Slippage of a spinous process hook during flexion in a flexible fixation system for the lumbar spine.

This study was undertaken to measure the amount of slippage of a spinous process hook (that forms part of a flexible fixation system) during flexion. Human cadaveric lumbar spines (10) were fitted with the device. A rig was designed to apply flexural displacements to a spine using a materials testing machine. Spherical markers were attached to the spine and hook. As a spine was flexed a digital video camera was used to record the positions of the markers. The movements of the markers were measured using interactive computer software to assess any slippage of the spinous process hook. During flexion the overall mean hook slippage was measured to be 0.10mm (standard deviation 0.04mm). The mean hook slippage, for each of the 10 specimens, was in the range of 0.05-0.14mm. The results imply that slippage of a spinous process hook during flexion is small.

Viscoelastic properties of the nucleus pulposus of the intervertebral disk in compression.

The viscoelastic properties of the nucleus pulposus were measured in compression for 35 specimens dissected from 9 sheep. Measurements on 19 specimens were made on the day of slaughter; the remaining 16 specimens were stored frozen and thawed before testing. A preload of 0.2 N was applied to each specimen and a cyclic compression of 10 microm applied at eight frequencies in the range 0.1-10 Hz at a temperature of 37 degrees C. Freezing appeared to increase the storage modulus, E ', but not the loss modulus, E ", or tan delta=E "/E '. These parameters, E ', E " and tan delta, had values of 64+/-28 kPa, 24+/-11 and 0.33 kPa+/-0.07, respectively. The value of tan delta passed through a minimum at a loading frequency of 0.9+/-0.2 Hz. The water content of the specimens was 80+/-2%.

Design of spinous process hooks for flexible fixation of the lumbar spine.

A prototype flexible fixation system for the lumbar spine was subjected to tensile testing to failure and cyclic tensile testing in order to determine any regions of weakness. The system consisted of a spinous process hook and two laminar hooks made of stainless steel (316L). Each laminar hook was attached to the spinous process hook by a loop of polyester braid secured by a crimped metal sleeve. In five tensile tests, the system failed by irreversible deformation of the spinous process hook at 2.5 +/- 0.3 kN (mean +/- standard deviation). In three cyclic tests, in which the applied tension varied sinusoidally between 0.04 and 0.4 kN at a frequency of 5 Hz, failure occurred after less than 400,000 loading cycles. This occurred as a result of fatigue crack initiation and propagation in the spinous process hook. A finite element model showed a stress concentration in the region where the crack occurred, which raised the applied stress above the tensile fatigue strength of this stainless steel. The spinous process hook was redesigned for manufacture in a titanium alloy (Ti-6AI-4V ELI) to minimize artefacts in magnetic resonance imaging. Further finite element models showed no unacceptable stress concentrations.

Mechanical testing of a flexible fixation device for the lumbar spine.

The aim of this study was to test mechanically a new flexible fixation system for the lumbar spine. This device incorporates loops of polyester braid which are secured by a crimped titanium sleeve. In tensile tests, all loops failed, by slippage through the crimped sleeve, at 434 +/- 25 N (mean +/- standard deviation from five loops) for a single crimp and 415 +/- 15 N (from five loops) for two crimps. The intact system was then tested according to the ASTM standard. In a static test, all five specimens failed by slippage of the braid through the sleeve. Initial slippage occurred between 600 and 700 N, but the mean maximum load sustained was 1090 +/- 140 N. Dynamic tests were performed on ten constructs at a frequency of 5 Hz, under a range of loading conditions. The maximum load applied in any of the tests was 825 N. Two constructs did not complete the required 5 x 10(6) test cycles because of fracture of their spinous process hooks. However, other tests, under the same conditions, showed no signs of failure. Fracture occurred as a result of fretting damage from the recommended stainless steel roll pins.

Design of an occipito-cervical fixation device.

Metal plates may be used to stabilize the cervical spine. The plates are attached to the posterior of the vertebra by placing screws into the lateral masses. The plating may be extended, in the form of rod or plate, to connect with and support the occiput. Several problems, such as screw loosening and the plate obscuring the surgeon's view as a screw is being inserted, have been identified with present plate systems. This paper describes the initial design for a cervical fixation device to overcome these problems, and the design and development that was undertaken to enable a prototype device to be manufactured.

Development of surgical instruments for implanting a flexible fixation device for the lumbar spine.

A new flexible fixation device for the lumbar spine has been developed. This paper describes the development and evaluation of two surgical instruments required for implanting this device. Prototypes were designed, manufactured and then evaluated for use in surgery. Further evaluation was performed, if necessary, and the design finalized, in accordance with BS EN 12011. This process involved close collaboration between engineers and surgeons.

Spinous process strength.

