Chemonucleolysis combined with dynamic loading for inducing degeneration in bovine caudal intervertebral discs.

Chemonucleolysis has become an established method of producing whole organ culture models of intervertebral disc (IVD) degeneration. However, the field needs more side-by-side comparisons of the degenerative effects of the major enzymes used in chemonucleolysis towards gaining a greater understanding of how these organ culture models mimic the wide spectrum of characteristics observed in human degeneration. In the current work we induced chemonucleolysis in bovine coccygeal IVDs with 100 µL of papain (65 U/mL), chondroitinase ABC (chABC, 5 U/mL), or collagenase II (col'ase, 0.5 U/mL). Each enzyme was applied in a concentration projected to produce moderate levels of degeneration. After 7 days of culture with daily dynamic physiological loading (0.02-0.2 MPa, 0.2 Hz, 2 h), the cellular, biochemical and histological properties of the IVDs were evaluated in comparison to a PBS-injected control. Papain and collagenase, but not chABC, produced macroscopic voids in the tissues. Compared to day 0 intact IVDs, papain induced the greatest magnitude glycosaminoglycan (GAG) loss compared to chABC and col'ase. Papain also induced the greatest height loss (3%), compared to 0.7%, 1.2% and 0.4% for chABC, col'ase, and PBS, respectively. Cell viability in the region adjacent to papain and PBS-injection remained at nearly 100% over the 7-day culture period, whereas it was reduced to 60%-70% by chABC and col'ase. Generally, enzyme treatment tended to downregulate gene expression for major ECM markers, type I collagen (COL1), type II collagen (COL2), and aggrecan (ACAN) in the tissue adjacent to injection. However, chABC treatment induced an increase in COL2 gene expression, which was significant compared to the papain treated group. In general, papain and col'ase treatment tended to recapitulate aspects of advanced IVD degeneration, whereas chABC treatment captured aspects of early-stage degeneration. Chemonucleolysis of whole bovine IVDs is a useful tool providing researchers with a robust spectrum of degenerative changes and can be utilized for examination of therapeutic interventions.

In vitro comparison of personalized 3D printed versus standard expandable titanium vertebral body replacement implants in the mid-thoracic spine using entire rib cage specimens.

BACKGROUND: Expandable titanium implants have proven their suitability as vertebral body replacement device in several clinical and biomechanical studies. Potential stabilizing features of personalized 3D printed titanium devices, however, have never been explored. This in vitro study aimed to prove their equivalence regarding primary stability and three-dimensional motion behavior in the mid-thoracic spine including the entire rib cage. METHODS: Six fresh frozen human thoracic spine specimens with intact rib cages were loaded with pure moments of 5 Nm while performing optical motion tracking of all vertebrae. Following testing in intact condition (1), the specimens were tested after inserting personalized 3D printed titanium vertebral body replacement implants (2) and the two standard expandable titanium implants Obelisc™ (3) and Synex™ (4), each at T6 level combined with posterior pedicle screw-rod fixation from T4 to T8. FINDINGS: No significant differences (P < .05) in primary and secondary T1-T12 ranges of motion were found between the three implant types. Compared to the intact condition, slight decreases of the range of motion were found, which were significant for Synex™ in primary flexion/extension (-17%), specifically at T3-T4 level (-46%), primary lateral bending (-18%), and secondary lateral bending during primary axial rotation (-53%). Range of motion solely increased at T8-T9 level, while being significant only for Obelisc™ (+35%). INTERPRETATION: Personalized 3D printed vertebral body replacement implants provide a promising alternative to standard expandable devices regarding primary stability and three-dimensional motion behavior in the mid-thoracic spine due to the stabilizing effect of the rib cage.

Thoracic Spinal Stability and Motion Behavior Are Affected by the Length of Posterior Instrumentation After Vertebral Body Replacement, but Not by the Surgical Approach Type: An in vitro Study With Entire Rib Cage Specimens.

