Temos aktualumas: 95% žmonių, kurių amžius 25–55 metai turi juosmeninės stuburo dalies tarpslankstelinę disko išvaržą L4–L5 arba L5–S1 segmentuose (Jordon et al., 2009). McKenzie tiesimo judesiai padeda daugumai pacientų, kurie skundžiasi juosmeninės stuburo dalies skausmais (Richmond, 2012). Tai saugus, nebrangus ir patikimas metodas, kuris naudojamas, kai norima išspręsti juosmeninės stuburo dalies skausmus su skausmo plitimu į koją (McKenzie, 2011). Darbo objektas: kineziterapijos ir McKenzie pratimų poveikis skausmui ir stuburo paslankumui esant juosmeninės stuburo dalies išvaržai. Tikslas: nustatyti McKenzie pratimų poveikį skausmui bei stuburo paslankumui esant juosmeninės stuburo dalies išvaržai. Uždaviniai: 1.Įvertinti ir palyginti juosmeninės stuburo dalies skausmo pokyčius taikant kineziterapiją ir McKenzie pratimus. 2.Įvertinti ir palyginti stuburo dalies paslankumą taikant kineziterapiją ir McKenzie pratimus. 3.Įvertinti ir palyginti funkcinę negalią klausimynais taikant kineziterapiją ir McKenzie pratimus. Hipotezė: manome, kad taikant McKenzie pratimus kartu su tradicine kineziterapija labiau sumažės skausmas, pagerės stuburo paslankumas juosmeninėje stuburo dalyje bei pagerės funkcinė būklė. Išvados: 1.McKenzie pratimai labiau sumažino juosmeninės stuburo dalies skausmą nei tradicinė kineziterapija. 2.McKnezie pratimai ir tradicinė kineziterapija pagerino juosmeninės stuburo dalies paslankumą. 3.McKenzie pratimai ir tradicinė kineziterapija sumažino... [toliau žr. visą tekstą] / Importance of the study: relevance of the topic: 95% of people, whos age is 25–55 years, have lumbar spine disc herniation in L4–L5 or L5–S1 segments (Jordon et al., 2009). McKenzie laying movements help for the most of the patients, who are complaining about lumbar spine part pains (Richmond, 2012). It is a safe, cheap and reliable method, which is used to solve lumbar spine part pains with pain spreading to the leg (McKenzie, 2011). Object of the research: effect of physical therapy and McKenzie exercises on pain and spine mobility in the lumbar spine hernia. The aim of the research: to determine the effect of McKenzie exercises regarding pain and mobility of spine in lumbar herniated disc. The task of the research: 1.To evaluate and compare the changes in pain of lumbar spine through physical therapy and McKenzie exercises. 2.To evaluate and compare changes in the mobility of lumbar spine through physical therapy and McKenzie exercises. 3.To evaluate and compare the functional disability after using physical therapy and McKenzie exercises. Hypothesis: the expected outcome is that physical therapy along with McKenzie exercises will reduce the pain, improve spinal mobility in the lumbar spine part and improves functional status Conclusions: 1.McKenzie exercises greater reduced the pain in lower back than conventional physical therapy. 2.McKnezie exercises and conventional physiotherapy improved the mobility of the lumbar spine. 3.McKenzie exercises and... [to full text]

Developing computational models of the human spine has been a hot topic in biornechanical research for a couple of decades in order to have an understanding of the behaviour of the whole spine and the individual spinal parts under various loading conditions. The objectives of this thesis are to develop a biofidefic multi-body model of the whole human spine especially for dynamic analysis of impact situations, such as frontal impact in a car crash, and to generate finite element (FE) models of the specific spinal parts to investigate causes of injury of the spinal components. As a proposed approach, the predictions of the multi-body model under dynamic impact loading conditions, such as reaction forces at lumbar motion segments, were utilised not only to have a better understanding of the gross kinetics and kinematics of the human spine, but also to constitute the boundary conditions for the finite element models of the selected spinal components. This novel approach provides a versatile, cost effective and powerful tool to analyse the behaviour of the spine under various loading conditions which in turn helps to develop a better understanding of injury mechanisms.

Degenerative disc disease is a common ailment with enormous medical, psychosocial and economic ramifications. This study was designed to investigate the utility of a thiol-modified hyaluronan(TMHA) and elastin-like polypeptide(EP) composite material as a potential tissue engineering scaffold to reconstitute the nucleus pulposus in early degenerative disc disease. TMHA and EP were combined in various concentrations and cross-linked using poly(ethylene glycol)diacrylate. Resulting materials were evaluated biomechanically and biologically. Confined compression testing revealed that the addition of EP to TMHA-based gels resulted in a stiffer construct, but remained an order of magnitude less stiff than native nucleus. The in vitro cell culture experiments with human intervertebral disc cells demonstrated 70% cell viability at three weeks with apparent maintenance of phenotype. The addition of EP did not have a significant biologic effect. An in vivo pilot study demonstrated biocompatibility of the TMHA-based hydrogels; additional power is required to adequately assess treatment effect.

