Thesis (Ph.D.)--University of Tennessee Health Sciences Center, 2005

Orientador: José Elias Tomazini / Banca: Mauro Hugo Mathias / Banca: Luiz Carlos de Queiroz / Resumo: 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. / Abstract: 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. / Mestre

The cause and best treatment option for mechanical low back pain due to disc degeneration remains unsolved, despite `spinal fusion' being the gold standard of surgical treatment, post conservative care, for a very long time. However, the potential drawbacks of spinal fusion and the ongoing evolution in the understanding of normal and symptomatic spine biomechanics, biology and mechanobiology in conjunction with the advancements in material sciences, and tissue engineering has led to a change in the clinical perspective towards treatment methodologies for spinal disorders. Clinically, a gradual shift in philosophy is being observed from a `one size fits all', i.e. spinal fusion for all patients with symptomatic low back pain to a `customized approach', i.e. patient and indication specific treatment modalities for spine care. This philosophy has laid the ground for concepts of `motion preservation' and `dynamic stabilization', the former being an established treatment modality in orthopedics for a long time. The aim of the current study is to perform a comprehensive scientific investigation to understand, evaluate and establish the in vitro biomechanical characteristics and performance of indication specific treatment modalities incorporating the concept of Posterolateral Disc Arthroplasty and Posterior Dynamic Stabilization for the treatment of symptomatic mechanical back pain. The results of this comprehensive study may help the clinicians to make an informed decision while selecting and designing a treating modality for their patients. To this end, the current thesis was undertaken to study the biomechanics of indication specific treatment modalities like motion preservation and dynamic stabilization with a goal to guide clinical and product development decision making. Through the comprehensive biomechanical investigation conducted in the current thesis we were able to theoretically prove the importance of a customized approach towards the treatment of spine care. Also, the most important conclusion of the biomechanical investigation was the fact that Range of Motion results alone are not sufficient to draw significant conclusions. It is imperative that in depth analysis of the quality of motion through the determination of instantaneous center of rotation is extremely important. Previous studies have shown only a single center of rotation between the extremes of motion which is also insufficient as the end points do not determine the path taken to reach the endpoints. This in depth analysis is also important for biomedical engineers to design and develop physiologically viable implants that will mimic the performance of the physiologic spine. Clinical studies are extremely important as a next step towards validating this customized approach towards spine care.

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.

No description available.

Vertebral fractures affect at least 12-20% of men and women over the age of 50, and the risk of fracture increases exponentially with age. Despite their high prevalence, the failure mechanisms leading to these fractures are not well understood. For example, clinical observations of fractured vertebra often note that one or both vertebral endplates have collapsed, but the precise involvement of the endplates in the initiation and progression of failure has not yet been defined. The mechanisms of failure may also relate to spatial variations in the density and microstructure of the porous trabecular bone within the vertebra as well as to the health of the adjacent intervertebral discs (IVDs) which transfer loads directly to the vertebral endplates. Delineating the contributions of these factors would shed light on the etiology of vertebral fractures and would aid in development of clinically feasible, patient-specific finite element (FE) models of the vertebra. These models are built from a patient's quantitative computed tomography (QCT) scan and have shown tremendous promise for accurate, patient-specific estimates of bone strength and fracture risk. Further validation studies are required to assess the impact of the choices of material properties and boundary conditions, as a prerequisite for broad implementation of these FE models in clinical care. The overall goal of this work was to define the failure processes involved in vertebral fractures and to evaluate the accuracy of patient-specific FE models in simulating these processes. Mechanical testing of human spine segments, in conjunction with micro-computed tomography, enabled the assessment of deformation at the vertebral endplate and deformation throughout the entire bone, as the vertebra was loaded to failure under both axial compression and anterior flexion. These data were compared against predictions of vertebral deformation obtained from QCT-based FE models. The impact of the choice of boundary conditions was specifically examined by comparing the accuracy of the FE predictions between models that simulated applied loads based on measured distributions of pressure within IVDs and models that used highly idealized boundary conditions. The results of these studies demonstrated that sudden and non-recoverable endplate deflection is a defining feature of biomechanical failure of the vertebra, for both compression and flexion loading. The locations of endplate collapse as vertebral failure progressed were associated with the porosity of the endplate and the microstructure of the underlying trabecular bone. FE analyses incorporating the experimentally observed endplate deflections as boundary conditions provided more accurate predictions of displacements throughout the rest of the vertebra when compared to FE models with highly idealized boundary conditions. Under anterior flexion, the use of boundary conditions informed by measurements of IVD pressure mitigated, but did not eliminate, the inaccuracy of the idealized boundary conditions. No further improvement in accuracy was found when using boundary conditions based on pressure measurements corresponding only to IVDs whose level of degeneration matched that observed in the IVDs adjacent to the vertebra being modeled. Overall, the accuracy of the FE predictions of vertebral deformation was only moderate, particularly near the locations of endplate collapse. The outcomes of this work indicate that the vertebral endplate is principally involved in vertebral fractures and that current methods for QCT-based FE models do not adequately capture this failure mechanism. These outcomes provide a biomechanical rationale for clinical diagnoses of vertebral fracture based on endplate collapse. These outcomes also emphasize that future studies of patient-specific FE models should incorporate physiologically relevant loading conditions and also material properties that more accurately represent the vertebral endplate in order to obtain higher fidelity predictions of vertebral failure.

