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ispartof: FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY vol:10 ispartof: location:Switzerland status: published

Introduction: Sufficient screw hold is an indispensable requirement for successful spinal fusion, but pedicle screw loosening is a highly prevalent burden. The aim of this study was to quantify the contribution of the pedicle and corpus region in relation to bone quality and loading amplitude of pedicle screws with traditional trajectories.Methods: After CT examination to classify bone quality, 14 pedicle screws were inserted into seven L5. Subsequently, Micro-CT images were acquired to analyze the screw’s location and the vertebrae were split in the midsagittal plane and horizontally along the screw’s axis to allow imprint tests with 6 mm long sections of the pedicle screws in a caudal direction perpendicular to the screw’s surface. Force-displacement curves in combination with the micro-CT data were used to reconstruct the resistance of the pedicle and corpus region at different loading amplitudes.Results: Bone quality was classified as normal in three specimens, as moderate in two and as bad in two specimens, resulting in six, four, and four pedicle screws per group. The screw length in the pedicle region in relation to the inserted screw length was measured at an average of 63%, 62%, and 52% for the three groups, respectively. At a calculated 100 N axial load acting on the whole pedicle screw, the pedicle region contributed an average of 55%, 58%, and 58% resistance for the normal, moderate, and bad bone quality specimens, respectively. With 500 N load, these values were measured at 59%, 63%, and 73% and with 1000 N load, they were quantified at 71%, 75%, and 81%.Conclusion: At lower loading amplitudes, the contribution of the pedicle and corpus region on pedicle screw hold are largely balanced and independent of bone quality. With increasing loading amplitudes, the contribution of the pedicle region increases disproportionally, and this increase is even more pronounced in situations with reduced bone quality. These results demonstrate the importance of the pedicle region for screw hold, especially for reduced bone quality.

Understanding spinal kinematics is essential, not only for the comprehension and diagnosis of spinal diseases, but also for improving modern tools and software. The sheer volume and complexity of now available information can be overwhelming. We aimed to distil it into a form that facilitates comparison among diverse studies addressing spinal kinematics under healthy and degenerative conditions. We specifically aimed to define a baseline definition of the spectrum of normal spinal kinematics that in turn allows a comparable definition of kinematics of the degenerative lumbar spine. The considered data was obtained by a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As for degenerative conditions, we collected publications on disc degeneration, facet joint osteoarthritis, facet joint tropism, spondylolisthesis, ligament degeneration and paraspinal muscle degeneration. While we could demonstrate repeating motion patterns for some topics, agreement in other fields is limited due to methodological variances and small sample sizes, particularly in publications with highly accurate but complex techniques. Besides, the high frequency of concurrent degenerative processes complicates the association between diseases and subsequent kinematical changes. Despite several substantial gaps, we stand at the precipice of technological breakthroughs that can power future large-scale studies.

Hydrostatic integrity of the intervertebral disc (IVD) is lost during the process of degeneration. Invasive pressure profilometry (IPP) can quantify it, however, is not applicable for clinical use. We aimed to investigate correlations between IPP and MRI findings to assess non-invasive MRI based methods for prediction of hydrostatic integrity of the intervertebral disc. The pressure profiles of 39 lumbar spinal segments originating from 22 human cadavers were recorded during axial compression in the neutral, the flexed and the extended positions. Disc pressure profiles were measured and mathematically transformed to a novel metric that quantifies pressure profile heterogeneity across the disc. The relationship between pressure profile inhomogeneity (“pressure score”) and clinically established magnetic resonance-based classifications systems and demographic parameters was then tested using Spearman correlation tests. Pressure profile inhomogeneities were correlated with IVD degeneration (according to Pfirrmann, rho = 0.43, p = 0.006), endplate defects (according to Rajasekaran, rho = 0.39, p = 0.013), segmental degeneration (according to Farshad, rho = 0.41, p = 0.009) and age (rho = 0.32, p = 0.049). Modic changes per se did not affect the pressure profiles significantly (p = 0.23) and pressure scores did not correlate with BMI (rho = -0.21, p = 0.2). Heterogeneity of segmental IVD pressure profiles is a unique measure of disc function. We demonstrate that established clinical methods for MRI characterization of the intervertebral disc, the endplate and overall segmental degeneration all correlate with the hydrostatic integrity of the IVD and can be used for its assessment., Journal of Biomechanics, 127, ISSN:0021-9290, ISSN:1873-2380

