Human Cadaveric Lumbar Spines Research Articles

A new sensing paradigm for the vibroacoustic detection of pedicle screw loosening.

The current clinical gold standard to assess the condition and detect loosening of pedicle screw implants is radiation-emitting medical imaging. However, solely based on medical imaging, clinicians are not able to reliably identify loose implants in a substantial amount of cases. To complement medical imaging for pedicle screw loosening detection, we propose a new methodology and paradigm for the radiation-free, non-destructive, and easy-to-integrate loosening detection based on vibroacoustic sensing. For the detection of a loose implant, we excite the vertebra of interest with a sine sweep vibration at the spinous process and use a custom highly sensitive piezo vibration sensor attached directly at the screw head to capture the propagated vibration characteristics which are analyzed using a detection pipeline based on spectrogram features and a SE-ResNet-18. To validate the proposed approach, we propose a novel, biomechanically validated simulation technique for pedicle screw loosening, conduct experiments using four human cadaveric lumbar spine specimens, and evaluate our algorithm in a cross-validation experiment. The proposed method reaches a sensitivity of and a specificity of for pedicle screw loosening detection.

Does index-level pedicle screw instrumentation affect cage subsidence after vertebral body replacement? – A biomechanical study in human cadaveric osteoporotic specimens

BackgroundVertebral body replacement is a common surgical procedure for treatment of disorders associated with spinal instability. Therefore, pedicle screws are usually inserted in adjacent vertebrae for stabilization of the posterior column, however, there is lack of evidence whether implantation of index-level pedicle screws is beneficial or not. This biomechanical study aims to investigate the effect of pedicle screw instrumentation on axial stability following vertebral body replacement. MethodsUnstable fracture at L3 level was simulated in lumbar spines from six human cadaveric specimens. Then instrumentation was performed one level above / one level below index level in three specimens and further, three specimens were instrumented at index-level (L3) additionaly. Then we used a testing protocol for biomechanical evaluation of axial loading on human cadaveric lumbar spines until cage subsidence occurred. FindingsOur results show that index-level instrumented spines endured significantly higher load until cage subsidence occurred compared to non-index-level instrumented specimens (p = 0.05). InterpretationOur results demonstrate pedicle screw instrumentation at index-level vertebra should be considered when possbile as it may have a protective effect against cage subsidence in patients undergoing vertebral body replacement surgery.

Dark-field X-ray imaging for the assessment of osteoporosis in human lumbar spine specimens.

Background: Dark-field imaging is a novel imaging modality that allows for the assessment of material interfaces by exploiting the wave character of x-ray. While it has been extensively studied in chest imaging, only little is known about the modality for imaging other tissues. Therefore, the purpose of this study was to evaluate whether a clinical X-ray dark-field scanner prototype allows for the assessment of osteoporosis. Materials and methods: In this prospective study we examined human cadaveric lumbar spine specimens (vertebral segments L2 to L4). We used a clinical prototype for dark-field radiography that yields both attenuation and dark-field images. All specimens were scanned in lateral orientation in vertical and horizontal position. All specimens were additionally imaged with CT as reference. Bone mineral density (BMD) values were derived from asynchronously calibrated quantitative CT measurements. Correlations between attenuation signal, dark-field signal and BMD were assessed using Spearman's rank correlation coefficients. The capability of the dark-field signal for the detection of osteoporosis/osteopenia was evaluated with receiver operating characteristics (ROC) curve analysis. Results: A total of 58 vertebrae from 20 human cadaveric spine specimens (mean age, 73years ±13 [standard deviation]; 11 women) were studied. The dark-field signal was positively correlated with the BMD, both in vertical (r = 0.56, p < .001) and horizontal position (r = 0.43, p < .001). Also, the dark-field signal ratio was positively correlated with BMD (r = 0.30, p = .02). No correlation was found between the signal ratio of attenuation signal and BMD (r = 0.14, p = .29). For the differentiation between specimens with and without osteoporosis/osteopenia, the area under the ROC curve (AUC) was 0.80 for the dark-field signal in vertical position. Conclusion: Dark-field imaging allows for the differentiation between spine specimens with and without osteoporosis/osteopenia and may therefore be a potential biomarker for bone stability.

