Load sharing within a human lumbar vertebral body using the finite element method

Biomechanical Effects of Different Sitting Postures and Physiologic Movements on the Lumbar Spine: A Finite Element Study

This study used the finite element method(FEM) to investigate how pressure on the lumbar spine changes during dynamic movements in different postures: standing, erect sitting on a chair, slumped sitting on a chair, and sitting on the floor. Three load modes (flexion, lateral bending, and axial rotation) were applied to the FEM, simulating movements of the lumbar spine. Results showed no significant difference in pressure distribution on the annulus fiber and nucleus pulposus, representing intradiscal pressure, as well as on the cortical bone during movements between standing and erect sitting postures. However, both slumped sitting on a chair and sitting on the floor postures significantly increased pressure on the nucleus pulposus, annulus fibrosus, and cortical bone in all three movements when compared to standing or erect sitting on a chair. Notably, sitting on the floor resulted in even higher pressure on the nucleus pulposus and annulus fibers compared to slumped sitting on a chair. The decreased lumbar lordosis while sitting on the floor led to the highest increase in pressure on the annulus fiber and nucleus pulposus in the lumbar spine. In conclusion, maintaining an erect sitting position with increased lumbar lordosis during seated activities can effectively reduce intradiscal pressure and cortical bone stress associated with degenerative disc diseases and spinal deformities.

Artificial lamina after laminectomy: Progress, applications, and future perspectives

In clinical practice, laminectomy is a commonly used procedure for spinal decompression in patients suffering from spinal disorders such as ossification of ligamentum flavum, lumbar stenosis, severe spinal fracture, and intraspinal tumors. However, the loss of posterior column bony support, the extensive proliferation of fibroblasts and scar formation after laminectomy, and other complications (such as postoperative epidural fibrosis and iatrogenic instability) may cause new symptoms requiring revision surgery. Implantation of an artificial lamina prosthesis is one of the most important methods to avoid post-laminectomy complications. Artificial lamina is a type of synthetic lamina tissue made of various materials and shapes designed to replace the resected autologous lamina. Artificial laminae can provide a barrier between the dural sac and posterior soft tissues to prevent postoperative epidural fibrosis and paravertebral muscle compression and provide mechanical support to maintain spinal alignment. In this paper, we briefly review the complications of laminectomy and the necessity of artificial lamina, then we review various artificial laminae from clinical practice and laboratory research perspectives. Based on a combination of additive manufacturing technology and finite element analysis for spine surgery, we propose a new designing perspective of artificial lamina for potential use in clinical practice.

Automated segmentation of vertebral cortex with 3D U-Net-based deep convolutional neural network

Objectives: We developed a 3D U-Net-based deep convolutional neural network for the automatic segmentation of the vertebral cortex. The purpose of this study was to evaluate the accuracy of the 3D U-Net deep learning model.

Methods: In this study, a fully automated vertebral cortical segmentation method with 3D U-Net was developed, and ten-fold cross-validation was employed. Through data augmentation, we obtained 1,672 3D images of chest CT scans. Segmentation was performed using a conventional image processing method and manually corrected by a senior radiologist to create the gold standard. To compare the segmentation performance, 3D U-Net, Res U-Net, Ki U-Net, and Seg Net were used to segment the vertebral cortex in CT images. The segmentation performance of 3D U-Net and the other three deep learning algorithms was evaluated using DSC, mIoU, MPA, and FPS.

Results: The DSC, mIoU, and MPA of 3D U-Net are better than the other three strategies, reaching 0.71 ± 0.03, 0.74 ± 0.08, and 0.83 ± 0.02, respectively, indicating promising automated segmentation results. The FPS is slightly lower than that of Seg Net (23.09 ± 1.26 vs. 30.42 ± 3.57).

Conclusion: Cortical bone can be effectively segmented based on 3D U-net.

Measuring the thickness of vertebral endplate and shell using digital tomosynthesis

The vertebral endplate and cortical shell play an important structural role and contribute to the overall strength of the vertebral body, are at highest risk of initial failure, and are involved in degenerative disease of the spine. The ability to accurately measure the thickness of these structures is therefore important, even if difficult due to relatively low resolution clinical imaging. We posit that digital tomosynthesis (DTS) may be a suitable imaging modality for measurement of endplate and cortical shell thickness owing to the ability to reconstruct multiplanar images with good spatial resolution at low radiation dose. In this study, for 25 cadaveric L1 vertebrae, average and standard deviation of endplate and cortical shell thickness were measured using images from DTS and microcomputed tomography (μCT). For endplate thickness measurements, significant correlations between DTS and μCT were found for all variables when comparing thicknesses measured in both the overall endplate volume (R² = 0.25-0.54) and when measurements were limited to a central range of coronal or sagittal slices (R² = 0.24-0.62). When compared to reference values from the overall shell volume, DTS thickness measurements were generally nonsignificant. However, when measurement of cortical shell thickness was limited to a range of central slices, DTS outcomes were significantly correlated with reference values for both sagittal and coronal central regions (R² = 0.21-0.49). DTS may therefore offer a means for measurement of endplate thickness and, within a limited sagittal or coronal measurement volume, for measurement of cortical shell thickness.

