Benjamin C. Gadomski

Finite Element Lumbar Spine Facet Contact Parameter Predictions are Affected by the Cartilage Thickness Distribution and Initial Joint Gap Size

Current finite element modeling techniques utilize geometrically inaccurate cartilage distribution representations in the lumbar spine. We hypothesize that this shortcoming severely limits the predictive fidelity of these simulations. Specifically, it is unclear how these anatomically inaccurate cartilage representations alter range of motion and facet contact predictions. In the current study, cadaveric vertebrae were serially sectioned, and images were taken of each slice in order to identify the osteochondral interface and the articulating surface. A series of custom-written algorithms were utilized in order to quantify each facet joints three-dimensional cartilage distribution using a previously developed methodology. These vertebrae-dependent thickness cartilage distributions were implemented on an L1 through L5 lumbar spine finite element model. Moments were applied in three principal planes of motion, and range of motion and facet contact predictions from the variable thickness and constant thickness distribution models were determined. Initial facet gap thickness dimensions were also parameterized. The data indicate that the mean and maximum cartilage thickness increased inferiorly from L1 to L5, with an overall mean thickness value of 0.57 mm. Cartilage distribution and initial facet joint gap thickness had little influence on the lumbar range of motion in any direction, whereas the mean contact pressure, total contact force, and total contact area predictions were altered considerably. The data indicate that range of motion predictions alone are insufficient to establish model validation intended to predict mechanical contact parameters. These data also emphasize the need for the careful consideration of the initial facet joint gap thickness with respect to the spinal condition being studied.

Modeling degenerative disk disease in the lumbar spine: a combined experimental, constitutive, and computational approach.

Using a continuum approach for modeling the constitutive mechanical behavior of the intervertebral disks annulus fibrosus holds the potential for facilitating the correlation of morphology and biomechanics of this clinically important tissue. Implementation of a continuum representation of the disks tissues into computational models would yield a particularly valuable tool for investigating the effects of degenerative disease. However, to date, relevant efforts in the literature towards this goal have been limited due to the lack of a computationally tractable and implementable constitutive function. In order to address this, annular specimens harvested from a total of 15 healthy and degenerated intervertebral disks were tested under planar biaxial tension. Predictions of a strain energy function, which was previously shown to be unconditionally convex, were fit to the experimental data, and the optimized coefficients were used to modify a previously validated finite element model of the L4/L5 functional spinal unit. Optimization of material coefficients based on experimental results indicated increases in the micro-level orientation dispersion of the collagen fibers and the mechanical nonlinearity of these fibers due to degeneration. On the other hand, the finite element model predicted a progressive increase in the stress generation in annulus fibrosus due to stepwise degeneration of initially the nucleus and then the entire disk. Range of motion was predicted to initially increase with the degeneration of the nucleus and then decrease with the degeneration of the annulus in all rotational loading directions, except for axial rotation. Overall, degeneration was observed to specifically impact the functional effectiveness of the collagen fiber network of the annulus, leading to changes in the biomechanical behavior at both the tissue level and the motion-segment level.

Partial gravity unloading inhibits bone healing responses in a large animal model

The reduction in mechanical loading associated with space travel results in dramatic decreases in the bone mineral density (BMD) and mechanical strength of skeletal tissue resulting in increased fracture risk during spaceflight missions. Previous rodent studies have highlighted distinct bone healing differences in animals in gravitational environments versus those during spaceflight. While these data have demonstrated that microgravity has deleterious effects on fracture healing, the direct translation of these results to human skeletal repair remains problematic due to substantial differences between rodent and human bone. Thus, the objective of this study was to investigate the effects of partial gravitational unloading on long-bone fracture healing in a previously-developed large animal Haversian bone model. In vivo measurements demonstrated significantly higher orthopedic plate strains (i.e. load burden) in the Partial Unloading (PU) Group as compared to the Full Loading (FL) Group following the 28-day healing period due to inhibited healing in the reduced loading environment. DEXA BMD in the metatarsus of the PU Group decreased 17.6% (p<0.01) at the time of the ostectomy surgery. Four-point bending stiffness of the PU Group was 4.4 times lower than that of the FL Group (p<0.01), while µCT and histomorphometry demonstrated reduced periosteal callus area (p<0.05), mineralizing surface (p<0.05), mineral apposition rate (p<0.001), bone formation rate (p<0.001), and periosteal/endosteal osteoblast numbers (p<0.001/p<0.01, respectively) as well as increased periosteal osteoclast number (p<0.05). These data provide strong evidence that the mechanical environment dramatically affects the fracture healing cascade, and likely has a negative impact on Haversian system healing during spaceflight.

