A database of lumbar spinal mechanical behavior for validation of spinal analytical models.

Data from two experimental studies with eight specimens each of spinal motion segments and/or intervertebral discs are presented in a form that can be used for comparison with finite element model predictions. The data include the effect of compressive preload (0, 250 and 500N) with quasistatic cyclic loading (0.0115Hz) and the effect of loading frequency (1, 0.1, 0.01 and 0.001Hz) with a physiological compressive preload (mean 642N). Specimens were tested with displacements in each of six degrees of freedom (three translations and three rotations) about defined anatomical axes. The three forces and three moments in the corresponding axis system were recorded during each test. Linearized stiffness matrices were calculated that could be used in multi-segmental biomechanical models of the spine and these matrices were analyzed to determine whether off-diagonal terms and symmetry assumptions should be included. These databases of lumbar spinal mechanical behavior under physiological conditions quantify behaviors that should be present in finite element model simulations. The addition of more specimens to identify sources of variability associated with physical dimensions, degeneration, and other variables would be beneficial. Supplementary data provide the recorded data and Matlab® codes for reading files. Linearized stiffness matrices derived from the tests at different preloads revealed few significant unexpected off-diagonal terms and little evidence of significant matrix asymmetry.

Metabolic Effects of Angulation, Compression, and Reduced Mobility on Annulus Fibrosis in a Model of Altered Mechanical Environment in Scoliosis.

STUDY DESIGN: Comparison of disc tissue from rat tails in 6 groups with different mechanical conditions imposed. OBJECTIVES: To identify disc annulus changes associated with the supposed altered biomechanical environment in a spine with scoliosis deformity using an immature rat model that produces disc narrowing and wedging. BACKGROUND: Intervertebral discs become wedged and narrowed in a scoliosis curve, probably partly because of an altered biomechanical environment. METHODS: We subjected tail discs of 5-week-old immature Sprague-Dawley rats to an altered mechanical environment using an external apparatus applying permutations of loading and deformity for 5 weeks. Together with a sham and a control group, we studied 4 groups of rats: A) 15° angulation, B) angulation with 0.1 MPa compression, C) 0.1 MPa compression, and R) reduced mobility. We measured disc height changes and matrix composition (water, deoxyribonucleic acid, glycosaminoglycan, and hyaluronic acid content) after 5 weeks, and proline and sulphate incorporation and messenger ribonucleic acid expression at 5 days and 5 weeks. RESULTS: After 5 weeks, disc space was significantly narrowed relative to internal controls in all 4 intervention groups. Water content and cellularity (deoxyribonucleic acid content) were not different at interventional levels relative to internal controls and not different between the concave and convex sides of the angulated discs. There was increased glycosaminoglycan content in compressed tissue (in Groups B and C), as expected, and compression resulted in a decrease in hyaluronic acid size. We observed slightly increased incorporation of tritiated proline into the concave side of angulated discs and compressed discs. Asymmetries of gene expression in Groups A and B and some group-wise differences did not identify consistent patterns associating the discs' responses to mechanical alterations. CONCLUSIONS: Intervertebral discs in this model underwent substantial narrowing after 5 weeks, with minimal alteration in tissue composition and minimal evidence of metabolic changes.

Contributions of Remodeling and Asymmetrical Growth to Vertebral Wedging in a Scoliosis Model.

