Optimization of ovine bone decalcification for increased cellular detail: a parametric study.

There are many published methods of decalcifying bone for paraffin histology; however, the current literature lacks details regarding the processing of ovine tissue. Ovine bone tissue presents challenges, as samples are often denser and larger than other comparative animal models, thus increasing decalcification times. Trifluoroacetic Acid (TFAA) has previously been used to decalcify ovine bone samples for histological analysis. Unfortunately, TFAA is a strong acid and often results in loss of cellular detail, especially in the connected soft tissue. This is generally manifested as over staining with eosin, and a decrease in cellular features which impacts overall histological interpretation. It is well known that leaving tissue in acid for long periods degrades cellular detail; therefore, minimizing decalcification time is critical to accurately determine cellular morphology. Six decalcification solutions (8% TFAA, 20% TFAA, 8% formic acid, 20% formic acid, Formical-4, and XLCal, and three temperatures (room temperature, 30°C, 37°C), were examined to determine their effects on cellular detail in ovine vertebrae and humeral heads. These data clearly indicate that 20% formic acid at 30°C yielded better decalcification rates (2.6 d ± 0.9 d) and cellular detail (none to mild changes) for the vertebrae samples, and 20% formic acid at RT yielded the best cellular detail (none to minimal loss) for humerus samples with a moderate amount of time (6.5 d ± 1.7). These results should establish the optimal demineralization procedures for ovine bone used in scientific studies resulting in improved cellular detail while minimizing decalcification times.

Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together.

Finite element (FE) model studies have made important contributions to our understanding of functional biomechanics of the lumbar spine. However, if a model is used to answer clinical and biomechanical questions over a certain population, their inherently large inter-subject variability has to be considered. Current FE model studies, however, generally account only for a single distinct spinal geometry with one set of material properties. This raises questions concerning their predictive power, their range of results and on their agreement with in vitro and in vivo values. Eight well-established FE models of the lumbar spine (L1-5) of different research centers around the globe were subjected to pure and combined loading modes and compared to in vitro and in vivo measurements for intervertebral rotations, disc pressures and facet joint forces. Under pure moment loading, the predicted L1-5 rotations of almost all models fell within the reported in vitro ranges, and their median values differed on average by only 2° for flexion-extension, 1° for lateral bending and 5° for axial rotation. Predicted median facet joint forces and disc pressures were also in good agreement with published median in vitro values. However, the ranges of predictions were larger and exceeded those reported in vitro, especially for the facet joint forces. For all combined loading modes, except for flexion, predicted median segmental intervertebral rotations and disc pressures were in good agreement with measured in vivo values. In light of high inter-subject variability, the generalization of results of a single model to a population remains a concern. This study demonstrated that the pooled median of individual model results, similar to a probabilistic approach, can be used as an improved predictive tool in order to estimate the response of the lumbar spine.

Deformation of the equine pelvis in response to in vitro 3D sacroiliac joint loading.

REASONS FOR PERFORMING STUDY: Sacroiliac joint injuries can cause poor performance; however, the interaction between pelvic mechanics and the sacroiliac joint is poorly understood. OBJECTIVE: To measure pelvic displacement during 3D sacroiliac joint loading. METHODS: Nine reflective triads were attached rigidly to bony prominences in sacropelvic specimens harvested from 14 horses for stereophotogrammetric analysis of triad displacements and joint kinematics. The sacrum was coupled to a load cell and mounted vertically within a material testing system (MTS). A pneumatic actuator was used to apply 90 Nm moments to the ischial arch to simulate nutation-counternutation and left and right lateral bending of the sacroiliac joints. Axial rotation of the sacrum was induced by torsion of the upper MTS fixture. Vectors of marker displacement within orthogonal planes of motion were measured during loading of the sacropelvic specimens. Comparisons in the magnitude and direction of triad displacements were made between paired left-right markers and paired loading conditions. RESULTS: Nutation-counternutation of the sacroiliac joint caused vertical displacement of the ischial tuberosities and cranial-caudal displacement of the wings of the ilium. Lateral bending induced rotational displacement within the horizontal plane of all pelvic landmarks, relative to the sacrum. Axial rotation of the sacrum caused elevation of the wing of the ilium ipsilateral to the direction of sacral rotation and depression of the contralateral ilial wing. Significant paired left-right differences occurred during most sacroiliac joint loading conditions. Comparable magnitudes of pelvic displacement were measured during nutation-counternutation, left and right lateral bending, and left and right axial rotation. CONCLUSIONS: The equine pelvis is not a rigid structure and asymmetric pelvic deformation occurs during most sacroiliac joint movements. CLINICAL RELEVANCE: Bony pelvic deformation should be considered a normal response to any sacroiliac joint movement.