STUDY DESIGN: Mechanical testing of cadaveric lumbar spines and dual energy radiograph absorptiometry scanning were performed. OBJECTIVES: To devise a technique to measure the strength of lumbar spinous processes and to determine the bone mineral density of the vertebrae used. SUMMARY OF BACKGROUND DATA: The spinous process has been identified as the weakest part of the anatomy to which a flexible fixation device can be attached. It was unknown if the spinous processes could withstand the forces applied by the device. METHODS: A hook was fitted to the spinous process of 32 lumbar vertebrae. A custom-built rig was designed to secure a vertebra to a materials testing machine. A loop of cord was passed over a bar mounted on the crosshead of the machine and around the two bollards of the hook. As the crosshead was raised, a tension was applied to the cord. Each vertebra was tested to failure. The bone mineral density of each vertebra was then measured using dual energy radiograph absorptiometry. RESULTS: Failure of the specimens occurred by failure of the spinous process, pedicles, or vertebral body. The logarithm (base 10) of the load (N) at which failure occurred was 2.53 +/- 0.3, which corresponded to a mean failure load of 339 N. The bone mineral density of each vertebral body varied between 0.263 and 0.997 g/cm2. A significant linear correlation was found between bone strength and bone mineral density (P < 0.0001). CONCLUSIONS: Specimens with a bone mineral density in the range of 0.263-0.997 g/cm2 failed at a mean load of 339 N when the load was applied through the spinous process hook of a flexible fixation device.

Glia modulate NMDA-mediated signaling in primary cultures of cerebellar granule cells.

Excessive activation of N-methyl-D-aspartate (NMDA) receptor channels (NRs) is a major cause of neuronal death associated with stroke and ischemia. Cerebellar granule neurons in vivo, but not in culture, are relatively resistant to toxicity, possibly owing to protective effects of glia. To evaluate whether NR-mediated signaling is modulated when developing neurons are cocultured with glia, the neurotoxic responses of rat cerebellar granule cells to applied NMDA or glutamate were compared in astrocyte-rich and astrocyte-poor cultures. In astrocyte-poor cultures, significant neurotoxicity was observed in response to NMDA or glutamate and was inhibited by an NR antagonist. Astrocyte-rich neuronal cultures demonstrated three significant differences, compared with astrocyte-poor cultures: (a) Neuronal viability was increased; (b) glutamate-mediated neurotoxicity was decreased, consistent with the presence of a sodium-coupled glutamate transport system in astrocytes; and (c) NMDA- but not kainate-mediated neurotoxicity was decreased, in a manner that depended on the relative abundance of glia in the culture. Because glia do not express NRs or an NMDA transport system, the mechanism of protection is distinct from that observed in response to glutamate. No differences in NR subunit composition (evaluated using RT-PCR assays for NR1 and NR2 subunit mRNAs), NR sensitivity (evaluated by measuring NR-mediated changes in intracellular Ca2+ levels), or glycine availability as a coagonist (evaluated in the presence and absence of exogenous glycine) were observed between astrocyte-rich and astrocyte-poor cultures, suggesting that glia do not directly modulate NR composition or function. Nordihydroguaiaretic acid, a lipoxygenase inhibitor, blocked NMDA-mediated toxicity in astrocyte-poor cultures, raising the possibility that glia effectively reduce the accumulation of highly diffusible and toxic arachidonic acid metabolites in neurons. Alternatively, glia may alter neuronal development/phenotype in a manner that selectively reduces susceptibility to NR-mediated toxicity.

Hip joint prosthesis design: effect of stem introducers.

The stress levels in the femoral component of a total hip prosthesis (Corin Taper Fit, Corin Medical Ltd, Cirencester, Gloucestershire, UK) were calculated by finite element (FE) analysis. This prosthesis has two holes drilled in the shoulder to engage a stem introducer. There were no unacceptable stress levels around these holes. Instead the maximum stresses were around the periphery of the shaft of the stem, as has been observed for FE analyses of conventional designs. Three prostheses were also subjected to cyclic mechanical testing (peak load 2.3 kN) according to the appropriate British Standard. The holes were examined for cracks, before and after testing, by stereomicroscopy. All three specimens were able to withstand 5 million loading cycles with no evidence of damage. Thus it is possible to design a femoral component with holes in the shoulder, to accommodate a stem introducer, without creating unacceptable stress concentrations.

Chronic mild acidosis specifically reduces functional expression of N-methyl-D-aspartate receptors and increases long-term survival in primary cultures of cerebellar granule cells.

