Three-dimensional evaluation of the coccyx movement between supine and standing positions using conventional and upright computed tomography imaging.

Currently, no three-dimensional reference data exist for the normal coccyx in the standing position on computed tomography (CT); however, this information could have utility for evaluating patients with coccydynia and pelvic floor dysfunction. Thus, we aimed to compare coccygeal parameters in the standing versus supine positions using upright and supine CT and evaluate the effects of sex, age, and body mass index (BMI) on coccygeal movement. Thirty-two healthy volunteers underwent both upright (standing position) and conventional (supine position) CT examinations. In the standing position, the coccyx became significantly longer and straighter, with the tip of the coccyx moving backward and downward (all p < 0.001). Additionally, the coccygeal straight length (standing/supine, 37.8 ± 7.1/35.7 ± 7.0 mm) and sacrococcygeal straight length (standing/supine, 131.7 ± 11.2/125.0 ± 10.7 mm) were significantly longer in the standing position. The sacrococcygeal angle (standing/supine, 115.0 ± 10.6/105.0 ± 12.5°) was significantly larger, while the lumbosacral angle (standing/supine, 21.1 ± 5.9/25.0 ± 4.9°) was significantly smaller. The migration length of the tip of the coccyx (mean, 7.9 mm) exhibited a moderate correlation with BMI (r = 0.42, p = 0.0163). Our results may provide important clues regarding the pathogenesis of coccydynia and pelvic floor dysfunction.

Failure to Reposition After Sliding Down in Bed Increases Pressure at the Sacrum and Heels.

UNLABELLED: The head of the bed (HOB) for a patient is often elevated since it improves comfort and facilitates respiratory functions. However, elevating the HOB essentially causes the patient support surface to turn into a ramp, forcing the patient's body to slide down. As the patient slides down, weight pressing on the pelvis, the coccyx, and the ischial tuberosities increases, resulting in associated increases in interface pressures. METHODS: In an institutional review board-approved study, pressure distribution was measured on volunteers at 4 discrete body positions sliding down in bed on 3 commonly used support surfaces. RESULTS: This study showed the total contact area of the patients decreased as they slid down, resulting in increased pressure, particularly on the sacral area and the heels. The study also confirmed that these pressure increases are persistent and occurred on all of the support surfaces tested. CONCLUSION: These increases in pressure likely contribute to the development of pressure ulcers.

Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury.

OBJECTIVE: Clinicians commonly recommend that power wheelchair users with spinal cord injury perform wheelchair tilt and recline maneuvers to redistribute seating loads away from the ischial tuberosities. However, ischial pressure reduction may be accompanied by coccygeal pressure increases. Although the coccyx is among the most common sites of pressure ulcers, few studies have reported coccygeal interface pressure. The purpose of this study was to investigate both ischial and coccygeal interface pressures in response to changes in wheelchair tilt and recline angles. DESIGN: Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15, 25, and 35 degrees) and recline (10 and 30 degrees, corresponding to traditional recline conventions of 100 and 120 degrees, respectively) angles were tested in random order. Each combination was tested with 5 mins of upright sitting, 5 mins of tilt and recline, as well as 5 mins of maximal pressure relief recovery. Peak pressure indices were calculated at the ischial and coccygeal sites. RESULTS: Ischial pressures monotonically decreased in response to increasing combinations of tilt and recline. Increments of 15 degrees of tilt did not produce significant differences under either recline angle, whereas increments of 25 degrees of tilt produced significant differences under both recline angles. Coccygeal pressures increased in response to the four smallest (of six) combinations of tilt and recline, whereas they decreased in response to the largest two combinations. CONCLUSIONS: Ischial pressures seemed to be redistributed to the coccyx in response to the four smallest angle combinations and redistributed to the back support in response to the two largest angle combinations. Future work should confirm this pressure redistribution to the back support and determine the back support locations of redistribution.

Ossification of sacral vertebral bodies in neonates born 24 to 38 weeks' gestational age and its relevance to spinal ultrasonography.

OBJECTIVE: Determination of gestational age and/or birth weight at which sacral ossification centers appear. STUDY DESIGN: Radiographs were reviewed of newborns admitted to Auckland City Hospital between January 2008 and December 2010. Infants were divided into weight clusters increasing in 100-g increments from 400 g to 3000 g and 500-g increments thereafter, for a total of 29 weight clusters. Adequate images were available for at least five newborns per cluster. RESULTS: Images of 163 newborns were reviewed. All but six newborns had five sacral ossification centers by 32 weeks' gestation and a birth weight of 1800 g. Five of the six infants had a congenital anomaly and associated growth restriction. CONCLUSIONS: Infants can be expected to have all five sacral ossification centers present by the time they reach a gestational age of 32 weeks and/or a birth weight of 1800 g. Variation from this can be associated with congenital anomalies and growth restriction.

Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging.

AIMS: The pubococcygeal line (PCL) is an important reference line for determining measures of pelvic organ support on sagittal-plane magnetic resonance imaging (MRI); however, there is no consensus on where to place the posterior point of the PCL. As coccyx movement produced during pelvic floor muscle (PFM) contractions may affect other measures, optimal placement of the posterior point is important. This study compared two methods for measuring the PCL, with different posterior points, on T2-weighted sagittal MRI to determine the effect of coccygeal movement on measures of pelvic organ support in older women. METHODS: MRI of the pelvis was performed in the midsagittal plane, at rest and during PFM contractions, on 47 community-dwelling women 60 and over. The first PCL was measured to the tip of the coccyx (PCLtip) and the second to the sacrococcygeal joint (PCLjnt). Four measures of pelvic organ support were made using each PCL as the reference line: urethrovesical junction height, uterovaginal junction height, M-line and levator plate angle. RESULTS: During the PFM contraction the PCLtip shortened and lifted (P < 0.001); the PCLjnt did not change (P > 0.05). The changes in the four measures of pelvic organ support were smaller when measured relative to the PCLtip as compared to those to the PCLjnt (P < 0.001). CONCLUSIONS: Coccyx movement affected the length and position of the PCLtip, which resulted in underestimates of the pelvic-organ lift produced by the PFM contraction. Therefore, we recommend that the PCL be measured to the sacrococcygeal joint and not to the tip of the coccyx.

In vitro organ culture of the bovine intervertebral disc: effects of vertebral endplate and potential for mechanobiology studies.

STUDY DESIGN: Whole bovine coccygeal discs were cultured under static load, with or without vertebral endplates (VEPs), and assessed for cell viability, biochemical stability, biosynthetic activity, and biosynthetic responsiveness to changes in mechanical load. OBJECTIVES: To assess the effects of VEPs on biochemical and cellular stability of disc cells during in vitro culture of large disc explants. To determine whether cultured discs could respond to mechanical perturbation. SUMMARY OF BACKGROUND DATA: Previous methods for culturing the intervertebral disc have focused on rabbit and rat discs, but the small size of these discs limits the relevance of these culture systems to the human condition. Bovine coccygeal discs have similar dimensions to the human lumbar disc (i.e., similar size and nominal stresses), but long-term culture of these discs has not been reported. METHODS: Bovine coccygeal discs were harvested with or without VEPs, cultured under static load (5 kg, approximately 0.25 MPa, in situ swelling pressure) for up to 1 week, and evaluated for changes in hydration, glycosaminoglycan content, cell viability, and biosynthetic activity. Additionally, the biochemical and biosynthetic response of discs cultured without VEP to increasing the load to a 20-kg (approximately 1 MPa, the estimated stress in human lumbar disc during heavy lifting) static load for 6 hours was assessed. RESULTS: During the first 24 hours, culturing discs with endplates was moderately better with regards to maintaining in situ anulus hydration and nucleus glycosaminoglycan levels. The endplates, however, obstructed media flow to the disc, resulting in a marked decrease in cell viability after 1 week of culture. Nucleus pulposus cell viability was maintained in discs cultured without endplates, but there was a significant drop in biosynthetic activity within 2 days of culture. Despite this drop, the disc cells in the discs without VEP remained biosynthetically responsive to changes in mechanical loading. CONCLUSIONS: It is possible to maintain cell viability and the biosynthetic responsiveness of large discs for up to 1 week in vitro when the discs are cultured under static load and without VEP.

Use of controlled mechanical stimulation in vivo to induce cartilage layer formation on the surface of osteotomized bone.

A micromachine was used to study the response of mesenchymal tissue to mechanically controlled motion in vivo. The middle portion of the coccygeal vertebra of Fischer 344 rats was osteotomized, and continuous bending motion was applied for 4 weeks. The experimental groups were divided into two groups with higher sliding displacement applied at the osteotomized gap of group II. Hyaline cartilage tissue was generated at the osteotomized ends, and was predominantly formed on the side that extended during the bending motion. These newly formed tissues stained intensively with safranin O and toluidine blue, positively with immunostain for type II collagen, but negatively with immunostain for type I collagen. Articular cartilage-like tissues with a surface and a layer structure were obtained in group II, in which higher sliding motion was applied. Light and electron microscopy revealed morphological features similar to those of normal articular cartilage tissue in the superficial and middle zones of the tissues obtained in group II. Collagen fibrils in the superficial zone were found aligned parallel to the smooth surface. Although tidemark formation was not observed in the deep zone, the structure was much more natural than that of any other tissue-engineered cartilage reported to date. These results suggest that controlled sliding stimulation can elicit the generation of articular cartilage structure in vivo.