STUDY DESIGN: We performed a laboratory study of rats of 3 different ages with imposed angulation and compressive loading to caudal vertebrae to determine causes of vertebral wedging. OBJECTIVES: The purpose was to determine the percentage of total vertebral wedging that was caused by asymmetric growth, vertebral body, and epiphyseal wedging. Approval from the Institutional Animal Care and Use Committee, the University of Vermont, was obtained for the live animal procedures used in this study. BACKGROUND SUMMARY: Vertebral wedging from asymmetrical growth (Hueter-Volkmann law) is reported to cause vertebral wedging in scoliosis with little attention to the possible contribution of bony remodeling (Wolff's law). METHODS: In our study, an external fixator imposed a 30° lateral curvature and compression of 0.1 megapascal (MPa) in 5- and 14-week-old animals (Groups 1 and 2) and 0.2 MPa in 14- and 32-week-old animals (groups 3 and 4). Total vertebral wedging was measured from micro CT scans. Wedging due to asymmetrical growth and epiphyseal remodeling was calculated from fluorescent labels and the difference was attributed to vertebral body wedging. RESULTS: Total vertebral wedging averaged 18°, 6°, 10° and 5° in Groups 1, 2, 3, and 4, respectively. Metaphyseal asymmetrical growth averaged 8°, 1°, 4°, 0° (44%, 17%, 40% and 0% of total). Epiphyseal wedging averaged 9°, 0°, 3°, and -1°. The difference (vertebral body) averaged 1°, 5°, 3°, and 7° (6%, 83%, 30% and 140% of total). The growth of the loaded vertebrae as a percentage of control vertebrae was 56%, 39% and 25% in Groups 1, 2 and 3; negligible in Group 4. Vertebral body cortical remodeling, with increased thickness and increased curvature on the concave side was evident in young animals and 0.2 MPa loaded older animals. CONCLUSIONS: We conclude that asymmetrical growth was the largest contributor to vertebral wedging in young animals; vertebral body remodeling was the largest contributor in older animals. If, conversely, vertebral wedging can be corrected by appropriate loading in young and old animals, it has important implications for the nonfusion treatment of scoliosis.

Intervertebral disc changes with angulation, compression and reduced mobility simulating altered mechanical environment in scoliosis.

PURPOSE: The intervertebral discs become wedged and narrowed in scoliosis, and this may result from altered biomechanical environment. The effects of four permutations of disc compression, angulation and reduced mobility were studied to identify possible causes of progressive disc deformity in scoliosis. The purpose of this study was to document morphological and biomechanical changes in four different models of altered mechanical environment in intervertebral discs of growing rats and in a sham and control groups. METHODS: External rings were attached by percutaneous pins transfixing adjacent caudal vertebrae of 5-week-old Sprague-Dawley rats. Four experimental Groups of animals underwent permutations of the imposed mechanical conditions (A) 15° disc angulation, (B) angulation with 0.1 MPa compression, (C) 0.1 MPa compression and (R) reduced mobility (N = 20 per group), and they were compared with a sham group (N = 12) and control group (N = 8) (total of 6 groups of animals). The altered mechanical conditions were applied for 5 weeks. Intervertebral disc space was measured from micro-CT images at weeks 1 and 5. Post euthanasia, lateral bending stiffness of experimental and within-animal control discs was measured in a mechanical testing jig and collagen crimp was measured from histological sections. RESULTS: After 5 weeks, micro-CT images showed disc space loss averaging 35, 53, 56 and 35% of the adjacent disc values in the four intervention groups. Lateral bending stiffness was 4.2 times that of within-animal controls in Group B and 2.3 times in Group R. The minimum stiffness occurred at an angle close to the in vivo value, indicating that angulated discs had adapted to the imposed deformity, this is also supported by measurements of collagen crimping at concave and convex sides of the disc annuli. CONCLUSION: Loss of disc space was present in all of the instrumented discs. Thus, reduced mobility, that was common to all interventions, may be a major source of the observed disc changes and may be a factor in disc deformity in scoliosis. Clinically, it is possible that rigid bracing for control of scoliosis progression may have secondary harmful effects by reducing spinal mobility.

Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups.

BACKGROUND: Antagonistic activation of abdominal muscles and increased intra-abdominal pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation regimens have been proposed to improve spinal stability via selective recruitment of certain trunk muscle groups. This biomechanical analytical study addressed whether lumbar spinal stability is increased by such selective activation. METHODS: The biomechanical model included anatomically realistic three-layers of curved abdominal musculature, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The muscle activations were calculated with the model loaded with either flexion, extension, lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of muscle activation were studied by forcing activation of selected abdominal muscles to at least 10% or 20% of maximum. FINDINGS: Spinal stability increased by an average factor of 1.8 with doubling of intra-abdominal pressure. Forcing at least 10% activation of obliques or transversus abdominis muscles increased stability slightly for efforts other than flexion, but forcing at least 20% activation generally did not produce further increase in stability. Forced activation of rectus abdominis did not increase stability. INTERPRETATION: Based on analytical predictions, the degree of stability was not substantially influenced by selective forcing of muscle activation. This casts doubt on the supposed mechanism of action of specific abdominal muscle exercise regimens that have been proposed for low back pain rehabilitation.