Intervertebral disc (IVD) degeneration is primarily involved in back pain, a morbidity that strongly affects the quality of life of individuals nowadays. Lumbar IVDs undergo stressful mechanical loads while being the largest avascular tissues in our body: Mechanical principles alone cannot unravel the intricate phenomena that occur at the cellular scale which are fundamental for the IVD regeneration. The present work aimed at coupling biomechanical and relevant molecular transport processes for disc cells to provide a mechanobiological finite element framework for a deeper understanding of degenerative processes and the planning of regenerative strategies. Given the importance of fluid flow within the IVD, the influence of poroelastic parameters such as permeabilities and solid-phase stiffness of the IVD subtissues was explored. A continuum porohyperelastic material model was then implemented. The angles of collagen fibers embedded in the annulus fibrosus (AF) were calibrated. The osmotic pressure of the central nucleus pulposus (NP) was also taken into account. In a parallel study of the human vertebral bone, microporomechanics was used together with experimental ultrasonic tests to characterize the stiffness of the solid matrix, and to provide estimates of poroelastic coefficients. Fluid dynamics analyses and microtomographic images were combined to understand the fluid exchanges at the bone-IVD interface. The porohyperelastic model of a lumbar IVD with poroelastic vertebral layers was coupled with a IVD transport model of three solutes - oxygen, lactate and glucose - interrelated to reproduce the glycolytic IVD metabolism. With such coupling it was possible to study the effect of deformations, fluid contents, solid-phase stiffness, permeabilities, pH, cell densities of IVD subtissues and NP osmotic pressure on the solute transport. Moreover, cell death governed by glucose deprivation and lactate accumulation was included to explore the mechanical effect on cell viability. Results showed that the stiffness of the AF had the most remarkable role on the poroelastic behavior of the IVD. The permeability of the thin cartilage endplate and the NP stiffness were also relevant. The porohyperelastic model was shown to reproduce the local AF mechanics, provided the fiber angles were calibrated regionally. Such back-calculation led to absolute values of fibers angles and to a global IVD poromechanical behavior in agreement with experiments in literature. The inclusion of osmotic pressure in the NP also led to stress values under confined compression comparable to those measured in healthy and degenerated NP specimens. For the solid bone matrix, axial and transverse stiffness coefficients found experimentally in the present work agreed with universal mass density-elasticity relationships, and combined with continuum microporomechanics provided poroelastic coefficients for undrained and drained cases. The effective permeability of the vertebral bony endplate calculated with fluid dynamics was highly correlated with the porosity measured in microtomographic images. The coupling of transport and porohyperelastic models revealed a mechanical effect acting under large volume changes and high compliance, favored by healthy rather than degenerated IVD properties. Such effect was attributed to strain-dependent diffusivities and diffusion distances and was shown to be beneficial for IVD cells due to the load-dependent increases of glucose levels. Cell density, NP osmotic pressure and porosity were the most important parameters affecting the coupled mechano-transport of metabolites. This novel study highlights the restoration of both cellular and mechanical factors and has a great potential impact for novel designs of treatments focused on tissue regeneration. It also provides methodological features that could be implemented in clinical image-based tools and improve the multiscale understanding of the human spine mechanobiology.

Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2007. / This thesis is concerned with the simulation of the in vivo biomechanical performance of a cervical disc replacement. A representative (averaged) maximum range of motion (ROM), determined by measurement of 10 student participants (5 male, 5 female), was used as head motion input to a simulation model of the cervical spine containing a disc implant at the C5/C6 intervertebral level. Intradiscal pressure, relative applied force on the C5 vertebrae, bending moments and vertebral rotations were recorded. The force and motion components of the results obtained were critically evaluated against the ISO and ASTM experimental protocol standards, probing the representativeness of these standards to the actual in vivo behaviour of the cervical functional spinal unit. Further, the wear resulting from a lifetime (10 million cycles) of the ISO prescribed -and simulation determined input cycles was simulated using a linear wear model with a triangulation technique for volume lost due to wear, and compared to in vitro results in the literature. The inputs used for the wear model were determined from a validated non-linear static contact finite element method (FEM) model. The simulation “chain” shows great potential as a comparative tool for the preexperimental testing of spinal implant designs and may be used with relative success as an alternative to expensive prototype testing.

