Spinal muscle forces, internal loads and stability in standing under various postures and loads—application of kinematics-based algorithm

This work aimed to evaluate trunk muscle forces, internal loads and stability margin under some simulated standing postures, with and without external loads, using a nonlinear finite element model of the T1–S1 spine with realistic nonlinear load-displacement properties. A novel kinematics-based algorithm was applied that exploited a set of spinal sagittal rotations, initially calculated to minimize balancing moments, to solve the redundant active–passive system. The loads consisted of upper body gravity distributed along the spine with or without 200 N held in the hands, either in the front of the body or on the sides. Nonlinear and linear stability/perturbation analyses at deformed, stressed configurations with a linear stiffness-force relationship for muscles identified the system stability and critical muscle stiffness coefficient. Predictions were in good agreement with reported measurements of posture, muscle EMG and intradiscal pressure. Minimal changes in posture (posterior pelvic tilt and lumbar flattening) substantially influenced muscle forces, internal loads and stability margin. Addition of 200 N load in front of the body markedly increased the system stability, global muscle forces, and internal loads, which reached anterior shear and compression forces of ~500 N and ~1,200 N, respectively, at lower lumbar levels. Co-activation in abdominal muscles (up to 3% maximum force) substantially increased extensor muscle forces, internal loads and stability margin, allowing a smaller critical muscle coefficient. A tradeoff existed between lower internal loads in passive tissues and higher stability margins, as both increased with greater muscle activation. The strength of the proposed model is in accounting for the synergy by simultaneous consideration of passive structure and muscle forces under applied postures and loads.     

Is it possible to simulate physiologic loading conditions by applying pure moments? A comparison of in vivo and in vitro load components in an internal fixator

STUDY DESIGN: Loads acting in an internal fixator measured in vitro under the application of pure moments such as those commonly used for implant testing and basic research were compared with loads measured in 10 patients in vivo. OBJECTIVES: To investigate whether these recommended loading conditions are valid by comparing in vivo measurements and those obtained in an in vitro experiment. SUMMARY OF BACKGROUND DATA: Pure bending moments are often preferred as loading conditions for spinal in vitro testing, either for implant testing or basic research. The advantage of this loading pattern is that the bending moment is uniform along the multisegmental specimen. However, functional loading of the spine by muscles or external loads subjects the spine to a combination of forces and moments. METHODS: In an in vivo experiment, loads acting on an internal spinal fixator in 10 patients were determined before and after anterior interbody fusion during flexion, extension, left and right lateral bending, and left and right axial twisting of the upper body with the patient standing. For comparison, an equivalent in vitro data set was created with 7 human lumbar specimens in which the same type of fixator was used. All specimens were tested under the application of pure bending moments in the three main motion planes in the intact state with fixator, after corpectomy, and with bone graft. RESULTS: Consistent qualitative agreement between in vivo and in vitro measurements for the loads acting in the internal spinal fixator were found for axial rotation and lateral bending. For flexion and extension, reasonable agreement was found only for the intact spines with fixators. After corpectomy and after inserting a bone graft, the median values for axial force and bending moment in the sagittal plane in vitro did not agree with in vivo measurements. An axial preload in the in vitro experiment slightly increased the axial compression force and flexion bending moment in the fixators. CONCLUSIONS: The application of pure moments to intact lumbar spinal specimens in vitro produces forces and moments in implants comparable with loads observed in vivo. During basic research on intact specimens or implant testing involving a removed disc or corpectomy, muscle forces are necessary to simulate realistic conditions.     

Some aspects of spine biomechanics and their clinical implications in idiopathic scoliosis]