Cortical bone trajectory for lumbar pedicle screws.

BACKGROUND CONTEXT: Achieving solid implant fixation to osteoporotic bone presents a clinical challenge. New techniques and devices are being designed to increase screw-bone purchase of pedicle screws in the lumbar spine via a novel cortical bone trajectory that may improve holding screw strength and minimize loosening. Preliminary clinical evidence suggests that this new trajectory provides screw interference that is equivalent to the more traditionally directed trajectory for lumbar pedicle screws. However, a biomechanical study has not been performed to substantiate the early clinical results. PURPOSE: Evaluate the mechanical competence of lumbar pedicle screws using a more medial-to-lateral path (ie, "cortical bone trajectory") than the traditionally used path. STUDY DESIGN: Human cadaveric biomechanical study. METHODS: Each vertebral level (L1-L5) was dual-energy X-ray absorptiometry (DXA) scanned and had two pedicle screws inserted. On one side, the traditional medially directed trajectory was drilled and tapped. On the contralateral side, the newly proposed cortical bone trajectory was drilled and tapped. After qCT scanning, screws were inserted into their respective trajectories and pullout and toggle testing ensued. In uniaxial pullout, the pedicle screw was withdrawn vertically from the constrained bone until failure occurred. The contralateral side was tested in the same manner. In screw toggle testing, the vertebral body was rigidly constrained and a longitudinal rod was attached to each screw head. The rod was grasped using a hydraulic grip and a quasi-static, upward displacement was implemented until construct failure. The contralateral pedicle screw was tested in the same manner. Yield pullout (N) and stiffness (N/mm) as well as failure moment (N-m) were compared and bone mineral content and bone density data were correlated with the yield pullout force. RESULTS: New cortical trajectory screws demonstrated a 30% increase in uniaxial yield pullout load relative to the traditional pedicle screws (p=0.080), although mixed loading demonstrated equivalency between the two trajectories. No significant difference in construct stiffness was noted between the two screw trajectories in either biomechanical test or were differences in failure moments (p=0.354). Pedicle screw fixation did not appear to depend on bone quality (DXA) yet positive correlations were demonstrated between trajectory and bone density scans (qCT) and pullout force for both pedicle screws. CONCLUSIONS: The current study demonstrated that the new cortical trajectory and screw design have equivalent pullout and toggle characteristics compared with the traditional trajectory pedicle screw, thus confirming preliminary clinical evidence. The 30% increase in failure load of the cortical trajectory screw in uniaxial pullout and its juxtaposition to higher quality bone justify its use in patients with poor trabecular bone quality.

Lower cervical spine facet cartilage thickness mapping.