Interspinous-Interbody Fusion via a Strictly Lateral Surgical Approach: A Biomechanical Stabilization Comparison to Constructs Requiring Both Lateral and Posterior Approaches.

Objective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the need for intraoperative repositioning and avoid disruption of the supraspinous ligament. The objective of this in vitrobiomechanical study was to investigate segmental multidirectional stability and maintenance of foraminal distraction of a lateral interspinous fixation device compared to commonly used pedicle screw and facet screw posterior fixation constructs when combined with lumbar interbody cages. Methods Six human cadaver lumbar spine specimens were subjected to nondestructive quasistatic loading in the following states: (1) intact; (2) interspinous fixation device alone and (3) with lateral interbody cage; (4) lateral lumbar interbody cage with bilateral pedicle screws; (5) lateral lumbar interbody cage with unilateral pedicle screws; and (6) lateral lumbar interbody cage with facet screws. Multidirectional pure bending in 1.5 Nm increments to 7.5 Nm, and 7.5 Nm flexion-extension bending with a 700 N compressive follower load were performed separately with optoelectronic segmental motion measurement. Relative angular motions of L2-L3, L3-L4, and L4-L5 functional spinal units were evaluated, and the mean instantaneous axis of rotation in the sagittal plane was calculated for the index level.Foraminal height was assessed during combined flexion-extension and compression loading for each test construct. Results All implant configurations significantly restricted flexion-extension motion compared with intact (p < 0.05). No significant differences were found in flexion-extension when comparing the different posterior implants combined with lateral lumbar interbody cages. All posterior fixation devices provided comparable neuroforaminal distraction and maintained distraction during flexion and extension. Conclusions When combinedwith lateral lumbar interbody cages, the minimally invasive lateral interspinous fixation device effectively stabilized the spine and maintained neuroforaminal distraction comparable to pedicle screw constructs or facet screws. These results suggest the lateral interspinous fixation device may provide a favorable alternative to other posterior systems that require patient repositioning during surgery and involve a greater disruption of native tissues.

Biomechanical evaluation of the hybrid pedicle screw—cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration—finite element analysis

BackgroundTransforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis.MethodsFour human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared.ResultsHybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed.ConclusionHybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.

MRI-based degeneration grades for lumbar facet joints do not correlate with cartilage mechanics.

Lumbar facet joint arthritis is characterized by degeneration of articular cartilage, loss of joint spacing, and increased boney spur formation. These signs of facet joint degeneration have been previously measured using destructive biochemical and mechanical analysis. Nondestructive clinical evaluation of the facet joint has also been performed using MRI scoring, which ranks the health of the facet joint using the Fujiwara scale. However, nondestructive clinical evaluation of facet joint arthritis using standard MRI scoring provides low resolution images which result in high interobserver variability. Therefore, to assess the accuracy of nondestructive MRI analysis with regard to the health of the facet joint, this study determined whether any correlations existed between lumbar facet joint articular cartilage mechanics, facet articular cartilage biochemical signatures, and Fujiwara scores. To accomplish this aim, human cadaveric lumbar spines were obtained and imaged using T1 MRI, then independently scored by three spine researchers. An osteochondral plug from each of the L2 thru L5 facet joints was obtained and loaded under unconfined compression. The experiments showed no trends between histological images and changes in the Fujiwara score. The mechanical properties of articular cartilage (thickness, Young's modulus, instantaneous modulus, and permeability) also had no correlations with the Fujiwara score. These results show that the current Fujiwara score cannot accurately describe the biomechanics or biochemical composition of facet joint articular cartilage.

Evaluation of the resection efficiency and safety of an enhanced power plasma generator using cadaveric intervertebral discs.

Plasma energy has been used to provide minimally invasive interventional treatment for spinal problems. However, this procedure has been used for limited indications mainly because of its small resection range. To overcome this problem, we designed the enhanced power plasma device. This device seeks to maximize the resection area by modifying the electrode arrangement and enhancing the maximum electric power. The purpose of this study is to assess the efficiency and safety of this newly designed plasma generator, a device for percutaneous disc decompression. We performed an intradiscal procedure on 7 fresh human cadaver lumbar spine specimens using the enhanced power plasma under C-arm fluoroscopic guidance at various voltages. As a result, the volume of the removed area was proportional to the applied magnitude of the electric power level. In particular, under the high-power level condition after 500s treatment, nearly the entire nucleus pulposus was eliminated. The generated plasma density also tends to grow along with the given electric power. The highest level of temperature rise did not exceed the level that would lead to degeneration in the collagen tissue of the intervertebral disc. Histopathologic examination also demonstrated that there was no thermal damage to the surrounding neural tissues. In conclusion, we speculate that the concepts of this newly designed enhanced plasma generator could be applied to remove huge disc materials without thermal or structural damage to the adjacent target tissues in future spine clinics.