The spine with it's physiological curves is designed to transfer loads to the pelvis and the lower limbs. The complex interplay of forces in the spine can be described by breaking down these forces into their basic components. These forces have a direction and can therefore treated as vectors in three axis, related to the anatomic planes: frontal, sagittal and transverse the static spine forces responsible for a correct posture create tension. Tension is defined as the relation of the vector force to the surface area to which the force is applied. Tension, depending an the direction of the force applied can be normal or tangent. Gravitational force is transferred by the vertebral bodies. Posterior elements of the spine (the lamina, the processes and ligaments) are stabilizing elements. The articular processes bear loads only when lateral bending of the spine. The complex nature of the scoliotic deformity usually leads toa decompensated spine even prior to surgery. Although considerable correction of the curve can be achieved using modern instrumentation systems, the spine can be restored. Lach of decompensation or decompensation of the spine is a major problem among many patients treated surgically with systems based on hooks and rods. Such decompensation in the frontal plane can be a result of correction beyond the compensatory possibilities of the lumbar spine, inadequate placing of hooks and incorrectly applied distraction forces. Overlooking the proximal junctional kyphosis (between the two proximal thoracic curves or overlooking the distal junctional kyphosis (between the lumbar and thoracic curve) can also lead to decompensation of the spine in the sagittal plane.     

Loads on internal spinal fixation devices

The loads acting on internal spinal fixation devices were measured for different activities in ten patients using telemeterized bisegmental implants. The highest loads were found for walking and lateral bending of the upper body while standing. When bending forwards the upper body, the fixator loads were only slightly altered. The forces and moments were not higher during sitting than during standing. Therefore, sitting should be allowed for patients with instrumented spines as soon as getting up is allowed. The forces and moments in the fixators were often altered due to anterior interbody fusion. Especially in patients with degenerative instability, the implant loads were higher after anterior interbody fusion than before. Braces were not able to markedly reduce the fixator loads. Therefore, it does not seem helpful to brace patients after mono- or bisegmental stabilization of the thoracic or lumbar spine.     

The porcine cervical spine as a model of the human lumbar spine: an anatomical, geometric, and functional comparison.

Animal models for analysis of spine injury and orthopaedic issues are common given concerns about bone integrity, disc degeneration, and controlled studies of identical specimens matched for age, weight, physical activity and genetic background. Given this asset, the question is asked: "Is the porcine cervical spine a reasonable model of the human lumbar spine?" Three porcine cervical spines (C2-C7) were assessed for geometric characteristics, with a larger cohort (N = 24) loaded to failure under compressive or shear loading. In addition, in vivo loading was estimated and compared between the human low back (biped) and the porcine neck (quadruped). Generally, the porcine vertebrae are smaller in all dimensions. The porcine vertebrae have anterior processes unlike humans; however, they possess similar ligamentous structure and facet joint orientation. Stiffness values (compression and shear) are similar, and comparable injuries resulted from applied compressive and shear loads. Given the scarcity of healthy, young human lumbar spines, porcine cervical spines may be a useful model for studying human lumbar injury because of the similarity of mechanical characteristics and the resulting injuries, particularly of the adolescent or young adult who has not experienced disc degeneration or calcified end-plates.     

The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine

Because the etiology of spondylolysis is not well understood, the authors performed an analysis of loads and stresses in human lumbar vertebrae to determine whether purely mechanical factors are likely to cause spondylolytic fractures in a normal spine. To perform these studies, modeling methods were applied. A mechanical system was developed to study muscle forces and reactions in joints of the lumbar spine. Next an optimization approach was applied to find loads on vertebrae and muscle forces. Finally photoelastic experiments were performed to find effective stresses and stress concentrations in low lumbar vertebrae. The analysis showed that the highest stresses appear in parts interarticularis. The results prove that factors of a purely mechanical nature are of fundamental importance in the etiology of spondylolysis.     

Direct real-time measurement of in vivo forces in the lumbar spine.

