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van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
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Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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2
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Waldenberg C, Eriksson S, Brisby H, Hebelka H, Lagerstrand KM. Detection of Imperceptible Intervertebral Disc Fissures in Conventional MRI-An AI Strategy for Improved Diagnostics. J Clin Med 2022; 12:jcm12010011. [PMID: 36614812 PMCID: PMC9821245 DOI: 10.3390/jcm12010011] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Annular fissures in the intervertebral discs are believed to be closely related to back pain. However, no sensitive non-invasive method exists to detect annular fissures. This study aimed to propose and test a method capable of detecting the presence and position of annular fissures in conventional magnetic resonance (MR) images non-invasively. The method utilizes textural features calculated from conventional MR images combined with attention mapping and artificial intelligence (AI)-based classification models. As ground truth, reference standard computed tomography (CT) discography was used. One hundred twenty-three intervertebral discs in 43 patients were examined with MR imaging followed by discography and CT. The fissure classification model determined the presence of fissures with 100% sensitivity and 97% specificity. Moreover, the true position of the fissures was correctly determined in 90 (87%) of the analyzed discs. Additionally, the proposed method was significantly more accurate at identifying fissures than the conventional radiological high-intensity zone marker. In conclusion, the findings suggest that the proposed method is a promising diagnostic tool to detect annular fissures of importance for back pain and might aid in clinical practice and allow for new non-invasive research related to the presence and position of individual fissures.
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Affiliation(s)
- Christian Waldenberg
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Correspondence:
| | - Stefanie Eriksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Kerstin Magdalena Lagerstrand
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Contrast-enhanced microCT evaluation of degeneration following partial and full width injuries to the mouse lumbar intervertebral disc. Sci Rep 2022; 12:15555. [PMID: 36114343 PMCID: PMC9481554 DOI: 10.1038/s41598-022-19487-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
A targeted injury to the mouse intervertebral disc (IVD) is often used to recapitulate the degenerative cascade of the human pathology. Since injuries can vary in magnitude and localization, it is critical to examine the effects of different injuries on IVD degeneration. We thus evaluated the degenerative progression resulting from either a partial- or full-width injury to the mouse lumbar IVD using contrast-enhanced micro-computed tomography and histological analyses. A lateral-retroperitoneal surgical approach was used to access the lumbar IVD, and the injuries to the IVD were produced by either incising one side of the annulus fibrosus or puncturing both sides of the annulus fibrosus. Female C57BL/6J mice of 3–4 months age were used in this study. They were divided into three groups to undergo partial-width, full-width, or sham injuries. The L5/6 and L6/S1 lumbar IVDs were surgically exposed, and then the L6/S1 IVDs were injured using either a surgical scalpel (partial-width) or a 33G needle (full-width), with the L5/6 serving as an internal control. These animals recovered and then euthanized at either 2-, 4-, or 8-weeks after surgery for evaluation. The IVDs were assessed for degeneration using contrast-enhanced microCT (CEµCT) and histological analysis. The high-resolution 3D CEµCT evaluation of the IVD confirmed that the respective injuries were localized within one side of the annulus fibrosus or spanned the full width of the IVD. The full-width injury caused significant deteriorations in the nucleus pulposus, annulus fibrous and at the interfaces after 2 weeks, which was sustained through the 8 weeks, while the partial width injury caused localized disruptions that remained limited to the annulus fibrosus. The use of CEµCT revealed distinct IVD degeneration profiles resulting from partial- and full-width injuries. The partial width injury may serve as an alternative model for IVD degeneration resulting from localized annulus fibrosus injuries.