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine.

Compared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof. Four human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement. Twenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively. We report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.

Primary stability of the Activ L® intervertebral disc prosthesis in cadaver bone and comparison of the keel and spike anchoring concept

BackgroundHigh primary stability is the key prerequisite for safe osseointegration of cementless intervertebral disc prostheses. The aim of our study was to determine the primary stability of intervertebral disc prostheses with two different anchoring concepts – keel and spike anchoring.MethodsTen ActivL intervertebral disc prostheses (5 x keel anchoring, 5 x spike anchoring) implanted in human cadaver lumbar spine specimens were tested in a spine movement simulator. Axial load flexion, extension, left and right bending and axial rotation motions were applied on the lumbar spine specimens through a defined three-dimensional movement program following ISO 2631 and ISO/CD 18192-1.3 standards. Tri-dimensional micromotions of the implants were measured for both anchor types and compared using Student’s T-test for significance after calculating 95 % confidence intervals.ResultsIn the transverse axis, the keel anchoring concept showed statistically significant (p < 0.05) lower mean values of micromotions compared to the spike anchoring concept. The highest micromotion values for both types were observed in the longitudinal axis. In no case the threshold of 200 micrometers was exceeded.ConclusionsBoth fixation systems fulfill the required criteria of primary stability. Independent of the selected anchorage type an immediate postoperative active mobilization doesn’t compromise the stability of the prostheses.

P12. Does posterior ligamentous complex disruption following lumbar pedicle screw and rod instrumentation affect the upper adjacent level?

<h3>BACKGROUND CONTEXT</h3> The lumbar level above the fusion segment is the most common level for the development of adjacent level instability. The posterior ligamentous complex (PLC), (eg, interspinous ligament, and supraspinous ligament) a posterior tension band that stabilizes the spine, is usually removed for laminectomy during lumbar fusion and decompression surgery. The removal of the posterior complex may jeopardize upper adjacent level stability. <h3>PURPOSE</h3> To compare mobility and principal disc strains at the upper adjacent level to L4-5 pedicel screw-rod fixation (PSR) between L4-5 PSR, L4-5 PSR+ bilateral laminotomy (PLC preservation), and L4-5 PSR+ conventional laminectomy, in cadaveric specimens. The disc strain was studied with a new optical technique of soft tissue strain analysis (3D digital image correlation (DIC) technique). <h3>STUDY DESIGN/SETTING</h3> Biomechanic testing in human cadaveric spine specimens. <h3>PATIENT SAMPLE</h3> Human cadaveric lumbar spine. <h3>OUTCOME MEASURES</h3> 1. Adjacent segment range of motion, 2. Disc surface strains. <h3>METHODS</h3> Seven human cadaveric L3-S1 specimens were instrumented with L4-5 PSR. All specimens were tested multi-directionally under pure moment loading (7.5Nm) following: 1) L4-5 PSR, 2) L4-5 PSR+bilateral L4 laminotomy while preserving PLC and 3) L4-5 PSR +L4 conventional laminectomy. DIC was performed with cameras positioned laterally (left side) to capture the change in disc principal strain (Pmax and Pmin) at upper adjacent level (L3-4) under peak load. Optical motion tracking was simultaneously performed on the right side. The disc region was divided into four similar sized quarters and included upper and lower endplates. Analysis of variance of upper adjacent level (L3-4) range of motion (ROM) and disc strain between the groups was performed. Statistically significant was set at p≤0.05. <h3>RESULTS</h3> ROM of the upper adjacent (L3-4) level was significantly greater with L4-5 PSR+laminectomy (6.26 degree) versus L4-5 PSR+ bilateral laminotomy (5.94 degree, p=0.006), and L4-5 PSR (5.20 degree, p<0.001) respectively, during flexion. During extension, left lateral bending, and axial rotation, upper adjacent level ROM was significantly greater with L4-5+ laminectomy and L4-5 PSR+ bilateral laminotomy versus L4-5 PSR (p≤0.046) but there were no significant differences between L4-5 PSR+ laminectomy and L4-5PSR+ bilateral laminotomy (p≥0.087). The intervertebral disc Pmax strains of the upper adjacent level were significantly greater with L4-5 PSR+laminectomy than L4-5 PSR during flexion (25,225 VS 18,007uE, p=0.031), extension (22,803 VS 19,356uE, p=0.020), left lateral bending (32,778 VS 24,100uE, p=0.027), right lateral bending (88,761 VS 62,869uE, p=0.024), and right axial rotation (24,747 VS 19,289uE, p=0.025). <h3>CONCLUSIONS</h3> The posterior ligamentous complex disruption during lumbar fusion surgery was associated with significant increases in upper adjacent level instability and principle (Pmax) intervertebral disc stress/strain. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P11. Does the choice of spinal interbody fusion approach significantly affect adjacent segment mobility?

