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Cadieux C, Brzozowski P, Fernandes RJR, McGregor ME, Zdero R, Bailey CS, McLachlin SD, Rasoulinejad P. Topping-Off a Long Thoracic Stabilization With Semi-Rigid Constructs May Have Favorable Biomechanical Effects to Prevent Proximal Junctional Kyphosis: A Biomechanical Comparison. Global Spine J 2024:21925682241259695. [PMID: 38828634 DOI: 10.1177/21925682241259695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
STUDY DESIGN In-vitro cadaveric biomechanical study. OBJECTIVES Long posterior spinal fusion is a standard treatment for adult spinal deformity. However, these rigid constructs are known to alter motion and stress to the adjacent non-instrumented vertebrae, increasing the risk of proximal junctional kyphosis (PJK). This study aimed to biomechanically compare a standard rigid construct vs constructs "topped off" with a semi-rigid construct. By understanding semi-rigid constructs' effect on motion and overall construct stiffness, surgeons and researchers could better optimize fusion constructs to potentially decrease the risk of PJK and the need for revision surgery. METHODS Nine human cadaveric spines (T1-T12) underwent non-destructive biomechanical range of motion tests in pure bending or torsion and were instrumented with an all-pedicle-screw (APS) construct from T6-T9. The specimens were sequentially instrumented with semi-rigid constructs at T5: (i) APS plus sublaminar bands; (ii) APS plus supralaminar hooks; (iii) APS plus transverse process hooks; and (iv) APS plus short pedicle screws. RESULTS APS plus transverse process hooks had a range of motion (ie, relative angle) for T4-T5 and T5-T6, as well as an overall mechanical stiffness for T1-T12, that was more favourable, as it reduced motion at adjacent levels without a stark increase in stiffness. Moreover, APS plus transverse process hooks had the most linear change for range of motion across the entire T3-T7 range. CONCLUSIONS Present findings suggest that APS plus transverse process hooks has a favourable biomechanical effect that may reduce PJK for long spinal fusions compared to the other constructs examined.
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Affiliation(s)
- Chloe Cadieux
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada
| | - Pawel Brzozowski
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
| | - Renan J R Fernandes
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada
| | - Martine E McGregor
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
| | - Christopher S Bailey
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
| | - Stewart D McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Parham Rasoulinejad
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
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Rasouligandomani M, Del Arco A, Chemorion FK, Bisotti MA, Galbusera F, Noailly J, González Ballester MA. Dataset of Finite Element Models of Normal and Deformed Thoracolumbar Spine. Sci Data 2024; 11:549. [PMID: 38811573 PMCID: PMC11137096 DOI: 10.1038/s41597-024-03351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
Adult spine deformity (ASD) is prevalent and leads to a sagittal misalignment in the vertebral column. Computational methods, including Finite Element (FE) Models, have emerged as valuable tools for investigating the causes and treatment of ASD through biomechanical simulations. However, the process of generating personalised FE models is often complex and time-consuming. To address this challenge, we present a dataset of FE models with diverse spine morphologies that statistically represent real geometries from a cohort of patients. These models are generated using EOS images, which are utilized to reconstruct 3D surface spine models. Subsequently, a Statistical Shape Model (SSM) is constructed, enabling the adaptation of a FE hexahedral mesh template for both the bone and soft tissues of the spine through mesh morphing. The SSM deformation fields facilitate the personalization of the mean hexahedral FE model based on sagittal balance measurements. Ultimately, this new hexahedral SSM tool offers a means to generate a virtual cohort of 16807 thoracolumbar FE spine models, which are openly shared in a public repository.
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Affiliation(s)
| | | | - Francis Kiptengwer Chemorion
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- InSilicoTrials Technologies Company, Trieste, 34123, Italy
- Barcelona Supercomputing Center, Barcelona, 08034, Spain
| | | | - Fabio Galbusera
- IRCCS Istituto Ortopedico Galeazzi, Milan, 20161, Italy
- Schulthess Klinik, Zürich, 8008, Switzerland
| | - Jérôme Noailly
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
| | - Miguel A González Ballester
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- ICREA, Barcelona, 08010, Spain
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de Sousa Almeida AP, Matsui EKK, da Silva FN, de Oliveira Vasconcelos FB, de Oliveira MR. Thoracic Spine Mobility and Posture: Correlation and Predictive Values in Physically Independent Older Adults. Eval Health Prof 2024; 47:133-138. [PMID: 38065535 DOI: 10.1177/01632787231220612] [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] [Indexed: 02/12/2024]
Abstract
The posture undergoes changes during aging and may serve as a marker for the evaluation of the thoracic spine. This study aimed to correlate the variables for the evaluation of thoracic spine mobility and propose predictive equation models from the measurements of the thoracic Schober test and the digital inclinometer in older adults. The mobility of thoracic flexion and extension by levels (T1, T8 and T12) of 41 older adult subjects (66 ± 7 years) was quantified with a digital inclinometer (degrees) and Schober's test (cm). There was a moderate positive correlation between the digital inclinometer and the Schober test at T1 (r = .69), T12 (r = .60), and total flexion levels T1 to T12 (r = .74). Simple linear regression equations showed that thoracic Schober predicts thoracic mobility measures for these same levels. Moderate to strong correlations were observed between the inclinometer and the Schober Test measurements. The development of predictive equation models based on the thoracic Schober test could potentially enhance the ability to predict spinal mobility in physically independent older adults.
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Belyaev RI, Nikolskaia P, Bushuev AV, Panyutina AA, Kozhanova DA, Prilepskaya NE. Running, jumping, hunting, and scavenging: Functional analysis of vertebral mobility and backbone properties in carnivorans. J Anat 2024; 244:205-231. [PMID: 37837214 PMCID: PMC10780164 DOI: 10.1111/joa.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
Carnivorans are well-known for their exceptional backbone mobility, which enables them to excel in fast running and long jumping, leading to them being among the most successful predators amongst terrestrial mammals. This study presents the first large-scale analysis of mobility throughout the presacral region of the vertebral column in carnivorans. The study covers representatives of 6 families, 24 genera and 34 species. We utilized a previously developed osteometry-based method to calculate available range of motion, quantifying all three directions of intervertebral mobility: sagittal bending (SB), lateral bending (LB), and axial rotation (AR). We observed a strong phylogenetic signal in the structural basis of the vertebral column (vertebral and joint formulae, length proportions of the backbone modules) and an insignificant phylogenetic signal in most characteristics of intervertebral mobility. This indicates that within the existing structure (stabilization of which occurred rather early in different phylogenetic lineages), intervertebral mobility in carnivorans is quite flexible. Our findings reveal that hyenas and canids, which use their jaws to seize prey, are characterized by a noticeably elongated cervical region and significantly higher SB and LB mobility of the cervical joints compared to other carnivorans. In representatives of other carnivoran families, the cervical region is very short, but the flexibility of the neck (both SB and LB) is significantly higher than that of short-necked odd-toed and even-toed ungulates. The lumbar region of the backbone in carnivorans is dorsomobile in the sagittal plane, being on average ~23° more mobile than in artiodactyls and ~38° more mobile than in perissodactyls. However, despite the general dorsomobility, only some representatives of Canidae, Felidae, and Viverridae are superior in lumbar flexibility to the most dorsomobile ungulates. The most dorsomobile artiodactyls are equal or even superior to carnivorans in their ability to engage in dorsal extension during galloping. In contrast, carnivorans are far superior to ungulates in their ability to engage ventral flexion. The cumulative SB in the lumbar region in carnivorans largely depends on the mode of running and hunting. Thus, adaptation to prolonged and enduring pursuit of prey in hyenas is accompanied by markedly reduced SB flexibility in the lumbar region. A more dorsostable run is also a characteristic of the Ursidae, and the peculiar maned wolf. Representatives of Felidae and Canidae have significantly more available SB mobility in the lumbar region. However, they fully engage it only occasionally at key moments of the hunt associated with the direct capture of the prey or when running in a straight line at maximum speed.
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Affiliation(s)
- Ruslan I. Belyaev
- A.N. Severtsov Institute of Ecology and EvolutionRussian Academy of SciencesMoscowRussian Federation
| | - Polina Nikolskaia
- Geological InstituteRussian Academy of SciencesMoscowRussian Federation
| | - Andrey V. Bushuev
- Department of Vertebrate Zoology, Faculty of BiologyLomonosov Moscow State UniversityMoscowRussian Federation
| | | | - Darya A. Kozhanova
- Department of Paleontology, Faculty of GeologyLomonosov Moscow State UniversityMoscowRussian Federation
| | - Natalya E. Prilepskaya
- A.N. Severtsov Institute of Ecology and EvolutionRussian Academy of SciencesMoscowRussian Federation
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Moore AC, Holder DA, Elliott DM. Off-Axis Loading Fixture for Spine Biomechanics: Combined Compression and Bending. J Biomech Eng 2023; 145:105001. [PMID: 37338241 PMCID: PMC10405279 DOI: 10.1115/1.4062780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
The spine is a multi-tissue musculoskeletal system that supports large multi-axial loads and motions during physiological activities. The healthy and pathological biomechanical function of the spine and its subtissues are generally studied using cadaveric specimens that often require multi-axis biomechanical test systems to mimic the complex loading environment of the spine. Unfortunately, an off-the-shelf device can easily exceed 200,000 USD, while a custom device requires extensive time and experience in mechatronics. Our goal was to develop a cost-appropriate compression and bending (flexion-extension and lateral bending) spine testing system that requires little time and minimal technical knowledge. Our solution was an off-axis loading fixture (OLaF) that mounts to an existing uni-axial test frame and requires no additional actuators. OLaF requires little machining, with most components purchased off-the-shelf, and costs less than 10,000 USD. The only external transducer required is a six-axis load cell. Furthermore, OLaF is controlled using the existing uni-axial test frame's software, while the load data is collected using the software included with the six-axis load cell. Here we provide the design rationale for how OLaF develops primary motions and loads and minimizes off-axis secondary constraints, verify the primary kinematics using motion capture, and demonstrate that the system is capable of applying physiologically relevant, noninjurious, axial compression and bending. While OLaF is limited to compression and bending studies it produces repeatable physiologically relevant biomechanics, with high quality data, and minimal startup costs.