Tissue engineering the annulus fibrosus (AF) for use in a functional intervertebral disc replacement is a promising alternative to current treatments of degenerative disc disease. Polycarbonate urethane (PU) scaffolds have demonstrated the ability to support AF cell attachment and matrix synthesis and are suitable for tissue engineering the AF. The present study investigates the effects of the physical and biochemical environment on AF cells grown on aligned nanofibrous PU scaffolds. First, the effect of dynamic spinner flask culture and fibronectin pre-coating on tissue formation was analyzed and then the role of scaffold fibre tension on annulus fibrosus cells was examined using a tailored culture system. The results of these studies demonstrated that AF cells are sensitive to differences in biochemical cues at the scaffold surface and their physical environment and respond by altering their cellular responses and, potentially by manipulating their microenvironments, including the physical characteristics of the PU-ADO scaffolds.

Degenerative disc disease is a common ailment with enormous medical, psychosocial and economic ramifications. This study was designed to investigate the utility of a thiol-modified hyaluronan(TMHA) and elastin-like polypeptide(EP) composite material as a potential tissue engineering scaffold to reconstitute the nucleus pulposus in early degenerative disc disease. TMHA and EP were combined in various concentrations and cross-linked using poly(ethylene glycol)diacrylate. Resulting materials were evaluated biomechanically and biologically. Confined compression testing revealed that the addition of EP to TMHA-based gels resulted in a stiffer construct, but remained an order of magnitude less stiff than native nucleus. The in vitro cell culture experiments with human intervertebral disc cells demonstrated 70% cell viability at three weeks with apparent maintenance of phenotype. The addition of EP did not have a significant biologic effect. An in vivo pilot study demonstrated biocompatibility of the TMHA-based hydrogels; additional power is required to adequately assess treatment effect.

Tissue engineering the annulus fibrosus (AF) for use in a functional intervertebral disc replacement is a promising alternative to current treatments of degenerative disc disease. Polycarbonate urethane (PU) scaffolds have demonstrated the ability to support AF cell attachment and matrix synthesis and are suitable for tissue engineering the AF. The present study investigates the effects of the physical and biochemical environment on AF cells grown on aligned nanofibrous PU scaffolds. First, the effect of dynamic spinner flask culture and fibronectin pre-coating on tissue formation was analyzed and then the role of scaffold fibre tension on annulus fibrosus cells was examined using a tailored culture system. The results of these studies demonstrated that AF cells are sensitive to differences in biochemical cues at the scaffold surface and their physical environment and respond by altering their cellular responses and, potentially by manipulating their microenvironments, including the physical characteristics of the PU-ADO scaffolds.