<h3>BACKGROUND CONTEXT</h3> Previous studies have concluded that LLIF, TLIF, and PLIF with posterior pedicle screw-rod fixation (PSR) provide equivalent stability in cadaveric specimens and are comparable in fusion rate and functional outcome. However, long-term complications, such as adjacent segment degeneration associated with each type of interbody device, are currently unclear. Little is known about the biomechanical effects of interbody fusion technique on the mobility of adjacent segments. <h3>PURPOSE</h3> To investigate the differences in adjacent segment mobility among three types of LIF: lateral lumbar interbody fusion (LLIF), transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF). <h3>STUDY DESIGN/SETTING</h3> Biomechanical study of range of motion (ROM) at the vertebral levels adjacent to the construct of posterior pedicle screw-rod fixation with different types of lumbar interbody fusion techniques (LIF). <h3>PATIENT SAMPLE</h3> Human cadaveric lumbar spine. <h3>OUTCOME MEASURES</h3> Adjacent segment range of motion. <h3>METHODS</h3> Normalized ROM data at the levels adjacent to L3–L4 PSR fixation with 3 different types of lumbar interbody fusion approaches (LLIF, TLIF, and PLIF) were analyzed. Intact (n=21) and instrumented (n=7 per group) L2–L5 cadaveric specimens were tested multidirectionally under pure moment loading (7.5 Nm). Analysis of variance of adjacent segment ROM among the groups was performed. Statistical significance was set at p<0.05. <h3>RESULTS</h3> Normalized ROM was significantly greater with PLIF than with LLIF in all directions at both proximal and distal adjacent segments (p≤0.02) except for axial rotation at the distal adjacent segment (p=0.07). TLIF also had greater normalized ROM than LLIF during lateral bending at the proximal adjacent segment (p=0.008) and during flexion, extension, and lateral bending at the distal adjacent segment (p≤0.03). Normalized ROM was not significantly different between PLIF and TLIF. <h3>CONCLUSIONS</h3> The choice of lumbar interbody fusion approach influences adjacent segment motion in a cadaveric model. LLIF had the least adjacent segment motion. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Biomechanical effects of posterior pedicle screw-based instrumentation using titanium versus carbon fiber reinforced PEEK in an osteoporotic spine human cadaver model

BackgroundAim of this biomechanical investigation was to compare the biomechanical effects of a carbon fiber reinforced PEEK and titanium pedicle screw/rod device in osteoporotic human cadaveric spine. MethodsTen human fresh-frozen cadaveric lumbar spines (L1-L5) have been used and were randomized into two groups according to the bone mineral density. A monosegmental posterior instrumentation (L3-L4) using titanium pedicle screws and rods was carried out in group A and using carbon fiber reinforced PEEK in group B. A cyclic loading test was performed at a frequency of 3 Hz, starting with a peak of 500 N for the first 2000 cycles, up to 950 N for 100,000 cycles under a general preload with 100 N. All specimens were evaluated with regard to a potential collapse of the implanted pedicle screws. A CT supported digital measurement of cavities around the pedicle at 3 defined measuring points was performed. Finally, the maximum zero-time failure load of all specimens was determined using a universal testing machine (80% Fmax). FindingsRegarding maximum axial force (group A: 2835 N, group B: 3006 N, p = 0.595) and maximum compression (group A: 11.67 mm, group B: 15.15 mm, p = 0.174) no statistical difference could be shown between the two groups. However, significant smaller cavity formation around the pedicle screws could be observed in group B (p = 0.007), especially around the screw tip (p < 0.001). InterpretationCarbon fiber reinforced PEEK devices seem to be advantageous in terms of microscopic screw loosening compared to titanium devices.

