O disco intervertebral é uma estrutura cuja função é receber, amortecer e distribuir o impacto das cargas impostas sobre a coluna vertebral. O aumento da idade e a postura adotada pelo indivíduo podem levar à degeneração do disco intervertebral. Atualmente, a Ressonância Magnética (RM) é considerada o melhor e mais sensível método não invasivo de avaliação por imagem do disco intervertebral. Neste trabalho foram desenvolvidos métodos quantitativos computadorizados para auxílio ao diagnóstico da degeneração do disco intervertebral em imagens de ressonância magnética ponderadas em T2 da coluna lombar, de acordo com a escala de Pfirrmann, uma escala semi-quantitativa, com cinco graus de degeneração. Os algoritmos computacionais foram testados em um conjunto de dados que consiste de imagens de 300 discos, obtidos de 102 indivíduos, com diferentes graus de degeneração. Máscaras binárias de discos segmentados manualmente foram utilizadas para calcular seus centroides, visando criar um ponto de referência para possibilitar a extração de atributos. Uma análise de textura foi realizada utilizando a abordagem proposta por Haralick. Para caracterização de forma, também foram calculados os momentos invariantes definidos por Hu e os momentos centrais para cada disco. A classificação do grau de degeneração foi realizada utilizando uma rede neural artificial e o conjunto de atributos extraídos de cada disco. Uma taxa média de acerto na classificação de 87%, com erro padrão de 6,59% e uma área média sob a curva ROC (Receiver Operating Characteristic) de 0,92 indicam o potencial de aplicação dos algoritmos desenvolvidos como ferramenta de apoio ao diagnóstico da degeneração do disco intervertebral. / The intervertebral disc is a structure whose function is to receive, absorb and transmit the impact loads imposed on the spine. Increasing age and the posture adopted by the individual can lead to degeneration of the intervertebral disc. Currently, Magnetic Resonance Imaging (MRI) is considered the best and most sensitive noninvasive method to imaging evaluation of the intervertebral disc. In this work were developed methods for quantitative computer-aided diagnosis of the intervertebral disc degeneration in MRI T2 weighted images of the lumbar column according to Pfirrmann scale, a semi-quantitative scale with five degrees of degeneration. The algorithms were tested on a dataset of 300 images obtained from 102 subjects with varying degrees of degeneration. Binary masks manually segmented of the discs were used to calculate their centroids, to create a reference point to enable extraction of attributes. A texture analysis was performed using the approach proposed by Haralick. For the shape characterization, invariant moments defined by Hu and central moments were also calculated for each disc. The rating of the degree of degeneration was performed using an artificial neural network and the set of extracted attributes of each disk. An average rate of correct classification of 87%, with standard error 6.59% and an average area under the ROC curve (Receiver Operating Characteristic) of 0.92 indicates the potential application of the algorithms developed as a diagnostic support tool to the degeneration of the intervertebral disc.

No description available.

Thesis (PhD (Industrial Engineering))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Back pain is a common concern amongst a growing population of people across the world today, where in most cases the pain can become unbearable resulting in major lifestyle adjustments. Seventy to eighty percent of the population of the Western world experiences low-back pain at one time or another. Pain can be produced as a worn disc becomes thin, narrowing the space between the vertebrae. Pieces of the damaged disc may also break off and cause irritation to the nerves signalling back pain. Depending on the severity of a patient’s condition, and after conservative treatment options have been exhausted, a disc replacement surgery (arthroplasty) procedure may be prescribed to restore spacing between vertebrae and relieve the pinched nerve, while still maintaining normal biomechanical movement. Typical complications that are however still observed in some cases of disc implants include: anterior migration of the disc, subsidence (sinking of disc) and lateral subluxation (partial dislocation of a joint). Issues such as function, correct placement and orientation, as well as secure fixation of such a disc implant to the adjacent vertebrae are highly important in order to replicate natural biomechanical behaviour and minimise the occurrence of the complications mentioned. As