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Belavy DL, Armbrecht G, Albracht K, Brisby H, Falla D, Scheuring R, Sovelius R, Wilke HJ, Rennerfelt K, Martinez-Valdes E, Arvanitidis M, Goell F, Braunstein B, Kaczorowski S, Karner V, Arora NK. Cervical spine and muscle adaptation after spaceflight and relationship to herniation risk: protocol from 'Cervical in Space' trial. BMC Musculoskelet Disord 2022; 23:772. [PMID: 35964076 PMCID: PMC9375326 DOI: 10.1186/s12891-022-05684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Astronauts have a higher risk of cervical intervertebral disc herniation. Several mechanisms have been attributed as causative factors for this increased risk. However, most of the previous studies have examined potential causal factors for lumbar intervertebral disc herniation only. Hence, we aim to conduct a study to identify the various changes in the cervical spine that lead to an increased risk of cervical disc herniation after spaceflight. Methods A cohort study with astronauts will be conducted. The data collection will involve four main components: a) Magnetic resonance imaging (MRI); b) cervical 3D kinematics; c) an Integrated Protocol consisting of maximal and submaximal voluntary contractions of the neck muscles, endurance testing of the neck muscles, neck muscle fatigue testing and questionnaires; and d) dual energy X-ray absorptiometry (DXA) examination. Measurements will be conducted at several time points before and after astronauts visit the International Space Station. The main outcomes of interest are adaptations in the cervical discs, muscles and bones. Discussion Astronauts are at higher risk of cervical disc herniation, but contributing factors remain unclear. The results of this study will inform future preventive measures for astronauts and will also contribute to the understanding of intervertebral disc herniation risk in the cervical spine for people on Earth. In addition, we anticipate deeper insight into the aetiology of neck pain with this research project. Trial registration German Clinical Trials Register, DRKS00026777. Registered on 08 October 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05684-0.
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Affiliation(s)
- Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Gabriele Armbrecht
- Center for Muscle and Bone Research, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kirsten Albracht
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Aachen, Germany.,Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Helena Brisby
- Department of Orthopedic Surgery, Sahlgrenska University Hospital, 415 45, Göteborg, Sweden
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Richard Scheuring
- NASA Johnson Space Center, 2101 NASA Parkway SD4, Houston, TX, 77058, USA
| | - Roope Sovelius
- Centre for Military Medicine, Satakunta Air Command, P.O.Box 761, 33101, Tampere, Finland
| | | | - Kajsa Rennerfelt
- Orthopaedics and Spine Surgery, Sahlgrenska University Hospital, Bruna Stråket 11B, Göteborg, 413 45, Sweden
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Michail Arvanitidis
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Fabian Goell
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Bjoern Braunstein
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Svenja Kaczorowski
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Vera Karner
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Nitin Kumar Arora
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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How annulus defects can act as initiation sites for herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1487-1500. [PMID: 35174401 DOI: 10.1007/s00586-022-07132-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Both posture and loading rate are key factors in the herniation process and can determine the mechanism of disc failure. The aim of this study was to test the hypothesis that disruption visible with HR-MRI post-testing corresponds with microstructural features and further elucidate the mechanism by which this disruption weakens the disc. This will enable us to gain new insights into the herniation process. METHODS Thirty ovine lumbar spinal segments were subjected to combinations of four loading conditions (0-12° flexion, 0-9° lateral bending, 0-4° axial rotation, 0-1500 N axial compression) for 1000 loading cycles at 2 Hz in a dynamic disc loading simulator. The discs were scanned in an ultra-high field MRI (11.7 T) then examined using brightfield microscopy to examine their microstructure. RESULTS Four discs herniated and seven discs suffered nucleus displacement. These discs contained pre-existing defects in the central posterior annulus. Generally, following testing discs contained more posterior annulus disruption, Microstructural investigation revealed there was clear correspondence between HR-MRI and microstructural observations, and that the mid-outer annular-endplate junction had failed in all discs examined in this study. CONCLUSIONS While all discs suffered outer annulus damage, only the discs containing pre-existing defects herniated. These pre-existing defects weakened the inner and mid annulus, allowing herniation to occur once the mid and outer annular wall was compromised. We propose this can occur during the degenerative cascade.
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Eriksson S, Waldenberg C, Torén L, Grimby-Ekman A, Brisby H, Hebelka H, Lagerstrand K. Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures. Spine (Phila Pa 1976) 2022; 47:430-437. [PMID: 34265808 DOI: 10.1097/brs.0000000000004160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain. SUMMARY OF BACKGROUND DATA Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics. METHODS Forty four LBP patients who underwent MRI, low-pressure discography (<50 psi), and computed tomography (CT) sequentially in 1 day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features was reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus versus short/no fissures. Fissure width was dichotomized into narrow (<10%) versus broad fissures (>10%), and into moderately broad (10%-50%) versus very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain-response were investigated. RESULTS Fissure extension could be depicted with sensitivity/specificity = 0.97/0.77 and area under curve (AUC) = 0.97. Corresponding results for width depiction were sensitivity/specificity = 0.94/0.39 and 0.85/0.62, and AUC = 0.86 and 0.81 for narrow versus broad and moderately broad versus very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity = 0.90/0.36, 0.88/0.4, 0.93/0.33; AUC = 0.69, 0.75, and 0.73 respectively. CONCLUSION Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.Level of Evidence: 2.