BACKGROUND CONTEXT: Accurate knowledge of the mechanical loads in the lumbar spine is critical to understanding the causes of degenerative disc disease and to developing suitable treatment options and functional disc replacements. To date, only indirect methods have been used to measure the forces developed in the spine in vivo. These methods are fraught with error, and results have never been validated using direct experimental measurements. PURPOSE: The major aims of this study were to develop a methodology to directly measure, in real time, the in vivo loading in the lumbar spine, to determine if the forces developed in the lumbar spine are dependent on activity and/or posture and to assess the baboon as an animal model for human lumbar spine research based on in vivo mechanical loading. STUDY DESIGN: Real-time telemetered data were collected from sensor-imbedded implants that were placed in the interbody space of the lumbar spines of two baboons. METHODS: An interbody spinal implant was designed and instrumented with strain gauges to be used as a load cell. The implant was placed anteriorly in the lumbar spine of the baboon. Strain data were collected in vivo during normal activities and transmitted by means of a telemetry system to a receiver. The forces transmitted through the implant were calculated from the measured strain based on precalibration of the load cell. Measured forces were correlated to videotaped activities to elucidate trends in force level as a function of activity and posture over a 6-week period. The procedure was repeated in a second baboon, and data were recorded for similar activities. RESULTS: Implants measured in vivo forces developed in the lumbar spine with less than 10% error. Loads in the lumbar spine are dependent on activity and posture. The maximum loads developed in the lumbar spine during normal (baboon) activities exceeded four times body weight and were recorded while animals were sitting flexed. Force data indicate similar trends between the human lumbar spine and the baboon lumbar spine. CONCLUSIONS: It is possible to monitor the real-time forces present in the lumbar spine. Force data correlate well to trends previously reported for in vivo pressure data. Results also indicate that the baboon may be an appropriate animal model for study of the human lumbar spine.     

Gender influences on spine loads during complex lifting.

BACKGROUND CONTEXT: Previous research has documented differences in spine loading between genders when the imposed load is normalized relative to the size of the person. However, under realistic work conditions the magnitude of the load handled is seldom adjusted relative to worker anthropometry. Thus, there is a void in our knowledge in that we do not understand how material handling influences spine loading and potential risk of injury as a function of gender under realistic lifting situations. PURPOSE: To evaluate the differences in spine loading between men and women when exposed to similar workplace demands. STUDY DESIGN: A laboratory study was conducted to investigate the biomechanical responses during realistic free-dynamic lifting tasks when subjects lifted from origins and destinations that were either fixed or set relative to the subject's anthropometry. PATIENT SAMPLE: Twenty men and 20 women asymptomatic for low back pain were recruited to participate in the study. OUTCOME MEASURES: The three-dimensional spine loads were predicted from a well-established electromyography-assisted model. METHODS: Both genders completed a series of symmetric and asymmetric (60-degree clockwise) lifts that originated from two shelf heights ("relative" to knee height and "set" at 35 cm from floor) and terminated at one of two destination heights ("relative" to waist and "set" 102 cm from the floor). Three levels of box weight were investigated (6.8, 13.6 and 22.7 kg). RESULTS: Men had significantly greater compression forces than women (about 640 N). Loading differences between genders were further magnified by several of the workplace factors. The differences between men and women were even greater when lifting either of the heavier loads from the lower fixed shelf (more than 50% greater). CONCLUSIONS: It is apparent that men produce the greater loads on their spines during lifting. However, engineering controls, such as adjustable workplace layout or less weight lifted, may reduce or eliminate gender-specific differences in spine loads. Furthermore, the differences in spine loads appear to be a result of kinematic trade-offs and muscle coactivity differences in combination with unequal body masses between genders. However, when the loads were put into context of the expected tolerances of the spine, women were found to be at increased risk of injury, especially when lifting heavy loads or under asymmetric lifting conditions. Collectively, the results indicate the need to account for differences between the genders when designing the workplace.     

Interbody allograft in a skeletally immature spine model

The objective of this cadaveric biomechanical study was to establish further bovine spines as models for evaluating lumbar interbody allografts and to provide guidance for their use in pediatric humans. It is unknown whether interbody allografts can be used in the pediatric spine without failure of the host vertebral bone. Allografts were placed in cow and calf spines and loaded in compression. The cow spines were much stronger and stiffer than the calf, but moderate in vivo activities were estimated to result in loads on the allograft constructs that would result in host bone failure. Bovine spines were established as suitable models for the compressive behavior of interbody allografts in the human spine, when bone density is considered. Interbody allografts should continue to be used with adjunctive instrumentation so as to preclude host bone failure.     

