (CV). The FE study confirmed that larger and thinner IVDs were stiffer while the normalization strongly attenuated the effect of the disc geometry on its stiffness. Yet, notwithstanding the results of the FE study, the experimental stiffness showed consistently higher CV after normalization. Assuming that geometry and material properties affect the mechanical response, they can also compensate for one another. Therefore, the larger CV after normalization can be interpreted as a strong variability of the material properties, previously hidden by the geometry's own influence. In conclusion, a new normalization protocol for the intervertebral disc stiffness in compression, flexion, extension, bilateral torsion and bending was proposed, with the possible use of MRI and FE to acquire the discs' anatomy and determine the nonlinear relations between stiffness and morphology. Such protocol may be useful to relate the disc's mechanical properties to its degree of degeneration.

The effect of creep on human lumbar intervertebral disk impact mechanics

The intervertebral disk (IVD) is a highly hydrated tissue, with interstitial fluid making up 80% of the wet weight of the nucleus pulposus (NP), and 70% of the annulus fibrosus (AF). It has often been modeled as a biphasic material, consisting of both a solid and fluid phase. The inherent porosity and osmotic potential of the disk causes an efflux of fluid while under constant load, which leads to a continuous displacement phenomenon known as creep. IVD compressive stiffness increases and NP pressure decreases as a result of creep displacement. Though the effects of creep on disk mechanics have been studied extensively, it has been limited to nonimpact loading conditions. The goal of this study is to better understand the influence of creep and fluid loss on IVD impact mechanics. Twenty-four human lumbar disk samples were divided into six groups according to the length of time they underwent creep (tcreep = 0, 3, 6, 9, 12, 15 h) under a constant compressive load of 400 N. At the end of tcreep, each disk was subjected to a sequence of impact loads of varying durations (timp = 80, 160, 320, 400, 600, 800, 1000 ms). Energy dissipation (ΔE), stiffness in the toe (ktoe) and linear (klin) regions, and neutral zone (NZ) were measured. Analyzing correlations with tcreep, there was a positive correlation with ΔE and NZ, along with a negative correlation with ktoe. There was no strong correlation between tcreep and klin. The data suggest that the IVD mechanical response to impact loading conditions is altered by fluid content and may result in a disk that exhibits less clinical stability and transfers more load to the AF. This could have implications for risk of diskogenic pain as a function of time of day or tissue hydration.

Biomechanical investigation of thoracolumbar spine in different postures during ejection using a combined finite element and multi-body approach

The aim of this study is to investigate the dynamic response of a multi-segment model of the thoracolumbar spine and determine how the sitting posture affects the response under the impact of ejection. A nonlinear finite element model of the thoracolumbar-pelvis complex (T9-S1) was developed and validated. A multi-body dynamic model of a pilot was also constructed so an ejection seat restraint system could be incorporated into the finite element model. The distribution of trunk mass on each vertebra was also considered in the model. Dynamics analysis showed that ejection impact induced obvious axial compression and anterior flexion of the spine, which may contribute to spinal injuries. Compared with a normal posture, the relaxed posture led to an increase in stress on the cortical wall, endplate, and intradiscal pressure of 43%, 10%, 13%, respectively, and accordingly increased the risk of inducing spinal injuries.

Adaptive velocity-based six degree of freedom load control for real-time unconstrained biomechanical testing

Robotic biomechanics is a powerful tool for further developing our understanding of biological joints, tissues and their repair. Both velocity-based and hybrid force control methods have been applied to biomechanics but the complex and non-linear properties of joints have limited these to slow or stepwise loading, which may not capture the real-time behaviour of joints. This paper presents a novel force control scheme combining stiffness and velocity based methods aimed at achieving six degree of freedom unconstrained force control at physiological loading rates.

Intervertebral disc characterization by shear wave elastography: An in vitro preliminary study

Patient-specific numerical simulation of the spine is a useful tool both in clinic and research. While geometrical personalization of the spine is no more an issue, thanks to recent technological advances, non-invasive personalization of soft tissue’s mechanical properties remains a challenge. Ultrasound elastography is a relatively recent measurement technique allowing the evaluation of soft tissue’s elastic modulus through the measurement of shear wave speed. The aim of this study was to determine the feasibility of elastographic measurements in intervertebral disc. An in vitro approach was chosen to test the hypothesis that shear wave speed can be used to evaluate intervertebral disc mechanical properties and to assess measurement repeatability. In total, 11 oxtail intervertebral discs were tested in compression to determine their stiffness and apparent elastic modulus at rest and at 400 N. Elastographic measurements were performed in these two conditions and compared to these mechanical parameters. The protocol was repeated six times to determine elastographic measurement repeatability. Average shear wave speed over all samples was 5.3 ± 1.0 m/s, with a repeatability of 7% at rest and 4.6% at 400 N; stiffness and apparent elastic modulus were 266.3 ± 70.5 N/mm and 5.4 ± 1.1 MPa at rest, respectively, while at 400 N they were 781.0 ± 153.8 N/mm and 13.2 ± 2.4 MPa, respectively. Correlations were found between elastographic measurements and intervertebral disc mechanical properties; these preliminary results are promising for further in vivo application.

How healthy discs herniate: a biomechanical and microstructural study investigating the combined effects of compression rate and flexion

STUDY DESIGN

Microstructural investigation of compression-induced disruption of the flexed lumbar disc.

OBJECTIVE

To provide a microstructural analysis of the mechanisms of annular wall failure in healthy discs subjected to flexion and an elevated rate of compression.

SUMMARY OF BACKGROUND DATA

At the level of the motion segment failure of the disc in compression has been extensively studied. However, at the microstructural level the exact mechanisms of disc failure are still poorly understood, especially in relation to loading posture and rate.