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Affiliation(s)
- Stefanie Eriksson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Waldenberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leif Torén
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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Guo Z, Li C, Cao Y, Jiang L, Zhang Y, Li P, Zhou Y, Duan C, Hu J, Lu H. 3D visualization and morphometric analysis of spinal motion segments and vascular networks: A synchrotron radiation-based micro-CT study in mice. J Anat 2022; 240:268-278. [PMID: 34622448 PMCID: PMC8742973 DOI: 10.1111/joa.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/08/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022] Open
Abstract
The structure of spinal motion segments and spinal vasculature is complicated. Visualizing the three-dimensional (3D) structure of the spine may provide guidance for spine surgery. However, conventional imaging techniques fail to simultaneously obtain 3D images of soft and hard tissues, and achieving such coimaging states of the spine and its vascular networks remains a challenge. Synchrotron radiation micro-CT (SRμCT) provides a relatively effective and novel method of acquiring detailed 3D information. In this study, specimens of the thoracic spine were obtained from six mice. SRμCT was employed to acquire 3D images of the structure, and histologic staining was performed for comparisons with the SRμCT images. The whole spinal motion segments and the spinal vascular network were simultaneously explored at high resolution. The mean thickness of the cartilaginous end plates (CEPs) and the volume of the intervertebral discs (IVDs) were calculated. The surface of the CEPs and the facet joint cartilage (FJC) were presented as heat maps, which allowed for direct visualization of the thickness distribution. Regional division revealed heterogeneity among the ventral, central, and dorsal parts of the CEPs and between the superior and inferior parts of the facet processes. Moreover, the connections and spatial morphology of the spinal vascular network were visualized. Our study indicates that SRμCT imaging is an ideal method for high-resolution visualization and 3D morphometric analysis of the whole spinal motion segments and spinal vascular network.
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Affiliation(s)
- Zhu Guo
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- Spine Surgery Department of the Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chengjun Li
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Yong Cao
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Liyuan Jiang
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Yi Zhang
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Traumatic Orthopaedic Institute of Shandong ProvinceAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ping Li
- Department of ObstetricsXiangya HospitalCentral South UniversityChangshaChina
| | - Yongchun Zhou
- Department of OrthopedicShanxi Provincial People’s HospitalXi’anChina
| | - Chunyue Duan
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
| | - Jianzhong Hu
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Hongbin Lu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
- Department of Sports MedicineResearch Centre of Sports MedicineXiangya HospitalCentral South UniversityChangshaChina
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Evaluating the effect of a post-processing algorithm in detection of annular fissure on MR imaging. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2150-2156. [PMID: 33683440 DOI: 10.1007/s00586-021-06793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Visualization of annular fissures on MRI is becoming increasingly important but remains challenging. Our purpose was to test whether an image processing algorithm could improve detection of annular fissures. MATERIALS AND METHODS In this retrospective study, two neuroradiologists identified 56 IVDs with annular fissures and 97 IVDs with normal annulus fibrosus in lumbar spine MRIs of 101 patients (58 M, 43 F; age ± SD 15.1 ± 3.0 years). Signal intensities of diseased and normal annulus fibrosus, and contrast-to-noise ratio between them on sagittal T2-weighted images were calculated before and after processing with a proprietary software. Effect of processing on detection of annular fissures by two masked neuroradiologists was also studied for IVDs with Pfirrmann grades of ≤ 2 and > 2. RESULTS Mean (SD) signal baseline intensities of diseased and normal annulus fibrosus were 57.6 (23.3) and 24.4 (7.8), respectively (p < 0.001). Processing increased (p < 0.001) the mean (SD) intensity of diseased annulus to 110.6 (47.9), without affecting the signal intensity of normal annulus (p = 0.14). Mean (SD) CNR between the diseased and normal annulus increased (p < 0.001) from 11.8 (14.1) to 29.6 (29.1). Both masked readers detected more annular fissures after processing in IVDs with Pfirrmann grade of ≤ 2 and > 2, with an apparent increased sensitivity and decreased specificity using predefined image-based human categorization as a reference standard. CONCLUSIONS Image processing improved CNR of annular fissures and detection rate of annular fissures. However, further studies with a more stringent reference standard are needed to assess its effect on sensitivity and specificity.