OBJECTIVE: Finite element (FE) models of the cervical spine have been used with increasing geometric fidelity to predict load transfer and range of motion (ROM) for normal, injured, and treated spines. However, FE modelers frequently treat the facet cartilage as a simple slab of constant thickness, impeding the accuracy of FE analyzes of spine kinematics and kinetics. Accurate prediction of facet joint contact forces and stresses, ROM, load transfer, and the effects of facet arthrosis require accurate representation of the geometry of the articular cartilage of the posterior facets. Previous research has described the orientations of the facet surfaces, their size and aspect ratio, and mean and maximum thickness. However, the perimeter shape of the cartilaginous region and the three-dimensional distribution of cartilage thickness remain ill-defined. As such, it was the intent of this research to further quantify these parameters. METHOD: Vertebrae from seven fresh-frozen unembalmed human cadavers were serially sectioned and the osteochondral interface and the articulating surface of each facet on each slice were identified. The cartilage thickness was recorded at nine equidistant points along the length of each facet. It was observed that facets tended to have elliptic or ovoid shapes, and best-fit ovoid perimeter shapes were calculated for each facet. The thickness distribution data were used to represent the entire three-dimensional cartilage distribution as a function of one variable, and a thickness distribution function was optimized to fit the thickness distribution. The antero-posterior and medial/lateral shifts of the thickness center relative to the geometric were calculated and reported. RESULTS: High correlation was observed between the ovoid perimeter shapes and the measured facet shapes in radial coordinates, indicating that the ovoid approximation is able to accurately represent the range of facet geometries observed. High correlation between the measured and fitted thickness distributions indicates that the fitting function used is able to accurately represent the range of cartilage thickness distributions observed. CONCLUSION: Utilization of a more physiologic cartilage thickness distribution in FE models will result in improved representation of cervical spine kinematics and increased predictive power. The consistency observed in the thickness distribution function in this study indicates that such a representation can be generated relatively easily.

A finite element investigation of upper cervical instrumentation.

STUDY DESIGN: The finite element technique was used to predict changes in biomechanics that accompany the application of a novel instrumentation system designed for use in the upper cervical spine. OBJECTIVE: To determine alterations in joint loading, kinematics, and instrumentation stresses in the craniovertebral junction after application of a novel instrumentation system. Specifically, this design was used to assess the changes in these parameters brought about by two different cervical anchor types: C2 pedicle versus C2-C1 transarticular screws, and unilateral versus bilateral instrumentation. SUMMARY OF BACKGROUND DATA: Arthrodesis procedures can be difficult to obtain in the highly mobile craniovertebral junction. Solid fusion is most likely achieved when motion is eliminated. Biomechanical studies have shown that C1-C2 transarticular screws provide good stability in craniovertebral constructs; however, implantation of these screws is accompanied by risk of vertebral artery injury. A novel instrumentation system that can be used with transarticular screws or with C2 pedicle screws has been developed. This design also allows for unilateral or bilateral implantation. However, the authors are unaware of any reports to date on the changes in joint loading or instrumentation stresses that are associated with the choice of C2 anchor or unilateral/bilateral use. METHODS: A ligamentous, nonlinear, sliding contact, three-dimensional finite element model of the C0-C1-C2 complex and a novel instrumentation system was developed. Validation of the model has been previously reported. Finite element models representing combinations of cervical anchor type (C1-C2 transarticular screws vs. C2 pedicle screws) and unilateral versus bilateral instrumentation were evaluated. All models were subjected to compression with pure moments in either flexion, extension, or lateral bending. Kinematic reductions with respect to the intact (uninjured and without instrumentation) case caused by instrumentation use were reported. Changes in loading profiles through the right and left C0-C1 and C1-C2 facets, transverse ligament-dens, and dens-anterior ring of C1 articulations were calculated by the finite element model. Maximum von Mises stresses within the instrumentation were predicted for each model variant and loading scenario. RESULTS: Bilateral instrumentation provided greater motion reductions than the unilateral instrumentation. When used bilaterally, C2 pedicle screws approximate the kinematic reductions and instrumentation stresses (except in lateral bending) that are seen with C1-C2 transarticular screws. The finite element model predicted that the maximum stress was always in the region in which the plate transformed into the rod. CONCLUSIONS: To the best of the authors' knowledge, this is the first report of predicting changes in loading in the upper cervical spine caused by instrumentation. The most significant conclusion that can be drawn from the finite element model predictions is that C2 pedicle screw fixation provides the same relative stability and instrumentation stresses as C1-C2 transarticular screw use. C2 pedicle screws can be a good alternative to C2-C1 transarticular screws when bilateral instrumentation is applied.

Acute biomechanical and histological effects of intradiscal electrothermal therapy on human lumbar discs.