Analysis of squat and stoop dynamic liftings: muscle forces and internal spinal loads

Despite the well-recognized role of lifting in back injuries, the relative biomechanical merits of squat versus stoop lifting remain controversial. In vivo kinematics measurements and model studies are combined to estimate trunk muscle forces and internal spinal loads under dynamic squat and stoop lifts with and without load in hands. Measurements were performed on healthy subjects to collect segmental rotations during lifts needed as input data in subsequent model studies. The model accounted for nonlinear properties of the ligamentous spine, wrapping of thoracic extensor muscles to take curved paths in flexion and trunk dynamic characteristics (inertia and damping) while subject to measured kinematics and gravity/external loads. A dynamic kinematics-driven approach was employed accounting for the spinal synergy by simultaneous consideration of passive structures and muscle forces under given posture and loads. Results satisfied kinematics and dynamic equilibrium conditions at all levels and directions. Net moments, muscle forces at different levels, passive (muscle or ligamentous) forces and internal compression/shear forces were larger in stoop lifts than in squat ones. These were due to significantly larger thorax, lumbar and pelvis rotations in stoop lifts. For the relatively slow lifting tasks performed in this study with the lowering and lifting phases each lasting ∼2 s, the effect of inertia and damping was not, in general, important. Moreover, posterior shift in the position of the external load in stoop lift reaching the same lever arm with respect to the S1 as that in squat lift did not influence the conclusion of this study on the merits of squat lifts over stoop ones. Results, for the tasks considered, advocate squat lifting over stoop lifting as the technique of choice in reducing net moments, muscle forces and internal spinal loads (i.e., moment, compression and shear force).     

Sudden and unexpected loading generates high forces on the lumbar spine

STUDY DESIGN: A cross-sectional study of spinal loading in healthy volunteers. OBJECTIVES: To measure the bending and compressive forces acting on the lumbar spine, in a range of postures, when unknown loads are delivered unexpectedly to the hands. SUMMARY OF BACKGROUND DATA: Epidemiologic studies suggest that sudden and unexpected loading events often lead to back injuries. Such incidents have been shown to increase back muscle activity, but their effects on the compressive force and bending moment acting on the spine have not been fully quantified. Furthermore, previous investigations have focused on the upright posture only. METHODS: In this study, 12 volunteers each stood on a force plate while weights of 0, 2, 4, and 6 kg (for men, 40% less for women) were delivered into their hands in one of three ways: 1) by the volunteer holding an empty box with handles, into which an unknown weight was dropped; 2) by the same way as in 1, but with volunteer wearing a blindfold and earphones to eliminate sensory cues; or 3) by the volunteer sliding a box of unknown weight off a smooth table. Experiments were carried out with participants standing in upright, partially flexed, and moderately flexed postures. Spinal compression resulting from muscular activity was quantified using electromyographic signals recorded from the back and abdominal muscles. The axial inertial force acting up the long axis of the spine was calculated from the vertical ground reaction force. The bending moment acting on the osteoligamentous spine was quantified by comparing measurements of lumbar curvature with the bending stiffness properties of cadaveric lumbar spines. RESULTS: The contribution from abdominal muscle contraction to overall spinal compression was small (average, 8%), as was the axial inertial force (average, 2.5%), and both were highest in the upright posture. Peak bending moments were higher in flexed postures, but did not increase much at the moment of load delivery in any posture. Peak spinal compressive forces were increased by 30% to 70% when loads were suddenly and unexpectedly dropped into the box, and by 20% to 30% when they were slid off the table, as compared with loads simply held statically in the same posture (P < 0.001). The removal of audiovisual cues had little effect. CONCLUSIONS: Sudden and alarming events associated with manual handling cause a reflex overreaction of the back muscles, which substantially increases spine compressive loading. Manual handling regulations should aim to prevent such events and limit the weight of objects to be lifted.     

Partitioning the contributing role of biomechanical, psychosocial, and individual risk factors in the development of spine loads.