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MRI During Spinal Loading Reveals Intervertebral Disc Behavior Corresponding to Discogram Findings of Annular Fissures and Pain Provocation. Spine (Phila Pa 1976) 2020; 45:E1500-E1506. [PMID: 32756277 DOI: 10.1097/brs.0000000000003631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE The aim of this study was to investigate whether spinal loading, depicted with magnetic resonance imaging (MRI), induces regional intervertebral disc (IVD) differences associated with presence and width of annular fissure and induced pain at discography. SUMMARY OF BACKGROUND DATA Annular fissures play a role in low back pain (LBP) but cannot be accurately characterized with conventional MRI. Recently, annular fissures were suggested to influence different load-induced IVD behavior during MRI when comparing LBP-patients and controls. Thus, the loading effect could characterize behavior related to annular fissures noninvasively with MRI. METHODS Lumbar spines of 30 LBP-patients were investigated with MRI with and without loading, discography and CT. Five IVD regions were outlined on sagittal MRI images. Difference in normalized signal intensity (SI) with and without loading was calculated for each region. Eighty-three CT-discograms were graded regarding presence and width of fissures. Discograms were classified as pain-positive if a concordant pain response was obtained at a pressure <50 psi. RESULTS Comparing IVDs with outer fissures with IVDs without fissures, loading induced different behavior in the two ventral regions and in the posterior region. Higher SI increase in the central region was induced in IVDs with narrower fissures compared to IVDs with wider fissures. In the group of pain-negative discograms, a SI decrease was induced in the dorsal region whereas lack of such in the pain-positive group. CONCLUSION The spinal loading-effect, depicted with MRI, reveals different regional behaviors between IVDs with outer fissures compared to those without, and between IVDs with narrow and broad fissures, as well as within posterior annulus between pain-positive and pain-negative discograms. Findings are of importance for future attempts to uncover phenotypes of painful IVDs. LEVEL OF EVIDENCE 2.
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10
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Schwan S, Ludtka C, Friedmann A, Heilmann A, Baerthel A, Brehm W, Wiesner I, Meisel HJ, Goehre F. Long-Term Pathology of Ovine Lumbar Spine Degeneration Following Injury Via Percutaneous Minimally Invasive Partial Nucleotomy. J Orthop Res 2019; 37:2376-2388. [PMID: 31283052 DOI: 10.1002/jor.24402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
The focus of this work is to assess the long-term progression of degeneration in the ovine lumbar spine following a minimally invasive model injury comparable to the damage of an intervertebral disc (IVD) herniation. A partial nucleotomy was performed on 18 sheep via the percutaneous dorsolateral approach. The animals were culled at 6 and 12 months to evaluate the damaged and neighboring functional spine units (FSUs) for degenerative characteristics via μ-CT and histology. Both quantitative μ-CT and histology investigations demonstrated statistically significant differences between the native and damaged FSUs investigated. Qualitative analysis of μ-CT revealed numerous pathological markers consistent with intervertebral disc degeneration (IDD), with differences in frequency and severity between the native and damaged FSUs. The annulus fibrosus reforms a pressure seal within 6 weeks, but the extent of the trauma is significant enough to initiate IVD degeneration, which is already clearly visible at 6 months and especially so 12 months post-op. IDD pathology consistent with signs of a herniation was seen in both the 6- and 12-month groups. This technique provides a useful model injury for the preclinical evaluation of IDD in large animal models, especially in regards to simulating disc herniation as well as for testing the efficacy of associated therapies in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2376-2388, 2019.