METHODS

Seventy-two healthy mature ovine lumbar motion segments were compressed to failure in either a neutral posture or in high physiological flexion (10°) at a displacement rate of either 2 mm/min (low) or 40 mm/min (high). Testing at the high rate was terminated at stages ranging from initial wall tearing through to facet fracture so as to capture the evolution of failure up to full herniation. The damaged discs were then analyzed microstructurally.

RESULTS

Approximately, 50% of the motion segments compressed in flexion at the high rate experienced annulus or annulus-endplate junction failure, the remainder failed via endplate fracture with no detectable wall damage. The average load to induce disc failure in flexion was 18% lower (P < 0.05) than that required to induce endplate fracture. Microstructural analysis indicated that wall rupture occurred first in the posterior mid-then-outer annulus.

CONCLUSION

Disc wall failure in healthy motion segments requires both flexion and an elevated rate of compression. Damage is initiated in the mid-then-outer annular fibers, this a likely consequence of the higher strain burden in these same fibers arising from endplate curvature. Given the similarity in geometry between ovine and human endplates, it is proposed that comparable mechanisms of damage initiation and herniation occur in human lumbar discs.

LEVEL OF EVIDENCE

N/A.

Compressive and tensile mechanical properties of the porcine nasal septum

The expanding nasal septal cartilage is believed to create a force that powers midfacial growth. In addition, the nasal septum is postulated to act as a mechanical strut that prevents the structural collapse of the face under masticatory loads. Both roles imply that the septum is subject to complex biomechanical loads during growth and mastication. The purpose of this study was to measure the mechanical properties of the nasal septum to determine (1) whether the cartilage is mechanically capable of playing an active role in midfacial growth and in maintaining facial structural integrity and (2) if regional variation in mechanical properties is present that could support any of the postulated loading regimens. Porcine septal samples were loaded along the horizontal or vertical axes in compression and tension, using different loading rates that approximate the in vivo situation. Samples were loaded in random order to predefined strain points (2-10%) and strain was held for 30 or 120 seconds while relaxation stress was measured. Subsequently, samples were loaded until failure. Stiffness, relaxation stress and ultimate stress and strain were recorded. Results showed that the septum was stiffer, stronger and displayed a greater drop in relaxation stress in compression compared to tension. Under compression, the septum displayed non-linear behavior with greater stiffness and stress relaxation under faster loading rates and higher strain levels. Under tension, stiffness was not affected by strain level. Although regional variation was present, it did not strongly support any of the suggested loading patterns. Overall, results suggest that the septum might be mechanically capable of playing an active role in midfacial growth as evidenced by increased compressive residual stress with decreased loading rates. However, the low stiffness of the septum compared to surrounding bone does not support a strut role. The relatively low stiffness combined with high stress relaxation under fast loading rates suggests that the nasal septum is a stress dampener, helping to absorb and dissipate loads generated during mastication.

The within-session change in low back pain intensity following spinal manipulative therapy is related to differences in diffusion of water in the intervertebral discs of the upper lumbar spine and L5-S1

STUDY DESIGN

Single-group, prospective, repeated-measures design with responder analysis.

OBJECTIVE

To determine differences in the changes in diffusion of water within the lumbar intervertebral discs between participants with low back pain who reported a within-session reduction in pain intensity following a single treatment of spinal manipulative therapy and those who did not.

BACKGROUND

There is a paucity of research that describes the physiologic events associated with analgesia following intervention for low back pain. Postintervention increases in the diffusion of water within various soft tissues of the spine may be one of many potential mechanisms linked to pain reduction.

METHODS

Nineteen adults between 20 and 45 years of age participated in this study. All participants reported low back pain of at least 2 on an 11-point (0-10) verbally administered numeric pain rating scale at the time of enrollment. Participants underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans immediately before and after receiving a single treatment of spinal manipulative therapy. Individuals who reported a decrease in current pain intensity of more than 2 following treatment were classified as "within-session responders," and the remainder were classified as "not-within-session responders." The apparent diffusion coefficient (ADC), representing the diffusion of water in the nucleus pulposus, was calculated from ADC maps derived from the midsagittal diffusion-weighted images.

RESULTS

Two-way, repeated-measures analyses of variance indicated significant group-by-time interactions. Participants in the within-session-responder group (n = 12) had a postintervention increase in ADC at L1-2 (P = .001), L2-3 (P = .002), and L5-S1 (P = .01) compared to those in the not-within-session-responder group (n = 7). Large effect sizes in ADC between responder groups were observed at L1-2 (d = 1.74), L2-3 (d = 1.83), and L5-S1 (d = 1.49). No significant group-by-time interactions were observed at the L3-4 and L4-5 levels.

CONCLUSION

Changes in the diffusion of water within the lumbar intervertebral discs at the L1-2, L2-3, and L5-S1 levels appear to be related to differences in within-session pain reports following a single treatment of spinal manipulative therapy.

An ultrasound study of altered hydration behaviour of proteoglycan-degraded articular cartilage

BACKGROUND

Articular cartilage is a solid-fluid biphasic material covering the bony ends of articulating joints. Hydration of articular cartilage is important to joint lubrication and weight-wearing. The aims of this study are to measure the altered hydration behaviour of the proteoglycan-degraded articular cartilage using high-frequency ultrasound and then to investigate the effect of proteoglycan (PG) degradation on cartilage hydration.

METHODS

Twelve porcine patellae with smooth cartilage surface were prepared and evenly divided into two groups: normal group without any enzyme treatment and trypsin group treated with 0.25% trypsin solution for 4 h to digest PG in the tissue. After 40-minute exposure to air at room temperature, the specimens were immerged into the physiological saline solution. The dehydration induced hydration behaviour of the specimen was monitored by the high-frequency (25 MHz) ultrasound pulser/receiver (P/R) system. Dynamic strain and equilibrium strain were extracted to quantitatively evaluate the hydration behaviour of the dehydrated cartilage tissues.