Stress distribution changes in bovine vertebrae just below the endplate after sustained loading.

OBJECTIVE: To describe the pattern of stress distribution in the vertebral body just behind the endplate, and to document its changes due to sustained loading. METHODS: Twelve fresh bovine coccygeal motion segments were dissected and tested. Each specimen was axially loaded with a sustained compressive force of 50% of its estimated compressive strength. Before loading, after 1.5 h and after 3 h of loading, the distribution of the axial pressure under the bottom vertebra (i.e., just below its top endplate) was recorded at three force levels (25%, 37.5% and 50% of the estimated compressive strength), using pressure-sensitive film. RESULTS: Stress distribution over the endplate was found to be fairly uniform. At low compression forces, the stress was the highest centrally. With increased compression and after sustained compression the uniformity improved through a significant redistribution of stress to the periphery. No stress peaks were found to occur after sustained loading. CONCLUSION: Stress peaks after sustained loading cannot explain the occurrence of endplate fractures in sustained cyclic compression in non-degenerated discs. Competing explanations, such as creep, and fatigue failure, would appear more likely candidates. RELEVANCE: It has been hypothesised that compression induced fractures of the lumbar vertebral endplate constitute an important etiological factor for low back pain. Competing theories exist on the fracture mechanism in sustained loading and these would have different implications with respect to prevention. The present study evaluated one of these theories.

Role of nitric oxide and prostaglandins in mechanically induced bone formation.

We have previously shown that prostaglandins (PG) and nitric oxide (NO) are required in the induction of bone formation by mechanical stimulation. We therefore tested the ability of NO donors, S-nitroso-N-acetyl-D,L-penicillamine (SNAP), and S-nitroso-glutathione (GSNO) to mimic or augment the osteogenic response of bone to a minimal mechanical stimulus. In rats administered vehicle or the vasodilator hydralazine, stimulation of the 8th caudal vertebra increased bone formation. In animals treated with SNAP or GSNO, there was significant potentiation of this osteogenic response. The bone formation rate in nonloaded vertebrae was unaffected by administration of the NO donors. We also found that while inhibition of either PG or NO production at the time of loading caused a partial suppression of c-fos mRNA expression in the loaded vertebrae, administration of indomethacin and NG-monomethyl-L-arginine together markedly suppressed c-fos expression. This suggests that although both PG and NO are required in mechanically induced osteogenesis, they appear to be generated largely independently of each other. Moreover, while exogenous NO potentiates the stimulatory effect of mechanical loading on bone formation, the lack of effect in nonloaded vertebrae suggests that NO is necessary but not sufficient for induction of bone formation.

Comparative push-out test of dense HA implants and HA-coated implants: findings in a canine study.

Two types of hydroxyapatite (HA) implants have been developed: an HA-coated implant and a dense HA implant. For a longer in situ life span, the HA implant must remain chemically stable and possess high resistance to occlusal force. To determine which type of HA implant shows better durability, this comparative dog study was done to evaluate push-out test results of HA-coated implants and dense HA implants of approximately the same size after implantation in the mandibular and coxal bones for periods ranging from 3 weeks to 10 months. The findings revealed that for the mandibular implants, the push-out values of HA-coated implants were significantly higher than those of dense HA implants at 2 and 4 months after implantation, with significance levels of p < .001 and p < 0.05, respectively. However, there was no significant difference between the two implant types at 10 months. As for the coxal implants, no significant differences were noted for any period. Furthermore, the ratio of push-out values of the dense HA implants to those of the HA-coated implants situated in the same position bilaterally in each bone of the body for each implantation period rose with the passage of time, especially in the mandible. In the mandibular implants, the correlation coefficient of the relationship between the ratio and duration of implantation was highly significant (p < 0.001). Push-out testing caused detachment of the surface portion of the HA coating that was bound to the dense bone from the HA-coated implant at 2, 4, and 10 months after implantation. Furthermore, at 10 months the HA-coated layer in the wide areas of the implants had completely detached from the metal substrate, in contrast to the dense HA implants, which remained durable throughout the test period.

Effect of calcium source, dietary calcium concentration, and gestation phase on various bone characteristics in gestating gilts.