BACKGROUND CONTEXT: The role of biomechanical workplace factors in spine loading has been well documented. However, our understanding of the role of psychosocial and individual factors in producing spine loads is poorly understood. Even less is understood about the relative contribution of these factors with respect to kinematic, kinetic and muscle activity responses, as well as spine loading. PURPOSE: To explore the relative contribution of biomechanical and psychosocial workplace factors and individual characteristics on the biomechanical responses and spine loading. STUDY DESIGN/SETTING: The contribution of various levels of workplace factors to spine loading was monitored under laboratory conditions. PATIENT SAMPLE: Sixty (30 male and 30 female) college-age individuals who were asymptomatic to low back pain. OUTCOME MEASURES: Trunk kinematics and kinetics, muscle activity and the three-dimensional spinal loads. METHODS: The subjects performed lifting tasks while being exposed to varying levels of biomechanical (lift rate, load weight and task asymmetry) and psychosocial (social support and mental concentration) workplace factors as well as an unexplored (load placement) workplace factor. RESULTS: The workplace job demands that had the largest contribution were load placement (4% to 30%) and load weight (15% to 55%). Mental concentration and social environment had a relatively small contribution to the spinal loads (up to 0.2%). Anthropometry played a large role in the shears (about 12% to 58%) but a relatively minor role in the compressive forces (about 3%). CONCLUSIONS: Under the given experimental conditions, load weight is the most important factor when controlling compression forces associated with lifting, but other factors, such as individual characteristics, significantly contribute to the shear loads. Thus, one must account for the weight lifted and the anthropometric dimensions when designing the workplace. For the first time, the relative contribution of workplace job demands and individual factors in the development of spine loading have been identified.     

Comparison of segmental spinal instrumentation devices in the correction of scoliosis

Harrington distraction rods with either sublaminar wires or convexity compression rods and transverse loading wires were used to treat idiopathic scoliotic patients. Laboratory measurement of transverse forces and orthographic projection of the apical vertebra enabled calculation of x- and y- plane forces in addition to torque. The construct utilizing sublaminar wires generated more favorable corrective vectors. Both devices tended to further rotate the scoliotic spine. Use of the compression apparatus should be limited to spines where reduction of kyphosis is desirable.     

A follower load increases the load-carrying capacity of the lumbar spine in compression.

STUDY DESIGN: An experimental approach was used to test human cadaveric spine specimens. OBJECTIVE: To assess the response of the whole lumbar spine to a compressive follower load whose path approximates the tangent to the curve of the lumbar spine. SUMMARY OF BACKGROUND DATA: Compression on the lumbar spine is 1000 N for standing and walking and is higher during lifting. Ex vivo experiments show it buckles at 80-100 N. Differences between maximum ex vivo and in vivo loads have not been satisfactorily explained. METHODS: A new experimental technique was developed for applying a compressive follower load of physiologic magnitudes up to 1200 N. The experimental technique applied loads that minimized the internal shear forces and bending moments, made the resultant internal force compressive, and caused the load path to approximate the tangent to the curve of the lumbar spine. RESULTS: A compressive vertical load applied in the neutral lordotic and forward-flexed postures caused large changes in lumbar lordosis at small load magnitudes. The specimen approached its extension or flexion limits at a vertical load of 100 N. In sharp contrast, the lumbar spine supported a load of up to 1200 N without damage or instability when the load path was tangent to the spinal curve. CONCLUSIONS: Until this study, an experimental technique for applying compressive loads of in vivo magnitudes to the whole lumbar spine was unavailable. The load-carrying capacity of the lumbar spine sharply increased under a compressive follower load, as long as the load path remained within a small range around the centers of rotation of the lumbar segments. The follower load path provides an explanation of how the whole lumbar spine can be lordotic and yet resist large compressive loads. This study may have implications for determining the role of trunk muscles in stabilizing the lumbar spine.     

Pedicle and transverse process screws of the upper thoracic spine. Biomechanical comparison of loads to failure

