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Gaume M, Loiselet K, Chekir H, Langlais T, Boddaert N, Stricker S, Pannier S, Skalli W, Miladi L, Vergari C. Evidence of spinal stiffening following fusionless bipolar fixation for neuromuscular scoliosis: a shear wave elastography assessment of lumbar annulus fibrosus. 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 2024; 33:1617-1623. [PMID: 37924389 DOI: 10.1007/s00586-023-08013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES There are no established criteria for stiffness after fusionless surgery for neuromuscular scoliosis (NMS). As a result, there is no consensus regarding the surgical strategy to propose at long-term follow-up. This study reports the first use of shear wave elastography for assessing the mechanical response of lumbar intervertebral discs (IVDs) after fusionless bipolar fixation (FBF) for NMS and compares them with healthy controls. The aim was to acquire evidence from the stiffness of the spine following FBF. PATIENTS AND METHODS Nineteen NMS operated on with FBF (18 ± 2y at last follow-up, 6 ± 1 y after surgery) were included prospectively. Preoperative Cobb was 89 ± 20° and 35 ± 1° at latest follow-up. All patients had reached skeletal maturity. Eighteen healthy patients (20 ± 4 y) were also included. Shear wave speed (SWS) was measured in the annulus fibrosus of L3L4, L4L5 and L5S1 IVDs and compared between the two groups. A measurement reliability was performed. RESULTS In healthy subjects, average SWS (all disc levels pooled) was 7.5 ± 2.6 m/s. In NMS patients, SWS was significantly higher at 9.9 ± 1.4 m/s (p < 0.05). Differences were significant between L3L4 (9.3 ± 1.8 m/s vs. 7.0 ± 2.5 m/s, p = 0.004) and L4L5 (10.3 ± 2.3 m/s vs. 7.1 ± 1.1 m/s, p = 0.0006). No difference was observed for L5S1 (p = 0.2). No correlation was found with age at surgery, Cobb angle correction and age at the SWE measurement. CONCLUSIONS This study shows a significant increase in disc stiffness at the end of growth for NMS patients treated by FBF. These findings are a useful adjunct to CT-scan in assessing stiffness of the spine allowing the avoidance of surgical final fusion at skeletal maturity.
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Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France.
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
- Necker Hospital, 149 Rue de Sevres, 75015, Paris, France.
| | - Klervie Loiselet
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Hedi Chekir
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Tristan Langlais
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Sarah Stricker
- Neurosurgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Stéphanie Pannier
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
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Galinié P, Eyssartier C, Sauret C, Tordjman M, Pissonier ML, Carlier R, Skalli W, Vergari C. In-vivo characterization of the lumbar annulus fibrosus in adults with ultrasonography and shear wave elastography. Med Eng Phys 2023; 120:104044. [PMID: 37838398 DOI: 10.1016/j.medengphy.2023.104044] [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: 06/17/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 10/16/2023]
Abstract
In vivo characterization of intervertebral disc (IVD) mechanical properties and microstructure could give an insight into the onset and progression of disc pathologies. Ultrasound shearwave elastography provided promising results in children, but feasibility in adult lumbar discs, which are deep in the abdomen, was never proved. The aim of this work was to determine the feasibility and reliability of ultrasound assessment of lumbar IVD in adults. Thirty asymptomatic adults were included (22 to 67 years old). Subjects were lying supine, and the annulus fibrosus of the L3-L4 IVD was imaged by conventional ultrasonography and shearwave elastography. Shear wave speed (SWS) and lamellar thickness were measured. Reliability was determined through repeated measurements acquired by three operators. Average SWS in AF at the L3L4 level was 4.0 ± 0.9 m/s, with an inter-operator uncertainty of 8.7%, while lamellar thickness was 255 ± 27 µm with an uncertainty of 9.6%. Measurement was not feasible in one out of four subjects with BMI > 24 kg/m² (overweight). Ultrasound assessment of annulus fibrosus revealed feasible, within certain limitations, and reproducible. This method gives an insight into disc microstructure and mechanical properties, and it could be applied for the early detection or follow-up of disc pathologies.
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Affiliation(s)
- Priscilla Galinié
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Camille Eyssartier
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Fédération Française de Gymnastique, Paris, France
| | - Christophe Sauret
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Centre d'Etudes et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, France
| | - Mickael Tordjman
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Marie-Line Pissonier
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Robert Carlier
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Wafa Skalli
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Claudio Vergari
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France.
