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Zheng LD, Lv HY, Yang YT, Yuan Q, Cao YT, Zhang K, Zhu R. Effect of compressive and tensile forces on glucose concentration and cell viability within the intervertebral disc: A finite element study. Med Eng Phys 2024; 129:104189. [PMID: 38906572 DOI: 10.1016/j.medengphy.2024.104189] [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: 01/04/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
Understanding the role of mechanical force on tissue nutrient transport is essential, as sustained force may affect nutrient levels within the disc and initiate disc degeneration. This study aims to evaluate the time-dependent effects of different compressive force amplitudes as well as tensile force on glucose concentration and cell viability within the disc. Based on the mechano-electrochemical mixture theory, a multiphasic finite element model of the lumbar intervertebral disc was developed. The minimum glucose concentration and minimum cell density in both normal and degenerated discs were predicted for different compressive force amplitudes, tensile force, and corresponding creep time. Under high compressive force, the minimum glucose concentration exhibited an increasing and then decreasing trend with creep time in the normal disc, whereas that of the degenerated disc increased, then decreased, and finally increased again. At steady state, a higher compressive force was accompanied by a lower glucose concentration distribution. In the degenerated disc, the minimum cell density was negatively correlated with creep time, with a greater range of affected tissue under a higher compressive force. For tensile force, the minimum glucose concentration of the degenerated disc raised over time. This study highlighted the importance of creep time, force magnitude, and force type in affecting nutrient concentration and cell viability. Sustained weight-bearing activities could deteriorate the nutrient environment of the degenerated disc, while tensile force might have a nonnegligible role in effectively improving nutrient levels within the degenerated disc.
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Affiliation(s)
- Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Hao-Yang Lv
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Qing Yuan
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai 200092, China
| | - Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Kai Zhang
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai 200092, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China.
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Nikkhoo M, Wang JL, Cheng CH, Parnianpour M, Khalaf K. Enzymatic denaturation versus excessive fatigue loading degeneration: Effects on the time-dependent response of the intervertebral disc. J Biomech 2024; 171:112159. [PMID: 38852480 DOI: 10.1016/j.jbiomech.2024.112159] [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: 08/30/2023] [Revised: 03/23/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
Degenerative disc disease (DDD), regardless of its phenotype and clinical grade, is widely associated with low back pain (LBP), which remains the single leading cause of disability worldwide. This work provides a quantitative methodology for comparatively investigating artificial IVD degeneration via two popular approaches: enzymatic denaturation and fatigue loading. An in-vitro animal study was used to study the time-dependent responses of forty fresh juvenile porcine thoracic IVDs in conjunction with inverse and forward finite element (FE) simulations. The IVDs were dissected from 6-month-old-juvenile pigs and equally assigned to 5 groups (intact, denatured, low-level, medium-level, high-level fatigue loading). Upon preloading, a sinusoid cyclic load (Peak-to-peak/0.1-to-0.8 MPa) was applied (0.01-10 Hz), and dynamic-mechanical-analyses (DMA) was performed. The DMA outcomes were integrated with a robust meta-model analysis to quantify the poroelastic IVD characteristics, while specimen-specific FE models were developed to study the detailed responses. The results demonstrated that enzymatic denaturation had a more significantly pronounced effect on the resistive strength and shock attenuation capabilities of the intervertebral discs. This can be attributed to the simultaneous disruption of the collagen fibers and water-proteoglycan bonds induced by trypsin digestion. Fatigue loading, on the other hand, primarily influenced the disc's resistance to deformation in a frequency-dependent pattern, where alterations were most noticeable at low loading frequencies. This study confirms the intricate interplay between the biochemical changes induced by enzymatic processes and the mechanical behavior stemming from fatigue loading, suggesting the need for a comprehensive approach to closely mimic the interrelated multifaceted processes of human disc degeneration.
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Affiliation(s)
- Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Center of Medical Devices, National Taiwan University, Taipei, Taiwan.
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates.