Stress analysis of the thoracolumbar junction in the process of backward fall: An experimental study and finite element analysis

The aim of the present study was to evaluate the biomechanical mechanism of injuries of the thoracolumbar junction by the methods of a backward fall simulation experiment and finite element (FE) analysis (FEA). In the backward fall simulation experiment, one volunteer was selected to obtain the contact force data of the sacrococcygeal region during a fall. Utilizing the fall data, the FEA simulation of the backward fall process was given to the trunk FE model to obtain the stress status of local bone structures of the thoracolumbar junction during the fall process. In the fall simulation test, the sacrococcygeal region of the volunteer landed first; the total impact time was 1.14±0.58 sec, and the impact force was up to 4,056±263 N. The stress of thoracic (T)11 was as high as 42 MPa, that of the posterior margin and the junction of T11 was as high as 70.67 MPa, and that of the inferior articular process and the superior articular process was as high as 128 MPa. The average stress of T12 and the anterior margin of lumbar 1 was 25 MPa, and that of the endplate was as high as 21.7 MPa, which was mostly distributed in the back of the endplate and the surrounding cortex. According to the data obtained from the fall experiment as the loading condition of the FE model, the backward fall process can be simulated to improve the accuracy of FEA results. In the process of backward fall, the front edge of the vertebral body and the root of vertebral arch in the thoracolumbar junction are stress concentration areas, which have a greater risk of injury.

Topological design and biomechanical evaluation for 3D printed multi-segment artificial vertebral implants

Customized spinal implants fabricated by additive manufacturing have been increasingly used clinically to restore the physiological functions. However, the mechanisms and methods about the design for the spinal implants are not clear, especially for the reconstruction of multi-segment vertebral. This study aims to develop a novel multi-objective optimization methodology based on various normal spinal activities, to design the artificial vertebral implant (AVI) with lightweight, high-strength and high-stability. The biomechanical performance for two types of AVI was analyzed and compared under different loading conditions by finite element method. These implants were manufactured via selective laser melting technology and evaluated via compressive testing. Results showed the maximum Mises stress of the optimized implant under various load cases were about 41.5% of that of the trussed implant, and below fatigue strength of 3D printed titanium materials. The optimized implant was about 2 times to trussed implant in term of the maximum compression load and compression stiffness to per unit mass, which indicated the optimized implant can meet the safety requirement. Finally, the optimized implant has been used in clinical practice and good short-term clinical outcomes were achieved. Therefore, the novel developed method provides a favorable guarantee for the design of 3D printed multi-segment artificial vertebral implants.

Region-dependent bone loss in the lumbar spine following femoral fracture in mice

We previously showed that after femur fracture, mice lose bone at distant skeletal sites, including the lumbar vertebrae. This bone loss may increase the risk of subsequent vertebral fractures, particularly if bone is lost from high-strain bone regions, which are most commonly found adjacent to the superior and inferior endplates of the vertebral body. To determine regional bone loss from the lumbar spine following femur fracture, we evaluated the cranial, center, and caudal portions of the L5 vertebral bodies of Young (3 month-old) and Middle-Aged (12 month-old) female C57BL/6 mice two weeks after a transverse femur fractures compared to Young and Middle-Aged uninjured control mice. We hypothesized that greater bone loss would be observed in the cranial and caudal regions than in the center region in both Young and Middle-Aged mice. Trabecular and cortical bone microstructure were evaluated using micro-computed tomography, and osteoclast number and eroded surface were evaluated histologically. In Young Mice, fracture led to decreased trabecular and cortical bone microstructure primarily in the cranial and caudal regions, but not the center region, while Middle-Aged mice demonstrated decreases in trabecular bone in all regions, but did not exhibit any changes in cortical bone microstructure after fracture. No significant differences in osteoclast number or eroded surface were observed at this time point. These data suggest that bone loss following fracture in Young Mice is concentrated in areas that contain a large amount of high-strain tissue, whereas bone loss in Middle-Aged mice is less region-dependent and is restricted to the trabecular bone compartment. These results illustrate how systemic bone loss after fracture could lead to decreases in vertebral strength, and how distinct regional patterns and age-dependent differences in bone loss may differentially affect vertebral fracture risk.

Reproduction Differentially Affects Trabecular Bone Depending on Its Mechanical Versus Metabolic Role

During pregnancy and lactation, the maternal skeleton provides calcium for fetal/infant growth, resulting in substantial bone loss, which partially recovers after weaning. However, the amount of bone that is lost and the extent of post-weaning recovery are highly variable among different skeletal sites, and, despite persistent alterations in bone structure at some locations, reproductive history does not increase postmenopausal fracture risk. To explain this phenomenon, we hypothesized that the degree of reproductive bone loss/recovery at trabecular sites may vary depending on the extent to which the trabecular compartment is involved in the bone's load-bearing function. Using a rat model, we quantified the proportion of the load carried by the trabeculae, as well as the extent of reproductive bone loss and recovery, at two distinct skeletal sites: the tibia and lumbar vertebra. Both sites underwent significant bone loss during pregnancy and lactation, which was partially recovered post-weaning. However, the extent of the deterioration and the resumption of trabecular load-bearing capacity after weaning varied substantially. Tibial trabecular bone, which bore a low proportion of the total applied load, underwent dramatic and irreversible microstructural deterioration during reproduction. Meanwhile, vertebral trabecular bone bore a greater fraction of the load, underwent minimal deterioration in microarchitecture, and resumed its full load-bearing capacity after weaning. Because pregnancy and lactation are physiological processes, the distinctive responses to these natural events among different skeletal sites may help to elucidate the extent of the trabecular bone's structural versus metabolic functions.

