Exploring interactions between force, repetition and posture on intervertebral disc height loss and bulging in isolated porcine cervical functional spinal units from sub-acute-failure magnitudes of cyclic compressive loading

Indentation mechanics and native collagen content in the cartilaginous endplate: A comparison between porcine cervical and human lumbar spines

This study characterized the regional indentation mechanics and native collagen content in cartilaginous endplates (CEPs) from the porcine cervical spine, young human lumbar spine, and aged human lumbar spine. Seventeen endplates were included in this study: six porcine cervical, nine young human lumbar, and two aged human lumbar. Width and depth measurements were obtained using a digital caliper and used to size-normalize and identify the central, anterior, posterior, and lateral regions. Regional microindentation tests were performed using a serial robot, where surface locations were loaded/unloaded at 0.1 mm/s and held at a constant 10 N force for 30 s. Loading stiffness and creep displacement were obtained from force-displacement data. Immunofluorescence staining for type I and type II collagen was subsequently performed on sagittal sections of all endplate regions. 255 images were obtained from which fluorescence intensity, sub-surface void area, and cartilage thickness were measured. CEPs from the young human lumbar spine were, on average, 27% more compliant, 0.891 mm thicker, had a lower fluorescence intensity for native collagen proteins within the cartilage (-58%) and subchondral bone (-24%), and had a sub-surface void area that was 19.7 times greater than porcine cervical CEPs. Compared to aged human lumbar CEPs, young human lumbar CEPs were 57% stiffer, 0.568 mm thicker, had a higher fluorescence intensity for native collagen proteins within the cartilage (+30%) and subchondral bone (+46%), and had a sub-surface void area that was 10.6 times smaller. Although not a perfect mechanical and structural surrogate, porcine cervical CEPs provided initial conditions that may be more representative of the young and healthy human lumbar spine compared to aged human cadaveric specimens. The indentation properties presented may have further applications to finite element models of the human lumbar spine.

Initiation and accumulation of loading induced changes to native collagen content and microstructural damage in the cartilaginous endplate

BACKGROUND CONTEXT

Injury to the cartilaginous endplate (CEP) is linked to clinically relevant low back disorders, including intervertebral disc degeneration and pain reporting. Despite this link to clinical disorders, the CEP injury pathways and the modulating effect of mechanical loading parameters on the pace of damage accumulation remains poorly understood.

PURPOSE

This study examined the effect of cyclic loading on the initiation and accumulation of changes to native collagen content (type I, type II) and microstructural damage in the central region of cadaveric porcine CEPs.

STUDY DESIGN

In vitro longitudinal study.

METHODS

One hundred fourteen porcine cervical spinal units were included (N=6 per group). The study contained a control group (no cyclic loading) and 18 experimental groups that differed by loading duration (1,000, 3,000, 5,000 cycles), joint posture (flexed, neutral), and cyclic peak compression variation (10%, 20%, 40%). Multicolor immunofluorescence staining was used to quantify loading induced changes to type I (ie, subchondral bone) and type II (ie, endplate) native collagen content (fluorescence area, fluorescence intensity) and microstructural damage (pore area [transverse plane], void area along the CEP-bone border [sagittal plane]).

RESULTS

Significant main effects of loading duration and posture were observed for fluorescence area and fluorescence intensity of type I and II collagen. In the transverse plane, type II fluorescence area significantly decreased following 1,000 cycles (-12%), but a significant change in fluorescence intensity was not observed until 3,000 cycles (-17%). Type II fluorescence area (-14%) and intensity (-10%) were both significantly less in flexed postures compared to neutral. Similar trends were observed for type I collagen in the sagittal plane sections. Generally, significant changes to fluorescence area were accompanied by the development of microstructural voids along the endplate-subchondral bone border.

CONCLUSIONS

These findings demonstrate that microstructural damage beneath the endplate surface occurs before significant changes to the density of native type I and II collagen fibers. Although flexed postures were associated with greater and accelerated changes to native collagen content, the injury initiation mechanism appears similar to neutral.

CLINICAL SIGNIFICANCE

Neutral joint postures can delay the initiation and pace of microdamage accumulation in the CEP during low-to-moderate demand lifting tasks. Furthermore, the management of peak compression exposures appeared relevant only when a neutral posture was maintained. Therefore, clinical low back injury prevention and load management efforts should consider low back posture in parallel with applied joint forces.