STUDY DESIGN: An In vitro biomechanical load-to-failure test. OBJECTIVES: To determine the comparative axial pullout strengths of pedicle screw versus transverse process screws in the upper thoracic spine (T1-T4), and to compare their failure loads with bone density as seen on computed tomography. SUMMARY OF THE BACKGROUND DATA: The morphology of the upper thoracic spine presents technical challenges for rigid segmental fixation. Though data are available for failure characteristics of cervical-lateral mass screws, analogous data are wanting in regard to screw fixation of the upper thoracic spine. METHODS: Ten fresh-frozen human spines (T1-T4) were quantitatively scanned using computed tomography to determine trabecular bone density at each level. The vertebrae were drilled and tapped for the insertion of a 3.5-mill meter-diameter cortical bone screw in either the pedicle or the transverse process position. A uniaxial load to failure was applied. RESULTS: The mean ultimate load to failure for the pedicle screws (658 N) was statistically greater than that of the transverse process screws (361 N; P < 0.001). The T1 pedicle screw sustained the highest load to failure (775 N). No significant difference was found between load to failure for the pedicle and transverse process screws at T1. A trend toward decreasing load to failure was seen for both screw positions with descending thoracic level. Neither pedicle dimensions nor screw working length correlated with load to failure. CONCLUSIONS: Upper thoracic pedicle screws have superior axial loading characteristics compared with bicortical transverse process screws, except at T1. Load behavior of either of these screws was not predictable based on anatomic parameters.     

Load-carrying capacity of the human cervical spine in compression is increased under a follower load

STUDY DESIGN: An experimental approach was used to test human cadaveric cervical spine specimens. OBJECTIVE: To assess the response of the cervical spine to a compressive follower load applied along a path that approximates the tangent to the curve of the cervical spine. SUMMARY OF BACKGROUND DATA: The compressive load on the human cervical spine is estimated to range from 120 to 1200 N during activities of daily living. Ex vivo experiments show it buckles at approximately 10 N. Differences between the estimated in vivo loads and the ex vivo load-carrying capacity have not been satisfactorily explained. METHODS: A new experimental technique was developed for applying a compressive follower load of physiologic magnitudes up to 250 N. The experimental technique applied loads that minimized the internal shear forces and bending moments, loading the specimen in nearly pure compression. RESULTS: A compressive vertical load applied in the neutral and forward-flexed postures caused large changes in cervical lordosis at small load magnitudes. The specimen collapsed in extension or flexion at a load of less than 40 N. In sharp contrast, the cervical spine supported a load of up to 250 N without damage or instability in both the sagittal and frontal planes when the load path was tangential to the spinal curve. The cervical spine was significantly less flexible under a compressive follower load compared with the hypermobility demonstrated under a compressive vertical load (P < 0.05). CONCLUSION: The load-carrying capacity of the ligamentous cervical spine sharply increased under a compressive follower load. This experiment explains how a whole cervical spine can be lordotic and yet withstand the large compressive loads estimated in vivo without damage or instability.     

Thoracohumeral muscle activity alters glenohumeral joint biomechanics during active abduction.

Normal function of the glenohumeral joint depends on coordinated muscle forces that stabilize the joint while moving the shoulder. These forces can either provide compressive forces to press the humeral head into the glenoid or translational forces that may destabilize the glenohumeral joint. The objective of this study was to quantify the effect of pectoralis major and latissimus dorsi muscle activity on glenohumeral kinematics and joint reaction forces during simulated active abduction. Nine fresh-frozen whole upper extremities were tested using a dynamic shoulder testing apparatus. Seven muscle force combinations were examined: a standard combination and 10%, 20%, or 30% of the deltoid force applied to the latissimus dorsi or pectoralis major tendon, respectively. Pectoralis major and latissimus dorsi muscle activity decreased the maximum angle of glenohumeral abduction and external rotation, and increased the maximum horizontal adduction angle compared to the standard muscle combination. Thoracohumeral muscle activity also created a more anteriorly directed joint reaction force that resulted in anterior translation compared to the standard muscle combination. Therefore, the ratio between anteriorly directed translational forces and compressive forces increased during abduction due to this muscle activity, suggesting that thoracohumeral muscle activity may decrease glenohumeral stability based on the joint position and applied loads. A better understanding of the contribution of muscle forces to stability may improve rehabilitation protocols for the shoulder aimed at maximizing compression and minimizing translation at the glenohumeral joint.     