STUDY DESIGN: Human cadaver lumbar spines were used to assess the acute effects of intradiscal electrothermal therapy in vitro. OBJECTIVE: To determine whether intradiscal electrothermal therapy produces acute changes in disc histology and motion segment stability. SUMMARY OF BACKGROUND DATA: Intradiscal electrothermal therapy has been introduced as an alternative for the treatment of discogenic low back pain. Several hypothesized mechanisms for the effect of intradiscal electrothermal therapy have been suggested including shrinkage of the nucleus or sealing of the anulus fibrosus by contraction of collagen fibers, and thermal ablation of sensitive nerve fibers in the outer anulus. METHODS: Intradiscal electrothermal therapy was performed with the Spinecath by Oratec on 19 fresh, frozen human lumbar cadaver specimens. In a separate study, eight specimens were tested biomechanically and instrumented to map the thermal distribution, whereas five specimens were tested only biomechanically, both before and after intradiscal electrothermal therapy. Six additional specimens were heated with intradiscal electrothermal therapy, and the resulting canal was backfilled with a silicone rubber compound to allow colocalization of the catheter and anular architecture. RESULTS: A consistent pattern of increased motion and decreased stiffness was observed. For the specimens in which only biomechanical measurements were taken, a 10% increase in the motion, on the average, at 5 Nm torque was observed after intradiscal electrothermal therapy. No apparent alteration of the anular architecture was observed around the catheter site in the intradiscal electrothermal therapy-treated discs. CONCLUSION: The data from this study suggest that the temperatures developed during intradiscal electrothermal therapy are insufficient to alter collagen architecture or stiffen the treated motion segment acutely.

Pathomechanisms of failures of the odontoid.

STUDY DESIGN: A finite element investigation to determine the causal mechanisms that lead to odontoid fracture. OBJECTIVES: To elucidate which loading scenarios, including rotational moments, compression-tension, and lateral and anteroposterior shear, can result in Type I, Type II, and Type III odontoid failures. SUMMARY OF BACKGROUND DATA: There is considerable controversy about the major loading path that causes odontoid fractures. A review of the clinical and laboratory research literature did not provide a consensus on this issue. METHODS: A three-dimensional, nonlinear finite element model of the occipito-atlantoaxial (C0-C1-C2) complex was generated from human cadaveric data. Force loads were applied at the posterior margin of the occiput and were applied as lone entities or after the model was prepositioned in flexion, extension, or lateral-bending moments through applied rotation moments. Intraosseous stresses were reported to characterize the probability of fracture due to the applied loadings. RESULTS: The data indicate that hyperextension can lead to failure of the odontoid at its superior tip (Type I). Finite element model predictions also demonstrated the propensity of loads that induce axial rotation to create relatively high maximum von Mises stress in the Type II fracture region. Flexion prepositioning reduced the stress response of the odontoid. CONCLUSIONS: Force loading that puts the head in extension coupled with lateral shear or compression leads to Type I fractures, whereas axial rotation and lateral shear can produce Type II fractures. The model failed to elucidate causal mechanisms for Type III fractures. Flexion seems to provide a protective mechanism against force application that would otherwise cause a higher risk of odontoid failure.

Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction.