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Affiliation(s)
- Axel C. Moore
- Department of Biomedical Engineering, University of Delaware, STAR Health Sciences Complex, Room 109 540 S. College Ave, Newark, DE 19713
| | - Dione A. Holder
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19713
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19713
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Orbach MR, Mahoney J, Bucklen BS, Balasubramanian S. In vitro coupled motions of the whole human thoracic and lumbar spine with rib cage. JOR Spine 2023; 6:e1257. [PMID: 37780824 PMCID: PMC10540827 DOI: 10.1002/jsp2.1257] [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: 10/10/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 10/03/2023] Open
Abstract
Study design In vitro biomechanical study investigating the coupled motions of the whole normative human thoracic spine (TS) and lumbar spine (LS) with rib cage. Objective To quantify the region-specific coupled motion patterns and magnitudes of the TS, thoracolumbar junction (TLJ), and LS simultaneously. Background Studying spinal coupled motions is important in understanding the development of complex spinal deformities and providing data for validating computational models. However, coupled motion patterns reported in vitro are controversial, and no quantitative data on region-specific coupled motions of the whole human TS and LS are available. Methods Pure, unconstrained bending moments of 8 Nm were applied to seven fresh-frozen human cadaveric TS and LS specimens (mean age: 70.3 ± 11.3 years) with rib cages to elicit flexion-extension (FE), lateral bending (LB), and axial rotation (AR). During each primary motion, region-specific rotational range of motion (ROM) data were captured. Results No statistically significant, consistent coupled motion patterns were observed during primary FE. During primary LB, there was significant (p < 0.05) ipsilateral AR in the TS and a general pattern of contralateral coupled AR in the TLJ and LS. There was also a tendency for the TS to extend and the LS to flex. During primary AR, significant coupled LB was ipsilateral in the TS and contralateral in both the TLJ and LS. Significant coupled flexion in the LS was also observed. Coupled LB and AR ROMs were not significantly different between the TS and LS or from one another. Conclusions The findings support evidence of consistent coupled motion patterns of the TS and LS during LB and AR. These novel data may serve as reference for computational model validations and future in vitro studies investigating spinal deformities and implants.
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Affiliation(s)
- Mattan R. Orbach
- School of Biomedical Engineering, Science and Health SystemsDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Jonathan Mahoney
- Musculoskeletal Education and Research CenterA Division of Globus Medical, IncAudubonPennsylvaniaUSA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research CenterA Division of Globus Medical, IncAudubonPennsylvaniaUSA
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health SystemsDrexel UniversityPhiladelphiaPennsylvaniaUSA
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7
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Nafo W, Guldeniz O, Jun H, Kim E. Ligamentous tethering and intradiscal pressure affecting the mechanical environment of scoliotic spines. Med Eng Phys 2023; 119:104035. [PMID: 37634912 DOI: 10.1016/j.medengphy.2023.104035] [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: 02/02/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
Despite several theories have been proposed to explain the progression of Adolescent Idiopathic Scoliosis (AIS), there is no consensus on the mechanical factors that control the spinal deformities. Prominent biomechanical notions focus on the geometrical asymmetry and differential growth, however, the correlation between these phenomena remains unclear. We postulate that intradiscal pressure and its connection with the supporting ligamentous structures are the reasons behind the asymmetric growth in AIS. To investigate this hypothesis, a numerical 3D patient-specific model of a scoliotic spine is constructed to carry upper body weight. Four analyses are performed: control simulation with no ligaments followed by 3 simulations, in each, a different and stiffer set of ligaments is employed. The analyses showed that intradiscal pressure is relatively high in the spine's higher-deformity region. Moreover, the stiffness effect of the ligamentous tethering correlated directly to intradiscal pressure; the stiffer the ligaments, the higher the intradiscal pressure. Due to geometrical asymmetry, the pressure is eccentric toward the concave region of deformed vertebral units. As a result, the deformed annulus fibrosus generated uplifts in the convex side of deformed vertebral units. The eccentric pressure and the uplift are opposite in location and direction creating an imbalanced mechanical environment for the spine during growth.
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Affiliation(s)
- Wanis Nafo
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea.
| | - Ogulcan Guldeniz
- Orthopaedics and Traumatology Department, University of Hong Kong, Hong Kong SAR, China
| | - Hyungmin Jun
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea
| | - Eunho Kim
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea
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8
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Polanco M, Ringleb S, Audette M, Kakar R, Bawab S. A comparison of intervertebral ligament properties utilized in a thoracic spine functional unit through kinematic evaluation. Comput Methods Biomech Biomed Engin 2023; 26:1330-1340. [PMID: 36106656 DOI: 10.1080/10255842.2022.2115293] [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: 02/22/2022] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
Ligament properties in the literature are variable, yet scarce, but needed to calibrate computational models for spine clinical research applications. A comparison of ligament stiffness properties and their effect on the kinematic behavior of a thoracic functional spinal unit (FSU) is examined in this paper. Six unique ligament property sets were utilized within a volumetric T7-T8 finite element (FE) model developed using computer-aided design (CAD) spinal geometry. A 7.5 Nm moment was applied along three anatomical planes both with and without costovertebral (CV) joints present. Range of Motion (RoM) was assessed for each property set and compared to published experimental data. Intact and serial ligament removal procedures were implemented in accordance with experimental protocol. The variance in both kinematic behavior and comparability with experimental data among property sets emphasizes the role nonlinear characterization plays in determining proper kinematic behavior in spinal FE models. Additionally, a decrease in RoM variation among property sets was exhibited when the model setup incorporated the CV joint. With proper assessment of the source and size of each ligament, the material properties considered here could be expanded and justified for implementation into thoracic spine clinical studies.
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Affiliation(s)
- Michael Polanco
- Mechanical and Aerospace Engineering Department, Old Dominion University, Norfolk, VA, USA
| | - Stacie Ringleb
- Mechanical and Aerospace Engineering Department, Old Dominion University, Norfolk, VA, USA
| | - Michel Audette
- Computational Modeling and Simulation Engineering, Old Dominion University, Norfolk, VA, USA
| | - Rumit Kakar
- School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Sebastian Bawab
- Mechanical and Aerospace Engineering Department, Old Dominion University, Norfolk, VA, USA
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van Agtmaal JL, Doodkorte RJP, Roth AK, Ito K, Arts JJC, Willems PC, van Rietbergen B. Biomechanical evaluation of different semi-rigid junctional fixation techniques using finite element analysis. Clin Biomech (Bristol, Avon) 2023; 108:106071. [PMID: 37597385 DOI: 10.1016/j.clinbiomech.2023.106071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Proximal junctional failure is a common complication attributed to the rigidity of long pedicle screw fixation constructs used for surgical correction of adult spinal deformity. Semi-rigid junctional fixation achieves a gradual transition in range of motion at the ends of spinal instrumentation, which could lead to reduced junctional stresses, and ultimately reduce the incidence of proximal junctional failure. This study investigates the biomechanical effect of different semi-rigid junctional fixation techniques in a T8-L3 finite element spine segment model. METHODS First, degeneration of the intervertebral disc was successfully implemented by altering the height. Second, transverse process hooks, one- and two-level clamped tapes, and one- and two-level knotted tapes instrumented proximally to three-level pedicle screw fixation were validated against ex vivo range of motion data of a previous study. Finally, the posterior ligament complex forces and nucleus pulposus stresses were quantified. FINDINGS Simulated range of motions demonstrated the fidelity of the general model and modelling of semi-rigid junctional fixation techniques. All semi-rigid junctional fixation techniques reduced the posterior ligament complex forces at the junctional zone compared to pedicle screw fixation. Transverse process hooks and knotted tapes reduced nucleus pulposus stresses, whereas clamped tapes increased nucleus pulposus stresses at the junctional zone. INTERPRETATION The relationship between the range of motion transition and the reductions in posterior ligament complex and nucleus pulposus stresses was complex and dependent on the fixation techniques. Clinical trials are required to compare the effectiveness of semi-rigid junctional fixation techniques in terms of reducing proximal junctional failure incidence rates.
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Affiliation(s)
- Julia L van Agtmaal
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612AZ Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Remco J P Doodkorte
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Alex K Roth
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612AZ Eindhoven, the Netherlands
| | - Jacobus J C Arts
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612AZ Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Paul C Willems
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612AZ Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands.
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Wilke H, Betz VM, Kienle A. Biomechanical in vitro evaluation of the kangaroo spine in comparison with human spinal data. J Anat 2023; 243:128-137. [PMID: 36929138 PMCID: PMC10273331 DOI: 10.1111/joa.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/12/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023] Open
Abstract
On the basis of the kangaroo's pseudo-biped locomotion and its upright position, it could be assumed that the kangaroo might be an interesting model for spine research and that it may serve as a reasonable surrogate model for biomechanical in vitro tests. The purpose of this in vitro study was to provide biomechanical properties of the kangaroo spine and compare them with human spinal data from the literature. In addition, references to already published kangaroo anatomical spinal parameters will be discussed. Thirteen kangaroo spines from C4 to S4 were sectioned into single-motion segments. The specimens were tested by a spine tester under pure moments. The range of motion and neutral zone of each segment were determined in flexion and extension, right and left lateral bending and left and right axial rotation. Overall, we found greater flexibility in the kangaroo spine compared to the human spine. Similarities were only found in the cervical, lower thoracic and lumbar spinal regions. The range of motion of the kangaroo and human spines displayed comparable trends in the cervical (C4-C7), lower thoracic and lumbar regions independent of the motion plane. In the upper and middle thoracic regions, the flexibility of the kangaroo spine was considerably larger. These results suggested that the kangaroo specimens could be considered to be a surrogate, but only in particular cases, for biomechanical in vitro tests.
