Hans-Joachim Wilke

New in vivo measurements of pressures in the intervertebral disc in daily life.

STUDY DESIGN We conducted intradiscal pressure measurements with one volunteer performing various activities normally found in daily life, sports, and spinal therapy. OBJECTIVES The goal of this study was to measure intradiscal pressure to complement earlier data from Nachemson with dynamic and long-term measurements over a broad range of activities. SUMMARY OF BACKGROUND DATA Loading of the spine still is not well understood. The most important in vivo data are from pioneering intradiscal pressure measurements recorded by Nachemson during the 1960s. Since that time, there have been few data to corroborate or dispute those findings. METHODS Under sterile surgical conditions, a pressure transducer with a diameter of 1.5 mm was implanted in the nucleus pulposus of a nondegenerated L4-L5 disc of a male volunteer 45-years-old and weighing 70 kg. Pressure was recorded with a telemetry system during a period of approximately 24 hours for various lying positions; sitting positions in a chair, in an armchair, and on a pezziball (ergonomic sitting ball); during sneezing, laughing, walking, jogging, stair climbing, load lifting during hydration over 7 hours of sleeping, and others. RESULTS The following values and more were measured: lying prone, 0.1 MPa; lying laterally, 0.12 MPa; relaxed standing, 0.5 MPa; standing flexed forward, 1.1 MPa; sitting unsupported, 0.46 MPa; sitting with maximum flexion, 0.83 MPa; nonchalant sitting, 0.3 MPa; and lifting a 20-kg weight with round flexed back, 2.3 MPa; with flexed knees, 1.7 MPa; and close to the body, 1.1 MPa. During the night, pressure increased from 0.1 to 0.24 MPa. CONCLUSIONS Good correlation was found with Nachemsons data during many exercises, with the exception of the comparison of standing and sitting or of the various lying positions. Notwithstanding the limitations related to the single-subject design of this study, these differences may be explained by the different transducers used. It can be cautiously concluded that the intradiscal pressure during sitting may in fact be less than that in erect standing, that muscle activity increases pressure, that constantly changing position is important to promote flow of fluid (nutrition) to the disc, and that many of the physiotherapy methods studied are valid, but a number of them should be re-evaluated.

Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants

Abstract New implants and new surgical approaches should be tested in vitro for primary stability in standardized laboratory tests in order to decide the most appropriate approach before being accepted for clinical use. Due to the complex and still unknown loading of the spine in vivo a variety of different test loading conditions have been used, making comparison of the results from different groups almost impossible. This recommendation was developed in a series of workshops with research scientists, orthopedic and trauma surgeons, and research and development executives from spinal implant companies. The purpose was to agree on in vitro testing conditions that would allow results from various research groups to be compared. This paper describes the recommended loading methods, specimen conditions, and analysis parameters resulting from these workshops.

Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study.

Study design This study investigated the influence of five different muscle groups on the monosegmental motion (L4–L5) during pure flexion/extension, lateral bending, and axial rotation moments. Objectives. The results showed and compared the effect of different muscle groups acting in different directions on the stability of a single motion segment to find loading conditions of in vitro experiments that simulate more physiologically reasonable loads. Summary of Background Data. In spine biomechanics research, most in vitro experiments have been carried out without applying muscle forces, even though these forces stabilize the spinal column in vivo. Methods. Seven human lumbosacral spines were tested in a spine tester that allows simulation of up to five symmetrical muscle forces. Changing pure flexion/extention, lateral binding, and axial rotation moments up to ±3.75 Nm were applied without muscle forces, with different muscle groups and combinations. The three-dimensional monosegmental motion was determined using an instrumented spatial linkage system. Results. Simulated muscle forces were found to strongly influence load-deformation characteristics. Muscle action generally increased the range of motion and the natural zone of the motion segments. This was most evident for flexion and extension. After five pairs of symmetrical, constant muscle forces were applied (80 N per pair) the range of motion decreased about 93% in flexion and 85% in extension. The total natural zone for flexion and extension was decreased by 83% muscle action. The multifluids muscle group had the strongest influence. Conclusion. This experiment showed the important of including at least some of the most important muscle groups in invitro experiments in lumbar spine specimens.