Trabecular bone loss at a distant skeletal site following noninvasive knee injury in mice

Traumatic injuries can have systemic consequences, as the early inflammatory response after trauma can lead to tissue destruction at sites not affected by the initial injury. This systemic catabolism may occur in the skeleton following traumatic injuries such as anterior cruciate ligament (ACL) rupture. However, bone loss following injury at distant,unrelated skeletal sites has not yet been established. In the current study, we utilized a mouse knee injury model to determine whether acute knee injury causes a mechanically significant trabecular bone loss at a distant, unrelated skeletal site (L5 vertebral body).Knee injury was noninvasively induced using either high-speed (HS; 500 mm/s) or lowspeed(LS; 1 mm/s) tibial compression overload. HS injury creates an ACL rupture by midsubstance tear, while LS injury creates an ACL rupture with an associated avulsion bone fracture. At 10 days post-injury, vertebral trabecular bone structure was quantified using high-resolution microcomputed tomography (lCT), and differences in mechanical properties were determined using finite element modeling (FEM) and compressive mechanical testing. We hypothesized that knee injury would initiate a loss of trabecular bone structure and strength at the L5 vertebral body. Consistent with our hypothesis, we found significant decreases in trabecular bone volume fraction (BV/TV) and trabecular number at the L5 vertebral body in LS injured mice compared to sham (8.8% and 5.0%, respectively), while HS injured mice exhibited a similar, but lower magnitude response (5.1% and 2.5%, respectively). Contrary to our hypothesis, this decrease intrabecular bone structure did not translate to a significant deficit in compressive stiffness or ultimate load of the full trabecular body assessed by mechanical testing or FEM. However,we were able to detect significant decreases in compressive stiffness in both HS and LS injured specimens when FE models were loaded directly through the trabecular bone region (9.9% and 8.1%, and 3, respectively). This finding may be particularly important for osteoporotic fracture risk, as damage within vertebral bodies has been shown to initiate within the trabecular bone compartment. Altogether, these data point to a systemic trabecular bone loss as a consequence of fracture or traumatic musculoskeletal injury, which may be an underlying mechanism contributing to increased risk of refracture following an initial injury. This finding may have consequences for treatment of acute musculoskeletal injuries and the prevention of future bone fragility.

Lumbar trabecular bone mineral density distribution in patients with and without vertebral fractures: a case-control study

PURPOSE

The proportion of load transmitted through the lumbar neural arch increases with aging, spinal degeneration, and lordosis, effectively shielding the lumbar vertebral bodies from load. This stress shielding may contribute to bone loss in the vertebral body, leading to increased fracture risk. To test his hypothesis, we performed a study to determine if vertebral body fractures were associated with a higher neural arch/vertebral body volumetric bone mineral density (vBMD) ratio.

METHODS

Trabecular vBMD was calculated by quantitative CT in the L3 vertebral body and neural arch (pars interarticularis) of 36 women with vertebral compression fractures and 39 controls. Neural arch/vertebral body vBMD ratio was calculated, and its relationship to fracture status was determined using linear regression models adjusted for age and body mass index.

RESULTS

Vertebral body trabecular vBMD was lower in fracture cases as compared to controls (mean ± SD, 49.0 ± 36.0 vs. 87.5 ± 36.8 mg/cm(3), respectively; P < 0.001), whereas trabecular vBMD of the neural arch was similar (96.1 ± 57.6 in cases vs. 118.2 ± 57.4 mg/cm(3) in controls; P = 0.182). The neural arch/vertebral body vBMD ratio was significantly greater in the fracture group than in controls (2.31 ± 1.07 vs. 1.44 ± 0.57, respectively; P < 0.001).

CONCLUSION

These results support the hypothesis that stress shielding is a contributor to vertebral body bone loss and may increase fracture risk. Although further studies are needed, there may be a role for interventions that can shift vertebral loading in the spine to help prevent fracture.

Strain changes on the cortical shell of vertebral bodies due to spine ageing: A parametric study using a finite element model evaluated by strain measurements

The probability of fractures of the cortical shell of vertebral bodies increases as ageing progresses. Ageing involves all the spinal component changes. However, the effect of the spinal component ageing on the fracture risk of the cortical shell remains poorly understood. In this study, the influence of the ageing of the spinal components on cortical shell strain was investigated. A lumbar spinal specimen (L3–L5) was mechanically tested under a quasi-static axial compressive load. Clinical computed tomography images of the same specimen were used to create a corresponding finite element model. The material properties were determined by calibrating the finite element model using the L4 cortical shell strains of the anterior centre measurement site. The remaining experiment data (axial displacement, the intra-discal pressures, L4 cortical shell strain on the lateral measurement site) were used to evaluate the model. The individual ageing process of the six spinal components (cortical shell, cancellous bone, bony endplate, posterior elements, nucleus pulposus and annulus matrix) was simulated by changing their Young’s moduli and Poisson’s ratios, and the effect on cortical shell strain was investigated. Results show that the cortical shell strain is more sensitive to the ageing of the cortical shell and the cancellous bone than to the ageing of the nucleus pulposus, the annulus matrix, and the bony endplates and of the posterior elements. The results can help the clinicians focus on the aspects that mainly influence the vertebral cortex fracture risk factor.