RESULTS

The hydration progress of the dehydrated cartilage tissue was observed in M-mode ultrasound image indicating that the hydration behaviour of the PG-degraded specimens decreased. The percentage value of the equilibrium strain (1.84 ± 0.21%) of the PG-degraded cartilage significantly (p < 0.01) decreased in comparison with healthy cartilage (3.46 ± 0.49%). The histological sections demonstrated that almost PG content in the entire cartilage layer was digested by trypsin.

CONCLUSION

Using high-frequency ultrasound, this study found a reduction in the hydration behaviour of the PG-degraded cartilage. The results indicated that the degradation of PG decreased the hydration capability of the dehydrated tissue. This study may provide useful information for further study on changes in the biomechanical property of articular cartilage in osteoarthritis.

Compressive properties of fibrous repair tissue compared to nucleus and annulus

The wound healing process includes filling the void between implant and tissue edges by collagenous connective repair tissue. This fibrous repair tissue may load share or stabilize implants such as spinal disc replacements. The objective of this study was the biomechanical characterization of human fibrous tissue compared to annulus fibrosus and nucleus pulposus. Human lumbar discs (10 nucleus and annulus) and 10 lumbar deep wound fibrous tissue specimens were sectioned into 12mm diameter×6mm high cylindrical samples. Confined compression testing, after 2h swelling at 0.11MPa, was performed at 5%, 10% and 15% strain over 3.5h. Unconfined dynamic testing (2-0.001Hz) was performed at 5-15% strain. Semi-quantitative histology estimated the proportion of proteoglycan to collagen. Fibrous tissue exhibited a decrease in height during the swelling period whereas annulus and nucleus tissues did not. The aggregate modulus was significantly less for fibrous tissue (p<0.002). Percent stress relaxation was greatest for the fibrous tissue and similar for annulus and nucleus. Dynamic testing found the storage modulus (E') was greater than the loss modulus (E″) for all tissues. Annulus were found to have greater E' and E″ than nucleus, whereas E' and E″ were similar between annulus and fibrous tissue. Fibrous tissue had the greatest increase in both moduli at greater frequencies, but had the lowest hydration and proteoglycan content. Fibrous tissue would not be a substitute for native tissue within the disc space but if adjacent to a disc prosthesis may impart some degree of intersegmental stability during acute loading activities.

Analysis of quantitative magnetic resonance imaging and biomechanical parameters on human discs with different grades of degeneration

PURPOSE

To establish relationships between quantitative MRI (qMRI) and biomechanical parameters in order to help inform and interpret alterations of human intervertebral discs (IVD) with different grades of degeneration.

MATERIALS AND METHODS

The properties of the nucleus pulposus (NP) and annulus fibrosus (AF) of each IVD of 10 lumbar spines (range, 32-77 years) were analyzed by qMRI (relaxation times T1 and T2, magnetization transfer ratio [MTR], and apparent diffusion coefficient [ADC]), and tested in confined compression and dynamic shear.

RESULTS

T1 and T2 significantly decreased in both the NP and AF with increasing degeneration grades while the MTR increased significantly with grade 4. In contrast to the other qMRI parameters, the ADC had a tendency to decrease with increasing grade. Disc degeneration caused a decrease in the aggregate modulus, hydraulic permeability and shear modulus magnitude along with an increase in phase angle in the AF. In contrast, disc degeneration of NPs demonstrated decreases in shear modulus and phase angle.

CONCLUSION

Our studies indicate that qMRI can be used as a noninvasive diagnostic tool in the detection of IVD properties with the potential to help interpret and detect early, middle, and late stages of degeneration. QMRI of human IVD can therefore become a very important diagnostic assessment tool in determining the functional state of the disc.

Biomechanical behavior of a biomimetic artificial intervertebral disc

STUDY DESIGN

The biomechanical behavior of a biomimetic artificial intervertebral disc (AID) was characterized in vitro in axial compression and compared with natural disc behavior.

OBJECTIVE

To evaluate the strength and durability of a novel biomimetic AID and to demonstrate whether its axial deformation behavior is similar to that of a natural disc.

SUMMARY OF BACKGROUND DATA

Current clinically used AIDs have reasonable success rates. However, because of their nonphysiological design, spinal mechanics are altered. To avoid long-term complications, a novel biomimetic AID, with a nucleus-annulus structure and osmotic swelling properties has been developed.

METHODS

Eighteen AIDs in total were tested in axial compression. Six were loaded monotonically to determine strength. Six were tested in fatigue (600-6000 N). Another 6 were used to characterize the axial creep and dynamic behavior (0.01-10 Hz). Creep and dynamic response were also determined for 4 AIDs after fatigue loading.

RESULTS

The AIDs remained intact up to 15 kN and 10 million cycles. The creep and dynamic behavior were similar to the natural disc behavior, except for hysteresis, which was 20% to 30% higher. After fatigue, creep decreased from 4% to 1%, stiffness increased 2-fold, and hysteresis was reduced to that for a normal disc.

CONCLUSION

A strong and durable AID design was introduced. Compared with current clinical articulating AIDs, this biomimetic AID introduces the natural disc annulus-nucleus structure, resulting in axial behavior closer to that of the natural disc.