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Huang W, Wang W, Xu X, Wang L, Wang J, Yu X. Radiological outcomes of PEEK rods in patients with lumbar degenerative diseases: A minimum 5-year follow-up. Front Surg 2023; 10:1146893. [PMID: 37051573 PMCID: PMC10083248 DOI: 10.3389/fsurg.2023.1146893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
PurposeTo determine the long-term radiological outcomes of PEEK rods in patients with lumbar degenerative diseases.MethodsRadiological outcomes of cohort cases with lumbar degenerative diseases following PEEK rods were retrospectively studied. Disc height index (DHI) and range of motion (ROM) were measured by x-rays. The CT scans and reconstruction were used to determine screw breakage, rods fracture, screw loosening and intervertebral bony fusion status. The MRI scans were used to evaluate the changes of intervertebral discs at the non-fusion segments and adjacent segments in terms of Pfirrmann Classification.ResultsA total of 40 patients completed the mean of 74.8 ± 9.6 months follow-up, with 32 patients undergoing hybrid surgery and 8 patients undergoing non-fusion surgery. The mean DHI changed from preoperative 0.34 to 0.36 at the final follow-up and the ROM declined from 8.8° preoperatively to 3.2° at the final visit, however, both had no statistical differences. Of the 40 levels underwent non-fusion procedure, 9 levels showed disc rehydration with 7 patients from Grade 4 to Grade 3 and 2 patients from Grade 3 to Grade 2. The other 30 cases did not show distinctive change. No screw loosening or rods breakage were detected during the follow-up periods.ConclusionPEEK rods have obvious protective effects on degenerated intervertebral disc of non-fusion segments and the incidence of complications related to internal fixation is low. PEEK rods pedicle screw system is safe and effective in the treatment of lumbar degenerative diseases.
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In-vitro models of disc degeneration - A review of methods and clinical relevance. J Biomech 2022; 142:111260. [PMID: 36027637 DOI: 10.1016/j.jbiomech.2022.111260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
Abstract
The intervertebral disc (IVD) provides flexibility, acts as a shock absorber, and transmits load. Degeneration of the IVD includes alterations in the biomechanics, extracellular matrix (ECM), and cellular activity. These changes are not always perceived, however, IVD degeneration can lead to severe health problems including long-term disability. To understand the pathogenesis of IVD degeneration and suitable testing methods for emerging treatments and therapies, this review documents in-vitro models of IVD degeneration including physical disruption, hyperphysiological loading, ECM degradation by enzyme digestion, or a combination of these methods. This paper reviews and critically analyses the models of degeneration published since the year 2000 in either in human or animal specimens. The results are categorised in terms of the IVD biomechanics, physical attributes, ECM composition, tissue damage and cellularity to evaluate the models with respect to natural human degeneration, and to provide recommendations for clinically relevant models for the various stages of degeneration. There is no one model that replicates the wide range of degenerative changes that occur as part of normal degeneration. However, cyclic overloading replicates many aspects of degeneration, with the advantage of a dose-response allowing the tuning of damage initiated. Models of severe degeneration are currently lacking, but there is potential that combining cyclic overloading and enzymatic digestion will provide model that closely resembles human IVD degeneration. This will provide an effective way to investigate the effects of severe degeneration, and the evaluation of treatments for the IVD, which would generally be indicated at this advanced stage of degeneration.
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Liu ZZ, Wen HQ, Zhu YQ, Zhao BL, Kong QC, Chen JY, Guo RM. Short-Term Effect of Lumbar Traction on Intervertebral Discs in Patients with Low Back Pain: Correlation between the T2 Value and ODI/VAS Score. Cartilage 2021; 13:414S-423S. [PMID: 33622056 PMCID: PMC8808794 DOI: 10.1177/1947603521996793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effect of lumbar traction on low back pain (LBP) patients is controversial. Our study aims to assess changes in the intervertebral disc water content after lumbar traction using T2 mapping and explore the correlation between changes in the T2 value and Oswestry Disability Index (ODI)/visual analogue scale (VAS) score. DESIGN Lumbar spine magnetic resonance imaging was performed, and the ODI/VAS scores were recorded in all 48 patients. Midsagittal T2-weighted imaging and T2 mapping were performed to determine the Pfirrmann grade and T2 value. Then, the T2 values were compared between pre- and posttraction, and the correlation between changes in the T2 value and ODI/VAS scores were examined. RESULTS In the traction group, the changes in the nucleus pulposus (NP) T2 values for Pfirrmann grades II-IV and the annulus fibrosus (AF) T2 values for Pfirrmann grade II were statistically significant after traction (P < 0.05). Changes in the mean NP T2 value of 5 discs in each patient and in the ODI/VAS score showed a strong correlation (r = 0.822, r = 0.793). CONCLUSION T2 mapping can be used to evaluate changes in the intervertebral disc water content. Ten sessions of traction resulted in a significant increase in quantitative T2 measurements of the NP in discs for Pfirrmann grade II-IV degeneration and remission of the patients' clinical symptoms in the following 6 months. Changes in the mean NP T2 value of 5 discs in each patient were strongly correlated with changes in the ODI/VAS score.