Low back pain is an ailment that affects a significant portion of the community. However, due to the complexity of the spine, which is a series of interconnected joints, and the loading conditions applied to these joints the causes for back pain are not well understood. Investigations of damage or failure of the spinal structures from a mechanical viewpoint may be viewed as a way of providing valuable information for the causes of back pain. Low back pain is commonly associated with injury to, or degeneration of, the intervertebral discs and involves the presence of tears or lesions in the anular disc material. The aim of the study presented in this thesis was to investigate the biomechanical effect of anular lesions on disc function using a finite element model of the L4/5 lumbar intervertebral disc. The intervertebral disc consists of three main components - the anulus fibrosus, the nucleus pulposus and the cartilaginous endplates. The anulus fibrosus is comprised of collagen fibres embedded in a ground substance while the nucleus is a gelatinous material. The components of the intervertebral disc were represented in the model together with the longitudinal ligaments that are attached to the anterior and posterior surface of the disc. All other bony and ligamentous structures were simulated through the loading and boundary conditions. A high level of both geometric and material accuracy was required to produce a physically realistic finite element model. The geometry of the model was derived from images of cadaveric human discs and published data on the in vivo configuration of the L4/5 disc. Material properties for the components were extracted from the existing literature. The anulus ground substance was represented as a Mooney-Rivlin hyperelastic material, the nucleus pulposus was modelled as a hydrostatic fluid in the healthy disc models and the cartilaginous endplates, collagen fibres and longitudinal ligaments were represented as linear elastic materials. A preliminary model was developed to assess the accuracy of the geometry and material properties of the disc components. It was found that the material parameters defined for the anulus ground substance did not accurately describe the nonlinear shear behaviour of the tissue. Accurate representation this nonlinear behaviour was thought to be important in ensuring the deformations observed in the anulus fibrosus of the finite element model were correct. There was no information found in the literature on the mechanical properties of the anulus ground substance. Experimentation was, therefore, carried out on specimens of sheep anulus fibrosus in order to quantify the mechanical response of the ground substance. Two testing protocols were employed. The first series of tests were undertaken to provide information on the strain required to initiate permanent damage in the ground substance. The second series of tests resulted in the acquisition of data on the mechanical response of the tissue to repeated loading. The results of the experimentation carried out to determine the strain necessary to initiate permanent damage suggested that during daily loading some derangement might be caused in the anulus ground substance. The results for the mechanical response of the tissue were used to determine hyperelastic constants which were incorporated in the finite element model. A second order Polynomial and a third order Ogden strain energy equation were used to define the anulus ground substance. Both these strain energy equations incorporated the nonlinear mechanical response of the tissue during shear loading conditions. Using these geometric data and material properties a finite element model of a representative L4/5 intervertebral disc was developed. When the measured material parameters for the anulus ground substance were implemented in the finite element model, large deformations were observed in the anulus fibrosus and excessive nucleus pressures were found. This suggested that the material parameters defining the anulus ground substance were overly compliant and in turn, implied the possibility that the stiffness of the sheep anulus ground substance was lower than the stiffness of the human tissue. Even so, the mechanical properties of the sheep joints had been shown to be similar to those of the human joint and it was concluded that the results of analyses using these parameters would provide valuable qualitative information on the disc mechanics. To represent the degeneration of the anulus fibrosus, the models included simulations of anular lesions - rim, radial and circumferential lesions. Degeneration of the nucleus may be characterised by a significant reduction in the hydrostatic nucleus pressure and a loss of hydration. This was simulated by removal of the hydrostatic nucleus pressure. Analyses were carried out using rotational loading conditions that were comparable to the ranges of motion observed physiologically. The results of these analyses showed that the removal of the hydrostatic nucleus pressure from an otherwise healthy disc resulted in a significant reduction in the stiffness of the disc. This indicated that when the nucleus pulposus is extremely degenerate, it offers no resistance to the deformation of the anulus and the mechanics of the disc are significantly changed. Specifically, the resistance to rotation offered by the intervertebral disc is reduced, which may affect the stability of the joint. When anular lesions were simulated in the finite element model they caused minimal changes in the peak moments resisted by the disc under rotational loading. This suggested that the removal of the nucleus pressure had a greater effect on the mechanics of the disc than the simulation of anular lesions. The results of the finite element model reproduced trends observed in both the healthy and degenerate intervertebral disc in terms of variations in nucleus pressure with loading conditions, axial displacement of the superior surface and bulge of the peripheral anulus. It was hypothesised that the reduced rotational stiffness of the degenerate disc may result in overload of the surrounding innervated osseoligamentous anatomy which may in turn cause back pain. Similarly back pain may result from the abnormal deformation of the innervated peripheral anulus in the vicinity of anular lesions. Furthermore, it was hypothesised that biochemical changes may result in the degeneration of the nucleus, which in turn may cause excessive strains in the anulus ground substance and lead to the initiation of permanent damage in the form of anular lesions. With further refinement of the components of the model and the methods used to define the anular lesions it was considered that this model would provide a powerful analysis tool for the investigation of the mechanics of intervertebral discs with and without significant degeneration.

