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.

Thesis (Ph.D)--University of Tennessee Health Science Center, 2007. / Title from title page screen (viewed on October 8, 2007). Research advisor: Joo L. Ong, Ph.D. Document formatted into pages (xiii, 128 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 106-114).

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

La migration radiaire est un des processus clefs de la corticogenèse menant à l’établissement d’un cortex en six couches chez les mammifères. La compréhension de ce mécanisme complexe est nécessaire à une meilleure appréhension du développement cortical. Dans ce travail de thèse, j’ai étudié la migration des neurones pyramidaux du cortex sous deux angles distincts. La 1ère partie se place d’un point de vue développemental en appréciant comment le positionnement laminaire résultant d’une migration normale ou anormale affecte la maturation neuronale. La 2nde partie se concentre sur une pathologie migratoire, l’hétérotopie en bande sous-corticale, et les altérations cognitives parfois associées à cette malformation. Pour ces deux projets, la migration neuronale a été altérée chez le rat par knockdown (KD) in utero de la doublecortine (Dcx), un effecteur majeur de la migration. Les neurones positionnés anormalement présentent une orientation incorrecte, un arbre dendritique moins développé, une spinogenère réduite et une altération morpho-fonctionnelle de la synaptogenèse glutamatergique. De plus, notre étude a mis en évidence l’implication de Dcx dans la dendritogenèse et la régulation fine des synapses glutamatergiques in vivo. Enfin, nous avons utilisé les rats Dcx-KD comme modèle d’hétérotopie en bande afin d’étudier comment un déficit de migration neuronale impacte le fonctionnement du cortex. La caractérisation comportementale, réalisée à l’aide d’une large gamme de tests, n’a pas mis en évidence de déficits majeurs des capacités motrices, somatosensorielles ou cognitives chez ces animaux. / Radial migration is one of the key processes leading to the formation of a six-layered cortex in mammals. Understanding this mechanism is necessary to get a better grasp of cortical development. During my PhD, I studied neuronal migration of pyramidal neurons from two different points of views. The 1st part is related to fundamental biology and assesses how laminar misplacement resulting from migration failure influences neuronal maturation. The 2nd one focuses on pathology by investigating a migration disorder, subcortical band heterotopia, and associated cognitive deficits. For both projects, neuronal migration was impaired in rat through in utero knockdown (KD) of doublecortin (Dcx), a major effector of cortical migration. Misplaced neurons display an abnormal orientation, a simplified dendritic arbor, a decreased spinogenesis and morpho-functional alterations of glutamatergic synaptogenesis. Moreover, our study shows that Dcx plays a role in dendritogenesis, in shaping spine morphology and in fine-tuning glutamatergic synaptogenesis. Finally, we used Dcx-KD rats as an animal model of subcortical band heterotopia to assess how migration failure would impact cortical functions. The behavioral characterization carried out through a wide range of tests did not bring to light any major shortcoming regarding motor, somatosensory or cognitive abilities in these animals. Therefore, although Dcx-KD rats display a SBH and develop spontaneous seizures, it does not seem to recapitulate cognitive deficits found in patients.