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Affiliation(s)
- Zhen-zhen Liu
- Department of Radiology, The Third
Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,Jian-yu Chen, Department of Radiology, Sun
Yat-Sen memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West,
Guangzhou, 510120, China.
| | - Hui-quan Wen
- Department of Radiology, The Third
Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ye-qing Zhu
- Department of Radiology, Icahn School of
Medicine at Mount Sinai, New York, NY, USA
| | - Bin-liang Zhao
- Department of Radiology, The Third
Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qing-cong Kong
- Department of Radiology, The Third
Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-yu Chen
- Department of Radiology, Sun Yat-Sen
Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruo-mi Guo
- Department of Radiology, The Third
Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Shalash W, Ahrens SR, Bardonova LA, Byvaltsev VA, Giers MB. Patient-specific apparent diffusion maps used to model nutrient availability in degenerated intervertebral discs. JOR Spine 2021; 4:e1179. [PMID: 35005445 PMCID: PMC8717112 DOI: 10.1002/jsp2.1179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In this study, magnetic resonance imaging data was used to (1) model IVD-specific gradients of glucose, oxygen, lactate, and pH; and (2) investigate possible effects of covariate factors (i.e., disc geometry, and mean apparent diffusion coefficient values) on the IVD's microenvironment. Mathematical modeling of the patient's specific IVD microenvironment could be important when selecting patients for stem cell therapy due to the increased nutrient demand created by that treatment. MATERIALS AND METHODS Disc geometry and water diffusion coefficients were extracted from MRIs of 37 patients using sagittal T1-weighted images, T2-weighted images, and ADC Maps. A 2-D steady state finite element mathematical model was developed in COMSOL Multiphysics® 5.4 to compute concentration maps of glucose, oxygen, lactate and pH. RESULTS Concentration of nutrients (i.e., glucose, and oxygen) dropped with increasing distance from the cartilaginous endplates (CEP), whereas acidity levels increased. Most discs experienced poor nutrient levels along with high acidity values in the inner annulus fibrosus (AF). The disc's physiological microenvironment became more deficient as degeneration progressed. For example, minimum glucose concentration in grade 4 dropped by 31.1% compared to grade 3 (p < 0.0001). The model further suggested a strong effect of the following parameters: disc size, AF and CEP diffusivities, metabolic reactions, and cell density on solute concentrations in the disc (p < 0.05). CONCLUSION The significance of this work implies that the individual morphology and physiological conditions of each disc, even among discs of the same Pfirrmann grade, should be evaluated when modeling IVD solute concentrations.
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Affiliation(s)
- Ward Shalash
- School of Chemical, Biological and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
| | - Sonia R. Ahrens
- School of Chemical, Biological and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
| | - Liudmila A. Bardonova
- School of Chemical, Biological and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
- Irkutsk State Medical UniversityIrkutskRussia
| | - Vadim A. Byvaltsev
- Irkutsk State Medical UniversityIrkutskRussia
- Railway Clinical Hospital at the Irkutsk‐Passazhirsky StationIrkutskRussia
| | - Morgan B. Giers
- School of Chemical, Biological and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
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Zaïri F, Moulart M, Fontaine C, Zaïri F, Tiffreau V, Logier R. Relevance of a novel external dynamic distraction device for treating back pain. Proc Inst Mech Eng H 2020; 235:264-272. [PMID: 33243076 DOI: 10.1177/0954411920971401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low back pain is a common, expensive, and disabling condition in industrialized countries. There is still no consensus for its ideal management. Believing in the beneficial effect of traction, we developed a novel external dynamic distraction device. The purpose of this work was to demonstrate that external distraction allows limiting the pressure exerted in standing-up position on the lower intervertebral discs. Numerical and cadaveric studies were used as complementary approaches. Firstly, we implemented the device into a numerical model of a validated musculoskeletal software (Anybody Modeling System) and we calculated the lower disc pressure while traction forces were applied. Secondly, we performed an anatomical study using a non-formalin preserved cadaver placed in a sitting position. A pressure sensor was placed in the lower discs under fluoroscopic control through a Jamshidi needle. The intradiscal pressure was then measured continuously at rest while applying a traction force of 200 N. Both numerical and cadaveric studies demonstrated a decrease in intradiscal pressures after applying a traction force with the external device. Using the numerical model, we showed that tensile forces below 500 N in total were sufficient. The application of higher forces seems useless and potentially deleterious. External dynamic distraction device is able to significantly decrease the intradiscal pressure in a sitting or standing position. However, the therapeutic effects need to be proven using clinical studies.