Experimentally dissociating the overuse mechanisms of endplate fracture lesions and Schmorl's node injuries using the porcine cervical spine model

BACKGROUND

Compared to the documented overuse mechanisms of endplate fracture lesions, the cause of Schmorl's node injuries remains unknown, despite existing hypotheses. Therefore, this study aimed to examine and dissociate the overuse injury mechanisms of these spinal pathologies.

METHODS

Forty-eight porcine cervical spinal units were included. Spinal units were randomly assigned to groups that differed by initial condition (control, sham, chemical fragility, structural void) and loading posture (flexed, neutral). Chemical fragility and structural void groups involved a verified 49% reduction in localized infra-endplate trabecular bone strength and removal of central trabecular bone, respectively. All experimental groups were exposed to cyclic compression loading that was normalized to 30% of the predicted tolerance until failure occurred. The cycles to failure were examined using a general linear model and the distribution of injury types were examined using chi-squared statistics.

FINDINGS

The incidence of fracture lesions and Schmorl's nodes was 31(65%) and 17(35%), respectively. Schmorl's nodes were exclusive to chemical fragility and structural void groups and 88% occurred in the caudal joint endplate (p = 0.004). In contrast, 100% of control and sham spinal units sustained fracture lesions, with 100% occurring in the cranial joint endplate (p < 0.001). Spinal units tolerated 665 fewer cycles when cyclically loaded in flexed postures compared to neutral (p = 0.015). Furthermore, the chemical fragility and structural void groups tolerated 5318 fewer cycles compared to the control and sham groups (p < 0.001).

INTERPRETATION

These findings demonstrate that Schmorl's node and fracture lesion injuries can result from pre-existing differences in the structural integrity of trabecular bone supporting the central endplate.

Cyclic loading history alters the joint compression tolerance and regional indentation responses in the cartilaginous endplate

This study quantified the effect of subthreshold loading histories that differed by joint posture (neutral, flexed), peak loading variation (10%, 20%, 40%), and loading duration (1000, 3000, 5000 cycles) on the post-loading Ultimate Compressive Tolerance (UCT), yield force, and regional Cartilaginous End Plate (CEP) indentation responses (loading stiffness and creep displacement). One hundred and fourteen porcine spinal units were included. Following conditioning and cyclic compression exposures, spinal units were transected and one endplate from each vertebra underwent subsequent UCT or microindentation testing. UCT testing was conducted by compressing a single vertebra at a rate of 3 kN/s using an indenter fabricated to a representative intervertebral disc size and shape. Force and actuator position were sampled at 100 Hz. Non-destructive uniaxial CEP indentation was performed at five surface locations (central, anterior, posterior, right, left) using a Motoman robot and aluminum indenter (3 mm hemisphere). Force and end-effector position were sampled at 10 Hz. A significant three-way interaction was observed for UCT (p = 0.038). Compared to neutral, the UCT was, on average, 1.9 kN less following each flexed loading duration. No effect of variation was observed in flexion; however, 40% variation caused the UCT to decrease by an average of 2.13 kN and 2.06 kN following 3000 and 5000 cycles, respectively. The indentation stiffness in the central CEP mimicked the UCT response. These results demonstrate a profound effect of posture on post-loading UCT and CEP behaviour. Control of peak compression exposures became particularly relevant only when a neutral posture was maintained and beyond the midpoint of the predicated lifespan.

Mechanically induced histochemical and structural damage in the annulus fibrosus and cartilaginous endplate: a multi-colour immunofluorescence analysis