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Affiliation(s)
- Stefan Schwan
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany.,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Christopher Ludtka
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,University of Tennessee Health Science Center, University of Tennessee, 910 Madison Ave., Memphis, Tennessee, 38163
| | - Andrea Friedmann
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany.,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Andreas Heilmann
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, Halle (Saale), 06120, Germany
| | - Andre Baerthel
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,Department of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Walther Brehm
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.,Department of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Ingo Wiesner
- Department of General Surgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Hans J Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Felix Goehre
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany.,Department of Neurosurgery, University Hospital and University of Helsinki, Helsinki, Finland
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Abstract
STUDY DESIGN An in vitro magnetic resonance imaging (MRI) study. OBJECTIVE Investigate the potential of high-field MRI for producing higher quality images of the intervertebral disc (IVD) to better distinguish structural details. SUMMARY OF BACKGROUND DATA Higher spatial and contrast resolution are important advantages when imaging the complex tissue structures in the spine such as the IVDs. However, at present it is challenging to capture the substructural details in the IVD such as the lamellae. METHODS Three MRI sequences; two-dimensional proton-density-weighted Turbo-Spin-Echo (PD-TSE), 2D T2-weighted Turbo-Spin-Echo (T2W-TSE) with fat-saturation (FS), and 3D Spoiled-Gradient-Echo (3D-GE), were modified based on the image quality and scan duration. IVDs of three intact cadaveric lumbar-spines (T12-S1, Age 83-94 yr) were imaged using these optimized sequences. Thereafter each IVD was transversely sectioned and the exposed surfaces were photographed. Landmark observations from corresponding MRI slices and photographs were compared to confirm the MRI captured morphology. The image quality was evaluated using signal-to-noise ratio (SNR), and relative-contrast values. Finally, the underlying tissue structures, including specific pathological features, were qualitatively compared between the MR images and photographs. RESULTS Observations from photographs and corresponding MRI slices matched well. The PD-TSE sequence had better overall SNR, but the relative contrast between the tissue types was relatively poor. The 3D-GE sequence had higher relative contrast between the IVD and bone, but not between annulus and nucleus regions. The T2W images provided the best relative contrast between the annulus and nucleus, however the standard deviations here were high. Structural details including fissures, vascular and granular tissue proliferation, and pathologies in the endplate region, were identifiable from the MR images obtained using the optimized sequences. CONCLUSION The results demonstrate the potential of high-field MRI to capture the IVD structural details. Since the acquisition durations were within clinically acceptable levels, these methodological improvements have the potential to enhance clinical diagnostics. LEVEL OF EVIDENCE 4.
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Three-dimensional microstructural reconstruction of the ovine intervertebral disc using ultrahigh field MRI. Spine J 2018; 18:2119-2127. [PMID: 29969731 DOI: 10.1016/j.spinee.2018.06.356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The intervertebral disc (IVD) is a complex organ that acts as a flexible coupling between two adjacent vertebral bodies and must therefore accommodate compression, bending, and torsion. It consists of three main components, which are elegantly structured to allow this: the annulus fibrosus (AF), the nucleus pulposus (NP), and the end-plates (EP). PURPOSE Thus far, it has not been possible to examine the microarchitecture of the disc directly in three dimensions in its unaltered state and thus knowledge of the overall architecture of the disc has been inferred from a range of imaging sources, or by using destructive methods. STUDY DESIGN A nondestructive ultrahigh field Magnetic Resonance Imaging (MRI) of 11.7 T was used together with image analysis to visualize the ovine IVDs. METHODS Three-dimensional image stacks from eight IVDs harvested from sheep, half of which were 4 to 5 years old and the others approximately 2 years old were reconstructed and examined, and their microstructure were imaged. The overall structure of the disc, including the average of 14 AF lamellae (9-28), NP, and EP was then visualized with particular attention given to integrating elements as radial translamellar cross-links, AF-NP transition zone EP-AF integration and EP-NP insertion nodes (ie the connecting junctions between the EP and NP). Moreover, collagen fiber orientation was determined at different depths and locations throughout the annulus. RESULTS It was found that there was a clearer demarcation in the AF-NP transition zone of the younger discs compared with the older ones. This difference was reflected in the visibility of AF-NP and EP-AF integration. It was also possible to view the fiber architecture of the AF-NP integration in greater depth than was possible previously with histological techniques. These fibers were mainly observed in the younger discs and their length was measured to be of 2.6 ± 0.2 mm. CONCLUSIONS The present results provide a substantial advance in visualization of the three-dimensional architecture of an intact IVD and the integration of its components.