Calibration of hyperelastic material properties of the human lumbar intervertebral disc under fast dynamic compressive loads

Under fast dynamic loading conditions (e.g. high-energy impact), the load rate dependency of the intervertebral disc (IVD) material properties may play a crucial role in the biomechanics of spinal trauma. However, most finite element models (FEM) of dynamic spinal trauma uses material properties derived from quasi-static experiments, thus neglecting this load rate dependency. The aim of this study was to identify hyperelastic material properties that ensure a more biofidelic simulation of the IVD under a fast dynamic compressive load. A hyperelastic material law based on a first-order Mooney-Rivlin formulation was implemented in a detailed FEM of a L2-L3 functional spinal unit (FSU) to represent the mechanical behavior of the IVD. Bony structures were modeled using an elasto-plastic Johnson-Cook material law that simulates bone fracture while ligaments were governed by a viscoelastic material law. To mimic experimental studies performed in fast dynamic compression, a compressive loading velocity of 1 m/s was applied to the superior half of L2, while the inferior half of L3 was fixed. An exploratory technique was used to simulate dynamic compression of the FSU using 34 sets of hyperelastic material constants randomly selected using an optimal Latin hypercube algorithm and a set of material constants derived from quasi-static experiments. Selection or rejection of the sets of material constants was based on compressive stiffness and failure parameters criteria measured experimentally. The two simulations performed with calibrated hyperelastic constants resulted in nonlinear load-displacement curves with compressive stiffness (7335 and 7079 N/mm), load (12,488 and 12,473 N), displacement (1.95 and 2.09 mm) and energy at failure (13.5 and 14.7 J) in agreement with experimental results (6551 ± 2017 N/mm, 12,411 ± 829 N, 2.1 ± 0.2 mm and 13.0 ± 1.5 J respectively). The fracture pattern and location also agreed with experimental results. The simulation performed with constants derived from quasi-static experiments showed a failure energy (13.2 J) and a fracture pattern and location in agreement with experimental results, but a compressive stiffness (1580 N/mm), a failure load (5976 N) and a displacement to failure (4.8 mm) outside the experimental corridors. The proposed method offers an innovative way to calibrate the hyperelastic material properties of the IVD and to offer a more realistic simulation of the FSU in fast dynamic compression.

Preclinical and clinical experience with a viscoelastic total disc replacement

BACKGROUND

The purpose of this study is to describe the mechanical durability and the clinical and radiographic outcomes of a viscoelastic total disc replacement (VTDR). The human intervertebral disc is a complex, viscoelastic structure, permitting and constraining motion in 3 axes, thus providing stability. The ideal disc replacement should be viscoelastic and deformable in all directions, and it should restore disc height and angle.

METHODS

Mechanical testing was conducted to validate the durability of the VTDR, and a clinical study was conducted to evaluate safety and performance. Fifty patients with single-level, symptomatic lumbar degenerative disc disease at L4-5 or L5-S1 were enrolled in a clinical trial at 3 European sites. Patients were assessed clinically and radiographically for 2 years by the Oswestry Disability Index (ODI), a visual analog scale (VAS), and independent radiographic analyses.

RESULTS

The VTDR showed a fatigue life in excess of 50 million cycles (50-year equivalent) and a physiologically appropriate level of stiffness, motion, geometry, and viscoelasticity. We enrolled 28 men and 22 women in the clinical study, with a mean age of 40 years. Independent quantitative radiographic assessment indicated that the VTDR restored and maintained disc height and lordosis while providing physiologic motion. Mean ODI scores decreased from 48% preoperatively to 23% at 2 years' follow-up. Mean VAS low-back pain scores decreased from 7.1 cm to 2.9 cm. Median scores indicated that half of the patient population had ODI scores below 10% and VAS low-back pain scores below 0.95 cm at 2 years.

CONCLUSIONS

The VTDR has excellent durability and performs clinically and radiographically as intended for the treatment of symptomatic lumbar degenerative disc disease.

CLINICAL RELEVANCE

The VTDR is intended to restore healthy anatomic properties and stability characteristics to the spinal segment. This study is the first to evaluate a VTDR in a 50-patient, multicenter European study.

EFFECT OF MUSCLES ACTIVATION ON HEAD-NECK COMPLEX UNDER SIMULATED EJECTION

A detailed three-dimensional head-neck (C0–C7) finite element (FE) model developed based on the actual geometry of an embalmed human cadaver specimen was exercised to dictate the motions of the cervical spine under dynamic loadings. The predicted results analyzed under vertex drop impact were compared against experimental study to validate the FE model. The validated C0–C7 FE model was then further analyzed to investigate the response of the whole head-neck complex under 10G-ejection condition. From the simulation of ejection process, obvious hyper-flexion of the head-neck complex could be found. The peak flexion angles of all the lower motion segments were beyond physiological tolerance indicating a potential injury in these regions. Furthermore, the stress values in the spine were also related to the magnitudes of rotation of the motion segments. During the acceleration onset stage, the maximum stresses in the bone components were low. After that, the stress values increased sharply into the dangerous range with increased rotational angles. The effect of muscles in alleviating the potential damage in the neck is significant. It was implied that it is important for pilots to stiffen the neck before ejection to avoid severe cervical injury.

Diffusion-weighted magnetic resonance imaging of the musculoskeletal system: an emerging technology with potential to impact clinical decision making

Diffusion-weighted imaging (DWI) is an application of magnetic resonance imaging that allows the measurement of water movement within and between tissues. Originally developed as a way of detecting early signs of stroke or brain disease, DWI is now being used to study physiologic events within the musculoskeletal system. The accurate measurement of water diffusion can provide important information regarding tissue responses associated with trauma and disease, as well as offer insight toward the mechanism by which physical therapy interventions affect tissues. The purpose of this paper is to discuss the rationale for DWI and its potential clinical and research applications for patients with musculoskeletal disorders. Specific examples of the use of DWI for patients with painful spinal disorders are used as illustrations.

Effect of spinal level and loading conditions on the production of vertebral burst fractures in a porcine model

Vertebral burst fractures are commonly studied with experimental animal models. There is however a lack of consensus as to what parameters are important to create an unstable burst fracture with a significant canal encroachment on such model. This study aims to assess the effect of the loading rate, flexion angle, spinal level, and their interactions on the production of a vertebral thoracolumbar burst fracture on a porcine model. Sixteen functional spinal units composed of three vertebrae were harvested from mature Yucatan minipigs. Two loading rates (0.01 and 500 mm/s), two flexion angles (0° and 15°), and two spinal levels (T11-T13 and T14-L2) were studied, following a full factorial experimental plan with one repetition. Compression was applied to each functional unit to create a vertebral fracture. The load-to-failure, loss of compressive stiffness, final canal encroachment, and fracture type were used as criteria to evaluate the resulting fracture. All specimens compressed without flexion resulted in burst fractures. Half of the specimens compressed with the 15° flexion angle resulted in compression fractures. Specimens positioned without flexion lost more of their compressive stiffness and had more significant canal encroachment. Fractured units compressed with a higher loading rate resulted in a greater loss of compressive stiffness. The spinal level had no significant effect on the resulting fractures. The main parameters which affect the resulting fracture are the loading rate and the flexion angle. A higher loading rate and the absence of flexion favors the production of burst fractures with a greater canal encroachment.