The annulus fibrosus (AF) and endplate (EP) are collagenous spine tissues that are frequently injured due to gradual mechanical overload. Macroscopic injuries to these tissues are typically a by-product of microdamage accumulation. Many existing histochemistry and biochemistry techniques are used to examine microdamage in the AF and EP; however, there are several limitations when used in isolation. Immunofluorescence may be sensitive to histochemical and structural damage and permits the simultaneous evaluation of multiple proteins-collagen I (COL I) and collagen II (COL II). This investigation characterized the histochemical and structural damage in initially healthy porcine spinal joints that were either unloaded (control) or loaded via biofidelic compression loading. The mean fluorescence area and mean fluorescence intensity of COL II significantly decreased (- 54.9 and - 44.8%, respectively) in the loaded AF (p ≤ 0.002), with no changes in COL I (p ≥ 0.471). In contrast, the EP displayed similar decreases in COL I and COL II fluorescence area (- 35.6 and - 37.7%, respectively) under loading conditions (p ≤ 0.027). A significant reduction (-31.1%) in mean fluorescence intensity was only observed for COL II (p = 0.043). The normalized area of pores was not altered on the endplate surface (p = 0.338), but a significant increase (+ 7.0%) in the void area was observed on the EP-subchondral bone interface (p = 0.002). Colocalization of COL I and COL II was minimal in all tissues (R < 0.34). In conclusion, the immunofluorescence analysis captured histochemical and structural damage in collagenous spine tissues, namely, the AF and EP.

Porcine Functional Spine Unit in orthopedic research, a systematic scoping review of the methodology

Purpose

The aim of this study was to conduct a systematic scoping review of previous in vitro spine studies that used pig functional spinal units (FSU) as a model to gain an understanding of how different experimental methods are presented in the literature. Research guidelines are often used to achieve high quality in methods, results, and reports, but no research guidelines are available regarding in vitro biomechanical spinal studies.

Methods

A systematic scoping review approach and protocol was used for the study with a systematic search in several data bases combined with an extra author search. The articles were examined in multiple stages by two different authors in a blinded manner. Data was extracted from the included articles and inserted into a previously crafted matrix with multiple variables. The data was analyzed to evaluate study methods and quality and included 70 studies.

Results

The results display that there is a lack of consensus regarding how the material, methods and results are presented. Load type, duration and magnitude were heterogeneous among the studies, but sixty-seven studies (96%) did include compressive load or tension in the testing protocol.

Conclusions

This study concludes that an improvement of reported data in the present field of research is needed. A protocol, modified from the ARRIVE guidelines, regarding enhanced report-structure, that would enable comparison between studies and improve the method quality is presented in the current study. There is also a clear need for a validated quality-assessment template for experimental animal studies.

Posture and Helmet Configuration Effects on Joint Reaction Loads in the Middle Cervical Spine

INTRODUCTION: Between 43 and 97% of helicopter pilots in the Canadian Armed Forces report neck pain. Potential contributing factors include the weight of their helmet, night vision goggles (NVG), and counterweight (CW) combined with deviated neck postures. Therefore, the purpose of this investigation was to quantify changes in neck loads associated with posture, helmet, NVG, and CW.METHODS: Eight male subjects volunteered. They undertook one of five deviated neck postures (flexion, extension, lateral bending, axial rotation) times four configurations (no helmet, helmet only, helmet and NVG, and helmet, NVG, and CW). 3D kinematics and EMG from 10 muscles (5 bilaterally) drove a 3D inverse dynamics, EMG-driven model of the cervical spine which calculated joint compression and shear at C5-C6.RESULTS: The compression in the neutral posture was 116.5 (5.7) N, which increased to 143.7 (11.4) N due to a 12.7 N helmet. NVGs, weighing 7.9 N, also generated this disproportionate increase, where the compression was 164.2 (3.7) N. In flexion or extension, the compression increased with increasing head-supported mass, with a maximum of 315.8 (67.5) N with the CW in flexion. Anteroposterior shear was highest in the lateral bending [34.0 (6.2) N] condition, but was generally low (< 30 N). Mediolateral shear was less than 5 N for all conditions.DISCUSSION: Repositioning the center of gravity of the helmet with either NVGs or CW resulted in posture-specific changes to loading. Posture demonstrated a greater potential to reposition the head segment's center of gravity compared to the helmet design. Therefore, helmet designs which consider repositioning the center of gravity may reduce loads in one posture, but likely exacerbate loading in other postures.Barrett JM, McKinnon CD, Dickerson CR, Laing AC, Callaghan JP. Posture and helmet configuration effects on joint reaction loads in the middle cervical spine. Aerosp Med Hum Perform. 2022; 93(5):458-466.