Modulating tibiofemoral contact force in the sheep hind limb via treadmill walking: Predictions from an opensim musculoskeletal model

Sheep are a predominant animal model used to study a variety of orthopedic conditions. Understanding and controlling the in‐vivo loading environment in the sheep hind limb is often necessary for investigations relating to bone and joint mechanics. The purpose of this study was to develop a musculoskeletal model of an adult sheep hind limb and investigate the effects of treadmill walking speed on muscle and joint contact forces. We constructed the skeletal geometry of the model from computed topography images. Dual‐energy x‐ray absorptiometry was utilized to establish the inertial properties of each model segment. Detailed dissection and tendon excursion experiments established the requisite muscle lines of actions. We used OpenSim and experimentally‐collected marker trajectories and ground reaction forces to quantify muscle and joint contact forces during treadmill walking at 0.25 m• s−1 and 0.75 m• s−1. Peak compressive and anterior–posterior tibiofemoral contact forces were 20% (0.38 BW, p = 0.008) and 37% (0.17 BW, p = 0.040) larger, respectively, at the moderate gait speed relative to the slower speed. Medial–lateral tibiofemoral contact forces were not significantly different. Adjusting treadmill speed appears to be a viable method to modulate compressive and anterior–posterior tibiofemoral contact forces in the sheep hind limb. The musculoskeletal model is freely‐available at www.SimTK.org.

An In Vivo Ovine Model of Bone Tissue Alterations in Simulated Microgravity Conditions

Microgravity and its inherent reduction in body-weight associated mechanical loading encountered during spaceflight have been shown to produce deleterious effects on important human physiological processes. Rodent hindlimb unloading is the most widely-used ground-based microgravity model. Unfortunately, results from these studies are difficult to translate to the human condition due to major anatomic and physiologic differences between the two species such as bone microarchitecture and healing rates. The use of translatable ovine models to investigate orthopedic-related conditions has become increasingly popular due to similarities in size and skeletal architecture of the two species. Thus, a new translational model of simulated microgravity was developed using common external fixation techniques to shield the metatarsal bone of the ovine hindlimb during normal daily activity over an 8 week period. Bone mineral density, quantified via dual-energy X-ray absorptiometry, decreased 29.0% (p < 0.001) in the treated metatarsi. Post-sacrifice biomechanical evaluation revealed reduced bending modulus (-25.8%, p < 0.05) and failure load (-27.8%, p < 0.001) following the microgravity treatment. Microcomputed tomography and histology revealed reduced bone volume (-35.9%, p < 0.01), trabecular thickness (-30.9%, p < 0.01), trabecular number (-22.5%, p < 0.05), bone formation rate (-57.7%, p < 0.01), and osteoblast number (-52.5%, p < 0.001), as well as increased osteoclast number (269.1%, p < 0.001) in the treated metatarsi of the microgravity group. No significant alterations occurred for any outcome parameter in the Sham Surgery Group. These data indicate that the external fixation technique utilized in this model was able to effectively unload the metatarsus and induce significant radiographic, biomechanical, and histomorphometric alterations that are known to be induced by spaceflight. Further, these findings demonstrate that the physiologic mechanisms driving bone remodeling in sheep and humans during prolonged periods of unloading (specifically increased osteoclast activity) are more similar than previously utilized models, allowing more comprehensive investigations of microgravity-related bone remodeling as it relates to human spaceflight.

An investigation of shock wave therapy and low-intensity pulsed ultrasound on fracture healing under reduced loading conditions in an ovine model

The use of shock wave therapy (SWT) and low‐intensity pulsed ultrasound (LIPUS) as countermeasures to the inhibited fracture healing experienced during mechanical unloading was investigated by administering treatment to the fracture sites of mature, female, Rambouillet Columbian ewes exposed to partial mechanical unloading or full gravitational loading. The amount of fracture healing experienced by the treatment groups was compared to controls in which identical surgical and testing protocols were administered except for SWT or LIPUS treatment. All groups were euthanized after a 28‐day healing period. In vivo mechanical measurements demonstrated no significant alteration in fixation plate strains between treatments within either partial unloading group. Similarly, DXA BMD and 4‐point bending stiffness were not significantly altered following either treatment. μCT analyses demonstrated lower callus bone volume for treated animals (SWT and LIPUS, p < 0.01) in the full gravity group but not between reduced loading groups. Callus osteoblast numbers as well as mineralized surface and bone formation rate were significantly elevated to the level of the full gravity groups in the reduced loading groups following both SWT and LIPUS. Although no increase in 4‐week mechanical strength was observed, it is possible that an increase in the overall rate of fracture healing (i.e., callus strength) may be experienced at longer time points under partial loading conditions given the increase in osteoblast numbers and bone formation parameters following SWT and LIPUS.