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Affiliation(s)
- Fahed Zaïri
- Department of Neurosurgery, Hôpital privé Le Bois, Ramsay Générale de Santé, Lille, France
| | | | | | - Fahmi Zaïri
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | | | - Régis Logier
- CIC-IT, Lille University Hospital, Lille, France
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Giers MB, Bardonova L, Eyster K, Byvaltsev V, Preul MC. APOPTOSIS, NUTRITION, AND METABOLISM OF TRANSPLANTED INTERVERTEBRAL DISC CELLS. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181704191006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Apoptosis is a contributing factor to degenerating intervertebral disc (IVD). Disc regeneration has been attempted by transplanting cells into the disc, with some gains in disc height achieved in animal models. Here, we study whether the apoptotic microenvironment affects the transplanted disc cells. Methods: Human annulus fibrosus (AF) and nucleus pulposus (NP) cells were grown in media then starved for 5 days in vitro by not changing the media. Three aspects of apoptotic cell influence on the transplanted cells were tested in a total of 32 samples: 1) the effect of apoptotic cytokines in the media, 2) reduced glucose in the media, and 3) apoptotic cell bodies in the flask. The Trypan Blue, AlamarBlue®, and 1,9-Dimethyl-Methylene Blue assays for sulfated glycosaminoglycan (sGAG) content were performed (n=4). Results: There were significant decreases in cell viability between the control, 25% conditioned media (CM) and starved control group. There were no significant differences in cell number, metabolic activity or sGAG production in cells grown in different conditioned media compared to cells grown in complete media. The cells of the control decreased in viability and number over the 5 days without feeding, then improved dramatically when feeding was resumed. Flasks that received transplanted cells in addition to renewed feeding did not recover as much as the cells in the re-fed group. Conclusions: Cytokines from starved cells negatively impact on the viability of healthy cells. Starving cells that receive new sources of nutrition have even higher viability than transplanted cells. This indicates that altering and improving the nutrient supply problem in the IVD could be a valuable option. Level of Evidence III; Case control studyg.
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Affiliation(s)
- Morgan B. Giers
- St. Joseph's Hospital and Medical Center, USA; Arizona State University, USA
| | - Liudmila Bardonova
- St. Joseph's Hospital and Medical Center, USA; Irkutsk Scientific Center of Surgery and Traumatology, Russia; Irkutsk State Medical University, Russia
| | | | - Vadim Byvaltsev
- Irkutsk Scientific Center of Surgery and Traumatology, Russia; Irkutsk State Medical University, Russia
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Bardonova LA, Sheikh O, Malova IO, Sorokovikov VA, Byvaltsev VA. ENERGY SUPPLY AND DEMAND IN THE INTERVERTEBRAL DISC. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The intervertebral disc (IVD) is one of the parts of the body most commonly affected by disease, and it is only recently that we have come closer to understanding the reasons for its degeneration, in which nutrient supply plays a crucial role. In this literature review, we discuss the basic principles and characteristics of energy supply and demand to the IVD. Specifically, we review how different metabolites influence IVD cell activity, the effects of mechanical loading on IVD cell metabolism, and differences in energy metabolism of the annulus fibrous and nucleus pulposus cell phenotypes. Determining the factors that influence nutrient supply and demand in the IVD will enhance our understanding of the IVD pathology, and help to elucidate new therapeutic targets for IVD degeneration treatment.