STUDY DESIGN: A finite-element model of the craniovertebral junction was developed and used to determine whether a biomechanical mechanism, in addition to inflammatory synovitis, is involved in the progression of rheumatoid arthritis in this region of the spine. OBJECTIVES: To determine specific structure involvement during the progression of rheumatoid arthritis and to evaluate these structures in terms of their effect on clinically observed erosive changes associated with the disease by assessing changes in loading patterns and degree of anterior atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA: Rheumatoid arthritis involvement of the occipito-atlantoaxial (C0-C1-C2) complex is commonly seen. However, the biomechanical contribution to the development and progression of the disease is neither well understood nor quantified. Although previous cadaver studies have elucidated information on kinematic motion and fusion techniques, the modeling of progressive disease states is not easily accomplished using these methods. The finite-element method is well suited for studying progressive disease states caused by the gradual changes in material properties that can be modeled. METHODS: A ligamentous, nonlinear, sliding-contact, three-dimensional finite-element model of the C0-C1-C2 complex was generated from 0.5 mm thick serial computed tomography scans. Validation of the model was accomplished by comparing baseline kinematic predictions with experimental data. Transverse, alar, and capsular ligament stiffness were reduced sequentially by 50%, 75%, and 100% (removal) of their intact values. All models were subjected to flexion moments replicating the clinical diagnosis of rheumatoid arthritis using full flexion lateral plane radiographs. Stress profiles at the transverse ligament-odontoid process junction were monitored. Changes in loading profiles through the C0-C1 and C1-C2 lateral articulations and their associated capsular ligaments were calculated. Anterior and posterior atlantodental interval values were calculated to correlate ligamentous destruction with advancement of atlantoaxial subluxation. RESULTS: Model predictions (at 0.3 Nm) fell within one standard deviation of experimental means, and range of motion data agreed with published in vitro and in vivo values. The model predicted that stresses at the posterior base of the odontoid process were greatly reduced with transverse ligament compromise beyond 75%. Decreases through the lateral C0-C1 and C1-C2 articulations were compensated by their capsular ligaments. Anterior and posterior atlantodental interval values indicate that the transverse ligament stiffness decreases beyond 75% had the greatest effect on atlantoaxial subluxation during the early stages of the disease (no alar and capsular ligament damage). Subsequent involvement of the alar and capsular ligaments produced advanced atlantoaxial subluxation, for which surgical intervention may be warranted. CONCLUSIONS: To the best of the authors' knowledge, this is the first report of a validated, three-dimensional model of the C0-C1-C2 complex with application to rheumatoid arthritis. The data indicate that there may be a mechanical component (in addition to enzymatic degradation) associated with the osseous resorption observed during rheumatoid arthritis. Specifically, erosion of the odontoid base may involve Wolff's law of unloading considerations. Changes through the lateral aspects of the atlas suggest that this same mechanism may be partially responsible for the erosive changes seen during progressive rheumatoid arthritis. Anterior and posterior atlantodental interval values indicate that complete destruction of the transverse ligament coupled with alar and/or capsular ligament compromise is requisite if advanced levels of atlantoaxial subluxation are present.

Biomechanical testing sequelae relevant to spinal fusion and instrumentation.

The increasing prevalence of spinal disorders and associated treatments has produced a dramatic increase in the number of available devices. The biomechanical evaluation leading to the design, development, and implementation of spinal instrumentation has resulted in a number of in vitro and in vivo testing methods. This article reviews some of the methods and associated results obtained by various evaluation techniques of spinal fusion hardware. Current work and future considerations also are presented.

Bioabsorbable pin fixation of intercarpal joints: an evaluation of fixation stiffness.

OBJECTIVE: Bioabsorbable pins made of poly-p-dioxanone (Johnson and Johnson Orthopaedics, Raynham, Massachusetts) were compared to steel pins in the fixation of the scapholunate and lunotriquetral intercarpal joints of the wrist. DESIGN: An in vitro experiment was performed using fresh-frozen cadaver wrists. BACKGROUND: In the surgical treatment of wrist ligament injuries, temporary intercarpal joint fixation is required. Although steel pins are currently used, there are several clinical problems associated with their use. These complications could potentially be reduced by using bioabsorbable fixation. METHODS: The carpal bones were mounted between sets of plates which were then attached to a materials testing machine. Two parallel pins were used for joint fixation; steel pin fixation was tested first in each joint. Seven scapholunate joints and seven lunotriquetral joints were each tested in three different modes: translation in two orthogonal directions, and rotation. RESULTS: Bioabsorbable pin fixation provided an average of 46% of the stiffness of steel pin fixation. CONCLUSIONS: Although bioabsorbable pin fixation was statistically less stiff than steel pin fixation, relatively high loads were required to induce significant intercarpal joint translation and rotation. RELEVANCE: The strength retention profile of poly-p-dioxanone pins and the quality of fixation demonstrated in this study indicate that these bioabsorbable pins could provide satisfactory fixation of the scapholunate and lunotriquetral joints in the treatment of partial injuries of the intercarpal ligaments.