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Affiliation(s)
- Hans‐Joachim Wilke
- Institute of Orthopaedic Research and BiomechanicsTrauma Research Centre Ulm, University of UlmUlmGermany
| | - Volker Michael Betz
- Institute of Orthopaedic Research and BiomechanicsTrauma Research Centre Ulm, University of UlmUlmGermany
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Belyaev RI, Kuznetsov AN, Prilepskaya NE. Truly dorsostable runners: Vertebral mobility in rhinoceroses, tapirs, and horses. J Anat 2023; 242:568-591. [PMID: 36519561 PMCID: PMC10008283 DOI: 10.1111/joa.13799] [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: 05/30/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
The vertebral column is a hallmark of vertebrates; it is the structural basis of their body and the locomotor apparatus in particular. Locomotion of any vertebrate animal in its typical habitat is directly associated with functional adaptations of its vertebrae. This study is the first large-scale analysis of mobility throughout the presacral region of the vertebral column covering a majority of extant odd-toed ungulates from 6 genera and 15 species. In this study, we used a previously developed osteometry-based method to calculate available range of motion. We quantified all three directions of intervertebral mobility: sagittal bending (SB), lateral bending (LB), and axial rotation (AR). The cervical region in perissodactyls was found to be the most mobile region of the presacral vertebral column in LB and SB. Rhinoceroses and tapirs are characterized by the least mobile necks in SB among odd-toed and even-toed ungulates. Equidae are characterized by very mobile necks, especially in LB. The first intrathoracic joint (T1-T2) in Equidae and Tapiridae is characterized by significantly increased mobility in the sagittal plane compared to the typical thoracic joints and is only slightly less mobile than typical cervical joints. The thoracolumbar part of the vertebral column in odd-toed ungulates is very stiff. Perissodactyls are characterized by frequent fusions of vertebrae with each other with complete loss of mobility. The posterior half of the thoracic region in perissodactyls is characterized by especially stiff intervertebral joints in the SB direction. This is probably associated with hindgut fermentation in perissodactyls: the sagittal stiffness of the posterior thoracic region of the vertebral column is able to passively support the hindgut heavily loaded with roughage. Horses are known as a prime example of a dorsostable galloper among mammals. However, based on SB in the lumbosacral part of the backbone, equids appear to be the least dorsostable among extant perissodactyls; the cumulative SB in equids and tapirs is as low as in the largest representatives of artiodactyls, while in Rhinocerotidae it is even lower representing the minimum across all odd-toed and even-toed ungulates. Morphological features of small Paleogene ancestors of rhinoceroses and equids indicate that dorsostability is a derived feature of perissodactyls and evolved convergently in the three extant families.
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Affiliation(s)
- Ruslan I Belyaev
- A.N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alexander N Kuznetsov
- A.N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation.,Borissiak Paleontological Institute, Russian Academy of Sciences, Moscow, Russian Federation
| | - Natalya E Prilepskaya
- A.N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation
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Trobisch P, Mahoney JM, Eichenlaub EK, Antonacci CL, Cuddihy L, Amin DB, Razo-Castaneda D, Orbach MR, McGuckin JP, Bucklen BS, Antonacci MD, Betz RR. An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction. 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; 32:1173-1186. [PMID: 36871254 DOI: 10.1007/s00586-023-07608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE To evaluate the motion-preserving properties of vertebral body tethering with varying cord/screw constructs and cord thicknesses in cadaveric thoracolumbar spines. METHODS In vitro flexibility tests were performed on six fresh-frozen human cadaveric spines (T1-L5) (2 M, 4F) with a median age of 63 (59-to-80). An ± 8 Nm load was applied to determine range of motion (ROM) in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the thoracic and lumbar spine. Specimens were tested with screws (T5-L4) and without cords. Single (4.0 mm and 5.0 mm) and double (4.0 mm) cord constructs were sequentially tensioned to 100 N and tested: (1) Single 4.0 mm and (2) 5.0 mm cords (T5-T12); (3) Double 4.0 mm cords (T5-12); (4) Single 4.0 mm and (5) 5.0 mm cord (T12-L4); (6) Double 4.0 mm cords (T12-L4). RESULTS In the thoracic spine (T5-T12), 4.0-5.0 mm single-cord constructs showed slight reductions in FE and 27-33% reductions in LB compared to intact, while double-cord constructs showed reductions of 24% and 40%, respectively. In the lumbar spine (T12-L4), double-cord constructs had greater reductions in FE (24%), LB (74%), and AR (25%) compared to intact, while single-cord constructs exhibited reductions of 2-4%, 68-69%, and 19-20%, respectively. CONCLUSIONS The present biomechanical study found similar motion for 4.0-5.0 mm single-cord constructs and the least motion for double-cord constructs in the thoracic and lumbar spine suggesting that larger diameter 5.0 mm cords may be a more promising motion-preserving option, due to their increased durability compared to smaller cords. Future clinical studies are necessary to determine the impact of these findings on patient outcomes.
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Affiliation(s)
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | - Emily K Eichenlaub
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | | | - Laury Cuddihy
- Institute for Spine and Scoliosis, Lawrenceville, NJ, USA
| | - Dhara B Amin
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | - Dominic Razo-Castaneda
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA , USA
| | - Mattan R Orbach
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA , USA
| | - Joshua P McGuckin
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | | | - Randal R Betz
- Institute for Spine and Scoliosis, Lawrenceville, NJ, USA
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Biomechanical Effect of Using Cement Augmentation to Prevent Proximal Junctional Kyphosis in Long-Segment Fusion: A Finite Element Study. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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14
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Yoshida R, Yasuda T, Kuruma H. Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain. J Man Manip Ther 2022; 30:328-333. [PMID: 35384789 PMCID: PMC9621240 DOI: 10.1080/10669817.2022.2056309] [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: 01/07/2023] Open
Abstract
BACKGROUND Neck pain is a common manifestation of musculoskeletal disorders of the cervical and thoracic spine. Manual therapy interventions to the thoracic spine are recommended for treating patients with several types of neck pain. However, only a few studies have investigated the thoracic spine mobility associated with neck movement. OBJECTIVES Compare cervical and upper thoracic rotation angles in subjects with and without neck pain. METHODS The subjects included nine individuals who experienced neck pain (pain, Group P) and 11 who did not (non-pain, Group N). The rotation angle was measured using MRI. The imaging limb position was at 90% of the maximum neck rotation. The MR images were analyzed using image analysis software to calculate the rotation angle of C1 to Th3. The rotation angle of the segment was then calculated by subtracting the rotation angle corresponding to the lower vertebra from that corresponding to the upper vertebra. The total rotation of each segment was calculated as the sum of the right and left rotation angle. Then, the segmental rotation angles were compared between groups. RESULTS/FINDINGS The rotation angles of C3-C4, C7-Th1, and Th1-Th2 were significantly smaller in Group P than in Group N, and C5-C6 and C6-C7 were significantly larger in Group P than in Group N. There was no statistical difference in rotational angle at all other spinal levels measured. CONCLUSIONS The results of this study indicate subjects with neck pain had hypermobility of the lower cervical spine and hypomobility of the cervico-thoracic junction and upper thoracic spine compared with subjects without neck pain. These results add to current understanding of biomechanical factors that may be related to neck pain.
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Affiliation(s)
- Ryota Yoshida
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan,Department of Rehabilitation, Yomiuri Clinic, Chiyoda-ku, Japan,CONTACT Ryota Yoshida Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo116-8551, Japan
| | - Toru Yasuda
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan,Department of Rehabilitation, Zama General Hospital, Zama City, Japan
| | - Hironobu Kuruma
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan
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Kardash K, Koutras C, Otaduy MA. Design of personalized scoliosis braces based on differentiable biomechanics—Synthetic study. Front Bioeng Biotechnol 2022; 10:1014365. [DOI: 10.3389/fbioe.2022.1014365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
This work describes a computational methodology for the design of braces for adolescent idiopathic scoliosis. The proposed methodology relies on a personalized simulation model of the patient’s trunk, and automatically searches for the brace geometry that optimizes the trade-off between clinical improvement and patient comfort. To do this, we introduce a formulation of differentiable biomechanics of the patient’s trunk, the brace, and their interaction. We design a simulation model that is differentiable with respect to both the deformation state and the brace design parameters, and we show how this differentiable model is used for the efficient update of brace design parameters within a numerical optimization algorithm. To evaluate the proposed methodology, we have obtained trunk models with personalized geometry for five patients of adolescent idiopathic scoliosis, and we have designed Boston-type braces. In a simulation setting, the designed braces improve clinical metrics by 45% on average, under acceptable comfort conditions. In the future, the methodology can be extended beyond synthetic validation, and tested with physical braces on the actual patients.
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Liebsch C, Wilke HJ. Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens. Spine J 2022; 22:1913-1921. [PMID: 35779838 DOI: 10.1016/j.spinee.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSE To evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGN Experimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1-T2 to T11-T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37-80 years). METHODS Degeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTS All tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONS Even mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCE Thoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany.