Refinement of elastic, poroelastic, and osmotic tissue properties of intervertebral disks to analyze behavior in compression.

Intervertebral disks support compressive forces because of their elastic stiffness as well as the fluid pressures resulting from poroelasticity and the osmotic (swelling) effects. Analytical methods can quantify the relative contributions, but only if correct material properties are used. To identify appropriate tissue properties, an experimental study and finite element analytical simulation of poroelastic and osmotic behavior of intervertebral disks were combined to refine published values of disk and endplate properties to optimize model fit to experimental data. Experimentally, nine human intervertebral disks with adjacent hemi-vertebrae were immersed sequentially in saline baths having concentrations of 0.015, 0.15, and 1.5 M and the loss of compressive force at constant height (force relaxation) was recorded over several hours after equilibration to a 300-N compressive force. Amplitude and time constant terms in exponential force-time curve-fits for experimental and finite element analytical simulations were compared. These experiments and finite element analyses provided data dependent on poroelastic and osmotic properties of the disk tissues. The sensitivities of the model to alterations in tissue material properties were used to obtain refined values of five key material parameters. The relaxation of the force in the three bath concentrations was exponential in form, expressed as mean compressive force loss of 48.7, 55.0, and 140 N, respectively, with time constants of 1.73, 2.78, and 3.40 h. This behavior was analytically well represented by a model having poroelastic and osmotic tissue properties with published tissue properties adjusted by multiplying factors between 0.55 and 2.6. Force relaxation and time constants from the analytical simulations were most sensitive to values of fixed charge density and endplate porosity.

Nonfusion treatment of adolescent idiopathic scoliosis by growth modulation and remodeling.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a common disorder in which the spine gradually develops a curvature that is first detected in patients between 11 and 17 years of age. The only accepted treatment methods are bracing and surgery. Whether brace treatment alters the natural history is being questioned, and patient compliance is low. Surgery usually includes a spinal fusion that creates a rigid spine and concentrates stresses at the ends. METHODS: This study focuses on correlating the laboratory results with clinical reports for treating patients with AIS. In the laboratory, scoliosis with vertebral wedging has been created by asymmetric mechanical loading and has been corrected by reversing the loading. In the clinic, bracing and derotational casting have been successful in some reports, but compliance has been a problem with bracing and derotational casts have mainly been used in young children. Operative treatment has been successful, but a nonfusion operation remains elusive. FINDINGS AND RESULTS: In the laboratory, axial loading of growth plates altered growth according to the Hueter-Volkmann law, which states that compression decreases and distraction increases growth. Asymmetric loading of the spine caused asymmetric growth resulting in scoliosis with vertebral wedging. Asymmetric loading of tail vertebrae created vertebral wedging according to Wolff's law, which states that the bone remodels over time in response to prevailing mechanical demands. In the clinic, studies have shown that bracing may work if patients wore the brace as prescribed. Derotational casting in young children has been shown to prevent progression and even correct the scoliosis in some patients. Convex vertebral stapling has been successful in mild curves, but the results in larger curves have been disappointing. Anterolateral tethering has been successful in mild curves in young patients, but there is limited experience with this technique in patients with large curves. CONCLUSIONS: A brace that applies the appropriate loading and is worn as prescribed may dramatically improve the results of brace treatment. A procedure using external fixation or adjustable anterolateral tethering may achieve a nonfusion correction of AIS. LEVEL OF EVIDENCE: Level II.

Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism.

BACKGROUND: The roles of antagonistic activation of abdominal muscles and of intra-abdominal pressurization remain enigmatic, but are thought to be associated with both spinal unloading and spinal stabilization in activities such as lifting. Biomechanical analyses are needed to understand the function of intra-abdominal pressurization because of the anatomical and physiological complexity, but prior analyses have been over-simplified. METHODS: To test whether increased intra-abdominal pressure was associated with reduced spinal compression forces for efforts that generated moments about each of the principal axis directions, a previously published biomechanical model of the spine and its musculature was modified by the addition of anatomically realistic three-layers of curved abdominal musculature connected by fascia to the spine. Published values of muscle cross-sectional areas and the active and passive stiffness properties were assigned. The muscle activations were calculated assuming minimized muscle stress and stretch for the model loaded with flexion, extension, lateral bending and axial rotation moments of up to 60 Nm, along with intra-abdominal pressurization of 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight (340 N). FINDINGS: The analysis predicted a reduction in spinal compressive force with increase in intra-abdominal pressurization from 5 to 10 kPa. This reduction at 60 Nm external effort was 21% for extension effort, 18% for flexion effort, 29% for lateral bending and 31% for axial rotation. INTERPRETATION: This analysis predicts that intra-abdominal pressure produces spinal unloading, and shows likely muscle activation patterns that achieve this.