Longitudinal changes in lumbar bone mineral density distribution may increase the risk of wedge fractures

BACKGROUND

Trabecular bone strength diminishes as a result of osteoporosis and altered biomechanical loading at the vertebral and spinal levels. The spine consists of the anterior, middle and posterior columns and the load supported by the anterior and middle columns will differ across different regions of the spine. Stress shielding of the anterior column can contribute to bone loss and increase the risk of wedge fracture. There is a lack of quantitative data related to regional spinal bone mineral density distribution over time. We hypothesize that there is an increase in the posterior-to-anterior vertebral body bone mineral density ratio and a decrease in whole-body bone mineral density over time.

METHODS

Bone mineral density was measured in 33 subjects using quantitative computed tomography scans for L1-L3 vertebrae, region (anterior and posterior vertebral body), and time (baseline and 6 years after).

FINDINGS

Lumbar bone mineral density decreased significantly (Δ: ~15%) from baseline to the 6th year visit. Individual vertebra differences over time (L1: ~14%, L2: ~14%, L3: ~17%) showed statistical significance. Anterior bone mineral density change was significantly greater than in the posterior vertebral body region (Δ anterior: ~18%; Δ posterior: ~13%). Posterior-to-anterior bone mineral density ratio was significantly greater in the 6th year compared to baseline values (mean (SD), 1.33 (0.2) vs. 1.23 (0.1)).

INTERPRETATION

This study provides longitudinal quantitative measurement of bone mineral density in vertebrae as well as regional changes in the anterior and posterior regions. Understanding bone mineral density distribution over time may help to decrease the risk of wedge fractures if interventions can be developed to bring spine loading to its normal state.

A pilot finite element study of an osteoporotic L1-vertebra compared to one with normal T-score

In this paper, two patient-specific finite element (FE) models of both an L1 vertebra with a normal T-score and a mildly wedging, osteoporotic one were created and analysed under usual action. Utilising commercial software packages for image processing and FE analysis (FEA) along with in house computer codes for a posteriori assignment of material properties, in vivo high-resolution spiral computed tomography of the entire vertebrae and FEA were combined. Using the vertebra with a normal T-score as baseline it was found that the maximum value of the von Mises stress in the osteoporotic vertebra was 60% higher but still far below bone strength, while the maximum value of von Mises strain in the same vertebra was 148% higher than that of the vertebra with normal T-score. In the vertebra with normal T-score, 17% of its volume exhibited values of von Mises strain higher than the threshold of 4500 μstrains, referenced by Homminga et al. as a threshold of fracture risk, while in the osteoporotic one this percentage was raised up to 37%. The results suggested that the osteoporotic vertebra is susceptible to fracture due to raised strains and not stresses.

Biomechanical analysis of the lumbar spine on facet joint force and intradiscal pressure--a finite element study

Background

Finite element analysis results will show significant differences if the model used is performed under various material properties, geometries, loading modes or other conditions. This study adopted an FE model, taking into account the possible asymmetry inherently existing in the spine with respect to the sagittal plane, with a more geometrically realistic outline to analyze and compare the biomechanical behaviour of the lumbar spine with regard to the facet force and intradiscal pressure, which are associated with low back pain symptoms and other spinal disorders. Dealing carefully with the contact surfaces of the facet joints at various levels of the lumbar spine can potentially help us further ascertain physiological behaviour concerning the frictional effects of facet joints under separate loadings or the responses to the compressive loads in the discs.

Methods

A lumbar spine model was constructed from processes including smoothing the bony outline of each scan image, stacking the boundary lines into a smooth surface model, and subsequent further processing in order to conform with the purpose of effective finite element analysis performance. For simplicity, most spinal components were modelled as isotropic and linear materials with the exception of spinal ligaments (bilinear). The contact behaviour of the facet joints and changes of the intradiscal pressure with different postures were analyzed.

Results

The results revealed that asymmetric responses of the facet joint forces exist in various postures and that such effect is amplified with larger loadings. In axial rotation, the facet joint forces were relatively larger in the contralateral facet joints than in the ipsilateral ones at the same level. Although the effect of the preloads on facet joint forces was not apparent, intradiscal pressure did increase with preload, and its magnitude increased more markedly in flexion than in extension and axial rotation.

Conclusions

Disc pressures showed a significant increase with preload and changed more noticeably in flexion than in extension or in axial rotation. Compared with the applied preloads, the postures played a more important role, especially in axial rotation; the facet joint forces were increased in the contralateral facet joints as compared to the ipsilateral ones at the same level of the lumbar spine.

Biomechanical modeling of the lateral decubitus posture during corrective scoliosis surgery

BACKGROUND

Patient prone positioning in scoliosis surgeries modifies the spinal curves prior to instrumentation. However, the biomechanical effects of the lateral decubitus posture, used in anterior approaches and minimally invasive techniques, have not yet been investigated. The objectives were to develop and validate a finite element model simulating the spinal changes resulting from this positioning.

METHODS

The 3D pre-op reconstructed geometries of six adolescent patients with idiopathic scoliosis were used to develop personalized finite element models of the spine, which integrated a three-step method simulating the lateral posture. Clinical indices were measured on pre- and intra-operative radiographs to validate the finite element model.

