Improving the fixation of an artificial intervertebral disc.

The fixation of an artificial intervertebral disc has been studied especially with respect to the dimensions, the convexity of the endplates and the size of the fixation elements. From literature and cadaveric vertebrae, the dimensions and shape of the lumbar vertebral endplates were determined and the dimensions of fixation ribs for the artificial intervertebral disc were calculated. To withstand shear forces and prevent dislocation, two sagittal ribs, each 3.5 mm in height and at least 20 mm in length and four transversal ribs, each 1.5 mm in height and with a total length of 60 mm are sufficient. A range of five different sagittal diameters was selected as sufficient for all patients. At least 72.6 % of the endplate of the vertebrae is covered. A convexity with a radius of 140 mm limits the gap to 0.62 mm.

Requirements for an artificial intervertebral disc.

Intervertebral disc degeneration is an important social and economic problem. Presently available artificial intervertebral discs (AIDs) are insufficient and the main surgical intervention is still spinal fusion. The objective of the present study is to present a list of requirements for the development of an AID which could replace the human lumbar intervertebral disc and restore its function. The list addresses geometry, stiffness, range of motion, strength, facet joint function, center of rotation, fixation, failsafety and implantation technique. Date are obtained from the literature, quantified where possible and checked for consistency. Existing AIDs are evaluated according to the presented list of requirements. Endplate size is a weak point in existing AIDs. These should be large and fit vertebral bodies to prevent migration. Disc height and wedge angle should be restored, unless this would overstretch ligaments. Finally, stiffness and range of motion in all directions should equal those of the healthy disc, except for the axial rotation to relieve the facet joints.

The geometry of the human paraspinal muscles with the aid of three-dimensional computed tomography scans and 3-Space Isotrak.

STUDY DESIGN: Accurate determination of the three-dimensional coordinates of paraspinal muscles is presented. OBJECTIVES: To determine the precise position and the size of the paraspinal muscles. SUMMARY OF BACKGROUND DATA: The accurate measurements of the muscle moment arms are important in the evaluation of computer models for spinal movement. It has been reported that a change in the modelling of the erector spinae muscles can alter the compressive forces in the spinal column by 20% and can increase the offsetting shear forces. Classic studies used measurements from cross-sectional anatomic diagrams of human cadavers, scaled to the width and depth of the trunk of the subject, to calculate the moment that produces the joint torque. METHODS: Computed tomography scans of two male cadavers provided data on the bony elements. Three-dimensional coordinates of the origins and insertions of the muscle-fascicles of the paraspinal muscles were obtained with the use of 3-Space Isotrak equipment. The bony and muscle coordinates were combined in the ANSYS (version 5.4; Swanson Analysis Systems, Canonsberg, PA) program. RESULTS: Results of this combination and the three-dimensional coordinates of the paraspinal muscles as acquired by the 3-Space Isotrak are given. CONCLUSION: The position and the moment arms of paraspinal muscles were accurately determined. This is important for further evaluation of mathematical models.