The central hip vertical axis: a reference axis for the Scoliosis Research Society three-dimensional classification of idiopathic scoliosis.

STUDY DESIGN: Reliability comparison of 2 radiographic axis systems by inter- and intraobserver variability. OBJECTIVE: To determine whether the central hip vertical axis (CHVA) provides a more reliable reference axis for the evaluation of scoliosis. SUMMARY OF BACKGROUND DATA: Current practices in the evaluation of the scoliotic spine use the central sacral vertical line (CSVL), a true vertical drawn upward from the middle of S1, to assess the spinal deformity. However, the CVSL is defined only in the coronal radiographic view and has no corresponding definition in the sagittal view. Therefore, it represents a 2-dimensional positioning of the scoliotic segments relative to the pelvis. In view of this limitation, the Scoliosis Research Society 3-dimensional (3D) scoliosis committee proposed the CHVA, a true vertical bisecting the line segment joining the centers of the 2 femoral heads, as a reference line for the 3D evaluation of the spinal deformity. Unlike the CSVL, the CHVA can be identified in both radiographic views (coronal and sagittal) and has been shown to represent the physiologic center of balance of the spino-pelvic unit. METHODS: A vertical axis was established on preoperative radiographs of 68 Lenke 1 main thoracic curves twice by 5 members of the Scoliosis Research Society 3D scoliosis committee assisted by dedicated software. The user digitized separately on the postero-anterior radiographs, the lateral borders of the S1 facets (for the CSVL), and 3 points on the 2 femoral heads (for the CHVA). The software then drew lines representing both axes. Then the observers determined the lumbar modifier (A, B, and C) using both axes. RESULTS.: There was no intra- and interobserver difference in the position of the CHVA (P > 0.1; SD: 0.4 mm), whereas intraobserver differences were found for the CSVL (P < 0.00007; SD: 0.9 mm). The CHVA was more reproducible and showed better intra- and interobserver agreement (kappa: 0.86/0.75; both excellent reliability), when compared with the CSVL (kappa 0.77/0.61; excellent and good reliability, respectively) for the identification of the lumbar modifier. The CSVL was on average 3.2 mm to the left, when compared with the CHVA generating a shift (A-->B-->C) in the assignment of the lumbar modifier. CONCLUSION: The CHVA is more reproducible and showed better intra- and interobserver agreement, when compared with the CSVL for the identification of the lumbar modifier. The CHVA can be easily computed in 3D and represents the physiologic center of balance of the spino-pelvic unit because it takes into account femoral head support. We recommend keeping the CSVL for 2-dimensional measurement to adapt the measures relative to the CSVL to the proposed CHVA axis and adopting CHVA as the reference axis for 3D evaluation of idiopathic scoliosis.

Interobserver and intraobserver variability in the identification of the Lenke classification lumbar modifier in adolescent idiopathic scoliosis.