Comparison of Biomechanical Properties of a Synthetic L3-S1 Spine Model and Cadaveric Human Samples.

Human cadavers currently represent the gold standard for spine biomechanical testing, but limitations such as costs, storage, handling, and high interspecimen variance motivate the development of alternatives. A commercially available synthetic surrogate for the human spine, the Sawbones spine model (SBSM), has been developed. The equivalence of SBSM to a human cadaver in terms of biomechanical behavior has not been fully assessed. The objective of this study is to compare the biomechanics of a lumbar tract of SBSM to that of a cadaver under physiologically relevant mechanical loads. An L3-S1 SBSM and 39 comparable human cadaver lumbar spine tracts were used. Each sample was loaded in pure flexion-extension or torsion. Gravity and follower loads were also included. The movement of each vertebral body was tracked via motion capture. The range of motion (ROM) of each spine segment was recorded, as well as the overall stiffness of each L3-S1 sample. The ROM of SBSM L3-L4 was larger than that found in cadavers in flexion-extension and torsion. For the other spine levels, the ROMs of SBSM were within one standard deviation from the mean values measured in cadavers. The values of structural stiffness for L3-S1 of SBSM were comparable to those of cadaveric specimens for both flexion and torsion. In extension, SBSM was more compliant than cadavers. In conclusion, most of the biomechanical properties of an L3-S1 SBSM model were comparable to those of human cadaveric specimens, supporting the use of this synthetic surrogate for testing applications.

Influence of additional cement augmentation on endplate stability in circumferential stabilisation of osteoporotic spine fractures

BackgroundAnterior stabilisation of osteoporotic spine fractures is uncommon but necessary in the case of complex vertebral body comminution. The purpose of this study was to investigate the effect of additional cement-augmentation on the endplate stability. MethodsTwelve human cadaveric lumbar spines were divided in two groups: (A) posterior cement-augmented pedicle screw/rod-based instrumentation of L3 to L5, posterior decompression of L4/5 and partial corpectomy of L4 and (B) same experimental setup with additional cement-augmentation of the adjacent endplates. A cyclic loading test was performed at a frequency of 3 Hz, starting with a peak of 500 N for the first 2.000 cycles, up to 950 N for 100.000 cycles under a general preload with 50 N. All specimens were evaluated with regard to a potential collapse of the adjacent endplates. Subsequently, the maximum zero-time failure load of all specimens was determined using a universal testing machine. FindingsThe median T-score of bone density was −4.32 (range −2.97 to −5.59), distributed equally in the two groups (average age 83 years). The specimen of the endplate-augmented group showed a significant higher failure load compared to non-endplate-augmented cadavers (group A: 2038 N, group B: 2990 N, p = 0.03). All specimens passed the full cyclic loading protocol with 100.000 cycles. No significant difference was observable regarding the adjacent endplate subsidence. InterpretationAdditional cement augmentation in circumferential stabilisation resulted in a significant enhancement of the endplate stability regarding the maximum axial load, while the cyclic loading did not significantly enhance the fatigue endurance of the vertebral endplates over the 100,000 cycles tested.