Intervertebral disc properties: challenges for biodevices

Intervertebral disc biodevices that employ motion-preservation strategies (e.g., nucleus replacement, total disc replacement and posterior stabilization devices) are currently in use or in development. However, their long-term performance is unknown and only a small number of randomized controlled trials have been conducted. In this article, we discuss the following biodevices: interbody cages, nuclear pulposus replacements, total disc replacements and posterior dynamic stabilization devices, as well as future biological treatments. These biodevices restore some function to the motion segment; however, contrary to expectations, the risk of adjacent-level degeneration does not appear to have been reduced. The short-term challenge is to replicate the complex biomechanical function of the motion segment (e.g., biphasic, viscoelastic behavior and nonlinearity) to improve the quality of motion and minimize adjacent level problems, while ensuring biodevice longevity for the younger, more active patient. Biological strategies for regeneration and repair of disc tissue are being developed and these offer exciting opportunities (and challenges) for the longer term. Responsible introduction and rigorous assessment of these new technologies are required. In this article, we will describe the properties of the disc, explore biodevices currently in use for the surgical treatment of low back pain (with an emphasis on lumbar total disc replacement) and discuss future directions for biological treatments. Finally, we will assess the challenges ahead for the next generation of biodevices designed to replace the disc.

Posterior short-segmental fixation combined with intermediate screws vs conventional intersegmental fixation for monosegmental thoracolumbar fractures

Posterior short-segmental fixation is reliable for the management of thoracolumbar fractures; however, it is associated with recurrence of kyphosis and failure of fixation. This study compared the short-term results of short-segmental fixation combined with intermediate screws with those of conventional intersegmental fixation in the treatment of monosegmental thoracolumbar fractures. The records of 62 consecutive patients with thoracolumbar monosegmental fractures who underwent conventional 4-screw intersegmental fixation (35 patients) or short-segmental fixation combined with intermediate screws (27 patients) were reviewed. The study population included 43 men and 19 women (mean age, 44.1±13.6 years). The majority of fractures were L1 (28 [45.1%]) and T12 (21 [33.9%]) fractures. There were no significant differences between the 2 groups with respect to the preoperative relative height of the fractured vertebra or the segmental kyphotic angle. There was a significant difference in the restoration rate between the conventional and short-segmental fixation groups (62.6±38.7% vs 100.4±25.4%, respectively; P<.001). However, a statistically significant decrease in postoperative segmental kyphotic angle was noted in both groups (P<.001). The mean change of segmental kyphotic angle in the short-segmental fixation group was greater than in the conventional fixation group (14.4±6.8° vs 8.3±7.9°, respectively; P<.002). Patients in the short-segmental fixation group ambulated an average of 10 days earlier than those in the conventional fixation group. These findings indicate that compared to conventional intersegmental fixation, short-segmental fixation combined with intermediate screws more effectively restores fractured vertebral height, is associated with a decrease in the segmental kyphotic angle, and allows earlier ambulation.

The effects of dynamic loading on the intervertebral disc

Loading is important to maintain the balance of matrix turnover in the intervertebral disc (IVD). Daily cyclic diurnal assists in the transport of large soluble factors across the IVD and its surrounding circulation and applies direct and indirect stimulus to disc cells. Acute mechanical injury and accumulated overloading, however, could induce disc degeneration. Recently, there is more information available on how cyclic loading, especially axial compression and hydrostatic pressure, affects IVD cell biology. This review summarises recent studies on the response of the IVD and stem cells to applied cyclic compression and hydrostatic pressure. These studies investigate the possible role of loading in the initiation and progression of disc degeneration as well as quantifying a physiological loading condition for the study of disc degeneration biological therapy. Subsequently, a possible physiological/beneficial loading range is proposed. This physiological/beneficial loading could provide insight into how to design loading regimes in specific system for the testing of various biological therapies such as cell therapy, chemical therapy or tissue engineering constructs to achieve a better final outcome. In addition, the parameter space of 'physiological' loading may also be an important factor for the differentiation of stem cells towards most ideally 'discogenic' cells for tissue engineering purpose.

Role of load history in intervertebral disc mechanics and intradiscal pressure generation

Solid-fluid interactions play an important role in mediating viscoelastic behaviour of biological tissues. In the intervertebral disc, water content is governed by a number of factors, including age, disease and mechanical loads, leading to changes in stiffness characteristics. We hypothesized that zonal stress distributions depend on load history, or the prior stresses experienced by the disc. To investigate these effects, rat caudal motion segments were subjected to compressive creep biomechanical testing in vitro using a protocol that consisted of two phases: a Prestress Phase (varied to represent different histories of load) followed immediately by an Exertion Phase, identical across all Prestress groups. Three analytical models were used to fit the experimental data in order to evaluate load history effects on gross and zonal disc mechanics. Model results indicated that while gross transient response was insensitive to load history, there may be changes in the internal mechanics of the disc. In particular, a fluid transport model suggested that the role of the nucleus pulposus in resisting creep during Exertion depended on Prestress conditions. Separate experiments using similarly defined load history regimens were performed to verify these predictions by measuring intradiscal pressure with a fibre optic sensor. We found that the ability for intradiscal pressure generation was load history-dependent and exhibited even greater sensitivity than predicted by analytical models. A 0.5 MPa Exertion load resulted in 537.2 kPa IDP for low magnitude Prestress compared with 373.7 kPa for high magnitude Prestress. Based on these measurements, we developed a simple model that may describe the pressure-shear environment in the nucleus pulposus. These findings may have important implications on our understanding of how mechanical stress contributes to disc health and disease etiology.