Previous studies suggest that chronic depolarization by addition of 25 mM KCl or N-methyl-D-aspartate to primary cultures of cerebellar granule cells promotes expression of the N-methyl-D-aspartate subtype of glutamate receptor, as determined by electrophysiological responsiveness and susceptibility to excitotoxicity. Recent studies have demonstrated that acute mild acidosis reduces N-methyl-D-aspartate receptor channel activity by a non-competitive action of H+ on an extracellular site of the receptor channel complex. Since the level of N-methyl-D-aspartate receptor expression in granule cell cultures is activity-dependent, we examined whether chronic mildly acidotic culture conditions would selectively diminish the level of N-methyl-D-aspartate responsiveness in granule cells, in effect producing a functional level of expression more comparable to that observed in vivo. To test this, cerebellar granule cells from eight-day neonatal rats were grown in an HCO3-buffered medium containing elevated K+ (25 mM KCl) either under standard conditions (95% air/5% CO2, pH 7.4), or under chronic mildly acidotic conditions (90% air/10% CO2, estimated pH of 7.1). Glutamate receptor subtype expression was subsequently assessed using standard neurotoxicity assays, a quantitative immunoblotting assay for N-methyl-D-aspartate receptors and whole cell patch clamp recordings. Cells grown in the 10% CO2 environment exhibited a significant reduction in susceptibility to L-glutamate neurotoxicity (at least 10-fold), but not kainate-induced neurotoxicity, relative to cells grown in 5% CO2. In both culture conditions, L-glutamate- and kainate-induced toxicity were mediated by activation of N-methyl-D-aspartate and non-N-methyl-D-aspartate receptors, respectively, as determined by the sensitivity of agonist-induced toxicity to specific receptor antagonists. Using polyclonal antibodies generated against a peptide sequence recognizing five of eight splice variants in the common "R1" subunit of N-methyl-D-aspartate receptors, a 31% reduction in the amount of immunoreactive protein was observed in membrane preparations from cells grown in 10% CO2, relative to the amount detected in cells grown in 5% CO2. Moreover, perfusion of cells with glutamate (50 microM) in a nominally Mg(2+)-free solution containing glycine (2 microM) elicited N-methyl-D-aspartate antagonist-sensitive inward currents in proportionately fewer cells cultured in 10% CO2, relative to cells cultured in 5% CO2. Long-term survival was also significantly enhanced in cells exposed chronically to mild acidotic culture conditions, relative to cells grown under standard pH conditions (22 days, 10% CO2 vs 16 days, 5% CO2).(ABSTRACT TRUNCATED AT 400 WORDS)

Demonstration of presynaptic protein kinase C activation following long-term potentiation in rat hippocampal slices.

Pharmacological and biochemical evidence implicate the Ca2+ and phospholipid-dependent protein kinase C in long-term potentiation. The in vitro hippocampal slice preparation was used to demonstrate redistribution of protein kinase C from cytosol to membrane and protein kinase C-dependent phosphorylation of the presynaptic growth-associated protein-43 substrate following long-term potentiation induction in area CA1. Protein kinase C translocation was assessed using both quantitative immunoblotting with a monoclonal antibody recognizing a common epitope in the alpha and beta isoforms of protein kinase C and Ca2+ and phospholipid-dependent phosphorylation of exogenous histone substrate. Slices examined 5 min after tetanus-induced spike potentiation showed no change in protein kinase C redistribution, whereas slices examined at 15-, 30- and 60-min intervals all showed a similar degree of protein kinase C translocation to membrane, although only at 15 min was the effect statistically significant. Additionally, an increase in protein kinase C-dependent growth-associated protein 43 phosphorylation was observed 10 min after high-frequency stimulation. The translocation of protein kinase C and phosphorylation of growth-associated protein 43 were dependent upon high-frequency (repetitive 400 Hz) afferent stimulation, as no effects were observed in slices receiving low-frequency (1 Hz) or no stimulation. The N-methyl-D-aspartate receptor antagonist, DL-2-amino-5-phosphonovaleric acid (50 microM), inhibited induction of long-term potentiation, redistribution of protein kinase C and phosphorylation of growth-associated protein 43. A significant redistribution of the predominantly presynaptic protein kinase C isoform, protein kinase C-alpha, was also detected 15 min after induction of long-term potentiation using an alpha-isoform-specific monoclonal antibody. These observations support a presynaptic role for protein kinase C and growth-associated protein 43 in the early maintenance phase of LTP, and further suggest that a retrograde messenger produced postsynaptically following N-methyl-D-aspartate receptor activation mediates these effects.

Differential synaptic effects on physiological flexor hindlimb motoneurons from cutaneous nerve inputs in spinal cat.