A Biomechanical Analysis of Lateral Interbody Construct and Supplemental Fixation in Adjacent-Segment Disease of the Lumbar Spine

To analyze the stability of lateral lumbar interbody fusion (LLIF) and compare various methods of supplemental fixation in adjacent-segment disease. Four fresh-frozen human cadaveric lumbar spines (L1 to sacrum) were used for motion analysis in extension, flexion, and lateral bending. The L4-L5 level was secured with a lateral interbody cage and pedicle screws to simulate a fused segment. The adjacent segment (L3-L4) was evaluated with flexibility testing sequentially under the following conditions: native disc (control), LLIF cage, cage with lateral plate, pedicle screws with z-rod, and single-rod construct. The difference in mean displacement (millimeters) between groups was studied by the analysis of variance and post-hoc Tukey test. Mean displacement (millimeters) on averaging motion in all planes was 0.741 for native disc, 0.273 for cage, 0.183 for cage with plate, 0.086 for pedicle screws and z-rod, and 0.106 for the single-rod construct. All 4 constructs led to a significant reduction (P < 0.001) in displacement in extension and flexion, as compared with native disc. There was no demonstrable superiority between the 4 constructs as the mean displacements were not significantly different from each other. LLIF with and without supplemental fixation reduced motion significantly at the adjacent segment as compared with intact disc. There was a trend toward increasing rigidity with supplemental fixation (plate and pedicle screw constructs). Further biomechanical studies with larger sample sizes are needed to confirm these initial findings.

Design and preliminary biomechanical analysis of a novel motion preservation device for lumbar spinal disease after vertebral corpectomy.

To design a novel prosthesis, a movable artificial lumbar complex (MALC), for non-fusion reconstruction after lumbar subtotal corpectomy and to evaluate the stability, range of motion and load-bearing strength in the human cadaveric lumbar spine. Biomechanical tests were performed on lumbar spine specimens from 15 healthy cadavers which were divided in three groups: non-fusion, fusion and intact group. The range of motion (ROM), stability and load-bearing strength were measured. The prosthesis was composed of three parts: the upper and lower artificial lumbar discs and the middle artificial vertebra. Both the MALC and titanium mesh cage re-established vertebral height, and no spinal cord compression or prosthesis dislocation was observed at the operative level. Regarding stability, there was no significant difference in all directions between the intact group and non-fusion group (P > 0.05). Segment movements of the specimens in the non-fusion group revealed significantly decreased T12-L1 ROM and significantly increased L1-2 and L2-3 ROM in flexion/extension and lateral bending compared with those in the fusion group (P < 0.05). Regarding load-bearing strength, when the lumbar vertebra was ruptured, there was no damage to the MALC and titanium mesh cage, but the maximum load in the non-fusion group was larger (P > 0.05). Compared with titanium cages, the MALC prosthesis not only restored the vertebral height and effectively preserved segment movements without any abnormal gain of mobility in adjacent inter-vertebral spaces but also bore the lumbar load and reduced the local stress load of adjacent vertebral endplates.

Biomechanical testing of different posterior fusion devices on lumbar spinal range of motion

BackgroundRecent minimal-invasive posterior fusion devices are supposed to provide stability and obtain fusion in combination with interbody cages in the instrumented segment. The aim of the present study is to evaluate the primary stability of two minimal-invasive posterior prototypes compared to an established spinous process plate and standard pedicle screw instrumentation. MethodsSeven fresh frozen human cadaver lumbar spines (L2–L5) were tested in a spinal testing device with a moment of 7.5 Nm. Spinal stability was determined as mean range of motion (RoM) in the segment L3/L4 during extension-flexion, lateral bending and axial rotation. The RoM was measured during five conditions: 1. intact; 2. working prototype composed of an interspinous device and process plates; 3. an established spinous process fixation device 4. working prototype of facet fixation and 5. pedicle screw fixation. FindingsAll devices caused a significant reduction of RoM during extension-flexion. The RoM during lateral bending was significantly reduced to 37% (of intact) by pedicle screws and 68% by facet fixation prototype. During axial rotation the RoM was significantly reduced to 52% by pedicle screws and to 86% by facet fixation prototype. The other devices had no significant influence on RoM during lateral bending and axial rotation. InterpretationThe facet fixation prototype provided less primary stability compared to pedicle screws, but had significant advantages over spinous process fixation techniques. The results encourage further testing of this implant as a minimal-invasive approach for posterior fixation.