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Moriguchi Y, Mojica-Santiago J, Grunert P, Pennicooke B, Berlin C, Khair T, Navarro-Ramirez R, Ricart Arbona RJ, Nguyen J, Härtl R, Bonassar LJ. Total disc replacement using tissue-engineered intervertebral discs in the canine cervical spine. PLoS One 2017; 12:e0185716. [PMID: 29053719 PMCID: PMC5650136 DOI: 10.1371/journal.pone.0185716] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/18/2017] [Indexed: 01/07/2023] Open
Abstract
The most common reason that adults in the United States see their physician is lower back or neck pain secondary to degenerative disc disease. To date, approaches to treat degenerative disc disease are confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Tissue engineered intervertebral discs (TE-IVDs) have been proposed as an alternative approach and have shown promise in replacing native IVD in the rodent tail spine. Here we demonstrate the efficacy of our TE-IVDs in the canine cervical spine. TE-IVD components were constructed using adult canine annulus fibrosis and nucleus pulposus cells seeded into collagen and alginate hydrogels, respectively. Seeded gels were formed into a single disc unit using molds designed from the geometry of the canine spine. Skeletally mature beagles underwent discectomy with whole IVD resection at levels between C3/4 and C6/7, and were then divided into two groups that received only discectomy or discectomy followed by implantation of TE-IVD. Stably implanted TE-IVDs demonstrated significant retention of disc height and physiological hydration compared to discectomy control. Both 4-week and 16-week histological assessments demonstrated chondrocytic cells surrounded by proteoglycan-rich matrices in the NP and by fibrocartilaginous matrices in the AF portions of implanted TE-IVDs. Integration into host tissue was confirmed over 16 weeks without any signs of immune reaction. Despite the significant biomechanical demands of the beagle cervical spine, our stably implanted TE-IVDs maintained their position, structure and hydration as well as disc height over 16 weeks in vivo.
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Affiliation(s)
- Yu Moriguchi
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Jorge Mojica-Santiago
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
| | - Peter Grunert
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Brenton Pennicooke
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Connor Berlin
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Thamina Khair
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Rodolfo J. Ricart Arbona
- Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center & Weill Cornell Medicine, New York, NY, United States of America
| | - Joseph Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, Hospital for Special Surgery, New York, NY, United States of America
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Lawrence J. Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
- * E-mail:
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Mitchell UH, Beattie PF, Bowden J, Larson R, Wang H. Age-related differences in the response of the L5-S1 intervertebral disc to spinal traction. Musculoskelet Sci Pract 2017. [PMID: 28624722 DOI: 10.1016/j.msksp.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lumbar traction is a common treatment for low back pain; however its mechanisms of action are poorly understood. It has been hypothesized that a key effect of lumbar traction is its capacity to influence fluid movement within the intervertebral disc (IVD). OBJECTIVES To determine differences in the apparent diffusion coefficient (ADC) obtained with lumbar diffusion-weighted imaging (DWI) of the L5-S1 IVD before, and during, the application of lumbar traction. DESIGN Case series, repeated measures. METHODS A static traction load of ∼50% of body-weight was applied to the low back using a novel "MRI-safe" apparatus. DWI of the lumbar spine was performed prior to, and during the application of the traction load. RESULTS Participants were currently asymptomatic and included a young adult group (n = 18) and a middle-aged group (n = 15). The young adult group had a non-significant 2.2% increase in ADC (mean change = 0.03 × 10-3 mm2/s, SD = 0.24, 95% CI = -0.09, 0.15). The ADC for the middle-aged group significantly increased by 20% (mean change of 0.18 × 10-3 mm2/s, SD = 0.19; 95% CI = 0.07, 0.28; p = 0.003; effect size = 0.95). There was an inverse relationship between the ADC obtained before traction and the percent increase in ADC that was measured during traction. CONCLUSION Static traction was associated with an increase in diffusion of water within the L5-S1 IVDs of middle-age individuals, but not in young adults, suggesting age-related differences in the diffusion response. Further study is needed to assess the relationship between these findings and the symptoms of back pain. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA.