various imaging and manufacturing technologies have developed, the option for individual, patientspecific implants is becoming more of a practical reality than it has been in the past. The combination of CT images and Rapid Manufacturing for example is already being used successfully in producing custom implants for maxilla/facial and cranial reconstructive surgeries. There exists a need to formalise a process chain for the design and manufacture of custom-made intervertebral disc implants and to address the issues involved during each step. Therefore this study has investigated the steps involved for such a process chain and the sensible flow of information as well as the use of state-of-the-art manufacturing technologies. Strong emphasis was placed on automation of some of the processes as well as the user-friendliness of software where engineers and surgeons often need to work together during this multi-disciplinary environment. One of the main benefits for customization was also investigated, namely a reduction in the risk and potential for implant subsidence. Stiffness values from pressure tests on vertebrae were compared between customized implants and implants with flat endplate designs. Results indicated a statistically significant improvement of customized, endplate matching implants as opposed to flat implant endplates. Therefore it may be concluded that the use of customized intervertebral disc implants with patient specific endplate geometry may decrease the risk and potential for the occurrence of subsidence. / AFRIKAANSE OPSOMMING: Rugpyn is ‘n algemene bekommernis vir ‘n groeiende populasie van mense in die wêreld vandag, waar in meeste gevalle die pyn ondraagbaar kan raak en groot leefstyl aanpassings vereis. Sewentig tot tagtig persent van die populasie in die Westerse wêreld ondervind lae rugpyn op een of ander stadium. Die pyn kan veroorsaak word deur ‘n intervertebrale skyf wat verweer en dunner word, en veroorsaak dat die spasie tussen die vertebrae vernou. Stukkies van die beskadigde skyf mag ook afbreek en irritasie aan die senuwees veroorsaak wat verdere pyn kan veroorsaak. Afhangende van die ernstigheid van ‘n pasiënt se geval, en nadat opsies vir konservatiewe behandeling uitgeput is, kan ‘n skyf vervangings-prosedure (artroskopie) voorgeskryf word om die spasie tussen die vertebrae te herstel en sodoende die geknypte senuwee te verlos. Die skyf vervanging herstel spasiëring tussen vertebrae terwyl die normale biomeganiese beweging ook behoue bly, in teenstelling met ‘n fusieprosedure wat die betrokke vertebrae aanmekaar vasheg en normale beweging belemmer. Tipiese komplikasies wat egter steeds na ‘n skyf vervanging in sommige gevalle waargeneem word sluit in: anterior migrasie van die inplantaat, insinking, sowel as laterale sublukasie (gedeeltelike dislokasie van ‘n gewrig). Faktore soos funksie, korrekte posisionering en orientasie, sowel as vashegting van so ‘n skyf inplantaat tot die aanliggende vertebrale bene is besonder belangrik om natuurlike biomeganiese beweging te herstel en sodoende bogenoemde komplikasies te verminder. Soos wat verskeie beeldings- en vervaardigingstegnologië verbeter het oor die laaste dekade, het die moontlikheid vir individuele, pasiënt-spesifieke inplantate al hoe meer ‘n praktiese realiteit begin word. Die kombinasie van Gerekenariseerde Tomografie (GT), tesame met Snel Vervaardiging word byvoorbeeld reeds suksesvol aangewend tydens die ontwerp en vervaardiging van pasiënt-spesifieke inplantate vir maksilla- en kraniale rekonstruktiewe chirurgie. Daar bestaan egter ‘n behoefte om ‘n formele prosesketting vir die ontwerp en vervaardiging van pasiënt-spesifieke intervertebrale skyf inplantate te ontwikkel en om belangrike faktore tydens elke stap noukeurig te beskryf. Hierdie studie het na die verskillende stappe in die prosesketting gekyk om ‘n sinvolle vloei van informasie en benutting van hoë gehalte vervaardigingstegnologië saam te snoer. Sterk klem was gelê op outomatisering van prosesse asook gebruikersvriendelikheid van sagteware waar ingenieurs en medici dikwels saam moet werk tydens hierdie kruisdissiplinêre omgewing. Een van die hoof verwagte voordele met die gebruik van pasklaar skyf inplantate, naamlik die vermindering van moontlike insinking van die inplantaat in die been, is ook ondersoek. Die ondersoek het druktoetse behels en die vergelyking van ooreenstemmende styfheid tussen inplantate wat die kontoer van die bene volg teenoor gewone plat eindplate. Die resultate was statisties beduidend in die guns van die pasklaar inplantate wat die beenkontoere gevolg het, en bewys dus dat die risiko vir insinking verminder is.