L’objectif de la thèse était d’étudier l’influence de facteurs anatomiques et biomécaniques tels que la présence d’ostéophytes vertébraux, le taux de chargement et le profil sagittal rachidien (défini par l’orientation et la forme de la colonne vertébrale dans le plan sagittal) sur les traumatismes de la colonne vertébrale thoracique et lombaire. Pour ce faire, des essais expérimentaux sur spécimens cadavériques rachidiens ont été réalisés et un modèle biomécanique détaillé du rachis T1-sacrum a été raffiné, validé expérimentalement et exploité. Les résultats ont démontré que les segments ostéophytiques présentaient des fractures de moindre sévérité localisées au niveau de la vertèbre proximale, contrairement aux segments sans ostéophytes, qui présentaient des fractures sévères (souvent comminutives) au niveau de la vertèbre médiane. Ils ont également confirmé que le taux de déformation jouait un rôle-clé dans l’initiation du traumatisme et que le profil sagittal avait une influence significative sur les caractéristiques des fractures osseuses lors d’accidents impliquant un mécanisme principalement en compression. En revanche, le profil sagittal n’exercerait qu’une influence limitée sur la nature des traumatismes lors d’un accident impliquant un mécanisme de flexion-distraction. / The objective of this thesis was to study the influence of anatomical and biomechanical factors such as the presence of vertebral osteophytes, the loading rate and the sagittal profile of the spine (defined by the orientation and shape of the spine in the sagittal plane) on spinal injuries at the thoracic and lumbar levels. To fulfill this objective, experiments on human cadaveric spines were performed and a detailed biomechanical model of the spine was refined, validated against experimental data, and exploited. Results showed that the presence of large osteophytes significantly influenced the location, pattern and type of fracture, and provided to the underlying vertebra a protective mechanism against severe compression fractures (e.g. burst fractures). They also showed that the loading rate played a key-role on the onset of spinal trauma and that the sagittal profile of the spine had a significant influence on the bone fracture in accidents that involve compression mechanisms. On the other hand, the sagittal profile of the spine had a limited influence on the nature of spinal injuries in accidents that involved flexion-distraction mechanisms.

Les vis pédiculaires sont largement utilisées pour l’instrumentation et la correction du rachis. L’objectif général de ce projet doctoral est d’étudier l'influence des choix chirurgicaux et des variations morphologiques des vertèbres sur l'ancrage biomécanique des vis pédiculaires. Pour cela, nous avons fait le choix de combiner une modélisation détaillée de l’interaction vis-vertèbre à l’acquisition de données expérimentales indispensables pour valider les outils de simulation. Ce projet doctoral propose un modèle par éléments finis original et innovant prenant en compte l’interface de contact entre les structures osseuses et un comportement élastoplastique avec modélisation de la fracture osseuse pour décrire la biomécanique de l’interaction vis-pédiculaire/vertèbre. De plus, ce projet a également permis de proposer un protocole et une méthode d’analyse pour l’étude de vis pédiculaires sous chargements non-axiaux. Les connaissances développées au cours de ce projet doctoral ont permis de fournir des recommandations pratiques pour les cliniciens ainsi que les développeurs d’implants biomédicaux, autant sur les futurs choix de design des vis pédiculaires que les choix de vis et leur placement afin d’obtenir un meilleur ancrage. À long terme, le modèle pourrait être adapté pour analyser plus en détail les caractéristiques spécifiques du patient et être utilisé comme une formation virtuelle ou d'un outil de planification préopératoire. / The pedicle screws are widely used for instrumentation and correction of the spine. The general objective of this doctoral project is to investigate the influence of surgical choice and morphological changes in the vertebrae on the biomechanical anchorage of pedicle screws. A combined approach using a detailed numerical model to simulate the screw-vertebrae interaction and the acquisition of necessary experimental data to validate the numerical tool was chosen. This doctoral project proposes an original and innovative finite element model taking into account the contact interface between the bone structures and an elastoplastic behavior with bone fracture modeling to describe the biomechanics of the screw / vertebra interaction. In addition, this project also propose a protocol and a method of analysis for the study pedicle screws in non-axial loads. The knowledge developed during this doctoral project have provided practical recommendations for clinicians and developers of biomedical implants, both on future choices of design pedicle screws that screw choice and placement to obtain better anchoring. In the long term, the model could be adapted to further analyze the specific characteristics of the patient and be used as a virtual training or a preoperative planning tool.