1. We previously demonstrated in the spinal cat that superficial peroneal cutaneous nerve stimulation produced strong reflex contraction in tibialis anterior (TA) and semitendinosus (St) muscles but unexpectedly produced mixed effects in another physiological flexor muscle, extensor digitorum longus (EDL). The goal of the present study was to further characterize the organization of ipsilateral cutaneous reflexes by examining the postsynaptic potentials (PSPs) produced in St, TA, and EDL motoneurons by superficial peroneal and saphenous nerve stimulation in decerebrate, spinal cats. 2. In TA and St motoneurons, low-intensity cutaneous nerve stimulation that activated only large (A alpha) fibers [i.e., approximately 2-3 times threshold (T)], typically produced biphasic PSPs consisting of an initial excitatory phase and subsequent inhibitory phase (EPSP, IPSP). Increasing the stimulus intensity to activate both large (A alpha) and small (A delta) myelinated cutaneous fibers supramaximally (15-45 T) tended to enhance later excitatory components in TA and St motoneurons. 3. In EDL motoneurons, 2-3 T stimulation of the superficial peroneal nerve evoked initial inhibition (of variable magnitude) in 7/10 EDL motoneurons tested, with either excitation (n = 2) or mixed effects (n = 1) observed in the remaining EDL motoneurons. Saphenous nerve stimuli produced excitation either alone, or preceded by an inhibitory phase in EDL. Increasing the stimulus intensity enhanced later inhibitory influences from superficial peroneal and excitatory influences both from superficial peroneal and saphenous nerve inputs in EDL motoneurons. 4. Short-latency (less than 1.8 ms) EPSPs were observed in a few motoneurons in all reflex pathways examined, except for EPSPs in EDL motoneurons evoked by saphenous stimulation. IPSPs with central latencies less than 1.8 ms were also produced by both saphenous (TA, n = 1; EDL, n = 2) and superficial peroneal (EDL, n = 4) nerve stimulation. 5. The results, in comparison with other reports employing spinal and nonspinal preparations, suggest that removal of influences from higher centers reveals inhibitory circuits from the superficial peroneal and saphenous nerves to EDL motoneurons in the spinal preparation. The inhibitory inputs observed are thought to reflect the activation of "specialized" reflex pathways. Additionally, the demonstration of short-latency EPSPs and IPSPs suggest that the minimal linkage in both the excitatory and inhibitory cutaneous reflex pathways examined is disynaptic. The results are discussed in relation to previous studies on classically conditioned flexion reflex facilitation in spinal cat.

Differential effects of isoquinolinesulfonamide protein kinase inhibitors on CA1 responses in hippocampal slices.

The effects of the isoquinolinesulfonamide protein kinase inhibitors 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H-7) and N-(2-guanidinoethyl)-5-isoquinolinesulfonamide (HA1004) on CA1 responses in hippocampal slices of the rat were examined to clarify their mode of action, and also to further define the role of Ca(2+) -dependent kinases in long-term potentiation. Initially, the inhibitory potencies of H-7 and HA1004 against both protein kinase C and type II Ca2+/calmodulin-dependent kinase were examined in standard in vitro phosphorylation assays. The apparent Ki values of H-7 and HA1004 for protein kinase C were 9 and 57 microM, respectively. In contrast, the Ki values of H-7 and HA1004 for type II calcium/calmodulin-dependent protein kinase were 156 and 13 microM, respectively. These results indicate that H-7 is a more effective inhibitor of protein kinase C, whereas HA1004 is a more effective inhibitor of type II calcium/calmodulin-dependent protein kinase. Following the induction of long-term potentiation, addition of 50 microM H-7 or HA1004 substantially increased the amplitude of the population spike in a control pathway, while producing no change or a slight increase in the spike amplitude in a previously potentiated long-term potentiation pathway. Moreover, H-7 (50 microM), but not HA1004, produced multiple population spikes in both pathways. Addition of a higher concentration of H-7 (300 microM) reduced the amplitude of the initial population spike but still produced multiple spikes. HA1004 (300 microM) typically produced effects similar to those observed with 50 microM H-7, increasing the amplitude of the control population spike and producing multiple spike activity in both pathways. In contrast to the differential concentration-dependent effects of H-7 on the population spike responses, qualitatively similar effects were observed at both low (50 microM) and high (300 microM) concentrations with regard to synaptic field responses. The initial slope of the population excitatory postsynaptic potential was significantly reduced by H-7, to a similar degree in both pathways. HA1004 produced a modest, but insignificant reduction in both pathways. These results, in conjunction with other reports, suggest that H-7 and HA1004 exert complex concentration-dependent effects with synchronously affect both excitatory and inhibitory synaptic transmission. We hypothesize that reduction of the population excitatory postsynaptic potential and spike (300 microM H-7) is due to reduction of excitatory inputs, whereas enhancement of the population spike amplitude (50 microM H-7) and the production of multiple spikes are due to the reduction of GABA-mediated inhibitory inputs.(ABSTRACT TRUNCATED AT 400 WORDS)