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Nevzati E, Moser M, Dietz N, Yaszay B, Lenke LG, Farshad M, Arvind V, Cho SK, Spiessberger A. Clinically relevant biomechanical properties of three different fixation techniques of the upper instrumented vertebra in deformity surgery. Spine Deform 2022; 10:1017-1027. [PMID: 35428950 DOI: 10.1007/s43390-022-00506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Adjacent segment disease, junctional kyphosis/failure and pseudarthrosis can negatively impact the mid to long-term outcome in spinal deformity surgery. These complications might be influenced by upper instrumented vertebra (UIV) fixation techniques. In this study we analyze key biomechanical properties of three different UIV fixation techniques and define their ideal clinical use based on patient-specific risk profiles using a finite element analysis (FEA) model. METHODS A T9-pelvis posterior instrumented spinal fusion was assumed. Three different FEA models were created based on the UIV fixation technique: T9 pedicle screws (PS); T9 cortical bone screws (CBS); T9 transverse process hooks (TPH). The three FEA models consisted of T8-T10 bone and ligamentous anatomy derived from a CT scan of a healthy patient as well as spinal implants consisting of either pedicle screws, cortical bone screws or transverse process hooks as well as cobalt chromium rods. The FEA models were constrained at T10, axial load as assumed for a healthy 80 kg male during flexion, extension and lateral bending were applied. As surrogate markers for risk of proximal junctional kyphosis, proximal junctional failure, adjacent segment disease and pseudarthrosis the following biomechanical parameters were calculated: UIV range of motion (ROM); intradiscal stress at UIV/UIV + 1; UIV intravertebral stress and screw pull out forces. One-way ANOVA analyses have been performed to compare biomechanical outcome parameters between the three construct variants under investigation. RESULTS UIV-ROM was restricted during flexion/extension/lateral bending by: PS: 73%/80%/86%, CBS: 71%/81%/85% and TPH: 62%/76%/85%. Average intradiscal stress at UIV/UIV + 1 during flexion/extension/lateral bending was (Mega Pascal, MPa): PS 0.42/0.44/0.38, CBS 0.49/0.4/0.44, TPH 0.66/0.51/0.58; average intravertebral stress of the UIV superior endplate during flexion/extension/lateral bending was (MPa): PS 2.23/2.12/2.21, CBS 1.87/1.98/1.8, TPH 1.67/0.98/1.53. Screw pull-out forces (N) at UIV during flexion/extension/lateral bending were: PS 476/320/375, CBS 444/245/308. Statistically significant differences were found for intradiscal stress as well as vertebral body average stress (p = 0.02 and p = 0.02). CONCLUSION Different UIV fixation techniques carry different biomechanical properties. Pedicle screw fixation is the most rigid, leading to the highest UIV stress and UIV screw pull out forces. Cortical bones screw fixation is similarly rigid; however, UIV stress and UIV screw pull out is significantly lower. Transverse process hook fixation is the least rigid, with the lowest UIV stress, however highest intradiscal stress at UIV/UIV + 1. Thus, these biomechanical differences may help select optimal UIV fixation techniques according to patient specific risk factors.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Manuel Moser
- Department of Neurosurgery, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Nick Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Burt Yaszay
- Department of Orthopedic Surgery, Rady's Children Hospital San Diego, San Diego, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, New York, USA
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Varun Arvind
- Department of Orthopedic Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, USA
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, USA
| | - Alexander Spiessberger
- Department of Neurosurgery, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA.
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Liebsch C, Wilke HJ. How Does the Rib Cage Affect the Biomechanical Properties of the Thoracic Spine? A Systematic Literature Review. Front Bioeng Biotechnol 2022; 10:904539. [PMID: 35782518 PMCID: PMC9240654 DOI: 10.3389/fbioe.2022.904539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
The vast majority of previous experimental studies on the thoracic spine were performed without the entire rib cage, while significant contributive aspects regarding stability and motion behavior were shown in several other studies. The aim of this literature review was to pool and increase evidence on the effect of the rib cage on human thoracic spinal biomechanical characteristics by collating and interrelating previous experimental findings in order to support interpretations of in vitro and in silico studies disregarding the rib cage to create comparability and reproducibility for all studies including the rib cage and provide combined comparative data for future biomechanical studies on the thoracic spine. After a systematic literature search corresponding to PRISMA guidelines, eleven studies were included and quantitatively evaluated in this review. The combined data exhibited that the rib cage increases the thoracic spinal stability in all motion planes, primarily in axial rotation and predominantly in the upper thorax half, reducing thoracic spinal range of motion, neutral zone, and intradiscal pressure, while increasing thoracic spinal neutral and elastic zone stiffness, compression resistance, and, in a neutral position, the intradiscal pressure. In particular, the costosternal connection was found to be the primary stabilizer and an essential determinant for the kinematics of the overall thoracic spine, while the costotransverse and costovertebral joints predominantly reinforce the stability of the single thoracic spinal segments but do not alter thoracic spinal kinematics. Neutral zone and neutral zone stiffness were more affected by rib cage removal than the range of motion and elastic zone stiffness, thus also representing the essential parameters for destabilization of the thoracic spine. As a result, the rib cage and thoracic spine form a biomechanical entity that should not be separated. Therefore, usage of entire human non-degenerated thoracic spine and rib cage specimens together with pure moment application and sagittal curvature determination is recommended for future in vitro testing in order to ensure comparability, reproducibility, and quasi-physiological validity.
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Belyaev RI, Kuznetsov AN, Prilepskaya NE. From dorsomobility to dorsostability: A study of lumbosacral joint range of motion in artiodactyls. J Anat 2022; 241:420-436. [PMID: 35616615 DOI: 10.1111/joa.13688] [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: 10/16/2021] [Revised: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
This study is the first analysis of mobility in the lumbosacral joint of even-toed ungulates covering the full range of body masses and running forms. In this study, we modified a previously developed osteometry-based method to calculate the available range of motion (aROM) in the lumbosacral joint in artiodactyls. We quantified all three directions of intervertebral mobility: sagittal bending (SB), lateral bending (LB), and axial rotation (AR). This research covers extant artiodactyls from 10 families, 57 genera, and 78 species. The lumbosacral joint in artiodactyls is on average almost twice as mobile in SB as the average intralumbar joint (aROM 15.68° vs 8.22°). In all artiodactyls, the first sacral prezygapophyses are equipped with postfacet fossae determining the available range of lumbosacral hyperextension. SB aROM in the lumbosacral joint in artiodactyls varies almost sevenfold (from 4.53° to 31.19°) and is closely related to the body mass and running form. An allometric equation was developed for the first time, for the joint angular amplitude of motion, exemplified by the artiodactyl lumbosacral SB aROMs, as a power function of body mass, the power coefficient value being close to -0.15. High SB aROM at the lumbosacral joint is characteristic of artiodactyls with at least one of the following characteristics: high cumulative and average SB aROM in the lumbar region (Pearson r = 0.467-0.617), small body mass (r = -0.531), saltatorial or saltatorial-cursorial running form (mean = 16.91-18.63°). The highest SB aROM in the lumbosacral joint is typical for small antelopes and Moschidae (mean = 20.24-20.27°). Among these artiodactyls SB aROMs in the lumbosacral joint are on par with various carnivores. Large and robust artiodactyls, adapted predominantly to mediportal and stilt (running on extremely tall limbs) running forms, have 2-3 times smaller SB aROMs in the lumbosacral joint. Adaptation to endurance galloping in open landscapes (cursorial running form) is accompanied by smaller lumbar and lumbosacral SB aROMs compared to that in saltatorial-cursorial artiodactyls of the same body mass. The wide range of species studied makes it possible to significantly expand the knowledge of relations of the mobility of the lumbosacral joint in artiodactyls to body mass and running form.
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Affiliation(s)
- Ruslan I Belyaev
- A.N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alexander N Kuznetsov
- Borissiak Paleontological Institute, Russian Academy of Sciences, Moscow, Russian Federation
| | - Natalya E Prilepskaya
- A.N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation
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AKINCI SALIHAZEYNEB, ARSLAN YUNUSZIYA. FINITE ELEMENT SPINE MODELS AND SPINAL INSTRUMENTS: A REVIEW. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is considerable biomechanics literature on finite element modeling and analysis of the spine. To accurately mimic the biomechanical behavior of the vertebral column, a generated computational model has to include anatomical structures that are consistent with physiological reality. In this review article, we focused on the finite element spine models that have been developed by various approaches in the literature. Firstly, the anatomical features of the spine and the spinal components have been briefly explained. We then focused on the modeling stages of vertebrae, ligaments, facet joints, intervertebral discs, and spinal instruments. With this paper, we expect to provide a comprehensive resource regarding the modeling preferences used in spine modeling.