Axial creep loading and unloaded recovery of the human intervertebral disc and the effect of degeneration

The intervertebral disc maintains a balance between externally applied loads and internal osmotic pressure. Fluid flow plays a key role in this process, causing fluctuations in disc hydration and height. The objectives of this study were to quantify and model the axial creep and recovery responses of nondegenerate and degenerate human lumbar discs. Two experiments were performed. First, a slow compressive ramp was applied to 2000 N, unloaded to allow recovery for up to 24 h, and re-applied. The linear-region stiffness and disc height were within 5% of the initial condition for recovery times greater than 8 h. In the second experiment, a 1000 N creep load was applied for four hours, unloaded recovery monitored for 24 h, and the creep load repeated. A viscoelastic model comprised of a "fast" and "slow" exponential response was used to describe the creep and recovery, where the fast response is associated with flow in the nucleus pulposus (NP) and endplate, while the slow response is associated with the annulus fibrosus (AF). The study demonstrated that recovery is 3-4X slower than loading. The fast response was correlated with degeneration, suggesting larger changes in the NP with degeneration compared to the AF. However, the fast response comprised only 10%-15% of the total equilibrium displacement, with the AF-dominated slow response comprising 40%-70%. Finally, the physiological loads and deformations and their associated long equilibrium times confirm that diurnal loading does not represent "equilibrium" in the disc, but that over time the disc is in steady-state.

Change in spine height measurements following sustained mid-range and end-range flexion of the lumbar spine

Workers lose height during the day. Flexion-based exercises and body positions are commonly prescribed to unload the spine and prevent back pain. Lumbar extension positions have been researched and result in an increase in spine height. End-range lumbar extension postures increase spine height to a greater extent than mid-range lumbar extension postures, but these positions are not always tolerated by patients with lumbar conditions. No study to date has investigated the effect of end-range versus mid-range lumbar flexion postures on spine height changes. The purpose of this study was to investigate the effects of two techniques commonly used in clinical settings to unload the lumbar intervertebral disc (IVD) segments through increasing spine height in: (1) a sidelying mid-range lumbar flexion position; and (2) a sidelying end-range lumbar flexion position. A total of 20 asymptomatic women and 21 asymptomatic men with a mean age of 23.8 years (±2.5) participated in the study. Subjects were randomized systematically into 2 groups to determine the order of testing position. Measurements were taken with a stadiometer in the sitting position to detect change in spine height after each position. Results of the paired t-tests indicated that compared to the spine height in sitting, the sidelying end-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 4.78 mm (±4.01) while the sidelying mid-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 5.84 mm (±4.4). No significant difference between the height changes observed following the two sidelying positions was found (p = .22). Sidelying lumbar flexion positions offer valuable alternatives to lumbar extension positions to increase spine height, possibly through increasing hydration levels of the lumbar IVD and could be proposed as techniques to offset spinal shrinkage and the biomechanical consequences of sustained loads.

ISSLS prize winner: how loading rate influences disc failure mechanics: a microstructural assessment of internal disruption

STUDY DESIGN

Mechanically induced disruption and subsequent microscopic investigation of lumbar intervertebral discs following a previously published testing protocol, but using a much higher rate of loading.

OBJECTIVE

To explore if loading rate affects the internal disruption mechanics of lumbar intervertebral discs.

SUMMARY OF BACKGROUND DATA

The failure mechanics of some bone-ligament-bone constructs vary with the rate of tensile load application. Like many ligaments, recent reports indicate that the mechanical response of the disc wall varies with strain-rate. It is possible that the internal failure mechanics of the disc wall also varies with strain-rate.

METHODS

Nuclear pressurization was used to deliver sudden pressure impulses directly to the nucleus of ovine lumbar motion segments. Pressure impulses were delivered to 12 neutrally positioned motion segments, and 15 motion segments held at 7° flexion. Aside from loading rate, testing was conducted in the same manner as 2 previously published studies that employed a gradual nuclear pressurization regime. Following testing, the internal damage resulting to each disc was analyzed using micro-CT and serial microscopy in tandem.

RESULTS

Radial tears of the medioposterior disc wall were the most frequent cause of disc failure. In most cases, radial tears involved a combination of annular and endplate disruption: Neutrally positioned discs frequently suffered tears within the superior cartilaginous endplate adjacent to the transition zone and/or inner anulus. Flexed discs frequently suffered tears adjacent to the outer anulus at the cartilaginous/vertebral endplate junction, or within the vertebral endplate. Both groups frequently suffered endplate tears adjacent to the mid anulus at the inferior cartilaginous/vertebral endplate junction.

CONCLUSION

The internal morphologies of the disc disruptions created in this study using high strain-rate impulse pressurization differed significantly from those documented previously for both neutrally positioned and flexed discs subjected to gradual low strain-rate pressurization. These morphologic differences show that the internal failure mechanics of lumbar intervertebral discs vary with the rate of internal radial load application.