Title: Physical activity of patients after surgical treatment of the lumbar spine. Aim: Main aim of my diploma thesis is to present an up to date review on the topic of postoperative physiotherapy in short-term and long-term phase after lumbar surgery and to find out how recommendations about postoperative physiotherapy are created. Methods: A systematic review on the topic. Results: The review answers the questions about physiotherapy after lumbar surgery in short-term and long-term phase and shows current trends and unique approaches in this study area. Keywords: Lumbar spine, intervertebral disc, discectomy, physiotherapy, physical activity.

Introdução: A degeneração do disco intervertebral tem alta prevalência e é sabidamente associada à dor lombar. O objetivo deste trabalho foi correlacionar os valores de relaxometria T2 dos discos intervertebrais lombares com os parâmetros espinopélvicos em pacientes com dor lombar crônica. Materiais e métodos: Entre março a setembro de 2015, 91 pacientes consecutivos (56 mulheres, média de idade 53,5 anos, DP 11,6 anos, 23-76 anos e 35 homens, média de idade 53,6 anos, DP 11,9 anos, 19-73 anos) com dor lombar crônica foram incluidos neste estudo prospectivo. O Comitê de Ética Local aprovou o estudo e o consentimento foi obtido de cada paciente. Todos os indivíduos foram avaliados pelo índice de incapacidade Oswestry e escala visual analógica e não possuiam outras doenças da coluna vertebral, exceto degeneração discal. Os parâmetros espinopélvicos incidência pélvica (IP) versão pélvica (VP), inclinação sacral (IS), eixo vertical sagital (EVS), versão global (VG), ângulo espinopélvico (ASP), ângulo espinossacral (ASS), ângulo T1 pélvico (ATP), lordose lombar (LL), cifose torácica (CT), diferença entre a incidência pélvica e a lordose lombar (IP-LL) e a falta de lordose lombar (FLL) foram mensurados a partir de radiografias panorâmicas da coluna e pelve com o paciente na posição supina utilizando o software Surgimap®. O grupo de estudo foi categorizado de acordo com a classificação de Roussouly. Os mapas de relaxometria T2 foram adquiridos em aparelho de ressonância magnética de 1.5 Tesla para extrair os tempos de relaxação T2 e a segmentação manual completa dos discos lombares intervertebrais de cada paciente foi realizada no software Display®. Para verificar a reprodutibilidade desta avaliação, a concordância inter-observador para a segmentação manual dos discos intervertebrais lombares e mensuração dos parâmetros espinopélvicos foi avaliada. A significância estatística foi aceita quando p <0,05. Resultados: Os valores de relaxação T2 se correlacionaram significativamente com os parâmetros VP, VG, ASP, ATP, IP-LL e FLL em pacientes com dor lombarcrônica. Não encontramos correlação significativa entre os valores de relaxação T2 e os parâmetros IS, IP, ASS, EVS, LL, CT e questionários clínicos. A divisão por subtipos de Roussouly não se correlacionou com a degeneração discal avaliado pelo tempo de relaxação T2. A mensuração dos parâmetros espinopélvicos e a segmentação manual dos discos intervertebrais lombares mostraram uma alta reprodutibilidade interobservador. Conclusões: Indivíduos com maiores VP, VG, ATP, IP-LL e FLL apresentaram valores mais baixos de relaxação T2 nos discos intervertebrais. Para o nosso conhecimento, esse é o primeiro estudo a correlacionar os parâmetros espinopélvicos com a degeneração discal avaliada por meio da relaxometria T2. / Purpose: Intervertebral disc degeneration has a high prevalence and is known to be associated with low back pain.The purpose of this study was to correlate quantitative T2 relaxation measurements of lumbar intervertebral discs (IVD) with spinopelvic parameters and clinical symptoms in patients with chronic low back pain. Methods: From March to September 2015, 455 intervertebral discs from 91 consecutive patients (56 women, mean age 53.5 years, SD 11,7 years, 23-76 years and 35 men, mean age 53,6 years, SD 11.9 years, 19-73 years) with chronic low back pain were included in this prospective study. The study was approved by the local ethics committee, and written consent was obtained from all patients. All subjects were assessed by Oswestry Disability Index and Visual Analog Score questionnaires and were confirmed to have no other spine diseases except disc degeneration. Spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), global tilt (GT), spinopelvic angle (SPA), spinosacral angle (SSA), T1-pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), PI-LL (pelvic incidence minus lumbar lordosis) and lack of lumbar lordosis (LLL) were measured from standing spine and pelvis lateral radiographs using the software Surgimap®. The study group was categorized according to the Roussouly classification. Saggital T2 maps were acquired in a 1.5T MRI scanner to extract the IVD relaxation times and the complete manual segmentation of the IVD of each patient in all levels was performed using the software Display®. To assess the reproducibility of this evaluation, the interobserver agreement fot the manual segmentation of the lumbar intervertebral discs and measurement of the spinopelvic parameters was performed. Statistical significance was accepted when p <0.05. Results: Lumbar intervertebral discs T2 relaxation times correlated significantly with PT, GT, SPA, TPA, PI-LL and LLL in patients with chronic low back pain. We found no significant correlation between T2 values and SS, PI, ASS, SVA, LL, TK andclinical questionnaires. Roussouly subtypes and clinical questionnaires did not correlate with T2 relaxation times. Conclusions: Individuals with higher PT, GT, TPA, PI-LL and LLL showed decreased intervertebral disc T2 relaxation values. To our knowledge, this is the first study to correlate spinopelvic parameters with disc degeneration evaluated by T2 relaxometry.