Role of disc area and trabecular bone density on lumbar spinal column fracture risk curves under vertical impact

While studies have been conducted using human cadaver lumbar spines to understand injury biomechanics in terms of stability/energy to fracture, and physiological responses under pure-moment/follower loads, data are sparse for inferior-to-superior impacts. Injuries occur under this mode from underbody blasts. Objectives: determine role of age, disc area, and trabecular bone density on tolerances/risk curves under vertical loading from a controlled group of specimens. T12-S1 columns were obtained, pretest X-rays and CTs taken, load cells attached to both ends, impacts applied at S1-end using custom vertical accelerator device, and posttest X-ray, CT, and dissections done. BMD of L2-L4 vertebrae were obtained from QCT. Survival analysis-based Human Injury Probability Curves (HIPCs) were derived using proximal and distal forces. Age, area, and BMD were covariates. Forces were considered uncensored, representing the load carrying capacity. The Akaike Information Criterion was used to determine optimal distributions. The mean forces, ±95% confidence intervals, and Normalized Confidence Interval Size (NCIS) were computed. The Lognormal distribution was the optimal function for both forces. Age, area, and BMD were not significant (p > 0.05) covariates for distal forces, while only BMD was significant for proximal forces. The NCIS was the lowest for force-BMD covariate HIPC. The HIPCs for both genders at 35 and 45 years were based on population BMDs. These HIPCs serve as human tolerance criteria for automotive, military, and other applications. In this controlled group of samples, BMD is a better predictor-covariate that characterizes lumbar column injury under inferior-to-superior impacts.

The Effects of Orientation of Lumbar Facet Joints on the Facet Joint Contact Forces: An In Vitro Biomechanical Study.

A biomechanical human cadaveric study. The aim of this study was to measure L2-L3 facet joint contact forces in a flexibility test using thin film electroresistive sensors, and facet joint orientation on computed tomographic (CT) scan images, to examine the effects of orientation of lumbar facet joint on the facet joint contact forces. Biomechanically, the bilateral facet joints play a critical role in maintaining stability of the lumbar spine. The effect of orientation of lumbar facet joints on the contact forces remains unknown. Eight human cadaveric lumbar spine specimens (L2-L3) were tested by applying a pure moment of ±7.5 Nm in three directions of loading (flexion-extension, lateral bending, and axial rotation) with and without a follower preload of 300 N. The orientation of the lumbar facet joints at the L2-L3 was measured on axial CT scans. Bilateral facet contact forces were measured during flexibility tests using thin film electroresistive sensors (Tekscan 6900). The average total peak facet loads was 66 N in axial rotation, 27 N in extension, and 20 N in lateral bending under a pure moment. Under a pure moment with a follower preload of 300 N, the average total peak facet loads was 53 N in axial rotation, 43 N in extension, and 24 N in lateral bending. The facet joint forces were correlated positively and significantly with the orientation in all directions with and without a compressive follower preload (P < 0.05). In addition, the facet joint contact forces at neutral position with a follower preload were correlated positively with the orientation (rs = 0.759, P = 0.001). This study identified that the greater coronal orientation of lumbar facet joints is, the higher the facet joint contact forces are. 3.

Biomechanical evaluation of different surgical procedures in single-level transforaminal lumbar interbody fusion in vitro

BackgroundsA variety of improved surgical methods were adopted in the transforaminal lumbar interbody fusion. A mechanical stability provides an ideal environment for the formation of a fusion mass and is the basis of their good outcomes. The object of this study is to evaluate the initial similarities and differences of four commonly-used posterior surgical procedures biomechanically. MethodsBiomechanical testing was performed at L3–4 motion segment in 6 fresh-frozen human cadaveric lumbar spines (L2–L5), including the following sequentially tested configurations: 1) intact motion segment; 2) bilateral pedicle screw fixation; 3) unilateral pedicle screw fixation; 4) unilateral pedicle screw plus contralateral translaminar facet joint screw fixation according to the Magerl technique; and 5) bilateral pedicle screw fixation with bilateral facetectomies. The range of motion, neutral zone and stiffness of each method and intact segment were collected and compared. FindingsAll of four methods reduce the range of motion significantly in flexion and extension and lateral bending but not in axial torsion compared with the native segment. There is no significant difference among four procedures about the range of motion in all loading modes. All of methods increase the stiffness of segmental motion compared with intact segment in all loading modes, but only bilateral pedicle screw fixation showed significant increases in stiffness in flexion and extension(p=0.02) and lateral bending(p=0.023). The stiffness offered by instrumented constructs in different methods showed no significant difference in all loading modes. InterpretationThe stiffness offered by four different posterior fixations in single segmental transforaminal lumbar interbody fusion is not significantly different.