Made available in DSpace on 2014-06-11T19:28:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01-13Bitstream added on 2014-06-13T19:37:19Z : No. of bitstreams: 1 lemos_ff_me_guara.pdf: 3167749 bytes, checksum: 900a2570260a39cccd178d8a2ecb5b4a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Para melhor entender os mecanismos degenerativos da coluna vertebral e avaliar o melhor método para seu tratamento é necessário que se conheça o comportamento dos diversos componentes das articulações intervertebrais. Com isso, torna-se essencial o desenvolvimento de dispositivos capazes de simular as condições fisiológicas de movimentos e cargas a fim de realizar testes in vitro que fornecerão dados para posteriormente serem testados in vivo. O objetivo deste trabalho é o desenvolvimento de dispositivos para a realização de testes in vitro com coluna vertebral. Estes dispositivos constam de uma máquina capaz de simular o movimento de flexão-extensão, pré-cargas axiais e a angulação pélvica, e uma lâmina de extensometria para captar as deformações dos tecidos testados. Foram realizados experimentos com discos invertebrais suínos a fim de avaliar a eficiência dos dispositivos. Realizaram-se dois experimentos usando os dispositivos desenvolvidos e um experimento na máquina universal de ensaios. Como resultado obteve-se valores de propriedades mecânicas coerentes com a literatura e o disco intervertebral comportando-se como um material viscoelástico. Outro ponto importante foi a obtenção da pressão intradiscal aproximada relacionando-a com o deslocamento angular da coluna. Conclui-se que os dispositivos apresentaram funcionamento satisfatório, abrindo perspectivas para outros estudos. / The best way to understand the degenerative mechanisms of the vertebral column and to evaluate appropriated methods for its treatment it is necessary to know the behavior of the diverse components of the intervertebral joints. So, it becomes essential to simulate the physiological conditions of movements and loads in order to carry through test in vitro that they will supply datas to be tested in vivo. The objective of this study is the development of devices of low cont for the accomplishment of tests in vitro with spine. These devices consist of a machine capable to simulate the movement of flexion-extension, daily pay-loads and the pelvic inclination, and an extensometry blade to catch the deformations of tested structures. POrcine had been carried through experiments with intervertebral discs in order to evaluate the efficiency od the devices. Two experiments had been become fullfilled using the developed devices and an experiment in the universal test machine. As result we got values of coherent mechanical properties with literature and the intervertebral disc behaving as a viscoelastic material. Another important point was the attainment of the intradiscal pressure approached relating it with the angular displacement of the spine. It is concluded that the devices had presented satisfactory functioning, opening perspective for other studies.

The association between age-related vertebral fractures (VFx) and disc degeneration (DD) is not clear, despite the high prevalence of both conditions. Load is transferred to the vertebra by the adjacent intervertebral discs, and degenerative changes within the disc alter how the net force is distributed over the interface between vertebra and disc, known as the vertebral endplate (EP). The ability of the vertebra to resist fracture depends not only on the magnitude of the net force, but also on the distribution. Multiple lines of evidence suggest that the ability of the vertebra to withstand the distribution of applied force depends on the spatial distribution of bone mineral density (BMD) within the vertebra. First, the strength and stiffness of a region of bone in the vertebra are highly correlated with the BMD of that region. Second, changes in the spatial distribution of regional BMD have been associated with aging and DD. Thirdly, some of these observed changes have been replicated in computer models bone adaption with in the presence of progressive DD, suggesting that bone adaption is occurring in response to the altered force distribution associated with DD, and that maladaptation could elevate the risk of fracture. Notably, the current clinical method of identifying patients at risk of fracture is to use an average measure of BMD for the entire vertebra. The lack of consideration of the spatial distribution of BMD may explain why the clinical method used at present does not adequately identify those at risk of fracture. The possible relationship among spatial distribution of BMD, DD, force distribution across the endplate, and vertebral strength suggests that characterizing the spatial distribution of BMD within a vertebra could add to the understanding of why some vertebra are more likely to fracture. This project sought to determine if an association exists between the spatial distribution of vertebral BMD and disc health in order to provide an improved perspective of the clinical sequelae of DD and to improve the ability of clinicians to identify those who would benefit most from intervention. This study found evidence that the distribution of bone in the vertebral body and EP depend on the health of the adjacent disc. The distribution of pressure in discs favors the anterior most portion of the disc in anteriorly flexed postures and the density in the anterior most portion of the EP appears to respond to this shift, suggesting that bone is adapting to loading patterns associated with certain postures more than others. This study also found association between reduced regional disc height and altered distribution of trabecular density which was positive in the nuclear region and negative in the annular region. In some cases there was a lack of association between disc height and density distribution that may indicate maladaptation and thus increased risk of fracture. This study, being cross-sectional could not identify whether the observed alterations in density and degeneration initiated in the vertebra or the disc. However, this study contributes to the understanding of the relationship between the distribution of vertebral density and the functional properties of the adjacent disc that may ultimately improve the clinician's ability to predict VFx. / 2017-06-21T00:00:00Z

In several cases, current therapies available to treat a large number of musculoskeletal system diseases are unsatisfactory as they provide only temporary or partial restoration of the damaged or degenerated site. In an attempt to maintain a high standard of life quality and minimise the economic losses due to the treatments of these frequently occurring ailments and subsequent lost working days, alternative therapies are being explored. Contrary to the current treatments, tissue engineering aims to regenerate the impaired tissue rather than repair and alleviate the symptoms; thus offering a definitive solution. The annulus fibrosus (AF) of the intervertebral disc (IVD) is a musculoskeletal system component frequently subjected to degeneration and rupture, characterised by predominance of anisotropically arranged collagen fibres. In the present thesis, electrospinning technology is used to fabricate polycaprolactone (PCL) scaffolds intended to replicate the anisotropic structure of the AF.