FINDINGS

The major Cobb angle and apical vertebral translation were reduced by 44% and 37% respectively between the pre- and intra-op postures. Using appropriately oriented gravity forces and boundary conditions, the finite element model simulations represented adequately these changes, with average differences of 4 degrees for the major Cobb angle and 4mm for the apical vertebral translation with the radiographic values.

INTERPRETATION

Lateral decubitus positioning significantly reduces the spinal deformities prior to instrumentation, as demonstrated by the finite element model. This study is a first step in the development of a modeling tool for the optimal adjustments of intra-operative positioning, which remains to be further investigated with complementary clinical studies.

Variation of trabecular microarchitectural parameters in cranial, caudal and mid-vertebral regions of the ovine L3 vertebra

The lumbar vertebrae are major load-bearing structures within the spinal column. The current understanding of the microstructure of these bodies and their full role in load-bearing is incomplete. There is a need to develop our understanding of these issues to improve fracture prediction in musculoskeletal diseases such as osteoporosis. The lumbar vertebrae consist primarily of trabecular bone enclosed in a thin cortical shell, but little is known about how microstructural parameters vary within these structures, particularly in relation to the trabecular compartment. The specific aim of this study was to use micro-computed tomography to characterize the trabecular microarchitecture of the ovine L3 vertebra in cranial, mid-vertebra and caudal regions. The L3 vertebra was obtained from skeletally mature ewes (n = 18) more than 4 years old. Three-dimensional reconstructions of three pre-defined regions were obtained and microarchitectural parameters were calculated. Whereas there was no difference in bone volume fraction or structural model index between regions, trabecular number, thickness, spacing, connectivity density, degree of anisotropy and bone mineral density all displayed significant regional variations. The observed differences were consistent with the biomechanical hypothesis that in vivo loads are distributed differently at the endplates compared with the mid-vertebra. Thus, a more integrative approach combining biomechanical theory and anatomical features may improve fracture risk assessment in the future.

Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile

STUDY DESIGN/SETTING

A community hospital prospective, nonrandomized chart review. March 2004 to December 2006, 58 patients were treated. Adverse events: new complaints and increasing length of stay limit early mobilization and require consultation with other physicians or reoperation. These formed the focus of the study.

OBJECTIVE

Assess patient demographics and adverse events related to direct lateral lumbar approach.

SUMMARY OF BACKGROUND DATA

Clinicians advocate anterior column support for lumbar conditions. Minimally invasive stabilization of lumbar spine via direct lateral approach gained popularity owing to perceived decrease in patient morbidity.

METHODS

Mild or major adverse events during hospital stay or within 6 weeks of discharge were considered early complications and designated as medical, approach, or implant related. A historical cohort of open posterior spinal fusion patients was used for comparison.

RESULTS

Forty-three female and 15 male patients with a mean age of 61 years formed the study group. Surgery performed included 38 single level, 19 2-level, and 1 3-level case. Adverse events occurred in 13 patients (22.4%); 8 events were approach, 3 medical, and 1 implant bone interface related. Major complications occurred in 5 patients (8.6%). Two patients (3.4%) with L4 nerve injury showed residual motor effects, at 1 year postoperatively. Significant differences were noted between single and 2-level cases; Estimated blood loss (EBL) and operative time. Open posterior fusion patients experienced greater operative time and increased EBL compared with minimally invasive cases.

CONCLUSIONS

Major adverse events approximated 8.6% with approach-related complaints of nerve irritation nearing 3.4%. Mild complications occurred in 13.7% of patients. Meralgia paresthetica was a primary approach-related complaint. Most complaints significantly reduced by first postoperative visit. One patient (1.7%) had symptoms lasting over a year that did not adversely affect function. Significant finding related to exposure, that is, 1-versus 2-level cases. Overall morbidity reduction noted by EBL is considerably less compared with the historical cohort. Direct lateral lumbar interbody fusion has proven to be of value.

Translational aspects of bone quality--vertebral fractures, cortical shell, microdamage and glycation: a tribute to Pierre D. Delmas

Among vertebral deformities, the prevalence of wedge fractures is about twice that of endplate (biconcave) deformities, both of which are greater than that of crush deformities. The anterior cortex is, therefore, a site of interest for understanding mechanisms of vertebral fracture. Despite its importance to vertebral mechanics, there are limited data describing the role of cortical shell, microdamage, and bone matrix parameters in vertebral fragility. This review of literature emphasizes the translational aspects of bone quality and demonstrates that a greater understanding of bone fractures will be gained through bone quality parameters related to both cortical and cancellous compartments as well as from microdamage and bone matrix parameters. In the context of vertebral fractures, measures of cortical shell and bone matrix parameters related to the organic matrix (advanced glycation products and alpha/beta CTX ratio) are independent of BMD measurements and can therefore provide an additional estimate of fracture risk in older patients.