Computational characterization of fracture healing under reduced gravity loading conditions

The literature is deficient with regard to how the localized mechanical environment of skeletal tissue is altered during reduced gravitational loading and how these alterations affect fracture healing. Thus, a finite element model of the ovine hindlimb was created to characterize the local mechanical environment responsible for the inhibited fracture healing observed under experimental simulated hypogravity conditions. Following convergence and verification studies, hydrostatic pressure and strain within a diaphyseal fracture of the metatarsus were evaluated for models under both 1 and 0.25 g loading environments and compared to results of a related in vivo study. Results of the study suggest that reductions in hydrostatic pressure and strain of the healing fracture for animals exposed to reduced gravitational loading conditions contributed to an inhibited healing process, with animals exposed to the simulated hypogravity environment subsequently initiating an intramembranous bone formation process rather than the typical endochondral ossification healing process experienced by animals healing in a 1 g gravitational environment.

Simulating Microgravity in a Large Animal Model

MATERIALS AND METHODSThe microgravity environment encountered during spaceflight has numerous deleterious effects on the human body, with one of the most drastic being decreased bone mass due to mechanical unloading. These alterations in bone mass and skeletal strength are one of the foremost limitations of future space exploration. Due to the cost of long-duration space missions, it is critically important to develop ground-based models of the microgravity environment encountered during spaceflight to investigate possible countermeasures to maintain skeletal integrity. Most ground-based microgravity models utilize rodent hindlimb suspension to simulate how reduced loading affects isolated physiologic systems (1,2). Unfortunately, results derived from these studies are difficult to directly translate to the human condition due to major anatomic and physiologic differences between rodents and humans. Specifically, the differences in rodent and human bone structure become increasingly important when studying orthopaedic issues such as bone maintenance and healing during spaceflight. For example, the basic microstructure of rodent bone, known as “plexiform” bone, lacks the osteons (Haversion systems) that are the main micro-architectural feature of human cortical bone. Furthermore, it is known that the osteogenic and healing potential of rodent bone far exceeds that of adult human tissue. Due to these limitations in current ground-based microgravity models, there is a need to develop a ground-based, large animal model of simulated weightlessness that more closely approximates the human condition. Thus, the aim of this study was: (1) to implement an external fixation-based unloading apparatus in a large animal long bone model and (2) to confirm that the unloading method utilized to simulate weightlessness induces the concomitant physiologic orthopaedic changes associated with microgravity. A previously characterized transarticular hybrid fixator was applied to the right hindlimb of seven skeletally mature sheep for 8 weeks (Microgravity Group, n=7). The device was designed such that unloading of the metatarsus was accomplished by attaching the external fixation device to the proximal phalanges and distal tibia via fixation pins (3). An Earth gravity test group (Sham Group, n=3) was simulated by implanting the associated fixation pins while removing the external fixation connecting rods from the construct, thus ensuring full loading was transmitted through the metatarsal bone. Efficacy of the unloading technique was evaluated by measuring the strains in the external fixation device and a standard orthopaedic locking plate implanted on the metatarsus. The relative unloading of the device was calculated by relating the amount of load transferred through the metatarsus to the total load transferred through the bone and device. Dual-energy x-ray absorptiometry (DEXA) bone mineral density (BMD) measurements were performed on the treated metatarsus, contralateral metatarsus, and tibia of the treated limb at the time of surgery and every two weeks until sacrifice (8 weeks post-operative). Post-sacrifice biomechanical, radiographical, and histological outcome parameters were measured on the treated metatarsus and compared to its contralateral control metatarsus. Mechanical competency was evaluated via four-point bending and diametral compression tests. Trabecular microarchitecture was quantified via micro-computed tomography (µCT), and bone formation parameters and cellular activity were quantified using static and dynamic histomorphometry techniques. Statistical differences between groups were determined via either a paired t-test or one-way ANOVA with a Student-Newman-Keuls

The effect of muscle loading on internal mechanical parameters of the lumbar spine: a finite element study

The human spine experiences complex loading in vivo; however, simplifications to these loading conditions are commonly made in computational and experimental protocols. Pure moments are often used in cadaveric preparations to replicate in vivo loading conditions, and previous studies have shown this method adequately predicts range of motion behavior (1, 2). It is unclear what effect pure moment loading has on the tissue-level internal mechanical parameters such as stresses in the annulus fibrosus and facet contact parameters. Recent advances in musculoskeletal modeling have elucidated previously unknown quantities of the musculature recruitment patterns such as times, forces, and directions. The advancements are especially relevant in cases of surgical intervention because the spinal musculature has been reported to play a critical role in providing additional stability to the spine when defects such as discectomy and nucleotomy are involved (2). Thus, the aim of the study was to determine the importance of computational loading conditions on the resultant global ranges of motion, as well as the tissue-level predictions of annulus fibrosus stresses, and facet contact pressures, forces, and areas.Copyright