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Affiliation(s)
- SALIHA ZEYNEB AKINCI
- Department of Biomedical Engineering and Bioinformatics, Graduate School of Engineering and Natural Sciences, Istanbul Medipol University, 34810 Beykoz, Istanbul, Turkey
| | - YUNUS ZIYA ARSLAN
- Department of Robotics and Intelligent Systems, Institute of Graduate Studies in Science and Engineering, Turkish-German University, Beykoz, Istanbul 34820, Turkey
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21
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Chang S, Maddox J, Berg E, Kim K, Messier S, Swanson L, Dobrusin R, Stein AB, Nakken GN, Noble J, Nydam R. Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry. J Osteopath Med 2021; 122:31-43. [PMID: 34643344 DOI: 10.1515/jom-2021-0020] [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: 01/14/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT The thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM) for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by palpating for asymmetry at the tips of the transverse processes (TPs). Previous studies reveal that instead of following the rule of threes, the TPs of a given thoracic vertebra generally align with the spinous process (SP) of the vertebra above. Ultrasonography has been widely utilized as a diagnostic tool to monitor musculoskeletal conditions; it does not utilize ionizing radiation, and it has comparable results to gold-standard modalities. In the case of thoracic somatic dysfunction, ultrasound (US) can be utilized to determine the location of each vertebral TP and its relationship with the SP. Previous studies have investigated the correlation between OMM and ultrasonography of the cervical, lumbar, and sacral regions. However, there has been no study yet that has compared osteopathic structural examination with ultrasonographic examination of the thoracic vertebral region. OBJECTIVES To examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation. METHODS The ClinicalTrials.gov study identifier is NCT04823637. Subjects were student volunteers recruited from the Midwestern University (MWU)-Glendale campus. A nontoxic, nonpermanent marker was utilized to mark bony landmarks on the skin. Two neuromusculoskeletal board-certified physicians (OMM1, OMM2) separately performed structural exams by palpating T2-T5 TPs to determine vertebral rotation. Two sonographers (US1, US2) separately scanned and measured the distance from the tip of the SP to the adjacent TPs of the vertebral segment below. Demographic variables were summarized with mean and standard deviation. Interexaminer agreement was assessed with percent agreement, Cohen's Kappa, and Fleiss' Kappa. Correlation was measured by Spearman's rank correlation coefficient. Recruitment and protocols were approved by the MWU Institutional Review Board (IRB). RESULTS US had fair interexaminer agreement for the overall most prominent segmental rotation of the T3-T5 thoracic spine, with Cohen's Kappa at 0.27 (0.09, 0.45), and a total agreement percentage at 51.5%. Osteopathic palpation revealed low interexaminer agreement for the overall most prominent vertebral rotation, with Cohen's Kappa at 0.05 (0.0, 0.27), and 31.8%. Segment-specific vertebral analysis revealed slight agreement between US examiners, with a correlation coefficient of 0.23, whereas all other pairwise comparisons showed low agreement and correlation. At T4, US had slight interexaminer agreement with 0.24 correlation coefficient, and osteopathic palpation showed low interexaminer (OMM1 vs. OMM2) agreement (0.17 correlation coefficient). At T5, there was moderate agreement between the two sonographers with 0.44 (0.27, 0.60) and 63.6%, with a correlation coefficient of 0.57, and slight agreement between OMM1 and OMM2 with 0.12 (0.0, 0.28) and 42.4%, with 0.23 correlation coefficient. CONCLUSIONS This preliminary study of an asymptomatic population revealed that there is a low-to-moderate interexaminer reliability between sonographers, low-to-slight interexaminer reliability between osteopathic physicians, and low interexaminer reliability between OMM palpatory examination and ultrasonographic evaluation of the thoracic spine.
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Affiliation(s)
- Shirley Chang
- Department of Osteopathic Manipulative Medicine, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Jason Maddox
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Erich Berg
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Karen Kim
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Scott Messier
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Loren Swanson
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Richard Dobrusin
- Department of Osteopathic Manipulative Medicine, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Amy B Stein
- Office of Research and Sponsored Programs, Midwesetern University, Glendale, AZ, USA
| | - G Nathan Nakken
- Department of Osteopathic Manipulative Medicine, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Jeannine Noble
- Department of Anatomy, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Randall Nydam
- Department of Anatomy, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
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From in vitro evaluation of a finite element model of the spine to in silico comparison of spine instrumentations. J Mech Behav Biomed Mater 2021; 123:104797. [PMID: 34492614 DOI: 10.1016/j.jmbbm.2021.104797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Abstract
Growth-preserving spinal surgery suffer from high complications rate. A recent bipolar instrumentation using two anchoring points (thoracic and pelvic) showed lower rates, but its biomechanical behaviour has not been characterised yet. The aim of this work was to combine in vitro and in vivo data to improve and validate a finite element model (FEM) of the spine, and to apply it to compare bipolar and classical all-screws implants. Spinal segments were tested in vitro to measure range of motion (ROM). Thoracic segments were also tested with bipolar instrumentation to measure ROM and rod strain using a strain gage. A subject-specific FEM of the spine, pelvis and ribcage of an in vivo asymptomatic subject was built. Spinal segments were extracted from it to reproduce the in-vitro mechanical tests. Experimental and simulated ROM and rod strain were compared. Then, the full trunk FEM was used to compare bipolar and all-screws instrumentations. The FEM fell within 1° of the experimental corridors, and both in silico and in vitro instrumentation rods showed 0.01% maximal axial strain. Bipolar and all-screws constructs had similar maximal Von Mises stresses. This work represents a first step towards subject-specific simulation to evaluate spinal constructs for neuromuscular scoliosis in children.
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Koutras C, Pérez J, Kardash K, Otaduy MA. A study of the sensitivity of biomechanical models of the spine for scoliosis brace design. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106125. [PMID: 34020374 DOI: 10.1016/j.cmpb.2021.106125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The development of biomechanical models of the torso and the spine opens the door to computational solutions for the design of braces for adolescent idiopathic scoliosis. However, the design of such biomechanical models faces several unknowns, such as the correct identification of relevant mechanical elements, or the required accuracy of model parameters. The objective of this study was to design a methodology for the identification of the aforementioned elements, with the purpose of creating personalized models suited for patient-specific brace design and the definition of parameter estimation criteria. METHODS We have developed a comprehensive model of the torso, including spine, ribcage and soft tissue, and we have developed computational tools for the analysis of the model parameters. With these tools, we perform an analysis of the model under typical loading conditions of scoliosis braces. RESULTS We present a complete sensitivity analysis of the models mechanical parameters and a comparison between a reference healthy subject and a subject suffering from scoliosis. Furthermore, we make a direct connection between error bounds on the deformation and tolerances for parameter estimation, which can guide the personalization of the model. CONCLUSIONS Not surprisingly, the stiffness parameters that govern the lateral deformation of the spine in the frontal plane are some of the most relevant parameters, and require careful modeling. More surprisingly, their relevance is on par with the correct parameterization of the soft tissue of the torso. For scoliosis patients, but not for healthy subjects, we observe that the axial rotation of the spine also requires careful modeling.
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Affiliation(s)
| | - Jesús Pérez
- Universidad Rey Juan Carlos, Madrid, 28933, Spain.
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A Dynamic Optimization Approach for Solving Spine Kinematics While Calibrating Subject-Specific Mechanical Properties. Ann Biomed Eng 2021; 49:2311-2322. [PMID: 33851322 DOI: 10.1007/s10439-021-02774-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
This study aims to propose a new optimization framework for solving spine kinematics based on skin-mounted markers and estimate subject-specific mechanical properties of the intervertebral joints. The approach enforces dynamic consistency in the entire skeletal system over the entire time-trajectory while personalizing spinal stiffness. 3D reflective markers mounted on ten vertebrae during spine motions were measured in ten healthy volunteers. Biplanar X-rays were taken during neutral stance of the subjects wearing the markers. Calculated spine kinematics were compared to those calculated using inverse kinematics (IK) and IK with imposed generic kinematic constraints. Calculated spine kinematics compared well with standing X-rays, with average root mean square differences of the vertebral body center positions below 10.1 mm and below [Formula: see text] for joint orientation angles. For flexion/extension and lateral bending, the lumbar rotation distribution patterns, as well as the ranges of rotations matched in vivo literature data. The approach outperforms state-of-art IK and IK with constraints methods. Calculated ratios reflect reduced spinal stiffness in low-resistance zone and increased stiffness in high-resistance zone. The patterns of calibrated stiffness were consistent with previously reported experimentally determined patterns. This approach will further our insight into spinal mechanics by increasing the physiological representativeness of spinal motion simulations.
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Georg Schmorl Prize of the German Spine Society (DWG) 2020: new biomechanical in vitro test method to determine subsidence risk of vertebral body replacements. 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; 30:1117-1124. [PMID: 33730216 DOI: 10.1007/s00586-021-06764-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Prevention of implant subsidence in osteoporotic (thoraco)lumbar spines is still a major challenge in spinal surgery. In this study, a new biomechanical in vitro test method was developed to simulate patient activities in order to determine the subsidence risk of vertebral body replacements during physiologic loading conditions. METHODS The study included 12 (thoraco)lumbar (T11-L1, L2-L4) human specimens. After dorsal stabilisation and corpectomy, vertebral body replacements (VBR) with (a) round centrally located and (b) lateral end pieces with apophyseal support were implanted, equally distributed regarding segment, sex, mean BMD ((a) 64.2 mgCaHA/cm3, (b) 66.7 mgCaHA/cm3) and age ((a) 78 years, (b) 73.5 years). The specimens were then subjected to everyday activities (climbing stairs, tying shoes, lifting 20 kg) simulated by a custom-made dynamic loading simulator combining corresponding axial loads with flexion-extension and lateral bending movements. They were applied in oscillating waves at 0.5 Hz and raised every 100 cycles phase-shifted to each other by 50 N or 0.25°, respectively. The range of motion (ROM) of the specimens was determined in all three motion planes under pure moments of 3.75 Nm prior to and after implantation as well as subsequently following activities. Simultaneously, subsidence depth was quantified from fluoroscope films. A mixed model (significance level: 0.05) was established to relate subsidence risk to implant geometries and patients' activities. RESULTS With this new test method, simulating everyday activities provoked clinically relevant subsidence schemes. Generally, severe everyday activities caused deeper subsidence which resulted in increased ROM. Subsidence of lateral end pieces was remarkably less pronounced which was accompanied by a smaller ROM in flexion-extension and higher motion possibilities in axial rotation (p = 0.05). CONCLUSION In this study, a new biomechanical test method was developed that simulates physiologic activities to examine implant subsidence. It appears that the highest risk of subsidence occurs most when lifting heavy weights, and into the ventral part of the caudal vertebra. The results indicate that lateral end pieces may better prevent from implant subsidence because of the additional cortical support. Generally, patients that are treated with a VBR should avoid activities that create high loading on the spine.