Are animal models useful for studying human disc disorders / degeneration?

Intervertebral disc (IVD) degeneration is an often investigated pathophysiological condition because of its implication in causing low back pain. As human material for such studies is difficult to obtain because of ethical and government regulatory restriction, animal tissue, organs and in vivo models have often been used for this purpose. However, there are many differences in cell population, tissue composition, disc and spine anatomy, development, physiology and mechanical properties, between animal species and human. Both naturally occurring and induced degenerative changes may differ significantly from those seen in humans. This paper reviews the many animal models developed for the study of IVD degeneration aetiopathogenesis and treatments thereof. In particular, the limitations and relevance of these models to the human condition are examined, and some general consensus guidelines are presented. Although animal models are invaluable to increase our understanding of disc biology, because of the differences between species, care must be taken when used to study human disc degeneration and much more effort is needed to facilitate research on human disc material.

Are sheep spines a valid biomechanical model for human spines

Study Design. Range of motion, neutral zone, and stiffness parameters of the complete cervical, thoracic, and lumbar sheep spine were determined in flexion and extension, axial left/right rotation, and right/left lateral bending. Objectives. To determine quantitative biomechanical properties of the sheep spine and compare them with those from the human spine. Summary of Background Data. Sheep spines often serve as a model for experimental in vivo and in vitro studies in spine research, but few quantitative biomechanical data from sheep spines for comparison with human specimens are available. Methods. Complete spines were sectioned into single‐joint segments and tested in a spine tester under pure moments in the three main anatomic planes. Results. The craniocaudal variation in range of motion in all load directions was qualitatively similar between sheep spines and values reported in the literature for human specimens. Conclusions. Based on the biomechanical similarities of sheep and human spines demonstrated in this study, it appears that the use of the sheep spine, which already includes evaluation of surgical techniques and bone healing processes, might be extended to spinal implants.

Dynamic Stabilization of the Lumbar Spine and Its Effects on Adjacent Segments An In Vitro Experiment

In recent years, nonfusion stabilization of the lumbar spine has gained more and more popularity. These nonfusion systems intend to maintain or restore the intersegmental motions to magnitudes of the intact spine and have no negative effects on the segments adjacent to the stabilized one. This study investigated the DYNESYS, a dynamic nonfusion system, which is designed to stabilize the bridged segments while maintaining the disc and the facet joints. To determine the magnitude of stabilization and the effect of the stabilization on the adjacent segment, six lumbar cadaver spines were fixed in a spine tester and loaded with pure moments in the three main motion planes. For each spine, four different stages were tested: intact, defect of the middle segment, fixation with the DYNESYS, and fixation with the internal fixator. Intersegmental motions were measured at all levels. For the bridged segment, the DYNESYS stabilized the spine and was more flexible than the internal fixator. This difference between the internal fixator and the DYNESYS was most pronounced in extension (P < 0.05), with the DYNESYS restoring the motion back to the level of the intact spine. The motion in the adjacent segments was not influenced by either stabilization method. Our results suggest that the DYNESYS provides substantial stability in case of degenerative spinal pathologies and can therefore be considered as an alternative method to fusion surgery in these indications while the motion segment is preserved.

Intradiscal pressure together with anthropometric data – a data set for the validation of models