An Examination of the Influence of Strain Rate on Subfailure Mechanical Properties of the Annulus Fibrosus

Disk herniation is often considered a cumulative injury in that repetitive stress on the posterior annulus can result in the nucleus pulposus penetrating the annulus fibrosus and eventually extruding posteriorly. Further, it has been documented that the nucleus pulposus works its way through the annulus through clefts, which form as a result of repetitive tensile strain. The annulus fibrosus is viscoelastic in nature and therefore could express different mechanical responses to applied strain at varying rates. Other viscoelastic tissues, including tendons and ligaments, have shown altered mechanical responses to different rates of applied strain, but the response of the annulus to varying rates of strain is largely unknown. The present study examined the mechanical properties of 20 two-layered samples of porcine annulus fibrosus tissue at three distinct rates of applied 20% biaxial strain (20% strain over 20 s (slow), over 10 s (medium), and over 5 s (fast)); these three rates are considered applicable to nontraumatic loading. No differences in the stiffness or maximum stress in each of the two directions of applied strain were observed between the three strain rates. Specifically, the average (standard deviation) moduli calculated at the fast, medium, and slow rates, respectively, in the axial direction were 7.42 MPa (6.06), 7.77 MPa (6.61), and 7.63 MPa (6.67) and 8.22 MPa (8.4), 8.63 MPa (9.00), and 8.49 MPa (8.69) in the circumferential direction. The maximum stress values reached during the fast, medium, and slow rates, respectively, in the axial direction were 0.40 (0.36) MPa, 0.40 (0.36) MPa, and 0.39 (0.35) MPa and 0.45 (0.47) MPa, 0.44 (0.46) MPa, and 0.43 (0.46) MPa in the circumferential direction. At submaximal strain magnitudes over a range of nontraumatic rates likely to result in clefts in the annulus and potentially leading to disk herniation, any strain rate dependence is not significant.

A phenotypic comparison of proteoglycan production of intervertebral disc cells isolated from rats, rabbits, and bovine tails; which animal model is most suitable to study tissue engineering and biological repair of human disc disorders?

The nucleus pulposus (NP) of the intervertebral disc in cattle and humans shows the most dramatic changes with aging of any cartilaginous tissue. In humans, notochordal cells disappear from the NP and are replaced with chondrocytic cells by adolescence. However, notochordal cells of the NP persist into adult life in some species, such as rats and rabbits. Therefore, comparison of the metabolic activity of notochordal and nonnotochordal cells is considered to be important for determining the type of cell to use for transplantation to regenerate intervertebral discs. In this study, we investigated the notochordal NP cells of rats and rabbits, as well as nonnotochordal (chondrocyte-like) bovine NP cells, in a three-dimensional culture system to examine whether proteoglycan metabolism varied among these three cell types. As a result, bovine NP cells produced around 0.18 mg/mL of glycosaminoglycan after culture for 5 days, while rat and rabbit NP cells produced about four and two times more glycosaminoglycan than bovine cells, respectively. In conclusion, this study demonstrated marked differences of energy metabolism and production of matrix components between notochordal and nonnotochordal NP cells. Animals with notochordal cells in the NP, such as rats and rabbits, may not provide good models for investigation of biological repair and tissue engineering for human disc disorders.

Reduced nucleus pulposus glycosaminoglycan content alters intervertebral disc dynamic viscoelastic mechanics

The intervertebral disc functions over a range of dynamic loading regimes including axial loads applied across a spectrum of frequencies at varying compressive loads. Biochemical changes occurring in early degeneration, including reduced nucleus pulposus glycosaminoglycan content, may alter disc mechanical behavior and thus may contribute to the progression of degeneration. The objective of this study was to determine disc dynamic viscoelastic properties under several equilibrium loads and loading frequencies, and further, to determine how reduced nucleus glycosaminoglycan content alters dynamic mechanics. We hypothesized that (1) dynamic stiffness would be elevated with increasing equilibrium load and increasing frequency, (2) the disc would behave more elastically at higher frequencies, and finally, (3) dynamic stiffness would be reduced at low equilibrium loads under all frequencies due to nucleus glycosaminoglycan loss. We mechanically tested control and chondroitinase ABC injected rat lumbar motion segments at several equilibrium loads using oscillatory loading at frequencies ranging from 0.05 to 5Hz. The rat lumbar disc behaved non-linearly with higher dynamic stiffness at elevated compressive loads irrespective of frequency. Phase angle was not affected by equilibrium load, although it decreased as frequency was increased. Reduced glycosaminoglycan decreased dynamic stiffness at low loads but not at high equilibrium loads and led to increased phase angle at all loads and frequencies. The findings of this study demonstrate the effect of equilibrium load and loading frequencies on dynamic disc mechanics and indicate possible mechanical mechanisms through which disc degeneration can progress.

Degenerative anular changes induced by puncture are associated with insufficiency of disc biomechanical function

STUDY DESIGN

In vivo experiments to examine physiologic consequences and in vitro tests to determine immediate biomechanical effects of anular injury by needle puncture.

OBJECTIVE

To determine whether a relationship exists between induction of degenerative changes in anulus fibrosus (AF) and compromised disc biomechanical function according to injury size.

SUMMARY OF BACKGROUND DATA

Various studies in intervertebral disc mechanics, degeneration, and regeneration involve the creation of a defect in the anulus fibrosus (AF). However, the impact of the puncture, itself, on biomechanical function and disc health are not understood.

METHODS

For in vivo experiments, rat caudal discs subjected to percutaneous anular punctures using different gauge size hypodermic needles (18, 22, 26 g) and nonpunctured controls were examined histologically up to 4 weeks postsurgery. For in vitro biomechanical testing, healthy motion segments were isolated and their creep compression response assessed immediately after needle puncture.

RESULTS

We found that needle size-dependence of creep compression behavior paralleled the size-dependence of degenerative changes in the AF. Specifically, 18-g punctures resulted in inward bulging of the AF, lamellar disorganization, and cellular changes. These changes were not seen in 22- and 26-g punctured discs. Biomechanical tests showed that only 18-g needle punctures led to significant changes in disc mechanics. Importantly, a statistically significant association was found between needle sizes that caused biomechanical changes and induction of degenerative changes in the AF.

CONCLUSION

Our findings suggest that injury sizes large enough to disrupt biomechanical function are needed to drive degenerative changes in rat caudal disc AF. Based on the data, we believe that small anular defects become sealed, allowing the disc to function normally and the AF to heal. Larger defects appear to require longer wound closure times, and may prolong the duration of impaired disc function.

Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation

Vertebral cement augmentation can restore the stiffness and strength of a fractured vertebra and relieve chronic pain. Previous finite element analysis, biomechanical tests and clinical studies have indirectly associated new adjacent vertebral fractures following augmentation to altered loading. The aim of this repeated measures in situ biomechanical study was to determine the changes in the adjacent and augmented endplate deformation following cement augmentation of human cadaveric functional spine units (FSU) using micro-computed tomography (micro-CT). The surrounding soft tissue and posterior elements of 22 cadaveric human FSU were removed. FSU were assigned to two groups, control (n = 8) (loaded on day 1 and day 2) and augmented (n = 14) (loaded on day 1, augmented 20% cement fill, and loaded on day 2). The augmented group was further subdivided into a prophylactic augmentation group (n = 9), and vertebrae which spontaneously fractured during loading on day 1 (n = 5). The FSU were axially loaded (200, 1,000, 1,500-2,000 N) within a custom made radiolucent, saline filled loading device. At each loading step, FSUs were scanned using the micro-CT. Endplate heights were determined using custom software. No significant increase in endplate deformation following cement augmentation was noted for the adjacent endplate (P > 0.05). The deformation of the augmented endplate was significantly reduced following cement augmentation for both the prophylactic and fracture group (P < 0.05, P < 0.01, respectively). Endplate deformation of the controls showed no statistically significant differences between loading on day 1 and day 2. A linear relationship was noted between the applied compressive load and endplate deflection (R (2) = 0.58). Evidence of significant endplate deformation differences between unaugmented and augmented FSU, while evident for the augmented endplate, was not present for the adjacent endplate. This non-invasive micro-CT method may also be useful to investigate endplate failure, and parameters that predict vertebral failure.

Quantitative MRI as a diagnostic tool of intervertebral disc matrix composition and integrity

Degenerative disc disease has been implicated as a major component of spine pathology. The current major clinical procedures for treating disc degeneration have been disappointing, because of altered spinal mechanics leading to subsequent degeneration at adjacent disc levels. Disc pathology treatment is shifting toward prevention and treatment of underlying etiologic processes at the level of the disc matrix composition and integrity and the biomechanics of the disc. The ability to perform such treatment relies on one's ability to accurately and objectively assess the state of the matrix and the effectiveness of treatment by a non-invasive technique. In this review, we will summarize our advances in efforts to develop an objective, accurate, non-invasive diagnostic tool (quantitative MRI) in the detection and quantification of matrix composition and integrity and of biomechanical changes in early intervertebral disc degeneration.

Intervertebral disc degeneration in a naturally occurring primate model: radiographic and biomechanical evidence

Classic degenerative disc disease is a serious health problem worldwide, whose etiological basis-mechanical stimulus, biochemical changes, or natural aging-is poorly understood. Animal models are critical to the study of degenerative disc disease initiation and progression and for attempts to regulate, ameliorate, or eliminate it. The macaque represents a primate model with natural disc degeneration that might serve to advance the field; we aimed to provide radiographic (morphologic) and biomechanical evidence of natural disc degeneration in this model. A factorial study design was used to examine the relationship between the radiographic appearance of disc degeneration and its biomechanical consequences. Eighteen macaques of advanced age (22.3 +/- 0.9 years) had radiographs taken to assess the degree of thoracolumbar intervertebral disc degeneration using a standard atlas method. Each spine was harvested and dynamic biomechanical tests were performed. Advancing disc degeneration (degree of disc space narrowing and osteophytosis) was associated with increased stiffness, decreased energy absorption, and increased natural frequency of the intervertebral disc. These associations linking the dynamics of the intervertebral disc and its degree of degeneration are similar to those found in humans. Our results indicate the macaque model with morphologic and biomechanical efficacy could aid in understanding the progression of disc degeneration and in developing therapeutic strategies to prevent or inhibit its course.

Frequency-dependent behavior of the intervertebral disc in response to each of six degree of freedom dynamic loading: solid phase and fluid phase contributions

STUDY DESIGN

Nondestructive displacement-controlled dynamic testing of cadaver material, with repeated measures design and randomized sequence of tests.

OBJECTIVE

To determine whether the frequency-dependent changes in disc stiffness and phase angle between load and displacement differ between the 6 principal directions of displacement, and whether these differences are greater in deformation directions associated with greater intradiscal fluid flow.

SUMMARY OF BACKGROUND DATA

Prior studies of time-dependent behavior of discs have focused on compression. Comparing different deformation directions allows effects of fluid flow to be distinguished from effects of the solid phase viscoelasticity.

METHODS

Vertebra-disc-vertebra preparations (N = 9) from human lumbar spines were subjected to each of 3 displacements and 3 rotations (6 degree of freedom) at each of 4 frequencies (0.001, 0.01, 0.1, and 1 Hz) after equilibration overnight under a 0.4 MPa preload in a bath of phosphate buffered saline at 37 degrees C with protease inhibitors. The forces and torques were recorded along with the applied translation or rotation. The stiffness (force/displacement or torque/rotation) and the phase angle (between each force and displacement) were calculated for each degree of freedom from recorded data.

RESULTS

Disc stiffness increased linearly with the log-frequency. The increases over the four decades of frequency were 35%, 33%, and 26% for AP shear, lateral shear, and torsion respectively, and were 45%, 29%, 51%, and 83% for compression, lateral bending, flexion, and extension. The phase angle (a measure of energy absorption) averaged 6.2, 5.1, and 5.1 degrees in AP shear, lateral shear, and torsion, respectively, and 7.0, 7.0, and 8.6 degrees for compression, lateral bending, and flexion-extension. There were no consistent variations of phase angle with frequency.

CONCLUSION

The stiffness increase and phase angle decrease with frequency were greater for deformation modes in which fluid flow effects are thought to be greater.