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Schwan S, Ludtka C, Wiesner I, Baerthel A, Friedmann A, Göhre F. Percutaneous posterolateral approach for the simulation of a far-lateral disc herniation in an ovine model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:222-230. [PMID: 29080003 DOI: 10.1007/s00586-017-5362-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE This work describes a minimally invasive damage model for ovine lumbar discs via partial nucleotomy using a posterolateral approach. METHODS Two cadavers were dissected to analyze the percutaneous corridor. Subsequently, 28 ovine had their annulus fibrosus punctured via awl penetration under fluoroscopic control and nucleus pulposus tissue removed via rongeur. Efficacy was assessed by animal morbidity, ease of access to T12-S1 disc spaces, and production of a mechanical injury as verified by discography, radiography, and histology. RESULTS T12-S1 were accessible with minimal nerve damage morbidity. Scar tissue sealed the disc puncture site in all animals within 6 weeks, withstanding 1 MP of intradiscal pressure. Partial nucleotomy led to a significant reduction in intervertebral disk height and an increased histological degeneration score. CONCLUSION Inducing a reproducible injury pattern of disc degeneration required minimal time, effort, and equipment. The posterolateral approach allows operation on several discs within a single surgery and multiple animal surgeries within a single day.
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Affiliation(s)
- Stefan Schwan
- Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Hülse-Str. 1, 06120, Halle (Saale), Germany.
| | - Christopher Ludtka
- Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Hülse-Str. 1, 06120, Halle (Saale), Germany.,Department of Chemical and Biomolecular Engineering, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Ingo Wiesner
- Department of General, Visceral and Vascular Surgery, BG-Klinik Bergmannstrost, Halle (Saale), Germany
| | - Andre Baerthel
- Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Andrea Friedmann
- Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Hülse-Str. 1, 06120, Halle (Saale), Germany
| | - Felix Göhre
- Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Department of Neurosurgery, BG-Klinik Bergmannstrost, Halle (Saale), Germany.,Department of Neurosurgery, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
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Comparison of Synchrotron Radiation-based Propagation Phase Contrast Imaging and Conventional Micro-computed Tomography for Assessing Intervertebral Discs and Endplates in a Murine Model. Spine (Phila Pa 1976) 2017; 42:E883-E889. [PMID: 28187077 DOI: 10.1097/brs.0000000000002110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The synchrotron radiation-based micro-computed tomography (SRμCT) and micro-CT (μCT) were applied to comparatively assess the intervertebral disc (IVD) and endplate (EP). OBJECTIVE To explore a new approach to evaluate the detailed structure of the IVD and EP during maturation and aging in a murine model. SUMMARY OF BACKGROUND DATA Till date, methods to observe the morphological changes in the IVD and EP from rodents have been relatively limited. SRμCT has been recognized as a potential way to visualize the structures containing sclerous and soft tissue. Our study focused on comparing the capacity of SRμCT and μCT in evaluating the detailed structure of the IVD and EP. METHODS Both SRμCT and μCT were performed to depict the structure of spinal tissue from 4-month-old mice. Then, the imaging quality was evaluated in the three-dimensional (3D) reconstructed model. Further, the changes in the EP and IVD during the maturation and aging process were assessed morphologically and quantitatively using SRμCT. RESULTS The 3D reconstructed model of the EP from both μCT and SRμCT provided detailed information on its inner structure. However, the IVD was only depicted using SRμCT. Multi-angle observations of the 3D structure of EP and IVD from mice of different ages (15 days, 2 months, 4 months, and 18 months) were dynamically performed by SRμCT. Quantitative evaluations indicated that the total volume of EP and IVD, the average height of IVD and the canal-total volume ratio of EP increased from 15-day-old mice to 4-month-old mice and decreased in 18-month-old mice. CONCLUSION The EP and IVD were clearly visualized using SRμCT. Compared with μCT, SRμCT provided a better ultrahigh resolution image of soft tissue and hard tissue simultaneously, which makes it a promising approach for the noninvasive study of disc degeneration. LEVEL OF EVIDENCE N /A.