Reaction Forces and Flexion-Extension Moments Imposed On Functional Spinal Units with Constrained and Unconstrained in Vitro Testing Systems

A mechanical goal of in vitro testing systems is to minimize differences between applied and actual forces and moments experienced by spinal units. This study quantified the joint reaction forces and reaction flexion-extension moments during dynamic compression loading imposed throughout the physiological flexion-extension range-of-motion. Constrained (fixed base) and unconstrained (floating base) testing systems were compared. Sixteen porcine spinal units were assigned to both testing groups. Following conditioning tests, specimens were dynamically loaded for 1 cycle with a 1 Hz compression waveform to a peak load of 1 kN and 2 kN while positioned in five different postures (neutral, 100% and 300% of the flexion and extension neutral zone), totalling ten trials per FSU. A six degree-of-freedom force and torque sensor was used to measure peak reaction forces and moments for each trial. Shear reaction forces were significantly greater (25.5 N - 85.7 N) when the testing system was constrained compared to unconstrained (p < 0.029). The reaction moment was influenced by posture (p = 0.037), particularly in C5C6 spinal units. In 300% extension (C5C6), the reaction moment was, on average, 9.9 Nm greater than the applied moment in both testing systems and differed from all other postures (p < 0.001). The reaction moment error was, on average, 0.45 Nm at all other postures. In conclusion, these findings demonstrate that comparable reaction moments can be achieved with unconstrained systems, but without inducing appreciable shear reaction forces.

Regulating Movement Frequency and Speed: Implications for Lumbar Spine Load Management Strategies Demonstrated Using an In Vitro Porcine Model

The relationship between internal loading dose and low-back injury risk during lifting is well known. However, the implications of movement parameters that influence joint loading rates-movement frequency and speed-on time-dependent spine loading responses remain less documented. This study quantified the effect of loading rate and frequency on the tolerated cumulative loading dose and its relation to joint lifespan. Thirty-two porcine spinal units were exposed to biofidelic compression loading paradigms that differed by joint compression rate (4.2 and 8.3 kN/s) and frequency (30 and 60 cycles per minute). Cyclic compression testing was applied until failure was detected or 10,800 continuous cycles were tolerated. Instantaneous weighting factors were calculated to evaluate the cumulative load and Kaplan-Meier survival probability functions were examined following nonlinear dose normalization of the cyclic lifespan. Significant reductions in cumulative compression were tolerated when spinal units were compressed at 8.3 kN/s (P < .001, 67%) and when loaded at 30 cycles per minute (P = .008, 45%). There was a positive moderate relationship between cumulative load tolerance and normalized cyclic lifespan (R2 = .52), which was supported by joint survivorship functions. The frequency and speed of movement execution should be evaluated in parallel to loading dose for the management of low-back training exposures.

Joint fatigue-failure: A demonstration of viscoelastic responses to rate and frequency loading parameters using the porcine cervical spine

Fatigue-failure in low back tissues is influenced by parameters of cyclic loading. Therefore, this study quantified the effect of loading rate and frequency on the number of tolerated compression cycles. Energy storage and vertical deformation were secondarily examined. Thirty-two porcine spinal units were randomly assigned to experimental groups that differed by loading rate (4.2 kN/s, 8.3 kN/s) and loading frequency (0.5 Hz, 1 Hz). Following preload and range-of-motion tests, specimens were cyclically loaded in a neutral posture until fatigue-failure occurred or 10800 cycles were tolerated. Macroscopic dissection was performed to identify the fracture morphology, and measurements of energy storage and vertical displacement were calculated throughout the specimen lifespan (1%, 10%, 50%, 90%, 99%). Given the differences in compression dose-force-time integral-between experimental conditions, the number of sustained cycles were assessed following linear and nonlinear dose-normalization via correction factors calculated from existing risk-exposure approximations. Without dose-normalization, an 8.3 kN/s loading rate and 0.5 Hz loading frequency reduced the fatigue lifetime by 3541 and 5977 cycles, respectively (p < 0.001). Linear and nonlinear dose-normalization resulted in a significant rate × frequency interaction (p < 0.001). For a 1 Hz loading frequency, the number of sustained loading cycles did not differ between loading rates (p_adj ≥ 0.988), but at 0.5 Hz, spinal units compressed at 8.3 kN/s sustained 99% (linear) and 97% (nonlinear) fewer cycles (p_adj < 0.001). These findings demonstrate that the interacting effects of loading frequency and loading rate on spinal fatigue-failure depend on the normalization of dose discrepancies between experimental groups.