This dissertation aims at verifying methodology used for somatographic evaluation of the shape and statics of the spine. The potential of the methodology verified lies in increased objectivity of upright body posture evaluation and thereby contributes to the specification of preventative measures for postural defects, and their consequences. Under a cross-sectional pilot study, a non-invasive somatographic method-a diagnostic DPT-3 system designated for spine shape diagnostics-was used to examine selected biomechanical parameters (spinal curves and statics in the sagittal plane in the upright position) in a total of 508 probands. Of this, 326 were school-age children and 182 adults. Among the key parameters monitored were: Cl (depth of cervical lordosis); LI (depth of lumbar lordosis); the sagittal balance of Cl/Ll, and VThk (distance of the peak of the thoracic kyphosis from the ideal verticals-IV). A questionnaire was used to evaluate the level of movement activity in probands and the relation between the occurrence of painful back and headaches and the measurement of biomechanical parameters and movement activity. A total of 81.3 % of children and 94.5 % of adults were found to have deviations from the biomechanically ideal posture model, which signals a postural defect. The values of the Cl (p...

The aim of the diploma thesis is to evaluate the mobility of the spine, the condition of flaton and the basic anthropological characteristics of boys and girls aged 13 and 15 years. Testing will be performed with non-invasive, standard tests and tests used in anthropological and medical practice. The data will be compared with the results of previous research. From the measured values, basic somatic dimensions, such as body weight, body height, circumference of right arm and head, were selected. The body mass index was calculated from body weight and height values. The diploma thesis deals with the assessment of the mobility of spine and flats. The Stibor test, Otto's test, Schober's test, the Cepoj test, the lateroflex test, and the modified Thomayer test were selected from the tests that evaluated the spine. In spine functional tests, the most interesting results of the Čepoj symptom are that the average values of cervical spine mobility deteriorate with the increasing age of boys. In the lateroflex tests, 13-year-old girls and 15-year-old boys beat the best average values. Additionally, these boys had the worst results in Stibor and Schrober's flag when deflected, but paradoxically achieved the best average values. The findings were compared with the results of previous research.

Problem: A lot of attention is given to the safety of the driving and the possibility to register fatigue of the drivers. Driving cars is monotony and static. Vibration loading, which causes changes in the axial system. This causes discomfort and fatigue to drivers after some time of exposure to the loading. Hypothesis: It is possible to prove the changes of mechanical characteristics (indicators) of the axial system using the TVS (transfer vibration through spine) method. By using TVS method before and after different types of loading or before and after relaxation it is possible to detect changes of the viscoelastic properties. This can be done by checking changes in the way of waves transfer through the axial system of the observed participants. Objective: Verify the possibility of use of TVS method to register changes of the viscoelastic characteristics of the axial system. Method: The TVS was chosen as a detection method. The method is based on the use of five-msec semi-bandwidth γ pulse stimuli and consequent application of continuously changing harmonic stimuli which periodically differ between 5Hz and 160Hz to the vertebrae C7 and L5. This wave is carried through the axial system and its acceleration on the spinous processes between C7 and S1 is scanned with the help of accelerometric...

Title: Comparison of the effectiveness of manual therapy and therapy using exercises in muscle postural strings for painful neck syndromes. Objective: The main aim of this work is to compare the effect of active and passive approaches, combinations thereof, used in normal physiotherapy practice for painful neck syndromes. Active physiotherapy techniques represent the concept of Dr. Raševa, exercises in open and closed kinematic strings and elements of developmental kinesiology. Passive physiotherapy techniques are soft tissue techniques, mobilization and manipulation. The combination of these techniques is the application of active and passive techniques, i.e. the concept of Dr. Rašev, exercises in open and closed kinematic strings, elements of developmental kinesiology and soft tissue techniques, mobilization and manipulation. Methods: The study involved a total of 30 probands with chronic neck pain, randomly divided into three groups of 10. The first group (LTV - health exercise) included active treatment approaches, i.e. the concept of Dr. Raševa, exercises in open and closed kinematic strings and elements of developmental kinesiology. In the second group (TMT - soft tissue techniques) the contents were passive therapeutic approaches, i.e. soft tissue techniques, mobilization and manipulation....