Discitis is a potential complication of any open or percutaneous spinal procedure which involves entry into the intervertebral disc. The infection initiates an inflammatory response which leads to endplate rupture. Although there are variations in the severity of symptoms, the main feature of discitis is severe back pain which is not relieved by rest. The infection may spontaneously resolve over time although incapacitating back pain may persist for many months. In some cases serious complications result from the spread of infection to the adjacent vertebral bodies and over time osteomyelitis will develop with resultant bone destruction and collapse. The prognosis for many patients with discitis is poor with continual disabling back pain, prolonged absence from gainful employment and inability to return to daily living activities. Clinical and experimental evidence now supports the prophylactic use of a suitable antibiotic to prevent discitis. In South Australia cephazolin is the antibiotic of choice to prevent or treat discitis due to Staphylococcus spp. While cephazolin has been shown to prevent discitis after inoculation with Staphylococcus spp. it is not universally accepted. Uncertainty exists regarding the ability of the antibiotic to enter the disc, and if it is effective in preventing and treating discitis. This is further complicated by the lack of suitable methods for detecting and measuring the concentration of cephazolin in the disc. An experimental ovine model was used to investigate ( a ) the natural progression of discitis in the growing lumbar spine ; ( b ) a technique to detect and measure the concentration of cephazolin in the disc ; ( c ) the effect of prophylaxis when dose and time of administration of cephazolin was varied ; ( d ) the effect of parenteral cephazolin after discitis was established and ( e ) the influence of health and age of the disc on prophylactic and parenteral treatment with cephazolin. In a clinical study the concentration of cephazolin was measured in degenerate human disc tissue to determine if therapeutic concentrations were achieved. The ovine studies showed that discitis had no significant effect on the development of the growing lumbar spine after one year although infection was associated with reduced disc area and height. Preventing discitis with cephazolin was reasonably successful, regardless of age and health of the disc. Timing of cephazolin administration was crucial to prevent discitis in immature animals. A high - performance liquid chromatography technique was used to measure the concentration of cephazolin in the disc. The greatest concentration of cephazolin in ovine discs was achieved 15 minutes after a bolus dose of intravenous antibiotic was administered, although detectable levels were measured for a further 2 hours. The concentration of cephazolin was not uniform across the disc with greater concentrations in the outer disc compared to the inner disc. Although there were measurable levels of cephazolin in these discs, it was ineffective at treating discitis once established. In the clinical study detectable levels of cephazolin were recovered in human discs for more than 2 hours after administering a 1 - g bolus dose. The concentration of cephazolin peaked in the human discs between 37 and 53 minutes, but in only half of the discs was the concentration of cephazolin considered therapeutic against Staphylococcus aureus. While discitis may spontaneously resolve over time, the infected disc does not recover to its original form. Furthermore, parenteral cephazolin was ineffective at preventing endplate destruction once an intradiscal inoculum was established. While this study proved cephazolin is able to enter the disc and provide reasonable protection against infection, it appears that discitis cannot be completely abolished. The timing of prophylaxis remains a critical factor to achieve therapeutic concentrations of cephazolin in the disc. Due to the serious complications that result from discitis this study supports the use of prophylactic antibiotic administered at an optimal time before the disc is violated during any spinal procedure. / Thesis (Ph.D.)--School of Medical Sciences, 2006.

M.Tech. (Chiropractic) / Please refer to full text to view abstract

Intervertebral disc (IVD) degeneration (DD) affects over 40% of adults, is a leading cause of disability and costs over $100 billion in economic burden annually. DD is a multifactorial process ultimately leading to tissue breakdown and loss of functionality. DD is associated with increased levels of pro-inflammatory cytokines within the disc and the catabolic effect of inflammatory stimulation on disc cell biology has been well studied. As part of its physiological functioning the disc experiences mechanical, hydrostatic, and osmotic stimuli. Cells within the disc are mechanosensitive to these signals, where hyper physiological and damaging physical signals can perpetuate degenerative effects in the disc. Despite the known contributions of inflammatory stimulation and biomechanics to DD individually, the interaction of inflammation and biomechanics in the IVD is still not well understood. The objective of this thesis is to examine the role of inflammatory stimulation on cellular biophysical properties in the disc, subsequent implications at the tissue level, and its contributions to DD. Here the cell cytoskeleton and actomyosin contractility are identified as key regulators of the response of cellular properties to inflammation. Actomyosin contractility is further identified as a regulator of well-known biological responses to inflammatory stimulation within the disc including ECM catabolism and altered disc tissue mechanics. Altered cellular biophysical properties observed in clinical human DD samples indicate the inflammatory milieu present in DD drive changes in cellular mechanics. Increasing actomyosin contractility is shown to be effective in mitigating the effects of inflammation on cellular biophysical properties and subsequent degenerative effects highlighting its potential as a therapeutic for the treatment of DD.