Top screw pullout is a significant problem in anterior scoliosis correction, with rates of 5-15% reported in the literature. The Mater Misericordiae Hospital in Brisbane currently has a series of 125 patients with scoliosis treated by thoracoscopic anterior fusion, instrumentation and correction between April 2000 and August 2007. In this series 11 top screws are known to have pulled out (a rate of 8.8%), with six occurring in the first week, and all within 6 weeks, suggesting that the problem is one of excessive static force rather than fatigue. This thesis describes a biomechanical investigation into the mechanics of vertebral body screw pullout in anterior scoliosis surgical constructs. Previous biomechanical studies of vertebral body screws have evaluated their resistance to either straight pullout or cephalo-caudad compression forces, however the aim of this study was to assess screw resistance to more realistic loading conditions, namely pullout of initially angled screws, and pullout where the motion path is an arc rather than a straight axial pullout, as would be expected in a single rod anterior construct. The first series of experiments involved straight and angled pullout tests using synthetic bone. In the angled tests, both locked and free-to-pivot configurations were tested. The second series of experiments tested the effect of cephalo-caudad pre-compression (the actual deformity correction step performed during surgery) on subsequent axial pullout strength. A third series of experiments performed arc pullouts using synthetic bone, and the final series of experiments tested the pullout resistance of a newly proposed screw position configuration against the standard screw positioning using ovine lumbar vertebrae. Synthetic bone testing revealed that for initially angled pullout, resistance is greatest as the screw angle approaches 0 (ie a direct axial pullout). Cephalo-caudad pre-compression reduced subsequent pullout strength for cases where a staple was not used under the screw head, but if a staple was used the pre-compression did not decrease pullout force significantly. Arc pullout resistance was greatest when the screw was angled at 10 cephalad, and the mean pullout strength for the proposed screw configuration using ovine lumbar vertebrae (1864N) was almost double that of the standard screw positioning (993N). The clinical implication of this study is that top screw pullout resistance can be maximised by placing the top screw as close as possible to the top endplate and the bottom screw as close as possible to the bottom endplate, although this will have detrimental effects on the pullout of the second screw should the top screw pull out. Screw angulation is a less important factor but any angulation should be in a cephalad direction and around 10º in magnitude. The experimental results also suggest that the use of a staple may play a role in preventing cephalo-caudad pre-compression forces from reducing screw resistance to subsequent pullout forces.

Caregivers injure their backs more than workers in any other industry. Efforts to reduce injuries have been on-going for decades with limited results. Mechanical lift devices have been incorporated into clinical practice over the past 30 years to reduce the risk of injury from patient lifting. Yet injury rates remain high. The use of mechanical lifts may be partly to blame. While these devices assist with lifting patients, they also introduce new activities that result in caregivers experiencing unsafe loading on the spine. We measured loads on the lower back during manoeuvres of the two most common lift types (overhead and floor) as well as during sling insertion. A new device called SlingSerterTM was evaluated for use in the clinical environment. We also investigated spine shrinkage as a measurement tool for estimating cumulative load. Caregivers worked alone and in pairs for both lift maneuvering and sling insertion activities. Overhead lift use resulted in much lower loads than floor lift use. We conclude caregivers can safely operate overhead lifts alone, while floor lift use remained unsafe even with two caregivers. Less-experienced caregivers had higher loads than more-experienced counterparts when using floor lifts. There was no corresponding effect of experience with overhead lift use and we found this to be a further benefit of overhead lifts over floor lifts. Most caregivers exceeded the safe limit for spine compression during sling insertion, though a single caregiver was at no higher risk of injury than two caregivers working together. Clinicians who tested SlingSerterTM agreed the device would be useful in clinical practice, particularly with bariatric patients and other special patient populations that are difficult to roll or turn. Finally, we investigated a novel method for estimating cumulative load based on spine shrinkage. There is growing recognition that excess cumulative load may be responsible for back injury. We found the variability in spine shrinkage was too large to estimate cumulative load directly. However, the technique may still be useful for determining the relative importance of the load from different activities to the cumulative total.