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Abstract
ABSTRACT Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.
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Affiliation(s)
- Alexandra Gundersen
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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Belyaev RI, Kuznetsov AN, Prilepskaya NE. A mechanistic approach for the calculation of intervertebral mobility in mammals based on vertebrae osteometry. J Anat 2021; 238:113-130. [PMID: 32951205 PMCID: PMC7754917 DOI: 10.1111/joa.13300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 01/03/2023] Open
Abstract
In this paper, we develop and validate an osteometry-based mechanistic approach to calculation of available range of motion (aROM) in presacral intervertebral joints in sagittal bending (SB), lateral bending (LB), and axial rotation (AR). Our basic assumption was the existence of a mechanistic interrelation between the geometry of zygapophysial articular facets and aROM. Trigonometric formulae are developed for aROM calculation, of which the general principle is that the angle of rotation is given by the ratio of the arc length of motion to the radius of this arc. We tested a number of alternative formulae against available in vitro data to identify the most suitable geometric ratios and coefficients for accurate calculation. aROM values calculated with the developed formulae show significant correlation with in vitro data in SB, LB, and AR (Pearson r = 0.900) in the reference mammals (man, sheep, pig, cow). It was found that separate formulae for different zygapophysial facet types (radial (Rf), tangential (Tf), radial with a lock (RfL)) give significantly greater accuracy in aROM calculation than the formulae for the presacral spine as a whole and greater accuracy than the separate formulae for different spine regions (cervical, thoracic, lumbar). The advantage of the facet-specific formulae over the region-specific ones shows that the facet type is a more reliable indicator of the spine mobility than the presence or absence of ribs. The greatest gain in calculation accuracy with the facet-specific formulae is characteristic in AR aROM. The most important theoretical outcome is that the evolutionary differentiation of the zygapophysial facets in mammals, that is the emergence of Tf joints in the rib cage area of the spine, was more likely associated with the development of AR rather than with SB mobility and, hence, with cornering rather than with forward galloping. The AR aROM can be calculated with the formulae common for man, sheep, pig, and cow. However, the SB aROM of the human spine is best calculated with different coefficient values in the formulae than those for studied artiodactyls. The most suitable coefficient values indicate that the zygapophysial articular facets tend to slide past each other to a greater extent in the human thoracolumbar spine rather than in artiodactyls. Due to this, artiodactyls retain relatively greater facet overlap in extremely flexed and extremely extended spine positions, which may be more crucial for their quadrupedal gallop than for human bipedal locomotion. The SB, LB, and AR aROMs are quite separate in respect of the formulae structure in the cervical region (radial facet type). However, throughout the thoracolumbar spine (tangential and radial with lock facets), the formulae for LB and AR are basically similar differing in coefficient values only. This means that, in the thoracolumbar spine, the greater the LB aROM, the greater the AR aROM, and vice versa. The approach developed promises a wide osteological screening of extant and extinct mammals to study the sex, age, geographical variations, and disorders.
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Affiliation(s)
- Ruslan I. Belyaev
- A.N. Severtsov Institute of Ecology and EvolutionRussian Academy of SciencesMoscowRussian Federation
| | | | - Natalya E. Prilepskaya
- A.N. Severtsov Institute of Ecology and EvolutionRussian Academy of SciencesMoscowRussian Federation
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Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity. J Biomech 2020; 110:109946. [DOI: 10.1016/j.jbiomech.2020.109946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
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Sangiorgio SN, Borkowski SL, Day MJ, Ho NC, Knutsen A, Scaduto AA, Bowen RE, Ebramzadeh E. Increasing loads and diminishing returns: a biomechanical study of direct vertebral rotation. Spine Deform 2020; 8:577-584. [PMID: 32026440 DOI: 10.1007/s43390-020-00061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Biomechanical simulation of DVR and pure-moment testing on thoracic spines. OBJECTIVES Characterize load-deformation response of thoracic spines under DVR maneuvers until failure, and compare to pure-moment testing of same spines. Despite reports of surgical complications, few studies exist on increase in ROM under DVR torque. Biomechanical models predicting increases from surgical releases have consistently used "pure-moments", a standard established for non-destructive measurement of ROM. Yet, DVR torque is not accurately modeled using pure moments and, moreover, magnitudes of torque applied during DVR maneuvers may be substantially higher than pure-moment testing. METHODS Cadaveric thoracic spines (N = 11) were imaged, then prepared. Polyaxial pedicle screws were implanted at T7-T10 after surgical releases. Bilateral facetectomies and Ponte osteotomies were completed at T10-T11. A custom apparatus, mounted into an 8-dof MTS load frame, was used to attach to pedicle screws, allowing simulation of surgical DVR maneuvers. Motions of vertebrae were measured using optical motion tracking. Torque was increased until rupture of the T10-T11 disc or fracture at the pedicle screw sites at any level. The torque-rotation behavior was compared to its behavior under pure-moment testing performed prior to the DVR maneuver. RESULTS Under DVR maneuvers, failure of the T10-T11 discs accompanied in most cases by pedicle screw loosening, occurred at 13.7-54.7 Nm torque, increasing axial rotation by 1.4°-8.9°. In contrast, pure-moment testing (4 Nm) increased axial rotation by only 0.0°-0.9°. CONCLUSIONS DVR resulted in substantially greater correction potential increases compared to pure-moment testing even at the same torque. These results suggest increased flexibility obtained by osteotomies and facetectomies is underestimated using pure-moment testing, misrepresenting clinical expectations. The present study is an important and necessary step toward the establishment of a more accurate and ultimately surgically applied model. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sophia N Sangiorgio
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
| | | | - Matthew J Day
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA.
| | - Nathan C Ho
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
| | - Ashleen Knutsen
- University of Southern California (USC), Los Angeles, CA, USA
| | - Anthony A Scaduto
- Orthopaedic Institute for Children (OIC) and the Department of Orthopaedic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Richard E Bowen
- Orthopaedic Institute for Children (OIC) and the Department of Orthopaedic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Edward Ebramzadeh
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
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Wilke HJ, Herkommer A, Werner K, Liebsch C. In vitro Analysis of the Intradiscal Pressure of the Thoracic Spine. Front Bioeng Biotechnol 2020; 8:614. [PMID: 32626699 PMCID: PMC7311578 DOI: 10.3389/fbioe.2020.00614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
The hydrostatic pressure of the nucleus pulposus represents an important parameter in the characterization of spinal biomechanics, affecting the segmental stability as well as the stress distribution across the anulus fibrosus and the endplates. For the development of experimental setups and the validation of numerical models of the spine, intradiscal pressure (IDP) values under defined boundary conditions are therefore essential. Due to the lack of data regarding the thoracic spine, the purpose of this in vitro study was to quantify the IDP of human thoracic spinal motion segments under pure moment loading. Thirty fresh-frozen functional spinal units from 19 donors, aged between 43 and 75 years, including all segmental levels from T1-T2 to T11-T12, were loaded up to 7.5 Nm in flexion/extension, lateral bending, and axial rotation. During loading, the IDP was measured using a flexible sensor tube, which was inserted into the nucleus pulposus under x-ray control. Pressure values were evaluated from third full loading cycles at 0.0, 2.5, 5.0, and 7.5 Nm in each motion direction. Highest IDP increase was found in flexion, being significantly (p < 0.05) increased compared to extension IDP. Median pressure values were lowest in lateral bending while exhibiting a large variation range. Flexion IDP was significantly increased in the upper compared to the mid- and lower thoracic spine, whereas extension IDP was significantly higher in the lower compared to the upper thoracic spine, both showing significant (p < 0.01) linear correlation with the segmental level at 7.5 Nm (flexion: r = -0.629, extension: r = 0.500). No significant effects of sex or age were detected, however trends toward higher IDP in specimens from female donors and decreasing IDP with increasing age, potentially caused by fibrotic degenerative changes in the nucleus pulposus tissue. Sagittal and transversal cuttings after testing revealed possible relationships between nucleus pulposus quality and pressure moment characteristics, overall leading to low or negative intrinsic IDP and non-linear pressure-moment behavior in case of fibrotic tissue alterations. In conclusion, this study provides insights into thoracic spinal IDP and offers a large dataset for the validation of numerical models of the thoracic spine.
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Affiliation(s)
- Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Andrea Herkommer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Karin Werner
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
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Ignasiak D. A novel method for prediction of postoperative global sagittal alignment based on full-body musculoskeletal modeling and posture optimization. J Biomech 2020; 102:109324. [PMID: 31526589 DOI: 10.1016/j.jbiomech.2019.109324] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/18/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
Associations between spinal sagittal balance and pain and disability are well documented. Reciprocal changes after spinal surgery might be critical for the outcomes, but assessing their extent remains a challenge. This paper proposes a method for predicting full-body sagittal alignment including reciprocal changes in response to spinal fusion, based on musculoskeletal modeling and inverse-inverse dynamics approach. An established body model (AnyBody) was used, with fused segments modeled as rigid. Posture was optimized based on muscle expenditure minimization, following the concept of the cone of economy. The data of adult spinal fusion patients were obtained retrospectively from an ongoing clinical study. Patient spino-pelvic alignment, body weight and height, age- and pathology-related muscle deterioration, and underwent treatment details were represented in the model. Predicted postural changes were compared to follow-up radiographs to evaluate method validity. Twenty-one cases were analyzed in this preliminary study (age range = 48-74; number of fused segments 1-14). The model predictions correlated well with the radiographic measures at follow-up: TPA, r = 0.83; ΔPILL, r = 0.90; LL, r = 0.90; TK, r = 0.77. The model demonstrated high accuracy in predicting sagittal imbalance (positive predictive value = 1.00, negative predictive value = 0.75). The presented method for patient- and treatment-specific postoperative posture prediction can be used to guide preoperative planning of spinal fusion, but more extensive validation is needed.