Dynamic neutralisation of the lumbar spine confirmed on a new lumbar spine simulator in vitro

A new dynamic neutralisation system for lumbar spine segments has been developed and tested on four cadaveric lumbar spines. Segments L4/5 (3 cases) and L3/4 (1 case) were tested on a new lumbar spine simulator which allowed the simultaneous application of bending moments, compressive and shear loads. The average applied loads were 18.3 Nm flexion moment, 2296 N compressive and 458 N anterior shear load for flexion, and 12.5 Nm extension moment, 667 N compressive and 74 N posterior shear load for extension. The relative motion of the upper vertebra in respect to the lower vertebra was measured with the three-dimensional FASTRAK system, using an advanced computer software. The endplate centres as well as the centre of the screw heads were taken as reference points, identified by orthogonally taken radiographs. The dynamic neutralisation system described reduces bending angles and horizontal translations, but it expands vertical translations. The bulging of the posterior annulus is also reduced. Received: 4 May 1998     

Transpedicular plate fixator as effective system of spine stabilisation: biomechanical characteristics

Introduction  Zespol fixator, which was created in Poland by Ramatowski and Granowski, has an angular stable connection of screws and plate. These properties of this plate fixator, that is effective and not an expensive system of osteosynthesis of shaft of long bone widely used in Poland, impelled us to adapt it as a transpedicular plate fixator of spine. Aim  The aim of our in vitro study was to measure loads acting on spine stabilized by transpedicular plate fixator and to determine if its stability is comparable with uninjured spine. We also hypothesized that the spine stability with examined fixator had similar properties as spine fixators constructed with screws and rods. Materials and methods  We tested its biomechanical properties and compared it with a CD device by using specimens of four human spines. Each spine with damage induced in laboratory conditions was stabilised by one of those stabilisers in one (L4–L5) or two (Th12–L2) motion segments and subsequently were subject to load. The spines without and with one of transpedicular stabilization were subject to an unsymmetrical shift of +3/−4 mm for extension–compression and symmetrical shift for bending, in the frontal plane (+0.14/−0.14 rad) and the sagittal plane (+0.11/−0.11 rad), respectively. Results  Loads during extension–compression and bending in the sagittal plane were similar to the uninjured spine for short stabilization by using both stabilizers and amounted to 92.3 and 98.26%, respectively, of the load range sums of healthy spines. For long stabilization these loads amounted to 93.2 and 84.4%, respectively. Only following short and long stabilization for both devices in case of bending in the frontal plane the increase in loads up to 144.2 and 163.3% of the range sums of uninjured spines was achieved. Conclusion  It corroborates the fact that the application of the modified Zespol device for spine stabilisation provides the possibility of restoring its load transfer capacity similar to that in the healthy spine and comparable with the CD device. The study was carried out with financial support of statutory fund from Collegium Medicum in Bydgoszcz and University of Technology and Agriculture in Bydgoszcz. We declare that our experimental study was carried out on complying with the current law and the ethics commission’s approval.     

A method to study lumbar spine response to axial compression during magnetic resonance imaging: technical note

STUDY DESIGN: A magnetic resonance imaging (MRI)-compatible device was developed to apply calibrated compression loads to the lumbar spine during imaging. Experiments were performed to establish a protocol to measure lumbar load-response and estimate muscle-force contribution to spinal load. OBJECTIVE: To develop experimental methodology for direct study of lumbar spine response to compression load. SUMMARY OF BACKGROUND DATA: Most lumbar MRI scans require subjects to lie relaxed and supine, but spinal stenosis has been demonstrated to increase during moderate compressive loading. Several devices have been used to load the spine during MRI, but they could not maintain and/or change calibrated loads during MRI experiments. Furthermore, artifact from viscoelastic creep during imaging was not considered. METHODS: An MRI-compatible spine compression unit with pneumatic load elements was developed to produce calibrated compression loads. Young healthy men were loaded with 140% body weight for up to 10 minutes to establish an appropriate test protocol. Muscle force contribution to spinal load was estimated from electromyography experiments. RESULTS: The spine compression unit produced specified loads +/- 29 N (standard deviation). Spine viscoelastic creep reached steady state by 6.5 minutes, leaving 3.5 minutes for image acquisition. The subjects could support 1.0 body weight for the requisite 10 minutes. Muscle compressive force estimates were only 135 N during application of 1.4 x body weight external compression load; thus, internal muscle forces during supine spine compression could be neglected. CONCLUSIONS: The lumbar load/image protocol fits within the time constraints of creep deformation and subject endurance. These methods allow acute lumbar mechanical response measurements during loading.