There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

Novel surgical strategies for spinal disc repair are currently being developed that require materials that (1) possess the appropriate mechanical properties to mimic the tissue the material is replacing or repairing and (2) maintain their mechanical function for long durations without negatively affecting the tissue response of adjacent tissue (i.e. bone). Polymers formed through photopolymerization have emerged as candidate biomaterials for many biomedical applications, but these materials possess limited toughness in vivo due to the presence of water inherent in most tissues. Therefore, the overall objective of this research was to develop photopolymerizable (meth)acrylate networks that are both mechanically and biologically compatible under physiological conditions to be implemented in spinal repair procedures. The fundamental approach was to determine structure-property relationships between toughness and network structure in the presence of phosphate buffered saline (PBS) using several model copolymer networks in order to facilitate the design of photopolymerizable networks that are tough in physiological solution. It was demonstrated that networks toughness could be optimized in PBS by tailoring the Tg of the copolymer network close to body temperature and incorporating the appropriate "tough" chemical structures. The ability to maintain toughness up to 9 months in PBS was dependent upon the viscoelastic state and overall hydrophobicity of the network. In tandem, the effect of network chemistry and stiffness on the response of MG63 pre-osteoblast cells was assessed in vitro. The ability of MG63 cells to differentiate on (meth)acrylate network surfaces was found to be primarily dependent on surface chemistry with PEG-based materials promoting a more mature osteoblast phenotype than 2HEMA surfaces. Amongst each copolymer group, copolymer stiffness was found to regulate osteoblast differentiation in a manner dependent upon the surface chemistry. In general, photopolymerizable (meth)acrylate networks that were deemed "tough" were able to promote osteoblast differentiation in a manner comparable if not exceeding that on tissue culture polystyrene (TCPS). This research will impact the field of biomaterials by elucidating the interrelationships between materials science, mechanics, and biology.

Introduction: A computer-based classification system is proposed for the characterization of cervical intervertebral disc degeneration from saggital magnetic resonance images. Materials and methods: Cervical intervertebral discs from saggital magnetic resonance images where assessed by an experienced orthopaedist as normal or degenerated (narrowed) employing Matsumoto’s classification scheme. The digital images where enhanced and the intervertebral discs which comprised the regions of interest were segmented. First and second order statistics textural features extracted from thirty-four discs (16 normal and 16 degenerated) were used in order to design and test the classification system. In addition textural features were calculated employing Laws TEM images. The existence of statistically significant differences between the textural features values that were generated from normal and degenerated discs was verified employing the Student’s paired t-test. A subset with the most discriminating features (p<0.01) was selected and the Exhaustive Search and Leave-One-Out methods were used to find the best features combination and validate the classification accuracy of the system. The proposed system used the Least Squares Minimum Distance Classifier in combination with four textural features with comprised the best features combination in order to