STUDY DESIGN: Interobserver and intraobserver reliability study for the identification of the Lenke classification lumbar modifier by a panel of experts compared with a computer algorithm. OBJECTIVES: To measure the variability of the Lenke classification lumbar modifier and determine if computer assistance using 3-dimensional spine models can improve the reliability of classification. SUMMARY OF BACKGROUND DATA: The lumbar modifier has been proposed to subclassify Lenke scoliotic curve types into A, B, and C on the basis of the relationship between the central sacral vertical line (CSVL) and the apical lumbar vertebra. Landmarks for identification of the CSVL have not been clearly defined, and the reliability of the actual CSVL position and lumbar modifier selection have never been tested independently. Therefore, the value of the lumbar modifier for curve classification remains unknown. METHODS: The preoperative radiographs of 68 patients with adolescent idiopathic scoliosis presenting a Lenke type 1 curve were measured manually twice by 6 members of the Scoliosis Research Society 3-dimensional classification committee at 6 months interval. Intraobserver and interobserver reliability was quantified using the percentage of agreement and kappa statistics. In addition, the lumbar curve of all subjects was reconstructed in 3-dimension using a stereoradiographic technique and was submitted to a computer algorithm to infer the lumbar modifier according to measurements from the pedicles. RESULTS: Interobserver rates for the first trial showed a mean kappa value of 0.56. Second trial rates were higher with a mean kappa value of 0.64. Intraobserver rates were evaluated at a mean kappa value of 0.69. The computer algorithm was successful in identifying the lumbar curve type and was in agreement with the observers by a proportion up to 93%. CONCLUSIONS: Agreement between and within observers for the Lenke lumbar modifier is only moderate to substantial with manual methods. Computer assistance with 3-dimensional models of the spine has the potential to decrease this variability.

Growth plate mechanics and mechanobiology. A survey of present understanding.

The longitudinal growth of long bones occurs in growth plates where chondrocytes synthesize cartilage that is subsequently ossified. Altered growth and subsequent deformity resulting from abnormal mechanical loading is often referred to as mechanical modulation of bone growth. This phenomenon has key implications in the progression of infant and juvenile musculoskeletal deformities, such as adolescent idiopathic scoliosis, hyperkyphosis, genu varus/valgus and tibia vara/valga, as well as neuromuscular diseases. Clinical management of these deformities is often directed at modifying the mechanical environment of affected bones. However, there is limited quantitative and physiological understanding of how bone growth is regulated in response to mechanical loading. This review of published work addresses the state of knowledge concerning key questions about mechanisms underlying biomechanical modulation of bone growth. The longitudinal growth of bones is apparently controlled by modifying the numbers of growth plate chondrocytes in the proliferative zone, their rate of proliferation, the amount of chondrocytic hypertrophy and the controlled synthesis and degradation of matrix throughout the growth plate. These variables may be modulated to produce a change in growth rate in the presence of sustained or cyclic mechanical load. Tissue and cellular deformations involved in the transduction of mechanical stimuli depend on the growth plate tissue material properties that are highly anisotropic, time-dependent, and that differ in different zones of the growth plate and with developmental stages. There is little information about the effects of time-varying changes in volume, water content, osmolarity of matrix, etc. on differentiation, maturation and metabolic activity of chondrocytes. Also, the effects of shear forces and torsion on the growth plate are incompletely characterized. Future work on growth plate mechanobiology should distinguish between changes in the regulation of bone growth resulting from different processes, such as direct stimulation of the cell nuclei, physico-chemical stimuli, mechanical degradation of matrix or cellular components and possible alterations of local blood supply.

Classification of scoliosis deformity three-dimensional spinal shape by cluster analysis.

STUDY DESIGN: Cluster analysis of existing database of spinal shape of patients attending a scoliosis clinic. OBJECTIVE: To determine whether patients with scoliosis can be classified into distinct groups by 3-dimensional curve shape. SUMMARY OF BACKGROUND DATA: Subjective or semiquantitative methods can be used to classify curve types in scoliosis, with the goal of rationalizing surgical planning. There are very few reports of using objective methods such as cluster analysis to improve this process. METHODS.: One hundred ten patients who underwent radiography of the spine by a stereo technique, at a scoliosis clinic in the period between 1982 and 1990, were studied. Fifty-six were studied longitudinally (average 3.4 clinic visits each), providing 245 total observations. Selected patients had 2 scoliosis curves with apex between T4 and L3, and both Cobb angles >9 degrees by an automated measurement. The 3-dimensional spinal shape was reconstructed from stereoradiographs. Each curve was quantified by its Cobb angle, apex level, apex vertebra rotation, and rotation of the plane of maximum curvature (PMC) (8 variables). Cluster analysis classified each patient at each visit by these variables. RESULTS: When the analysis searched for 4 clusters, the largest cluster (148 of 245 observations) was the pattern having counterclockwise rotation of the PMC of both curves (typically, a right upper scoliosis curve with kyphosis and left lower scoliosis curve with lordosis). The other 3 clusters (48, 34, and 15 observations) were the other permutations of these variables. Substantial overlap of all the other variables between groups was observed. Of the 56 patients seen longitudinally, 25 were consistently grouped at all clinic visits. CONCLUSION: Spinal shape of patients in a clinic population with 2 scoliosis curves form distinct groups according to the 4 permutations of the signs of the rotations of the PMC in 2 curve regions. The pattern can change with repeated observation, often because a slight curvature in the sagittal plane can change because of postural variation and measurement errors. Overlap of the other curve-shape variables between groups suggests that these spinal deformity classifications alone should not determine treatment strategy.