Trabecular shear stress amplification and variability in human vertebral cancellous bone: relationship with age, gender, spine level and trabecular architecture

Trabecular shear stress magnitude and variability have been implicated in damage formation and reduced bone strength associated with bone loss for human vertebral bone. This study addresses the issue of whether these parameters change with age, gender or anatomical location, and if so whether this is independent of bone mass. Additionally, 3D-stereology-based architectural parameters were examined in order to establish the relationship between stress distribution parameters and trabecular architecture. Eighty cancellous bone specimens were cored from the anterior region of thoracic 12 and donor-matched lumbar 1 vertebrae from a randomly selected population of 40 cadavers. The specimens were scanned at 21-microm voxel size using microcomputed tomography (microCT) and reconstructed at 50microm. Bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), bone surface-to-volume ratio (BS/BV), degree of anisotropy (MIL1/MIL3), and connectivity density (-#Euler/Vol) were calculated directly from micro-CT images. Large-scale finite element models were constructed and superoinferior compressive loading was simulated. Apparent cancellous modulus (EFEM) was calculated. The average trabecular von Mises stress generated per uniaxial apparent stress (sigma (-)VM / sigmaapp) and coefficient of variation of trabecular von Mises stresses (COV) were calculated as measures of the magnitude and variability of shear stresses in the trabeculae. Mixed-models and regression were used for analysis. sigma(-)VM / sigmaapp and COV were not different between genders and vertebrae. Both sigma(-)VM / sigmaapp and COV increased with age accompanied by a decrease in BV/TV. Strong relationship of sigma(-)VM / sigmaapp with BV/TV was found whereas COV was strongly related to EFEM/(BV/TV). The results from T12 and L1 were not different and highly correlated with each other. The relationship of sigma(-)VM / sigmaapp with COV was observed to be different between males and females. This difference could not be explained by architectural parameters considered in this study. Our results support the relevance of trabecular shear stress amplification and variability in age-related vertebral bone fragility. The relationships found are expected to help understand the micro-mechanisms by which cancellous bone mass and mechanical properties are modulated through a collection of local stress parameters.

Regional variation in vertebral bone morphology and its contribution to vertebral fracture strength

Vertebral fractures may result in pain, loss of height, spinal instability, kyphotic deformity and ultimately increased morbidity. Fracture risk can be estimated by vertebral bone mineral density (BMD). However, vertebral fractures may be better defined by more selective methods that account for micro-architecture. Our aim was to quantify regional variations in bone architecture parameters (BAPs) and to assess the degree with which regional variations in BAPs affect vertebral fracture strength. The influence of disc health and endplate thickness on fracture strength was also determined. The soft tissue and posterior elements of 20 human functional spine units (FSU) were removed (T9 to L5, mean 74.45+/-4.25 years). After micro-CT scanning of the entire FSU, the strength of the specimens was determined using a materials testing system. Specimens were loaded in compression to failure. BAPs were assessed for 10 regions of the vertebral cancellous bone. Disc health (glycosaminoglycan content of the nucleus pulposus) was determined using the degree of binding with Alcian Blue. Vertebrae were not morphologically homogeneous. Posterior regions of the vertebrae had greater bone volume, more connections, reduced trabecular separation and more plate-like isotropic structures than their corresponding anterior regions. Significant heterogeneity also exists between posterior superior and inferior regions (BV/TV: posterior superior 12.6+/-2.8%, inferior 14.6+/-3%; anterior superior 10.5+/-2.2%, inferior 10.7+/-2.4%). Of the two endplates that abutted a common disc, the cranial inferior endplate was thicker (0.44+/-0.15 mm) than the caudal superior endplate (0.37+/-0.13 mm). Our study found good correlations between BV/TV, connective density and yield strength. Fracture risk prediction, using BV/TV multiplied by the cross sectional area of the endplate, can be improved through regional analysis of the underlying cancellous bone of the endplate of interest (R(2) 0.78) rather than analysis of the entire vertebra (R(2) 0.65) or BMD (R(2) 0.47). Degenerated discs lack a defined nucleus. A negative linear relationship between disc health and vertebral strength (R(2) 0.70) was observed, likely due to a shift in loading from the weaker anterior vertebral region to the stronger posterior region and cortical shell. Our results show the importance of considering regional variations in cancellous BAPs and disc health when assessing fracture risk.

The Effect of Regional Variations of the Trabecular Bone Properties on the Compressive Strength of Human Vertebral Bodies

Cancellous centrum is a major component of the vertebral body and significantly contributes to its structural strength and fracture risk. We hypothesized that the variability of cancellous bone properties in the centrum is associated with vertebral strength. Microcomputed tomography (micro-CT)-based gray level density (GLD), bone volume fraction (BV/TV), and finite element modulus (E) were examined for different regions of the trabecular centrum and correlated with vertebral body strength determined experimentally. Two sets of images in the cancellous centrum were digitally prepared from micro-CT images of eight human vertebral bodies (T10-L5). One set included a cubic volume (1 per vertebral centrum, n = 8) in which the largest amount of cancellous material from the centrum was included but all the shell materials were excluded. The other set included cylindrical volumes (6 per vertebral centrum, n = 48) from the anterior (4 regions: front, center, left, and right of the midline of vertebra) and the posterior (2 regions: left and right) regions of the centrum. Significant positive correlations of vertebral strength with GLD (r (2) = 0.57, p = 0.03) and E (r (2) = 0.63, p = 0.02) of the whole centrum and with GLD (r (2) = 0.65, p = 0.02), BV/TV (r (2) = 0.72, p = 0.01) and E (r (2) = 0.85, p = 0.001) of the central region of the vertebral centrum were found. Vertebral strength decreased with increasing coefficient of variation of GLD, BV/TV, and E calculated from subregions of the vertebral centrum. The values of GLD, BV/TV, and E in centrum were significantly smaller for the anterior region than for the posterior region. Overall, these findings supported the significant role of regional variability of centrum properties in determining the whole vertebral strength.