| | - Paul F Beattie
- Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, 1300 Wheat St., University of South Carolina, Columbia, SC, 29208, USA
| | - Jennifer Bowden
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Robert Larson
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Haonan Wang
- Department of Electrical & Computer Engineering, Brigham Young University, 459 Clyde Building, Provo, UT, 84602, USA
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Mitchell UH, Helgeson K, Mintken P. Physiological effects of physical therapy interventions on lumbar intervertebral discs: A systematic review. Physiother Theory Pract 2017; 33:695-705. [PMID: 28715273 DOI: 10.1080/09593985.2017.1345026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND CONTEXT The use of physical therapy has been recommended in the treatment of low back pain based on primarily mechanical and neurophysiological effects. Recent studies have measured the physiological effects of physical therapy interventions, including manual therapy and traction, on the intervertebral discs (IVD), and these findings may have implications for the long-term management or even prevention of low back pain. PURPOSE The objective of this systematic review is to investigate the literature regarding possible physiological effects of physical therapy interventions on the intervertebral disc (IVD). STUDY DESIGN Systematic Review. METHODS A literature search of published articles through December 2014 resulted in the retrieval of 8 clinical studies assessing the influence of physical therapy interventions on the physiology of the IVD. RESULTS Three studies, including two using animal models, investigated the effects of 30-minute intermittent traction on disc height. One in vivo animal study and two studies using human subjects assessed changes of disc height associated with static traction. Three studies investigated the effects of lumbar spine manipulation and mobilization on changes in water diffusion within the IVD. All studies confirmed, either directly or indirectly, that their respective intervention influenced disc physiology primarily through water flow. CONCLUSION Physical therapy interventions may have an effect on the physiology of the IVD, primarily through water diffusion and molecular transport, which are important for the health of the IVD.
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Affiliation(s)
- Ulrike H Mitchell
- a Department of Exercise Sciences , Brigham Young University , Provo , UT , USA
| | - Kevin Helgeson
- b Department of Physical Therapy, Rocky Mountain University of Health Professions , Provo , UT , USA
| | - Paul Mintken
- c Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine , Aurora , CO , USA
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Wang K, Wang H, Deng Z, Li Z, Zhan H, Niu W. Cervical traction therapy with and without neck support: A finite element analysis. Musculoskelet Sci Pract 2017; 28:1-9. [PMID: 28171773 DOI: 10.1016/j.msksp.2017.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/02/2017] [Accepted: 01/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cervical traction is commonly used for treating neck pain. However, few studies have investigated the biomechanical impact such traction has on soft tissues. OBJECTIVES To analyze the biomechanics of cervical traction therapy in a supine position with and without neck support (NS and non-NS). METHODS A finite element model of the cervical spine was constructed to investigate the mechanism behind cervical traction therapy. An axial traction force of 100-N was loaded on the upper surface of C0 to simulate traction weight. Neck support traction was simulated by additionally constraining anterior-posterior motion of the surface of the C4 vertebral lamina. The average von Mises stress, tensile force and motions of related tissues were calculated and compared between the two conditions. Stress in the posterior annulus fibers under flexion was also recorded for comparison. RESULTS At the C4-C5 and C5-C6 levels, NS traction resulted in less of a decrease in the lordotic angle. At these levels, the highest average stress was distributed in the posterior annulus fibers with non-NS traction and both traction therapies produced greater stress on the posterior annulus fibers than physical flexion. The intradiscal pressure in all intervertebral discs between C4-T1 decreased during both traction therapies. CONCLUSION Neck support traction therapy produced less tension on the posterior annulus fibers and ligaments posterior to it at the C4-C5 and C5-C6 levels. In order to minimize the potential harm to soft tissue in clinical practice, it may be beneficial to use a neck support according to the targeted level.
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Affiliation(s)
- Kuan Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Huihao Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Zhen Deng
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Zhengyan Li
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China.
| | - Wenxin Niu
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai 200092, China; Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), Shanghai 201619, China.
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Giers MB, Munter BT, Eyster KJ, Ide GD, Newcomb AG, Lehrman JN, Belykh E, Byvaltsev VA, Kelly BP, Preul MC, Theodore N. Biomechanical and Endplate Effects on Nutrient Transport in the Intervertebral Disc. World Neurosurg 2017; 99:395-402. [DOI: 10.1016/j.wneu.2016.12.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 01/18/2023]
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