OBJECTIVE To provide a database of intradiscal pressure measurements together with anthropometric data as basis for the validation of models that predict spinal loads. DESIGN Intradiscal pressure was measured in a non-degenerated L4-5 disc of a volunteer. The anthropometric characteristics of this subject were extensively determined. BACKGROUND Since it is usually impossible to quantify the load in the spine directly, it is predicted by various biomechanical models. However, they often cannot be validated because of the few in vivo data and missing anthropometric characteristics pertaining to them. METHODS A pressure transducer (diameter 1.5 mm) was implanted in the nucleus pulposus of a non-degenerated L4-5 disc of a volunteer. Pressure was determined during exercises while standing, lifting activities, sitting unsupported on a stool or an ergonomic sitting ball, sitting in different postures and others. The anthropometric characteristics were determined using different tools. RESULTS Pressure values: relaxed standing 0.5 MPa; standing flexed forward 1.1 MPa; standing extended backward 0.6 MPa; sitting unsupported 0.46 MPa; maximum values during lateral bending 0.6 MPa, during axial rotation 0.7 MPa, lifting a 20 kg weight with a round flexed back 2.3 MPa, with flexed knees 1.7 MPa, close to the body 1.1 MPa; sitting unsupported relaxed 0.45 MPa, actively straightening the back 0.55 MPa, with flexion 0.9 MPa; non-chalant sitting 0.3 MPa and others. Anthropometric characteristics with emphasis on data for the trunk are provided in tables.Conclusions. Intradiscal pressure depends on the kind of preceding activity, posture, external loads and muscle activity. RELEVANCE The data set can be used to verify a biomechanical model adjusted to the individual characteristics by a comparison of measured and predicted intradiscal pressures.

Anatomy of the sheep spine and its comparison to the human spine

The sheep spine is often used as a model for the human spine, although the degree to which these spines are anatomically comparable has yet to be categorically established. The purpose of this study was to investigate the characteristic anatomical dimensions of the sheep spine and to compare these with existing human data.

A universal spine tester for in vitro experiments with muscle force simulation

SummaryWe report a new apparatus to determine the quasistatic, three-dimensional, load-displacement characteristics of spines including muscle forces. The loading frame can be adapted to mono- and polysegmental specimens from the lumbar or cervical spine as well as to entire spines. Three force and three moment components can be applied in either direction individually or in combination with no constraint on the resulting motion; the loads can be applied at user-chosen rates of application and release with continuous recording of displacements, so as to study either creep or relaxation. The loads and displacement-measuring devices are computer-controlled. Thus, this testing device provides a tool for many kinds of stability tests and for basic research of spine biomechanics. A first experiment shows that the application of muscle forces significantly affects the load-deformation characteristics and intradiscal pressure.

Review of existing grading systems for cervical or lumbar disc and facet joint degeneration

The aim of this literature review was to present and to evaluate all grading systems for cervical and lumbar disc and facet joint degeneration, which are accessible from the MEDLINE database. A MEDLINE search was conducted to select all articles presenting own grading systems for cervical or lumbar disc or facet joint degeneration. To give an overview, these grading systems were listed systematically depending on the spinal region they refer to and the methodology used for grading. All systems were checked for reliability tests and those recommended for use having an interobserver Kappa or Intraclass Correlation Coefficient >0.60 if disc degeneration was graded and >0.40 if facet joint degeneration was graded. MEDLINE search revealed 42 different grading systems. Thirty of these were used to grade lumbar spine degeneration, ten were used to grade cervical spine degeneration and two were used to grade both. Thus, the grading systems for the lumbar spine represented the vast majority of all 42 grading systems. Interobserver reliability tests were found for 12 grading systems. Based on their Kappa or Intraclass Correlation Coefficients nine of these could be recommended for use and three could not. All other systems could neither be recommended nor not be recommended since reliability tests were missing. These systems should therefore first be tested before use. The design of the grading systems varied considerably. Five grading systems were beginning with the lowest degree of degeneration, 37, however, with the normal, not degenerated state. A 5-grade scale was used in six systems, a 4-grade scale in 24, a 3-grade scale in eight and a 2-grade scale in three systems. In 15 cases the normal, not degenerated state was assigned to “grade 0”, in another 15 cases, however, this state was assigned to “grade 1”. This wide variety in the design of the grading systems makes comparisons difficult and may easily lead to confusion. We would therefore recommend to define certain standards. Our suggestion would be to use a scale of three to five grades, to begin the scale with the not degenerated state and to assign this state to “grade 0”.