Comparison of biomechanical function at ideal and varied surgical placement for two lumbar artificial disc implant designs: mobile-core versus fixed-core

STUDY DESIGN

Finite element model.

OBJECTIVES

To estimate the effect of lumbar mobile-core and fixed-core artificial disc design and placement on the loading of the facet joints, and stresses on the polyethylene core.

SUMMARY OF BACKGROUND DATA

Although both mobile-core and fixed-core lumbar artificial disc designs have been used clinically, the effect of their design and the effect of placement within the disc space on the structural element loading, and in particular the facets and the implant itself, have not been investigated.

METHODS

A 3D nonlinear finite element model of an intact ligamentous L4-L5 motion segment was developed and validated in all 6 df based on previous experiments conducted on human cadavers. Facet loading of a mobile-core TDR and a fixed-core TDR were estimated with 4 different prosthesis placements for 3 different ranges of motion.

RESULTS

Placing the mobile-core TDR anywhere within the disc space reduced facet loading by more than 50%, while the fixed-core TDR increased facet loading by more than 10% when compared with the intact disc in axial rotation. For central (ideal) placement, the mobile- and fixed-core implants were subjected to compressive stresses on the order of 3 MPa and 24 MPa, respectively. The mobile-core stresses were not affected by implant placement, while the fixed-core stresses increased by up to 40%.

CONCLUSION

A mobile-core artificial disc design is less sensitive to placement, and unloads the facet joints, compared with a fixed-core design. The decreased core stress may result in a reduced potential for wear in a mobile-core prosthesis compared with a fixed-core prosthesis, which may increase the functional longevity of the device.

Biomechanical Alterations in Intact Osteoporotic Spine Due to Synthetic Augmentation: Finite Element Investigation

A three-dimensional nonlinear finite element model (FEM) was developed for a parametric study that examined the effect of synthetic augmentation on nonfractured vertebrae. The objective was to isolate those parameters primarily responsible for the effectiveness of the procedure; bone cement volume and bone density were expected to be highly important. Injection of bone cement was simulated in the FEM of a vertebral body that included a cellular model for the trabecular core. The addition of 10% and 20% cement by volume resulted in an increase in failure load, and the larger volume resulted in an increase in stiffness for the vertebral body. Placement of cement within the vertebral body was not as critical a parameter as cement amount. Simulated models of very poor bone quality saw the best therapeutic benefits.

Measurement and analyses of the effects of adjacent end plate curvatures on vertebral stresses

BACKGROUND

Vertebral end plates of the lumbosacral spine have various degrees of concavity and convexity. It is believed that the shape of the end plates alters the distribution of loads transferred along the spine, between the vertebrae. Animal models have been regularly used in the design and development of vertebral disc implants and cages; to date, very little information is known about the animal vertebral end plate curvature.

PURPOSE

The purpose was to measure and analyze the end plate curvature in the cadaver human male-female, chimpanzee, and canine lumbar vertebral bones.

STUDY DESIGN/SETTING

Nondestructive and nontouching scanning method was designed to obtain curvature in anterior-posterior and medial-lateral directions in the cadaver bones. Statistical analysis was performed on the data collected, and this data was then used to create a biomechanical model to evaluate the load transmission.

METHOD

Measurements in anterior-posterior and medial-lateral directions were performed on human, canine, and chimpanzee cadaver lumbar bones to obtain accurate data for the end plate curvatures. Six sets of measurements (on human male-female L4 lower to S1 upper end plates) were performed. A parametric vertebral motion segment model (with and without posterior elements) that includes the experimental curvature information was developed. The characteristic kidney-shaped cross-sectional model was created using a parametric equation. This model was used to perform finite element analyses investigating the effects of the location of maximum curvature on the stress distributions.

RESULTS

The measurements for different species showed that the canine and chimpanzees, the quadrupeds, have entirely different curvature of their upper end plates compared with those in humans, the bipeds. Also, the curvatures of the human S1 upper end plates are significantly different from the rest of the vertebrae. This is a very useful piece of information in the comparison of these species. The stress distribution varied as the location of the maximum curvature shifted from the center to a more posterior position. The stresses in the vertebral core were found to decrease, with the shell taking more loads.

CONCLUSIONS

This provides essential information for rehabilitation and surgical techniques, including designs for various interbody devices such as fusion cages, bone grafts, and disc prosthesis.

Cortical and trabecular load sharing in the human vertebral body

The biomechanical role of the vertebral cortical shell remains poorly understood. Using high-resolution finite element modeling of a cohort of elderly vertebrae, we found that the biomechanical role of the shell can be substantial and that the load sharing between the cortical and trabecular bone is complex. As a result, a more integrative measure of the trabecular and cortical bone should improve noninvasive assessment of fracture risk and treatments.

INTRODUCTION

A fundamental but poorly understood issue in the assessment of both osteoporotic vertebral fracture risk and effects of treatment is the role of the trabecular bone and cortical shell in the load-carrying capacity of the vertebral body.

MATERIALS AND METHODS

High-resolution microCT-based finite element models were developed for 13 elderly human vertebrae (age range: 54-87 years; 74.6 +/- 9.4 years), and parameter studies-with and without endplates-were performed to determine the role of the shell versus trabecular bone and the effect of model assumptions.

