Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength.

Patient-specific measures derived from quantitative computed tomography (QCT) scans are currently being developed as a clinical tool for vertebral strength prediction. QCT-based measurement techniques vary greatly in structural complexity and generally fall into one of three categories: (1) bone mineral density (BMD), (2) "mechanics of solids" (MOS) models, such as minimum axial rigidity (the product of axial stiffness and vertebral height), or (3) three-dimensional finite element (FE) models. There is no clear consensus as to the relative performance of these measures due to differences in experimental protocols, sample sizes and demographics, and outcome metrics. The goal of this study was to directly compare the performance of QCT-based assessment techniques of varying degrees of structural sophistication in predicting experimental vertebral compressive strength. Eighty-one human thoracic vertebrae (T6-T10) from 44 donors cadavers (F=32, M=12; 85+/-8 years old, max=97 years old, min=54 years old) were QCT scanned and destructively tested in uniaxial compression. The QCT scans were processed to generate FE models and various BMD and MOS measures, including trabecular bone mineral density (tBMD), integral bone mineral density (iBMD), and axial rigidity. Bone mineral density was weakly to moderately predictive of compressive strength (R(2)=0.16 and 0.62 for tBMD and iBMD, respectively). In vitro vertebral strength was strongly correlated with both axial rigidity (R(2)=0.81) and FE strength measurements (R(2)=0.80), and the predictive capabilities of these two metrics were statistically equivalent (p>0.05 for differences between FE and axial rigidity). The results of this study indicate that non-invasive predictive measures of vertebral strength should include some level of structural sophistication, specifically, gross geometric and material property distribution information. For uniaxial compression of isolated vertebrae, which is the current biomechanical testing paradigm for new non-invasive strength assessment techniques, QCT-based FE and axial rigidity measures are equivalent predictors of experimental strength. However, before abandoning the FE method in favor of more simplistic techniques, future work should investigate the performance of the FE method versus MOS measures for more physiologically representative loading conditions, e.g., anterior bending or in situ loading with intervertebral discs intact.

Relative strength of thoracic vertebrae in axial compression versus flexion.

BACKGROUND CONTEXT: Noninvasive strength assessment techniques are the clinical standard in the diagnosis and treatment of osteoporotic vertebral fractures, and the efficacy of these protocols depends on their ability to predict vertebral strength at all at-risk spinal levels under multiple physiological loading conditions. PURPOSE: To assess differences in vertebral strength between loading modes and across spinal levels. STUDY DESIGN/SETTING: This study examined the relative strength of isolated vertebral bodies in compression versus flexion. METHODS: Destructive biomechanical tests were conducted on 30 pairs of donor-matched, isolated thoracic vertebral bodies (T9 and T10; F=19, M=11; 87+5 years old, max=97 years old, min=80 years old) in both uniform axial compression and flexion using previously described protocols. Quantitative computed tomography (QCT) scans were taken before mechanical testing and used to obtain bone mineral density (BMD) and "mechanics of solids" (MOS) measures, such as axial and bending rigidities. RESULTS: Compressive strength was higher than flexion strength for each donor by 940+152N (p<.001, paired t test), and vertebral strengths in the two loading modes were moderately correlated (adjusted R(2)=0.50, p<.001). For both compression and flexion loading modes, adjacent-level BMD and MOS metrics had approximately half the predictive capacity as same-level measurements, and BMD and MOS values were only moderately correlated across spinal levels. CONCLUSIONS: The results of this study are important in designing clinical test protocols for assessing vertebral fracture risk. Because vertebral body flexion and compressive strength are not strongly correlated and flexion strength is significantly less than compressive strength, it is imperative to investigate a patient's spinal structural capacity under bending loading conditions. Furthermore, our work suggests that clinicians using QCT-based measures should perform site-specific strength assessments on each at-risk spinal level. Future work should focus on improving the accuracy of densitometric measures in predicting vertebral strength in flexion and also on examining same- versus adjacent-level strength assessment for radiographic techniques with lower X-ray dosage, such as dual-energy X-ray absorptiometry.

The mechanical properties of cranial bone: the effect of loading rate and cranial sampling position.

Linear and depressed skull fractures are frequent mechanisms of head injury and are often associated with traumatic brain injury. Accurate knowledge of the fracture of cranial bone can provide insight into the prevention of skull fracture injuries and help aid the design of energy absorbing head protection systems and safety helmets. Cranial bone is a complex material comprising of a three-layered structure: external layers consist of compact, high-density cortical bone and the central layer consists of a low-density, irregularly porous bone structure. In this study, cranial bone specimens were extracted from 8 fresh-frozen cadavers (F=4, M=4; 81+/-11 years old). 63 specimens were obtained from the parietal and frontal cranial bones. Prior to testing, all specimens were scanned using a microCT scanner at a resolution of 56.9 microm. The specimens were tested in a three-point bend set-up at different dynamic speeds (0.5, 1 and 2.5 m/s). The associated mechanical properties that were calculated for each specimen include the 2nd moment of inertia, the sectional elastic modulus, the maximum force at failure, the energy absorbed until failure and the maximum bending stress. Additionally, the morphological parameters of each specimen and their correlation with the resulting mechanical parameters were examined. It was found that testing speed, strain rate, cranial sampling position and intercranial variation all have a significant effect on some or all of the computed mechanical parameters. A modest correlation was also found between percent bone volume and both the elastic modulus and the maximum bending stress.