classify the discs as normal or degenerated. Results: The overall classification accuracy was 93.8% misdiagnosing 2 discs. In addition the system’s sensitivity in detecting a narrow disc was 93.8% and its specificity was also 93.8%. Conclusion: Further investigation and the use of a larger sample for validation could make the proposed system a trustworthy and useful tool to the physicians for the evaluation of degenerative disc disease in the cervical spine. / Σκοπός: Η στένωση των μεσοσπονδύλιων δίσκων της αυχενικής μοίρας, ως κύρια έκφραση εκφυλιστικής νόσου, είναι μια από τις σημαντικότερες αιτίες πρόκλησης πόνου στην περιοχή του αυχένα. Στην κλινική πράξη η αξιολόγηση της στένωσης γίνεται μέσω μέτρησης του μεσοσπονδύλιου διαστήματος, σε διάφορες απεικονίσεις της αυχενικής μοίρας του ασθενούς. Στην παρούσα εργασία προτείνεται μια υπολογιστική μέθοδος ανάλυσης εικόνας, για την αυτοματοποιημένη εκτίμηση της στένωσης από εικόνες μαγνητικής τομογραφίας. Υλικό και Μέθοδος: Μελετήθηκαν 34 μεσοσπονδύλιοι δίσκοι από οβελιαίες τομές μαγνητικής τομογραφίας της αυχενικής μοίρας, οι οποίες ελήφθησαν με χρήση Τ2 ακολουθίας. Η στένωση των μεσοσπονδύλιων δίσκων αξιολογήθηκε από έμπειρο ορθοπαιδικό βάσει της κλίμακας Matsumoto. Οι δίσκοι χωρίστηκαν σε δύο κατηγορίες: (α) 16 φυσιολογικοί και (β) 16 δίσκοι που παρουσίαζαν στένωση. Με χρήση διαδραστικού περιβάλλοντος επεξεργασίας εικάνας καθορίστηκε το περίγραμμα των μεσοσπονδύλιων δίσκων οι οποίοι αποτελούν τις προς ανάλυση περιοχές ενδιαφέροντος (Π.Ε.). Σε κάθε Π.Ε. εφαρμόστηκαν αλγόριθμοι εξαγωγής χαρακτηριστικών υφής. Συγκεκριμένα υπολογίστικαν χαρακτηριστικά υφής από στατιστικά πρώτης και δεύτερης τάξης καθώς και χαρακτηριστικά από τα μέτρα ενέργειας υφλης κατλα Laws. Τα παραπάνω χαρακτηριστικά, ποσοτικοποιούν διαγνωστικές πληροφορίες της έντασης του σήματος της Π.Ε. και συσχετίζονται με τη βιοχημική σύσταση των απεικονιζόμενων δομών. Τα εξαχθέντα χαρακτηριστικά υφής αξιοποιήθηκαν για τη σχεδίαση του ταξινομητή ελάχιστης απόστασης ελαχίστων τετραγώνων, ο οποίος χρησιμοποιήθηκε για το διαχωρισμό μεταξύ φυσιολογικών δίσκων και δίσκων που παρουσίαζαν στένωση (εκφυλισμένων). Αποτελέσματα: Η ακρίβεια της ταξινόμησης φυσιολογικών και εκφυλισμένων μεσοσπονδύλιων δίσκων ανήλθε σε 93.8%. Η ευαισθησία καθώς και η ειδικότητα της μεθόδου, σε ότι αφορά την ανίχνευση εκφυλισμένων δίσκων, είναι επίσης 93.8%. Συμπέρασμα: Με δεδομένο το μικρό μέγεθος του δείγματος που χρησιμοποιήθηκε για το σχεδιασμό της μεθόδου, απαιτούνται περετέρω εργασίες πιστοποίησης της ακρίβειας ταξινόμησης, προκειμένου η μέθοδος αυτή να αξιοποιηθεί από ακτινολόγους και ορθοπαιδικους, ως βοηθητικό διαγνωστικό εργαλείο.

The current study characterizes the mechanical and biodegradation properties of a polycarbonate polyurethane (PU) electrospun nanofiber scaffold intended for use in the growth of a tissue engineered annulus fibrosus (AF) intervertebral disc component. Both the tensile strength and initial modulus of aligned scaffolds were higher than those of random scaffolds and remained unaffected during a 4 week biodegradation study, suggesting a surface-mediated degradation mechanism. The resulting degradation products were non-toxic. Confined compressive mechanical force of 1kPa, was applied at 1Hz to in vitro bovine AF tissue grown on the scaffolds to investigate the influence of mechanical force on AF tissue production, which was found to decrease significantly at 72 hours relative to 24 hours, independent of any effects from mechanical forces. Overall, the consistent rate of PU degradation, along with mechanical properties comparable to those of native AF tissue, and the absence of cytotoxic effects, make this polymer suitable for further investigation for use in tissue-engineering the AF.