Exploring the regional disc bulge response of the cervical porcine intervertebral disc under varying loads and posture

Nerve compression due to intervertebral disc (IVD) bulging is a known mechanism for low back pain and typically occurs in the posterior region of the disc. Most in vitro studies are limited in the ability to quantify the magnitude of bulging on the posterior aspect of the disc due to the boney structures that occlude a direct line-of-sight in the intact functional spinal units (FSUs). This study examined anterior and posterior annulus fibrosus (AF) bulges in reduced (posterior elements removed) cervical porcine specimens across four loading conditions and two postures. Surface scans from the anterior and posterior aspect of the IVD were recorded in both neutral and flexed postures using a 3D laser scanner to characterize changes in AF bulge. A significant negative correlation was observed for peak AF bulge on the anterior and posterior side of the disc in a flexed posture (Pearson's r = -0.448; p = 0.002; r² = 0.2003). The results from this investigation support that there may be a connection between the magnitude of AF bulge on the posterior side and estimations computed using the anterior side.

Examining endplate fatigue failure during cyclic compression loading with variable and consistent peak magnitudes using a force weighting adjustment approach: an in vitro study

Repetitive movement is common in many occupational contexts. Therefore, cumulative load is a widely recognised risk factor for lowback injury. This study quantified the effect of force weighting factors on cumulative load estimates and injury prediction during cyclic loading. Forty-eight porcine cervical spine motion segments were assigned to experimental groups that differed by average peak compression magnitude (30%, 50% and 70% of predicted tolerance) and amplitude variation (consistent, variable). Cyclic loading was performed at a frequency of 0.5 Hz until fatigue failure occurred. Weighting factors were determined and applied instantaneously. Inclusion of weighting factors resulted in statistically similar cumulative load estimates at injury between variable and consistent loading (p > .071). Further, survivorship was generally greater when the peak compression magnitude was consistent compared to variable. These results emphasise the importance of weighting factors as an equalisation tool for the evaluation of cumulative low back loading exposures in occupational contexts. Practitioner summary: Weighting factors can equalise the risk of injury based on compression magnitude. When weighted, the cumulative compression was similar between consistent and variable cyclic loading protocols, despite being significantly different when unweighted and having similar injury rates. Therefore, assessing representative occupational exposures without evaluating task performance variability may underestimate injury risk. Abbreviations: FSU: functional spinal unit; UCT: ultimate compression tolerance.

Incorporating loading variability into in vitro injury analyses and its effect on cumulative compression tolerance in porcine cervical spine units

During repetitive movement, low-back loading exposures are inherently variable in magnitude. The current study aimed to investigate how variation in successive compression exposures influences cumulative load tolerance in the spine. Forty-eight porcine cervical spine units were randomly assigned to one of six combinations of mean peak compression force (30%, 50%, 70% of the predicted tolerance) and loading variation (consistent peak amplitude, variable peak amplitude). Following preload and passive range-of-motion tests, specimens were positioned in a neutral posture and then cyclically loaded in compression until failure occurred or the maximum 12 h duration was reached. Specimens were dissected to classify macroscopic injury and measurements of cumulative load, cycles, and height loss sustained at failure were calculated. Statistical comparisons were made between loading protocols within each normalized compression group. A significant loading variation × compression interaction was demonstrated for cumulative load (p = 0.026) and cycles to failure (p = 0.021). Cumulative compression was reduced under all normalized compression loads (30% p = 0.016; 50% p = 0.030; 70% p = 0.020) when variable loading was incorporated. The largest reduction was by 33% and occurred in the 30% compression group. The number of sustained cycles was reduced by 31% (p = 0.017), 72% (p = 0.030), and 76% (p = 0.009) under normalized compression loads of 30%, 50%, and 70%, respectively. These findings suggest that variation in compression exposures interact to reduce cumulative compression tolerance of the spine and could elevate low-back injury risk during time-varying repetitive tasks.