RESULTS

Across vertebrae, whereas the average thickness of the cortical shell was only 0.38 +/- 0.06 mm, the shell mass fraction (shell mass/total bone mass)-not including the endplates-ranged from 0.21 to 0.39. The maximum load fraction taken by the shell varied from 0.38 to 0.54 across vertebrae and occurred at the narrowest section. The maximum load fraction taken by the trabecular bone varied from 0.76 to 0.89 across vertebrae and occurred near the endplates. Neither the maximum shell load fraction nor the maximum trabecular load fraction depended on any of the densitometric or morphologic properties of the vertebra, indicating the complex nature of the load sharing mechanism. The variation of the shell load-carrying capacity across vertebrae was significantly altered by the removal of endplates, although these models captured the overall trend within a vertebra.

CONCLUSIONS

The biomechanical role of the thin cortical shell in the vertebral body can be substantial, being about 45% at the midtransverse section but as low as 15% close to the endplates. As a result of the complexity of load sharing, sampling of only midsection trabecular bone as a strength surrogate misses important biomechanical information. A more integrative approach that combines the structural role of both cortical and trabecular bone should improve noninvasive assessment of vertebral bone strength in vivo.

Susceptibility of aging human bone to mixed-mode fracture increases bone fragility

Since bone-mass-based measurements have demonstrated limited success in predicting age-related increase in fracture incidence, recent emphasis has been placed on quantification of bone quality. Specifically, material parameters such as strength, stiffness, and toughness have been quantified to characterize bone quality through mechanical testing. This study is the first one to report multiaxial failure characteristics of bone (quality) by conducting fatigue tests on human cortical bone specimens under physiologically relevant loading involving simultaneous application of axial and torsional loading to produce previously reported in vivo shear/normal stress ratios. Our results show that, compared to uniaxial tests, multiaxial fatigue tests show up to a 20-fold reduction in the fatigue life of human cortical bone. More significantly, the susceptibility of mixed-mode failure increases bone fragility in aging human bone. Furthermore, since the magnitude of mixed-mode loading varies with physiological activities, results of this study also suggest that a reduction in the activities involving significant mixed-mode loading may lower the overall fracture incidence among older individuals.

The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies

It remains unclear whether adjacent vertebral body fractures are related to the natural progression of osteoporosis or if adjacent fractures are a consequence of augmentation with bone cement. Experimental or computational studies have not completely addressed the biomechanical effects of kyphoplasty on adjacent levels immediately following augmentation. This study presents a validated two-functional spinal unit (FSU) T12-L2 finite element model with a simulated kyphoplasty augmentation in L1 to predict stresses and strains within the bone cement and bone of the treated and adjacent nontreated vertebral bodies. The findings from this multiple-FSU study and a recent retrospective clinical study suggest that changes in stresses and strains in levels adjacent to a kyphoplasty-treated level are minimal. Furthermore, the stress and strain levels found in the treated levels are less than injury tolerance limits of cancellous and cortical bone. Therefore, subsequent adjacent level fractures may be related to the underlying etiology (weakening of the bone) rather than the surgical intervention.

Effects of tumor location, shape and surface serration on burst fracture risk in the metastatic spine

Spinal metastatic disease occurs in up to one-third of all cancer patients. Advanced spread can lead to vertebral burst fracture, which may result in neurologic compromise. Developing a better understanding of factors affecting burst fracture risk has significant clinical importance, as early intervention can prevent vertebral fracture in high-risk patients. The primary objective of this study was to quantify the effects of tumor location and shape on vertebral body stability and burst fracture risk in the metastatic spine using poroelastic parametric finite element modeling. This study also compared two distinct surface modeling techniques in the representation of lytic defects. A total of 16 ellipsoidal tumor scenarios were analyzed. Single tumors were situated in central, anterior, posterior, superior, inferior, and lateral locations, with smooth and serrated tumor surfaces. Two central shapes and two serrated surface multi-tumor scenarios were also analyzed. Outcome parameters of maximum vertebral bulge and axial displacement were assessed as representative of burst fracture risk. Posterior movement of the tumor caused the greatest increase in vertebral bulge. Tumor shape also affected burst fracture risk. The multi-tumor scenarios yielded the greatest reductions in both vertebral bulge and axial displacement. Serrated tumor scenarios abided by similar trends as smooth tumor scenarios, although tumor serration caused a slight increase in fracture risk. Tumor shape and volume are best controlled by smooth surface modeling. Improved understanding of factors contributing to metastatic burst fracture risk will aid in directing future modeling efforts and in the development of accurate risk assessment criteria.

[Stress levels in bones and bone cement in the thoracolumbar spine afer kyphoplasty. Finite element study]

The study quantified the stress levels in treated and untreated vertebral bodies following kyphoplasty. Three-dimensional FE models of treated and untreated T11, T12, L1, and L2 vertebral bodies were evaluated to examine the stress levels within the bone and bone cement. A validated T12-L1 model was used to investigate the effect of kyphoplasty treatment on adjacent vertebral stresses and strains. Using the single vertebral models, bone cement modulus changes had minimal effect on the stresses in the bone or the cement. The presence of bone cement had a minimal effect on the stress magnitudes or distribution in the adjacent T12 vertebra. This study provides quantification of the stress levels in bone cement and bone in vertebral bodies treated with kyphoplasty under in vivo-like loading conditions. The presence of bone cement immediately following kyphoplasty has only a slight effect on the stress magnitudes or distributions in adjacent vertebrae.