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Liebsch C, Jonas R, Wilke HJ. Thoracic spinal kinematics is affected by the grade of intervertebral disc degeneration, but not by the presence of the ribs: An in vitro study. Spine J 2020; 20:488-498. [PMID: 31654810 DOI: 10.1016/j.spinee.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Thoracic spinal three-dimensional kinematics is widely unknown. For the evaluation of surgical treatments and the complete validation of numerical models, however, kinematic data of the thoracic spine are essential. PURPOSE To identify possible effects of rib presence and grade of intervertebral disc degeneration on thoracic spinal kinematics including three-plane helical axes and instantaneous centers of rotation. DESIGN/SETTING Radiological grading of intervertebral disc degeneration and in vitro tests using n=8 human thoracic functional spinal units of the segmental levels T1-T2, T3-T4, T5-T6, T7-T8, T9-T10, and T11-T12, respectively, were performed with as well as without ribs to analyze the specific kinematic properties. METHODS Specimens were loaded with pure moments of 5 Nm and constant loading rates of 1°/s in flexion/extension, lateral bending, and axial rotation. Optical motion tracking was performed to visualize helical axes and instantaneous centers of rotation on three-plane X-rays and to evaluate primary ranges of motion (ROMs) and coupled motions. RESULTS Motion segments with no or mild disc degeneration showed reproducible kinematics in all motion planes, whereas medium or severely degenerated specimens offered high variations and shifts of the rotational axes to the distal direction as well as lower ROM. Coupled motions were generally not detected. CONCLUSIONS With progressing disc degeneration, the rotational axes show higher variation and tend to shift in distal direction, especially in flexion/extension with a shift to the anterior direction, whereas rib resection does not affect thoracic spinal kinematics but its stability. Rib resections as part of spinal deformity treatment destabilize the thoracic spine, but do not alter its kinematics. Young and healthy discs, however, could be affected by surgical treatments of the thoracic spine regarding thoracic spinal kinematics.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstraße 14, Ulm 89081, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstraße 14, Ulm 89081, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstraße 14, Ulm 89081, Germany.
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Liebsch C, Wilke HJ. Rib Presence, Anterior Rib Cage Integrity, and Segmental Length Affect the Stability of the Human Thoracic Spine: An in vitro Study. Front Bioeng Biotechnol 2020; 8:46. [PMID: 32117927 PMCID: PMC7018667 DOI: 10.3389/fbioe.2020.00046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022] Open
Abstract
The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on thoracic spinal stability have not been extensively investigated, but are essential for the calibration and validation of numerical models of the thoracic spine and rib cage. The aim of the study was to quantify these effects by in vitro experiments. Eight human thoracic spine specimens (C7-L1) including the rib cage were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation while tracking the motions of all functional spinal units. Specimens were tested stepwise in four different conditions: (1) In the intact condition, (2) after cutting all anterior rib-to-rib connections, (3) after partitioning the polysegmental specimens into monosegmental specimens, and (4) after removing the ribs in the monosegmental condition. Significant increases of the range of motion (p < 0.05) were especially found at the segmental levels of the upper half of the thoracic spine in all motion planes and for all resection steps, particularly in axial rotation, while the stabilizing effects of the structures decreased in inferior direction. Partitioning of polysegmental specimens into monosegmental specimens primarily affected the stability in lateral bending, while the effects of resection were generally lowest in flexion/extension. Presence of the ribs, anterior rib cage integrity, and segmental length all affect the thoracic spinal stability and have therefore to be considered in the calibration process of numerical models of the thoracic spine and rib cage.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
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Ruiz J, Feigenbaum L, Best TM. The Thoracic Spine in the Overhead Athlete. Curr Sports Med Rep 2020; 19:11-16. [PMID: 31913918 DOI: 10.1249/jsr.0000000000000671] [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]
Abstract
Overhead athletes are susceptible to many injuries, particularly in the shoulder and lumbar spine. Due to the heterogeneity of these two regional injuries, it is difficult to pinpoint the exact origin. A potential contributing factor that should be thoroughly evaluated is the thoracic spine. It can be challenging to quantify exactly how much thoracic spine mobility or lack thereof plays a role toward injury. Despite this, when examining mechanics of an overhead athlete, if neuromuscular control of the thorax is impaired, adjacent motion segments often take the brunt of the required movements. This article addresses the need to incorporate the thoracic spine when analyzing the entire kinetic chain. Clinical pearls regarding thoracic neuromuscular control and rehabilitation were explored, as well as a review of recent literature. Further investigation of thoracic spine therapeutic interventions should be considered when treating overhead athletes.
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Affiliation(s)
- Jeffrey Ruiz
- Department of Physical Therapy and Athletics, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Luis Feigenbaum
- Department of Physical Therapy and Athletics, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Thomas M Best
- Division of Sports Medicine, Department of Orthopedics, Miller School of Medicine, University of Miami Sports Medicine Institute, Coral Gables, FL
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Wang W, Wang D, De Groote F, Scheys L, Jonkers I. Implementation of physiological functional spinal units in a rigid-body model of the thoracolumbar spine. J Biomech 2020; 98:109437. [DOI: 10.1016/j.jbiomech.2019.109437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/14/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
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Zhang C, Mannen EM, Sis HL, Cadel ES, Wong BM, Wang W, Cheng B, Friis EA, Anderson DE. Moment-rotation behavior of intervertebral joints in flexion-extension, lateral bending, and axial rotation at all levels of the human spine: A structured review and meta-regression analysis. J Biomech 2019; 100:109579. [PMID: 31911050 DOI: 10.1016/j.jbiomech.2019.109579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Spinal intervertebral joints are complex structures allowing motion in multiple directions, and many experimental studies have reported moment-rotation response. However, experimental methods, reporting of results, and levels of the spine tested vary widely, and a comprehensive assessment of moment-rotation response across all levels of the spine is lacking. This review aims to characterize moment-rotation response in a consistent manner for all levels of the human spine. A literature search was conducted in PubMed for moment versus rotation data from mechanical testing of intact human cadaveric intervertebral joint specimens in flexion-extension, lateral bending, and axial rotation. A total of 45 studies were included, providing data from testing of an estimated 1,648 intervertebral joints from 518 human cadavers. We used mixed-effects regression analysis to create 75 regression models of moment-rotation response (25 intervertebral joints × 3 directions). We found that a cubic polynomial model provides a good representation of the moment-rotation behavior of most intervertebral joints, and that compressive loading increases rotational stiffness throughout the spine in all directions. The results allow for the direct evaluation of intervertebral ranges of motion across the whole of the spine for given loading conditions. The random-effects outcomes, representing standard deviations of the model coefficients across the dataset, can aid understanding of normal variations in moment-rotation responses. Overall these results fill a large gap, providing the first realistic and comprehensive representations of moment-rotation behavior at all levels of the spine, with broad implications for surgical planning, medical device design, computational modeling, and understanding of spine biomechanics.
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Affiliation(s)
- Chaofei Zhang
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Tsinghua University, Beijing, China
| | - Erin M Mannen
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | - Bo Cheng
- Tsinghua University, Beijing, China
| | | | - Dennis E Anderson
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Rahm MD, Brooks DM, Harris JA, Hart RA, Hughes JL, Ferrick BJ, Bucklen BS. Stabilizing effect of the rib cage on adjacent segment motion following thoracolumbar posterior fixation of the human thoracic cadaveric spine: A biomechanical study. Clin Biomech (Bristol, Avon) 2019; 70:217-222. [PMID: 31669919 DOI: 10.1016/j.clinbiomech.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the rib cage provides substantial stability to the thoracic spine, few biomechanical studies have incorporated it into their testing model, and no studies have determined the influence of the rib cage on adjacent segment motion of long fusion constructs. The present biomechanical study aimed to determine the mechanical contribution of the intact rib cage during the testing of instrumented specimens. METHODS A cyclic loading (CL) protocol with instrumentation (T4-L2 pedicle screw-rod fixation) was conducted on five thoracic spines (C7-L2) with intact rib cages. Range of motion (±5 Nm pure moment) in flexion-extension, lateral bending, and axial rotation was captured for intact ribs, partial ribs, and no ribs conditions. Comparisons at the supra-adjacent (T2-T3), adjacent (T3-T4), first instrumented (T4-T5), and second instrumented (T5-T6) levels were made between conditions (P ≤ 0.05). FINDINGS A trend of increased motion at the adjacent level was seen for partial ribs and no ribs in all 3 bending modes. This trend was also observed at the supra-adjacent level for both conditions. No significant changes in motion compared to the intact ribs condition were seen at the first and second instrumented levels (P > 0.05). INTERPRETATION The segment adjacent to long fusion constructs, which may appear more grossly unstable when tested in the disarticulated spine, is reinforced by the rib cage. In order to avoid overestimating adjacent level motion, when testing the effectiveness of surgical techniques of the thoracic spine, inclusion of the rib cage may be warranted to better reflect clinical circumstances.