Sixty gravid crossbred gilts were allotted to a 2 x 3 x 2 factorial arrangement of treatments: two Ca sources (sun-cured alfalfa meal and CaCO3), three dietary concentrations of Ca (50, 75, and 100% of NRC requirements), and two phases of gestation (55 and 105 d). The objectives were to determine the effect of Ca source, dietary Ca concentration, and gestation phase on bone characteristics (bone breaking strength, bone ash percentage, bone density, and bone ash density in the rib, thoracic, and coccygeal bones), to correlate bone responses to determine relative bone activity, and to determine reliability of the coccygeal bones as indicators of Ca status in the body. At 55 d, rib strength and coccygeal ash content were lower (P < .01) than at 105 d of gestation. A gestation phase x Ca concentration (P < .05) interaction occurred. As Ca concentration increased, thoracic strength and rib ash responded quadratically during each gestation phase, for which at 55 d a minima and at 105 d a maxima was produced at 75% of NRC. A Ca source x Ca concentration (P < .05) interaction occurred. Gilts fed alfalfa had the lowest rib bone and ash density when fed 75% of NRC for Ca, whereas gilts fed CaCO3 were highest at this level of Ca compared with the other concentrations. Generally, all bones were positively correlated with respect to their response to dietary Ca concentration. Few negative correlations were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Density of myosin filaments in the rat anococcygeus muscle, at rest and in contraction. II.

Rat anococcygeus muscles were fixed at rest or in contraction by conventional methods and prepared for electron microscopy. Myosin filaments were counted on cross sections and their density expressed per unit cytoplasmic area. In contracted muscles, the mean density increased from 86 to 168 filaments per micron 2 (1.95 times), while the density of intermediate (10 nm) filaments increased by 1.25 times. Cell cross sections from the same muscles were measured. Contraction produced a shrinkage which explains the apparent increased density of the 10 nm filaments; however an excess of 61 myosin filaments per micron 2 cannot be explained in this way. These findings provide the structural basis which quantitatively explains the birefringence changes observed in living contracted muscle (Godfraind-De Becker & Gillis, 1988). Our optical and electron optical results provide evidence for a reversible formation of myosin filaments during contraction of the rat anococcygeus muscle.

Analysis of the birefringence of the smooth muscle anococcygeus of the rat, at rest and in contraction. I.

The birefringence of the rat anococcygeus muscle was measured at rest and in contraction. A large increase (+30%) of the optical retardation was observed in muscles fully stimulated by Noradrenaline, in isometric conditions. This was associated with a reduction of the muscle thickness (-12%), so that the birefringence increased by 48%. These changes were reversed upon relaxation. The relationship between the birefringence increase and the mechanical response was investigated as a function of time and of Noradrenaline concentration. Possible origins for the birefringence increase are considered: an increased density of birefringent material, mainly filaments, seems the most likely explanation of the results.

Visual control of step length during running over irregular terrain.

Running over uneven ground requires visually regulating step length to secure proper footing. To examine how this is achieved, we studied subjects running on a treadmill on a series of irregularly spaced targets. The movements of their lower limbs and coccyx relative to the targets were monitored opto-electronically by a Selspot system. The results indicated that step length was adjusted to strike the targets primarily by varying the vertical component of impulse applied to the ground during the stance phase. In contrast, horizontal impulse was not varied significantly, and changing the reach forward of the foot on landing contributed little to variation in step length. Changing the vertical impulse simply altered the step time proportionately. Thus the data are consistent with a time-based model in which vertical impulse is modulated by the optic variable delta tau (Lee, 1976) specifying the time gap that has to be bridged by the runner between two targets.

The rabbit anococcygeus muscle and its response to field stimulation and to some drugs.

1. The response of the rabbit anococcygeus muscle to field stimulation of its intramural nerves and to some drugs has been examined and compared with results previously obtained in the rat and the cat. 2. The rabbit muscle possesses an adrenergic innervation as demonstrated histologically by the Falck and Hillarp fluorescence technique. This innervation is sparser than in the rat or cat. 3. In vitro the muscle usually shows little tone but if suitably stretched will develop a maintained contraction. The response to field stimulation depends on the level of tone. When this is low purely motor responses are obtained. In the presence of tone the response depends on its level and the frequency of stimulation; low frequencies are purely inhibitory, with increasing frequency the response becomes biphasic and high frequencies produce a purely motor response. The higher the tone the more prominent the inhibitory components. Guanethidine 10(-5)M abolishes the motor component. 4. The muscle is caused to contract by noradrenaline, acting through alpha receptors, by hista,ome actomg through H1 receptors and by 5-hydroxy-tryptamine. Part of the effect of the latter appears to be due to the release of noradrenaline. 5. The muscle is caused to relax by acetylcholine acting through muscarinic receptors, by isoprenaline through beta receptors, by histamine in the presence of mepyramine through H2 receptors and by ATP and bradykinin. 6. The significance of these findings for the motor and inhibitory innervation of the muscle is discussed.