Spinal tumors and unstable vertebral body fractures usually require surgical treatment including vertebral body replacement. Regarding primary stability, however, the best possible treatment depends on the spinal region. The purpose of this in vitro study was to evaluate the effects of instrumentation length and approach size on thoracic spinal stability including the entire rib cage. Six fresh frozen human thoracic spine specimens with intact rib cages (C7-L1) were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation, while monitoring the relative motions of all spinal segments using optical motion tracking. The specimens were tested (1) in the intact condition, followed by testing after vertebral body replacement at T6 level using a unilateral approach combined with (2) long instrumentation (T4-T8) and (3) short instrumentation (T5-T7) as well as a bilateral approach combined with (4) long and (5) short instrumentation. Significant increases of the range of motion (p < 0.05) were found in the entire thoracic spine (T1-T12) using the bilateral approach and short instrumentation in primary flexion/extension and in secondary axial rotation during primary lateral bending compared to both conditions with long instrumentation, as well as in secondary lateral bending during primary axial rotation compared to unilateral approach and long instrumentation. Compared to the intact condition, the range of motion was significantly decreased using unilateral approach and long instrumentation in flexion extension and secondary lateral bending during primary axial rotation, as well as using bilateral approach and long instrumentation in lateral bending. On the segmental level, the range of motion was significantly increased at T4-T5 level in lateral bending using unilateral approach and short instrumentation and significantly decreased using bilateral approach and long instrumentation compared to their respective previous conditions. Regardless of the approach type, which did not affect thoracic spinal stability in the present study, short instrumentation overall shows sufficient primary stability in the mid-thoracic spine with intact rib cage, while creating considerably more instability compared to long instrumentation, potentially being of importance regarding long-term implant failure. Moreover, short instrumentation could affect adjacent segment disease due to increased motion at the upper segmental level.

Comparison of fracture toughness measurements for zirconia materials using two test methods.

To determine the influence of the fracture toughness (KIC) methods [single-edge-V-notch-beam (SEVNB) and chevron-notch-beam (CNB)] as well as an optional heat treatment on the KIC of three different zirconia generations (1st: ZI, 3rd: FX, 4th: HT). One hundred and twenty specimens each (3×4×45 mm) were fabricated, sintered, notched (n=360) and half of them heat treated before KIC measurements with 4-point-flexural-strength test. SEM images of the notches were recorded. Highest KIC was found for ZI followed by HT and FX. SEVNB resulted in significantly higher KIC than CNB. Heat treatment resulted in decrease for SEVNB and increase for CNB of KIC (except for FX). Groups tested using CNB showed higher reliability of values (Weibull modulus) than tested using SEVNB. SEM images present crack path and fracture surface. Different zirconia materials lead to different KIC values. The test method and a prior heat treatment showed an influence on the KIC values and their reliability.

Impact of high-speed sintering on translucency, phase content, grain sizes, and flexural strength of 3Y-TZP and 4Y-TZP zirconia materials.

STATEMENT OF PROBLEM: The lengthy sintering time of zirconia is costly and limits applications. The consequences of shortening the sintering time are mainly unknown. PURPOSE: The purpose of this in vitro study was to test and compare 2 high-speed sintering protocols and 1 conventional sintering protocol on the translucency, phase content, grain sizes, and flexural strength of 3 zirconia materials. MATERIAL AND METHODS: In total, 450 specimens of 3 zirconia materials-two were 3 mol% yttria-stabilized tetragonal zirconia polycrystals (3Y-TZPs), Ceramill ZI and Zolid (ZD), and a 4 mol% yttria-stabilized tetragonal zirconia polycrystal (4Y-TZP), Zolid HT+ (n=150)-and 5 thicknesses (1.0, 1.5, 2.0, 2.5, and 3.0 mm; n=30) were sintered according to 2 high-speed sintering protocols (final temperature 1570 °C and 1590 °C; n=10) and a reference sintering protocol (1450 °C; n=10). After measuring the monoclinic phase content with Raman spectrometry (n=3), the specimens were polished, and translucency was determined. The biaxial flexural strength of specimens with a thickness of 1.0 mm and 1.5 mm was tested (n=20). Statistical evaluation included 1-way ANOVA, the Kolmogorov-Smirnov, Kruskal-Wallis, Mann-Whitney-U, and Spearman-Rho tests and the Bonferroni correction (α=.0011). RESULTS: For ZI, the sintering protocols did not affect the translucency or biaxial flexural strength. ZD and HT+ showed significantly lower translucency for high-speed sintering protocols (P≤.001), but the biaxial flexural strength remained the same after the high-speed sintering protocol at 1590 °C. Grain sizes increased with increasing final sintering temperature for ZI and HT+, whereas translucency generally decreased with increasing material thickness. No monoclinic phase was detected in any group. CONCLUSIONS: The flexural strength was maintained with high-speed sintering but led to a decrease in translucency for ZD and HT+.