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Affiliation(s)
- Mark D Rahm
- Department of Orthopaedic Surgery, Baylor Scott and White Health/Texas A&M University College of Medicine, 2401 S 31(st) Street, Temple, Texas, 76508, USA.
| | - Daina M Brooks
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, 601 Broadway, Seattle, WA 98122, USA.
| | - Jessica L Hughes
- Department of Orthopaedic Surgery, Baylor Scott and White Health/Texas A&M University College of Medicine, 2401 S 31(st) Street, Temple, Texas, 76508, USA.
| | - Bryan J Ferrick
- Drexel University School of Biomedical Engineering, Science and Health Systems, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
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Wilke HJ, Grundler S, Ottardi C, Mathew CE, Schlager B, Liebsch C. In vitro analysis of thoracic spinal motion segment flexibility during stepwise reduction of all functional structures. 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 2019; 29:179-185. [PMID: 31664565 DOI: 10.1007/s00586-019-06196-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to quantify the stabilizing effect of the passive structures in thoracic spinal motion segments by stepwise resections. These data can be used to calibrate finite element models of the thoracic spine, which are needed to explore novel surgical treatments of spinal deformities, fractures, and tumours. METHOD Six human thoracic spinal motion segments from three segmental levels (T2-T3, T6-T7, and T10-T11) were loaded with pure moments of 1 and 2.5 Nm in flexion/extension, lateral bending, and axial rotation. After each loading step, the ligaments, facet capsules, and the nucleus pulposus were stepwise resected from posterior to anterior direction, while the segmental relative motions were measured using an optical motion tracking system. RESULTS Significant increases (p < 0.05) in the range of motion were detected after resecting the anterior spinal structures depending on loading magnitude, motion direction, and segmental level. The highest relative increases in the range of motion were observed after nucleotomy in all motion directions. The vertebral arch mostly stabilized the thoracic spinal motion segments in flexion and extension, while the facet joint capsules mainly affected the segmental stability in axial rotation. Coupled motions were not observed. CONCLUSIONS The anulus fibrosus defines the motion characteristics qualitatively, while the ligaments and the presence of the nucleus pulposus restrict the mobility of a thoracic spinal motion segment solely in a quantitative manner. The posterior ligaments do not predominantly serve for primary stability but for the prevention of hyperflexion. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Hans-Joachim Wilke
- Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany.
| | - Stefan Grundler
- Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Claudia Ottardi
- LaBS, Department of Chemistry, Material and Chemical Engineering, Politecnico di Milano, Milan, Italy
| | - Chinnu-Elsa Mathew
- Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Benedikt Schlager
- Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Christian Liebsch
- Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
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Tachihara H, Hamada J. Characteristic Movement of the Ribs, Thoracic Vertebrae while Elevating the Upper Limbs - Influences of Age and Gender on Movements. Open Orthop J 2019. [DOI: 10.2174/1874325001913010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
The rib cage, such as the thoracic spine and ribs, influences glenohumeral mobility and the development of shoulder disorders.
Objective:
To evaluate movements of the ribs, thoracic vertebrae during bilateral arm elevation and to clarify the characteristic influences of age and gender.
Methods:
Subjects comprised 33 healthy individuals divided into a young group (10 males, 7 females; mean age, 25 years) and a middle-aged group (8 males, 8 females; mean age, 52 years). Chest CT was performed with two arm positions: arms hanging downwards; and arms elevated at 160°. Images were three-dimensionally reconstructed to evaluate rib movement, extension angle of thoracic vertebrae.
Results:
Maximal movement was observed at the fifth rib, and rib movement decreased with increasing distance from the fifth rib in both the groups. In males, movement of the second to fourth ribs was smaller in the middle-aged group than in the young group (p < 0.05). Movement of the first to ninth ribs was smaller in females than in males (p < 0.05). No significant difference in the extension angle of the thoracic vertebrae was found.
Conclusion:
Fifth rib movement is the largest among all ribs during bilateral arm elevation. Reduction of upper rib movement initially arises as an age-related degradation in males. Women exhibit less rib movement during bilateral arm elevation.
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Wei W, Evin M, Bailly N, Llari M, Laporte JD, Arnoux PJ. Spinal injury analysis for typical snowboarding backward falls. Scand J Med Sci Sports 2018; 29:450-459. [PMID: 30468539 DOI: 10.1111/sms.13342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
Spinal injury (SPI) often causes death and disability in snow-sport accidents. SPIs often result from spinal compression and flexion, but the injury risks due to over flexion have not been studied. Back protectors are used to prevent SPIs but the testing standards do not evaluate the flexion-extension resistance. To investigate SPI risks and to better define back-protector specifications, this study quantified the flexion-extension range of motions (ROMs) of the thoracic-lumbar spine during typical snowboarding backward falls. A human facet-multibody model, which was calibrated against spinal flexion-extension responses and validated against vehicle-pedestrian impact and snowboarding backward fall, was used to reproduce typical snowboarding backward falls considering various initial conditions (initial velocity, slope steepness, body posture, angle of approach, anthropometry, and snow stiffness). The SPI risks were quantified by normalizing the numerical spinal flexion-extension ROMs against the corresponding ROM thresholds from literature. A high risk of SPI was found in most of the 324 accident scenarios. The thoracic segment T6-T7 had the highest injury risk and incidence. The thoracic spine was found more vulnerable than the lumbar spine. Larger anthropometries and higher initial velocities tended to increase SPI risks while bigger angles of approach helped to reduce the risks. SPIs can result from excessive spinal flexion-extension during snowboarding backward falls. Additional evaluation of back protector's flexion-extension resistance should be included in current testing standards. An ideal back protector should consider the vulnerable spinal segments, the snowboarder's skill level and anthropometry.
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Affiliation(s)
- Wei Wei
- IFSTTAR, LBA UMR T24, Aix-Marseille University, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Morgane Evin
- IFSTTAR, LBA UMR T24, Aix-Marseille University, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Nicolas Bailly
- IFSTTAR, LBA UMR T24, Aix-Marseille University, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France.,Department of Mechanical Engineering, Ecole de Technologie Supérieure, Montreal, QC, Canada
| | - Maxime Llari
- IFSTTAR, LBA UMR T24, Aix-Marseille University, Marseille, France
| | | | - Pierre-Jean Arnoux
- IFSTTAR, LBA UMR T24, Aix-Marseille University, Marseille, France.,iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
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The effect of follower load on the intersegmental coupled motion characteristics of the human thoracic spine: An in vitro study using entire rib cage specimens. J Biomech 2018; 78:36-44. [DOI: 10.1016/j.jbiomech.2018.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022]
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Pan F, Firouzabadi A, Reitmaier S, Zander T, Schmidt H. The shape and mobility of the thoracic spine in asymptomatic adults - A systematic review of in vivo studies. J Biomech 2018; 78:21-35. [PMID: 30100219 DOI: 10.1016/j.jbiomech.2018.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022]
Abstract
A comprehensive knowledge of the thoracic shape and kinematics is essential for effective risk prevention, diagnose and proper management of thoracic disorders and assessment of treatment or rehabilitation strategies as well as for in silico and in vitro models for realistic applications of boundary conditions. After an extensive search of the existing literature, this study summarizes 45 studies on in vivo thoracic kyphosis and kinematics and creates a systematic and detailed database. The thoracic kyphosis over T1-12 determined using non-radiological devices (34°) was relatively less than measured using radiological devices (40°) during standing. The majority of kinematical measurements are based on non-radiological devices. The thoracic range of motion (RoM) was greatest during axial rotation (40°), followed by lateral bending (26°), and flexion (21°) when determined using non-radiological devices during standing. The smallest RoM was identified during extension (13°). The lower thoracic level (T8-12) contributed more to the RoM than the upper (T1-4) and middle (T4-8) levels during flexion and lateral bending. During axial rotation and extension, the middle level (T4-8) contributed the most. Coupled motion was evident, mostly during lateral bending and axial rotation. With aging, the thoracic kyphosis increased by about 3° per decade, whereas the RoM decreased by about 5° per decade for all load directions. These changes with aging mainly occurred in the lower region (T6-12). The influence of sex on thoracic kyphosis and the RoM has been described as partly contradictory. Obesity was found to decrease the thoracic RoM. Studies comparing standing, sitting and lying reported the effect of posture as significant.
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Affiliation(s)
- Fumin Pan
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Ali Firouzabadi
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Sandra Reitmaier
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Thomas Zander
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
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Schlager B, Niemeyer F, Galbusera F, Wilke HJ. Asymmetrical intrapleural pressure distribution: a cause for scoliosis? A computational analysis. Eur J Appl Physiol 2018; 118:1315-1329. [PMID: 29654404 DOI: 10.1007/s00421-018-3864-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The mechanical link between the pleural physiology and the development of scoliosis is still unresolved. The intrapleural pressure (IPP) which is distributed across the inner chest wall has yet been widely neglected in etiology debates. With this study, we attempted to investigate the mechanical influence of the IPP distribution on the shape of the spinal curvature. METHODS A finite element model of pleura, chest and spine was created based on CT data of a patient with no visual deformities. Different IPP distributions at a static end of expiration condition were investigated, such as the influence of an asymmetry in the IPP distribution between the left and right hemithorax. The results were then compared to clinical data. RESULTS The application of the IPP resulted in a compressive force of 22.3 N and a flexion moment of 2.8 N m at S1. An asymmetrical pressure between the left and right hemithorax resulted in lateral deviation of the spine towards the side of the reduced negative pressure. In particular, the pressure within the dorsal section of the rib cage had a strong influence on the vertebral rotation, while the pressure in medial and ventral region affected the lateral displacement. CONCLUSIONS An asymmetrical IPP caused spinal deformation patterns which were comparable to deformation patterns seen in scoliotic spines. The calculated reaction forces suggest that the IPP contributes in counterbalancing the weight of the intrathoracic organs. The study confirms the potential relevance of the IPP for spinal biomechanics and pathologies, such as adolescent idiopathic scoliosis.
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Affiliation(s)
- Benedikt Schlager
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Fabio Galbusera
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany.
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