Three-dimensional classification of thoracic scoliotic curves.

STUDY DESIGN: Three-dimensional (3D) characterization of the thoracic scoliotic spine (cross-sectional study). OBJECTIVES: To investigate the presence of subgroups within Lenke type-1 curves by evaluating the thoracic segment indices extracted from 3D reconstructions of the spine, and to propose a new clinically relevant means (the daVinci representation) to report 3D spinal deformities. SUMMARY OF BACKGROUND DATA: Although scoliosis is recognized to be a 3D deformity of the spine its measurement and classification have predominantly been based on radiographs which are 2D projections in the coronal and sagittal planes. METHODS: Thoracic segment indices derived from 3D reconstructions of coronal and sagittal standing radiographs of 172 patients with right thoracic adolescent idiopathic scoliosis, reviewed by the 3D Classification Committee of the Scoliosis Research Society, were analyzed using the ISOData unsupervised clustering algorithm. Four curve indices were analyzed: Cobb angle, axial rotation of the apical vertebrae, orientation of the plane of maximum curvature of the main thoracic curve, and kyphosis (T4-T12). No assumptions were made regarding grouping tendencies in the data nor were the number of clusters predefined. RESULTS: Three primary groups were revealed wherein kyphosis and the orientation of the PMC of the main thoracic curve were the major discriminating factors with slight overlap between groups. A small group (G1) of 22 patients having smaller, nonsurgical (minor) curves was identified. Although the remaining patients had similar Cobb angles they were split into 2 groups (G2: 79 patients; G3: 71 patients) with different PMC (G2: 65 degrees -81 degrees ; G3: 76 degrees -104 degrees ) and kyphotic measures (G2: 23 degrees -43 degrees ; G3: 7 degrees -25 degrees). CONCLUSION: Two distinct subgroups within the surgical cases (major curves) of Lenke type-1 curves were found thus suggesting that thoracic curves are not always hypokyphotic. The ISOData cluster analysis technique helped to capture inherent 3D structural curve complexities that were not evident in a 2D radiographic plane. The daVinci representation is a new clinically relevant means to report 3D spinal deformities.

Spatially resolved streaming potentials of human intervertebral disk motion segments under dynamic axial compression.

Intervertebral disk degeneration results in alterations in the mechanical, chemical, and electrical properties of the disk tissue. The purpose of this study is to record spatially resolved streaming potential measurements across intervertebral disks exposed to cyclic compressive loading. We hypothesize that the streaming potential profile across the disk will vary with radial position and frequency and is proportional to applied load amplitude, according to the presumed fluid-solid relative velocity and measured glycosaminoglycan content. Needle electrodes were fabricated using a linear array of AgAgCl micro-electrodes and inserted into human motion segments in the midline from anterior to posterior. They were connected to an amplifier to measure electrode potentials relative to the saline bath ground. Motion segments were loaded in axial compression under a preload of 500 N, sinusoidal amplitudes of +/-200 N and +/-400 N, and frequencies of 0.01 Hz, 0.1 Hz, and 1 Hz. Streaming potential data were normalized by applied force amplitude, and also compared with paired experimental measurements of glycosaminoglycans in each disk. Normalized streaming potentials varied significantly with sagittal position and there was a significant location difference at the different frequencies. Normalized streaming potential was largest in the central nucleus region at frequencies of 0.1 Hz and 1.0 Hz with values of approximately 3.5 microVN. Under 0.01 Hz loading, normalized streaming potential was largest in the outer annulus regions with a maximum value of 3.0 microVN. Correlations between streaming potential and glycosaminoglycan content were significant, with R(2) ranging from 0.5 to 0.8. Phasic relationships between applied force and electrical potential did not differ significantly by disk region or frequency, although the largest phase angles were observed at the outermost electrodes. Normalized streaming potentials were associated with glycosaminoglycan content, fluid, and ion transport. Results suggested that at higher frequencies the transport of water and ions in the central nucleus region may be larger, while at lower frequencies there is enhanced transport near the periphery of the annulus. This study provides data that will be helpful to validate multiphasic models of the disk.