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Abstract
STUDY DESIGN High resolution imaging investigation of the failure of ovine lumbar intervertebral discs under complex loading. OBJECTIVE To investigate how different loading combinations influence the mechanism and extent of intervertebral disc failure. SUMMARY OF BACKGROUND DATA Even though there has been extensive research on how an intervertebral disc fails under various conditions, failure mechanisms remain unclear. In addition, the influence of different loading directions on the mode and extent of failure under complex loading was never systematically investigated. METHODS Thirty ovine lumbar spinal segments were loaded in a newly developed, dynamic, 6-degree-of-freedom (6-DOF) disc loading simulator under five combinations of the following loading parameters: 0°-13° flexion, 0°-10° lateral bending, 0°-4° axial rotation, 0-800 N axial compression. A total of 1000 cycles at 2 Hz were done. After testing, imaging of the discs was performed in an ultra-high field magnetic resonance imaging (11.7 T) scanner and with a micro-computed tomography scanner. RESULTS A total of 13 large endplate junction failures (EPJFs) occurred, of which all but one maintained an intact cartilaginous endplate. Ten out of 13 EPJFs occurred caudally. Four solely annulus failures occurred affecting only the outer posterior annulus. A herniation was not observed. The maximum moments measured in any group (median) were 52.5 N · m flexion, 16.5 N · m lateral bending, and 14.0 N · m axial rotation. CONCLUSION Complex loading protocols could lead to EPJFs (76%) and annulus failures (24%) in vitro. The combination of flexion, lateral bending, axial rotation, and axial compression bears the highest risk for caudal EPJF. Flexion without lateral bending and vice versa has the lowest risk for failure. Both axial compression and axial rotation seem to have a smaller influence than flexion and lateral bending. It seems that a herniation requires an additional failure of the cartilaginous endplate, likely initiated by further axial compressive load. LEVEL OF EVIDENCE 4.
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Wilke HJ, Kienle A, Maile S, Rasche V, Berger-Roscher N. A new dynamic six degrees of freedom disc-loading simulator allows to provoke disc damage and herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1363-1372. [DOI: 10.1007/s00586-016-4416-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 12/14/2015] [Accepted: 01/19/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Purpose
The cause of disc herniation is not well understood yet. It is assumed that heavy lifting and extreme postures can cause small injuries starting either in the inner anulus or from the outside close to the endplate. Such injuries are accumulated over years until its structure is weakened and finally a single loading event leads to a sudden failure of the last few intact lamellae. This paper describes a novel, custom-developed dynamic 6-DOF disc-loading simulator that allows complex loading to provoke such disc damage and herniations.
Methods
The machine’s axes are driven by six independent servomotors providing high loads (10 kN axial compression, 2 kN shear, 100 Nm torque) up to 5 Hz. A positional accuracy test was conducted to validate the machine. Subsequently, initial experiments with lumbar ovine motion segments under complex loading were performed. After testing, the discs were examined in an ultra-high field MRI (11.7 T). A three-dimensional reconstruction was performed to visualise the internal disc lesions.
Results
Validation tests demonstrated positioning with an accuracy of ≤0.08°/≤0.026 mm at 0.5 Hz and ≤0.27°/≤0.048 mm at 3.0 Hz with amplitudes of ±17°/±2 mm. Typical failure patterns and herniations could be provoked with complex asymmetrical loading protocols. Loading with axial compression, flexion, lateral bending and torsion lead in 8 specimens to 4 herniated discs, two protrusions and two delaminations. All disc failures occurred in the posterior region of the disc.
Conclusion
This new dynamic disc-loading simulator has proven to be able to apply complex motion combinations and allows to create artificial lesions in the disc with complex loading protocols. The aim of further tests is to better understand the mechanisms by which disc failure occurs at the microstructural level under different loading conditions. Visualisation with ultra-high field MRI at different time points is a promising method to investigate the gradual development of such lesions, which may finally lead to disc failure. These kinds of experiments will help to better investigate the mechanical failure of discs to provide new insights into the initiation of intervertebral disc herniation. This device will also serve for many other applications in spine biomechanics research.
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