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Yancey M, Rbil N, Chatterjee A, Lin H, Wyles HL, Ko LM, Nwawka OK, Khormaee S. Ultrasound Shear Wave Elastography Quantitatively Assesses Tension Changes of Supraspinous/Interspinous Ligament Complex Under Varied Loads. Int J Spine Surg 2023; 17:502-510. [PMID: 37402508 PMCID: PMC10478687 DOI: 10.14444/8479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Although interspinous and supraspinous ligaments of the lumbar spine are thought to contribute to spinal stability, little is known about their dynamic biomechanics. We demonstrate that shear wave elastography (SWE) offers a novel technique to noninvasively and quantitatively evaluate posterior spinous ligament complex functional loading and stiffness in different physiologic positions. METHODS We performed SWE and measured the length of the interspinous/supraspinous ligament complex in cadaveric torsos (N = 5), isolated ligaments (N = 10), and healthy volunteers (N = 9) to obtain length and shear wave velocity measurements. For cadavers and volunteers, SWE was utilized in 2 lumbar positions: lumbar spine flexion and extension. In addition, SWE was performed on isolated ligaments undergoing uniaxial tension to correlate shear wave velocities with experienced load. RESULTS Average shear wave velocity in cadaveric supraspinous/interspinous ligament complexes increased for lumbar levels (23%-43%) and most thoracic levels (0%-50%). This corresponded to an average increase in interspinous distance from extension to flexion for the lumbar spine (19%-63%) and thoracic spine (3%-8%). Volunteer spines also demonstrated an average increase in shear wave velocity from extension to flexion for both the lumbar spine (195% at L2-L3 to 200% at L4-L5) and thoracic spine (31% at T10-T11). There was an average increase in interspinous distance from extension to flexion for the lumbar spine (93% at L2-L3 to 127% at L4-L5) and thoracic spine (11% at T10-T11). In isolated ligaments, there was a positive correlation between applied tensile load and average shear wave velocity. CONCLUSION This study creates a foundation to apply SWE as a noninvasive tool for assessing the mechanical stiffness of posterior ligamentous structures and has potential applications in augmenting or evaluating these ligaments in patients with spine pathology. CLINICAL RELEVANCE The interspinous and supraspinous ligaments are critical soft tissue supports of the posterior lumbar spine. Disruption of these structures is thought to have a negative impact on spinal stability in trauma and spine deformities. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Nada Rbil
- Hospital for Special Surgery, New York, NY, USA
| | | | - Hannah Lin
- Hospital for Special Surgery, New York, NY, USA
| | | | - Lydia M Ko
- Hospital for Special Surgery, New York, NY, USA
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Zeng HZ, Zheng LD, Xu ML, Zhu SJ, Zhou L, Candito A, Wu T, Zhu R, Chen Y. Biomechanical effect of age-related structural changes on cervical intervertebral disc: A finite element study. Proc Inst Mech Eng H 2022; 236:1541-1551. [DOI: 10.1177/09544119221122007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous literature has investigated the biomechanical response of healthy and degenerative discs, but the biomechanical response of suboptimal healthy intervertebral discs received less attention. The purpose was to compare the biomechanical responses and risk of herniation of young healthy, suboptimal healthy, and degenerative intervertebral discs. A cervical spine model was established and validated using the finite element method. Suboptimal healthy, mildly, moderately, and severely degenerative disc models were developed. Disc height deformation, range of motion, intradiscal pressure, and von Mises stress in annulus fibrosus were analyzed by applying a moment of 4 Nm in flexion, extension, lateral bending, and axial rotation with 100 N compressive loads. Disc height deformation in young healthy, suboptimal healthy, mildly, moderately, and severely degenerative discs was 40%, 37%, 21%, 12%, and 8%, respectively. The decreasing order of the range of motion was young healthy spine > suboptimal healthy spine > mildly degenerative spine > moderately degenerative spine > severely degenerative spine. The mean stress of annulus ground substance in the suboptimal healthy disc was higher than in the young healthy disc. The mean stress of inter-lamellar matrix and annulus ground substance in moderately and severely degenerative discs was higher than in other discs. Age-related structural changes and degenerative changes increased the stiffness and reduced the elastic deformation of intervertebral discs. Decreased range of motion due to the effects of aging or degeneration on the intervertebral disc, may cause compensation of adjacent segments and lead to progressive degeneration of multiple segments. The effect of aging on the intervertebral disc increased the risk of annulus fibrosus damage from the biomechanical point of view. Moderately and severely degenerative discs may have a higher risk of herniation due to the higher risk of damage and layers separation of annulus fibrosus caused by increased stress in the annulus ground substance and inter-lamellar matrix.
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Affiliation(s)
- Hui-zi Zeng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang-dong Zheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meng-lei Xu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shi-jie Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Zhou
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Antonio Candito
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Clinical Research Center for Ageing and Medicine, Shanghai, China
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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Pickering E, Pivonka P, Little JP. Toward Patient Specific Models of Pediatric IVDs: A Parametric Study of IVD Mechanical Properties. Front Bioeng Biotechnol 2021; 9:632408. [PMID: 33659242 PMCID: PMC7917075 DOI: 10.3389/fbioe.2021.632408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022] Open
Abstract
Patient specific finite element (FE) modeling of the pediatric spine is an important challenge which offers to revolutionize the treatment of pediatric spinal pathologies, for example adolescent idiopathic scoliosis (AIS). In particular, modeling of the intervertebral disc (IVD) is a unique challenge due to its structural and mechanical complexity. This is compounded by limited ability to non-invasively interrogate key mechanical parameters of a patient's IVD. In this work, we seek to better understand the link between mechanical properties and mechanical behavior of patient specific FE models of the pediatric lumbar spine. A parametric study of IVD parameter was conducted, coupled with insights from current knowledge of the pediatric IVD. In particular, the combined effects of parameters was investigated. Recommendations are made toward areas of importance in patient specific FE modeling of the pediatric IVD. In particular, collagen fiber bundles of the IVD are found to dominate IVD mechanical behavior and are thus recommended as an area of primary focus for patient specific FE models. In addition, areas requiring further experimental research are identified. This work provides a valuable building block toward the development of patient specific models of the pediatric spine.
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Affiliation(s)
- Edmund Pickering
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - J Paige Little
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
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