Mechanical modulation of spinal growth and progression of adolescent scoliosis.

It is unclear why some children with a small magnitude scoliosis at the onset of the adolescent growth spurt develop a progressive curve. Normally the skeleton grows symmetrically, presumably because genetic and epigenetic factors regulating growth to maintain growth symmetry despite activities and environmental factors causing asymmetrical loading of the spine. This chapter reviews the recently published data relating to the notion that progression of scoliosis is a result of biomechanical factors modulating spinal growth ('vicious cycle' theory). Quantitative data exist for the key variables in an analysis of scoliosis curve progression. In a predictive model of the evolution of scoliosis simulating the 'vicious cycle' theory, and using these published data, a small lateral curvature of the spine can produce asymmetrical spinal loading that causes asymmetrical growth and a self-perpetuating progressive deformity during skeletal growth. This can occur if the neuromuscular control of muscle activation is directed at minimizing the muscular stress (force per unit cross section), although other activation strategies may produce differing spinal growth patterns. Mechanical modulation of vertebral growth is a significant contributor to the progression of an established scoliosis deformity. Quantitative simulation of this mechanism demonstrates how therapeutic interventions to alter neuromuscular control of trunk muscles or otherwise modify spinal loading may alter the natural history of progression.

Different effects of static versus cyclic compressive loading on rat intervertebral disc height and water loss in vitro.

STUDY DESIGN: In vitro biomechanical study on rat caudal motion segments to evaluate association between compressive loading and water content under static and cyclic conditions. OBJECTIVE: To test hypotheses: 1) there is no difference in height loss and fluid (volume) loss of discs loaded in compression under cyclic (0.15-1.0 MPa) and static conditions with the same root-mean-square (RMS) magnitudes (0.575 MPa); and 2) after initial disc bulge, tissue water loss is directly proportional to height loss under static loading. SUMMARY OF BACKGROUND DATA: Disc degeneration affects water content, elastic and viscoelastic behaviors. There is limited understanding of the association between transient water loss and viscoelastic creep in a controlled in vitro environment where inferences may be made regarding mechanisms of viscoelasticity. METHODS: A total of 126 caudal motion segments from 21 Wistar rats were tested in compression using 1 of 6 protocols: Static loading at 1.0 MPa for 9, 90, and 900 minutes, Cyclic loading at 0.15 to 1.0 MPa/1 Hz for 90 minutes, Mid-Static loading at 0.575 MPa for 90 minutes, and control. Water content was then measured in anulus and nucleus regions. RESULTS: Percent water loss was significantly greater in nucleus than anulus regions, suggesting some water redistribution, with average values under 1 MPa static loading of 23.0% and 14.9% after 90 minutes and 26.9% and 17.6% after 900 minutes, respectively. Cyclic loading resulted in significantly greater height loss (0.506 +/- 0.108 mm) than static loading with the same RMS value (0.402 +/- 0.096 mm), but not significantly less than static loading at peak value (0.539 +/- 0.122 mm). Significant and strong correlations were found between percent water loss and disc height loss, suggesting water was lost through volume decrease. CONCLUSION: Peak magnitude of cyclic compression and not RMS value was most important in determining height change and water loss, likely due to differences between disc creep and recovery rates. Water redistribution from nucleus to anulus occurred under loading consistent with an initial elastic compression (and associated disc bulge) followed by a reduction in disc volume over time.

Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation.