The human spine is an integral part of the human body. Its functions include mobilizing the torso, controlling postural stability, and transferring loads from upper body to lower body, all of which are essential for the activities of daily living. However, the many complex tasks of the spine leave it vulnerable to damage from a variety of sources. Prolonged walking with a heavy backpack can cause spinal injuries. Spinal diseases, such as scoliosis, can make the spine abnormally deform. Neurological disorders, such as cerebral palsy, can lead to a loss of torso control. External torso support has been used in these cases to mitigate the risk of spinal injuries, to halt the progression of spinal deformities, and to support the torso. However, current torso support designs are limited by rigid, passive, and non-sensorized structures. These limitations were the motivations for this work in developing the science for design of torso exoskeletons that can improve the effectiveness of current external torso support solutions. Central features to the design of these exoskeletons were the abilities to sense and actively control the motion of or the forces applied to the torso. Two applications of external torso support are the main focus in this study, backpack load carriage and correction of spine deformities. The goal was to develop torso exoskeletons for these two applications, evaluate their effectiveness, and exploit novel assistive and/or treatment paradigms. With regard to backpack load carriage, current torso support solutions are limited and do not provide any means to measure and/or adjust the load distribution between the shoulders and the pelvis, or to reduce dynamic loads induced by walking. Because of these limitations, determining the effects of modulating these loads between the shoulders and the pelvis has not been possible. Hence, the first scientific question that this work aims to address is What are the biomechanical and physiological effects of distributing the load and reducing the dynamic load of a backpack on human body during backpack load carriage? Concerning the correction of spinal deformities, the most common treatment is the use of a spine brace. This method has been shown to effectively slow down the progression of spinal deformity. However , a limitation in the effectiveness of this treatment is the lack of knowledge of the stiffness characteristics of the human torso. Previously, there has been no means to measure the stiffness of human torso. An improved understanding of this subject would directly affect treatment outcomes by better informing the appropriate external forces (or displacements) to apply in order to achieve the desired correction of the spine. Hence, the second scientific question that this work aims to address is How can we characterize three dimensional stiffness of the human torso for quantifiable assessment and targeted treatment of spinal deformities? In this work, a torso exoskeleton called the Wearable upper Body Suit (WEBS) was developed to address the first question. The WEBS distributes the backpack load between the shoulders and the pelvis, senses the vertical motion of the pelvis, and provides gait synchronized compensatory forces to reduce dynamic loads of a backpack during walking. It was hypothesized that during typical backpack load carriage, load distribution and dynamic load compensation reduce gait and postural adaptations, the user’s overall effort and metabolic cost. This hypothesis was supported by biomechanical and physiological measurements taken from twelve healthy male subjects while they walked on a treadmill with a 25 percent body weight backpack. In terms of load distribution and dynamic load compensation, the results showed reductions in gait and postural adaptations, muscle activity, vertical and braking ground reaction forces, and metabolic cost. Based on these results, it was concluded that the wearable upper body suit can potentially reduce the risk of musculoskeletal injuries and muscle fatigue associated with carrying heavy backpack loads, as well as reducing the metabolic cost of loaded walking. To address the second question, the Robotic Spine Exoskeleton (ROSE) was developed. The ROSE consists of two parallel robot platforms connected in series that can adjust to fit snugly at different levels of the human torso and dynamically modulate either the posture of the torso or the forces exerted on the torso. An experimental evaluation of the ROSE was performed with ten healthy male subjects that validated its efficacy in controlling three dimensional corrective forces exerted on the torso while providing flexibility for a wide range of torso motions. The feasibility of characterizing the three dimensional stiffness of the human torso was also validated using the ROSE. Based on these results, it was concluded that the ROSE may alleviate some of the limitations in current brace technology and treatment methods for spine deformities, and offer a means to explore new treatment approaches to potentially improve the therapeutic outcomes of the brace treatment.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non - specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the nonspecific effect in the healing encounter by manipulating the practice setting in which the patients were treated. This was achieved using a prospective, randomised, comparative clinical experiment consisting of 60 individuals with Low Back Pain (LBP), selected by convenience sampling. Individuals were then divided into 2 groups of 30. The IV first group's treatment consisted of the standard diversified method of manipulation in a Clinical Research Setting, and the second group received the same treatment except the treatment took place in a Normal Practice Setting. / M

M.Tech. (Chiropractic) / The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xviii, 140 leaves / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non – specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the non-specific effect in the healing encounter by manipulating the practice setting in which the patients were treated.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xviii, 140 leaves / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non – specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the non-specific effect in the healing encounter by manipulating the practice setting in which the patients were treated.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.