Peak Stress in the Annulus Fibrosus Under Cyclic Biaxial Tensile Loading

Risk Factors in Patients with Low Back Pain Under 40 Years Old: Quantitative Analysis Based on Computed Tomography and Magnetic Resonance Imaging mDIXON-Quant

Purpose

While low back pain (LBP) constitutes a global life disorder cause, the contribution of paraspinal muscles to its pathogenicity remains elusive. We characterized the paraspinal muscles of patients with LBP using lumbar three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) mDIXON-Quant, and evaluated the risk factors combined with clinical data.

Methods

A retrospective study involving 181 patients (10-40 years) who underwent lumbar 3D-CT and MRI mDIXON from January 1, 2021 to December 31, 2022, and divided into normal, non-chronic LBP [non-CLBP], and CLBP groups. Clinical data, paraspinal muscle cross-sectional area, Hounsfield unit for CT values, and fat fraction derived from mDIXON-Quant were compared. Three readers analyzed the images independently; intra- and interobserver agreement was measured. Spearman analysis and multiple logistic regression were used to analyze the correlation between clinical data, radiologic and paraspinal muscle parameters. A nomogram was constructed for individualized prediction.

Results

Correlation analysis revealed that body mass index, visual analog scale score, Pfirrmann grade, annulus fibrosus tear, lumbar lordosis (LL), and Modic changes correlated with LBP (all P<0.05). The Pfirrmann grade and annulus fibrosus tear showed positive correlation (r=0.673, 0.559), whereas LL was negatively correlated (r=-0.469). The multifidus CT values were negatively correlated with LBP at L4-5/L5-S1; the multifidus fat fraction was positively correlated at L4-5/L5-S1 (r=0.734, r=0.584, P<0.001). The multiple logistic regression showed that L4-5 multifidus fat fraction (P=0.046, OR=1.167), Pfirrmann grade (P=0.017, OR=0.063), LL (P=0.002, OR=0.828) and annulus fibrosus tear (P=0.005, OR=0.024) were risk factors for predicting LBP in the non-CLBP group; in the CLBP group, BMI (P=0.048 OR=1.225), L4-5 multifidus fat fraction (P=0.001 OR=1.299), LL (P=0.003, OR=0.841) and Pfirrmann classification (P=0.009, OR=0.046) were risk factors.

Conclusion

BMI, L4-5 multifidus fat fraction, LL, and Pfirrmann grade are risk factors for CLBP in patients under 40; whereas annulus fibrosus tear is an independent risk factor for non-CLBP, nomograms derived from these parameters can help predict LBP and MRI mDIXON-Quant is recommended for quantitatively analyzing paraspinal muscle fat infiltration.

A Novel Testing Method to Quantify Mechanical Properties of the Intact Annulus Fibrosus Ring From Rat-Tail Intervertebral Discs

The annulus fibrosus is the ring-like exterior of the intervertebral disc which is composed of concentrically organized layers of collagen fibre bundles. The mechanical properties of the annulus have been studied extensively; however, tests are typically performed on extracted fragments or multilayered samples of the annulus and not on the annulus as a whole. The purpose of this study was two-fold: 1) to develop a novel testing technique to measure the mechanical properties of the intact, isolated annulus; and 2) to perform a preliminary analysis of the rate-dependency of these mechanical properties. Twenty-nine whole annulus ring samples were dissected from 11 skeletally mature Sprague Dawley rat tails and underwent a tensile failure test at either 2%/s (n=16) or 20%/s (n=13). Force and displacement were sampled at 100Hz and were subsequently normalized to stress and strain. Various mechanical properties were derived from the stress-strain curves and statistically compared between the rates. All mechanical variables, with the exception of initial failure stress, were found to be unaffected by rate. Interestingly, initial failure stress was higher for samples tested at the slower rate compared to the higher rate which is atypical for viscoelastic tissues. Although in general rate did not appear to impact the annulus ring response to tensile loading, this novel, intact annular ring testing technique provides an alternative way to quantify mechanical properties of the annulus.

Ratcheting Behavior of Intervertebral Discs Under Cyclic Compression: Experiment and Prediction

OBJECTIVE

To evaluate the ratcheting behavior of intervertebral discs (IVD) by experiments and theoretical study.

METHOD

The lumbar spines of sheep were obtained at a local slaughterhouse, and the IVD was processed with upper and lower vertebral bodies (about 5 mm) to ensure the mechanical state of the IVD in situ. The ratcheting tests of uniaxial cyclic compression loading for disc samples is carried out using the Electronic Universal Fatigue Testing System at room temperature. The effects of different stress variations, stress rates, as well as different segments on ratcheting behavior of discs were investigated.

RESULTS

The ratcheting strain evolution of lumbar IVD include stages of sharp increase and asymptotic stability. Both the ratcheting strain and ratcheting strain rate increase with an increase of stress variation (R = 0.962, P = 0.004) but decrease with an increase of the stress rate (R = -0.876, P = 0.019 ). Compression stiffness increases with an increase of the stress rate (R = 0.964, P = 0.004 ) or stress variation (R = 0.838, P = 0.037). Compared with L_{5 - 6} , the L_{6 - 7} disc showed less ratcheting strain (P = 0.04 ), indicating that the disc at this segment was more resistant to the impact of the ratcheting cycle. In addition, ratcheting strain evolution was predicted using a ratcheting evolution constitutive equation, and the predicted results were in good agreement with experimental data.

CONCLUSIONS

The ratcheting behavior occurs in IVD, and this cumulative deformation is consistent with the general ratcheting behavior. The constitutive equation can predict the ratcheting strain evolution of IVD very well. These results are of great significance for the analysis of defects and the development of repair in IVD.

The Effect of Local Hydration Environment on the Mechanical Properties and Unloaded Temporal Changes of Isolated Porcine Annular Samples

Preventing dehydration during in vitro testing of isolated layers of annulus fibrosus tissue may require different test conditions than functional spine units. The purpose of the study was twofold: (A) to quantify changes in mass and thickness of multilayer annulus samples in four hydration environments over 120 min; and (B) to quantify cycle-varying biaxial tensile properties of annulus samples in the four environments. The environments included a saline bath, air, relative humidity control, and misting combined with controlled humidity. The loading protocol implemented 24 cycles of biaxial tensile loading to 20% strain at a rate of 2%/s with 3-, 8-, and 13-min of intermittent rest. Specimen mass increased an average (standard deviation) 72% (11) when immersed for 120 min (p < 0.0001). The air condition and the combined mist and relative humidity conditions reduced mass by 45% (15) and 25% (23), respectively, after 120 min (p < 0.0014). Stress at 16% stretch in the air condition was higher at cycle 18 (18 min of exposure) and cycle 24 (33 min of exposure) compared to all other environments in both the axial and circumferential directions (p < 0.0460). There was no significant change in mass or thickness over time in the relative humidity condition and the change in circumferential stress at 16% stretch between cycles 6 and 24 was a maximum of 0.099 MPa and not statistically significant. Implementation of a controlled relative humidity environment is recommended to maintain hydration of isolated annulus layers during cyclic tensile testing.