Scoliosis is thought to progress during growth because spinal deformity produces asymmetrical spinal loading, generating asymmetrical growth, etc. in a 'vicious cycle.' The aim of this study was to test quantitatively whether calculated loading asymmetry of a spine with scoliosis, together with measured bone growth sensitivity to altered compression, can explain the observed rate of scoliosis progression in the coronal plane during adolescent growth. The simulated spinal geometry represented a lumbar scoliosis of different initial magnitudes, averaged and scaled from measurements of 15 patients' radiographs. Level-specific stresses acting on the vertebrae were estimated for each of 11 external loading directions ('efforts') from published values of spinal loading asymmetry. These calculations assumed a physiologically plausible muscle activation strategy. The rate of vertebral growth was obtained from published reports of growth of the spine. The distribution of growth across vertebrae was modulated according to published values of growth sensitivity to stress. Mechanically modulated growth of a spine having an initial 13 degrees Cobb scoliosis at age 11 with the spine subjected to an unweighted combination of eleven loading conditions (different effort direction and magnitude) was predicted to progress during growth. The overall shape of the curve was retained. The averaged final lumbar spinal curve magnitude was 32 degrees Cobb at age 16 years for the lower magnitude of effort (that produced compressive stress averaging 0.48 MPa at the curve apex) and it was 38 degrees Cobb when the higher magnitudes of efforts (that produced compressive stress averaging 0.81 MPa at the apex). An initial curve of 26 degrees progressed to 46 degrees and 56 degrees, respectively. The calculated stresses on growth plates were within the range of those measured by intradiscal pressures in typical daily activities. These analyses predicted that a substantial component of scoliosis progression during growth is biomechanically mediated. The rationale for conservative management of scoliosis during skeletal growth assumes a biomechanical mode of deformity progression (Hueter-Volkmann principle). The present study provides a quantitative basis for this previously qualitative hypothesis. The findings suggest that an important difference between progressive and non-progressive scoliosis might lie in the differing muscle activation strategies adopted by individuals, leading to the possibility of improved prognosis and conservative or less invasive interventions.

Measurements of proteoglycan and water content distribution in human lumbar intervertebral discs.

STUDY DESIGN: Study of regional variations in composition in a sample of 9 mildly to moderately degenerated human intervertebral discs. OBJECTIVE: The aim of this study was to obtain proteoglycan distribution in human lumbar discs with high position resolution in the: 1) sagittal, 2) coronal, and 3) axial directions. SUMMARY OF BACKGROUND DATA: Regional variation in disc proteoglycan content has only been reported in coronal sections in a small number of discs and with low spatial resolution in the sagittal direction, and has not been reported in the axial direction. METHODS: Each of 9 human L2-L3 or L3-L4 lumbar discs (age, 53-56 years) were dissected into 36 to 41 specimens using a rectangular cutting die, measured for water content and analyzed for glycosaminoglycan content using the dimethylmethylene blue dye binding assay. RESULTS: The intervertebral discs were mildly to moderately degenerated. They had glycosaminoglycan content ranging approximately 40 to 600 microg/mg dry tissue, with largest values in the nucleus and lowest in the outer anulus. In general, posterior regions had greater glycosaminoglycan content than anterior regions, although values were not as high as in the nucleus. Small variations in glycosaminoglycan content in the axial direction were observed with the largest values in the center, although this variation was small compared with radial variations. Water content results followed similar trends as glycosaminoglycan content with average values ranging from approximately 66% to 86%. CONCLUSIONS: A refined map of proteoglycan content is presented with 3 important findings. First, sagittal variations were distinct from coronal variations. Second, the proteoglycan content was not uniform across the nucleus regions. Third, some specimens had localized variations in proteoglycan and water contents suggestive of focal damage and degeneration.

Alterations in the growth plate associated with growth modulation by sustained compression or distraction.

Sustained mechanical load is known to modulate endochondral growth in the immature skeleton, but it is not known what causes this mechanical sensitivity. This study aimed to quantify alterations in parameters of growth plate performance associated with mechanically altered growth rate. Vertebral and proximal tibial growth plates of immature rats and cattle, and rabbit (proximal tibia only) were subjected to different magnitudes of sustained loading, which altered growth rates by up to 53%. The numbers of proliferative chondrocytes, their rate of proliferation, and the amount of chondrocytic enlargement occurring in the hypertrophic zone were quantified. It was found that reduced growth rate with compression and increased growth rate with distraction were associated with corresponding changes in the number of proliferative chondrocytes per unit width of growth plate, and in the final (maximum) chondrocytic height in the hypertrophic zone (overall correlation coefficients 0.38 and 0.56 respectively). According to multiple linear regression coefficients for these two variables (0.72 and 1.39 respectively), chondrocytic enlargement made a greater contribution to altered growth rates.