Information on the local stiffness characteristics of the intervertebral disc (IVD) is crucial for the understanding of its structure-function properties in health and disease and may improve numerical modeling. Previous studies have attempted to map local tissue stiffness by sectioning the disc and performing mechanical testing on these discrete tissue units, which is technically challenging and may bias the results. Shear wave elastography (SWE) represents a nondestructive alternative that can provide spatially continuous elasticity estimates. We investigated the feasibility of SWE for human intervertebral disc elasticity mapping in a laboratory setting. To this end, global spinal segment mechanical behavior was determined in 6 loading directions and served as ground truth data for the validation of the approach. Subsequently, the cranial spinal vertebra was removed and shear wave elastographic scans of the IVD were acquired. SWE-measurements were reconstructed into three-dimensional elastographic maps, discretized into distinct IVD regions and correlated with global segment mechanical parameters. SWE-derived Young's modulus estimates were compared among different regions and as a function of their state of degeneration. We found annulus shear wave speed to be moderately correlated with segment mechanical behavior irrespective of the loading direction whereas shear wave speed in the nucleus pulposus showed a very weak association (mean (SD) absolute Pearson correlation coefficients: 0.51 (0.14) and 0.17 (0.12), respectively). Young's modulus mapping of the intervertebral disc revealed stiffness to be highest in the ventral annulus with a stiffness decrease both circumferentially towards the dorsal aspect as well as towards the center of the disc. SWE hence provides a valid alternative to disc sectioning and piecewise mechanical testing.

3D printed clamps provide multiple advantages compared to potting for the fixation of spinal specimens and in a recent study, superior fixation stability was reported. The aim of this study was to evaluate the fixation efficacy of 3D printed vertebra clamps during routine application and to present and evaluate a novel clamp for sacrum fixation. Further, public access to the template files is provided. 98 human single-level cadaveric specimens were biomechanically tested in flexion-extension (FE), lateral bending (LB), axial rotation (AR), anteroposterior shear (AS), lateral shear (LS) and axial compression-decompression (AC). Loading amplitudes were +/-7.5 Nm for FE, LB and AR, +/- 150 N for AS and LS and + 400/-100 N for AC. The novel sacrum clamp was used in 8 specimens. The median relative motion between clamps and specimens was 0.6 degrees in FE, 0.7 degrees in LB, 0.3 degrees in AR, 0.5 mm in AS, 0.5 mm in LS and 0.1 mm in AC. With sacrum clamps, the median relative motion was 0.3 degrees in FE, 0.1 degrees in LB, 0.08 degrees in AR, 0.8 mm in AS, 0.7 mm in LS and 0.2 mm in AC. The vertebra clamps used during routine testing provided better stability compared to the values in the literature in all six loading directions (p < 0.05). The sacrum clamp showed superior anchoring stability in three loading directions compared to the caudal vertebra clamps (p < 0.05), while inferior stability was measured in AS (p < 0.001). We conclude that 3D printed vertebra clamps and 3D printed sacrum clamps represent reliable methods for specimen fixation during routine biomechanical testing., Journal of Biomechanics, 125, ISSN:0021-9290, ISSN:1873-2380

Pedicle screws are used for the treatment of a wide variety of spinal pathologies. A good screw holding power in bone is required for treatment success, but has so far not been predictable computationally. The goal of this study was to develop an automated tool able to predict patient-specific screw fixation strength through finite element simulation. We compared the simulation results with results from biomechanical pull-out tests performed on animal lumbar specimens. Experimental and simulation pull-out strengths were highly correlated [Formula: see text] and the mean error was 20.25%. The fixation strength was also associated to great extent with pull-out stiffness and strain energy, as well as the screw size and mean vertebral density.

Conventional bone surgery leads to unwanted damage to the surrounding tissues and a slow healing process for the patients. Additionally, physicians are not able to perform free cutting shapes due to the limitations of available systems. These issues can be overcome by robot-assisted contactless laser surgery since it provides less mechanical stress, allows precise functional cuts, and leads to faster healing. The remaining drawback of laser surgery is the low ablation rate that is not yet competitive with conventional mechanical piezo-osteotomes. Therefore, we aim at maximizing the efficiency in hard tissue laser ablation by optimizing the lateral movement speed for different irrigation conditions. The results of this study show a non-linear relationship between cutting rates, speeds, and depths that should be critically considered for integration in robotic laser surgery., at - Automatisierungstechnik, 66 (12), ISSN:0178-2312, ISSN:2196-677X

This study presents an anatomically customizable fixation technique for biomechanical spine experiments using a 3D printed clamping system. The aim of this study is to evaluate the feasibility and compare the fixation rigidity of the novel technique to PMMA potting with and without screw augmentation. For this purpose, 16 thoracic and lumbar functional spine units of bovine, porcine, ovine and human cadavers (4 each) were consecutively fixed with all three techniques and loaded in six degrees of freedom. The combined relative movement between the cranial and caudal vertebral body and their corresponding fixtures were recorded using a 3D motion capture system. The 3D printed clamps did provide multiple advantages, showed no failures and the fixation rigidity was superior to potting in all loading directions and superior to screw-augmented potting in two of six loading directions (p