In vivo measurement of the subchondral bone thickness of lumbar facet joint using magnetic resonance imaging.

OBJECTIVE: To measure in vivo thicknesses of the facet joint subchondral bone across genders, age groups, with or without low back pain symptom groups and spinal levels. METHODS: Lumbar (L1-L2 to L5-S1) magnetic resonance (MR) imaging was performed in 81 subjects (41 males and 40 females, mean age 37.6 years). Thicknesses of the subchondral bone were measured in 1620 facet joints using the MR images with custom-written image processing algorithms together with a multi-threshold segmentation technique using each facet joint's middle axial-slice. This method was validated with 12 cadaver facet joints, scanned with both MR and micro-computed tomography images. RESULTS: An overall average thickness value for the 1620 analyzed joints was measured as 1.56±0.01 mm. The subchondral bone thickness values showed significant increases with successive lower spinal levels in the subjects without low back pain. The facet joint subchondral bone thickness in asymptomatic females was much smaller than in asymptomatic males. Mean subchondral bone thickness in the superior facet was greater than that in the inferior facet in both female and male asymptomatic subjects. CONCLUSIONS: This study is the first to quantitatively show subchondral bone thickness using a validated MR-based technique. The subchondral bone thickness was greater in asymptomatic males and increased with each successive lower spinal level. These findings may suggest that the subchondral bone thickness increases with loading. Furthermore, the superior facet subchondral bone was thicker than the inferior facet in all cases regardless of gender, age or spinal level in the subjects without low back pain. More research is needed to link subchondral bone microstructure to facet joint kinematics and spinal loads.

Does the asymmetry multiplier in the 1991 NIOSH lifting equation adequately control the biomechanical loading of the spine?

The aim of this research was to evaluate whether the asymmetry multiplier incorporated in the 1991 National Institute for Occupational Safety and Health lifting equation adequately controls the biomechanical spine loads during asymmetric lifting. Sixteen male subjects lifted a box from four initial locations varying in terms of the angular deviation from the mid-sagittal plane (0, 30, 60 and 90 degrees). From each location, boxes that weighed the recommended weight limit (RWL) and three times the RWL were lifted at two qualitatively defined lifting speeds. Ground reaction forces were combined with kinematic data in a linked-segment model to quantify the 3-D moments at the base of the spine (L5/S1) and the spine compression forces. The results show that the twisting and lateral bending moments increased with task asymmetry despite the lessening of the RWL (p<0.01). The flexion moment and the spine compression decreased with asymmetry, although at a slower rate than the RWL. When the dynamics were removed from the linked segment spine model to approximate the assumption of slow and smooth lifting, the estimated compression remained approximately 3400 N across all asymmetry conditions. Thus, the reduction in the RWL due to asymmetry multiplier appears appropriate and should not be changed, as been suggested by recent psychophysical studies.

The combination of pamidronate and calcitriol reverses particle- and TNF-alpha-induced altered functions of bone-marrow-derived stromal cells with osteoblastic phenotype.

Periprosthetic bone loss after total joint arthroplasty is a major clinical problem resulting in aseptic loosening of the implant. Among many cell types, osteoblasts play a crucial role in the development of peri-implant osteolysis. In this study, we tested the effects of calcitriol (1alpha,25-dihydroxy-vitamin-D3) and the bisphosphonate pamidronate on titanium-particle- and TNF-alpha-induced release of interleukin-6 and suppression of osteoblast-specific gene expressions in bone-marrow-derived stromal cells with an osteoblastic phenotype. We monitored the expression of procollagen alpha1[1], osteocalcin, osteonectin and alkaline phosphatase mRNAs by Northern blots and real-time reverse transcription and polymerase chain reaction analyses. The release of various cytokines was also analysed by ELISA. We found that calcitriol or pamidronate could only partially recover the altered functions of osteoblasts when added alone. Only a combination of these compounds restored all the tested functions of osteoblasts. The local delivery of these drugs may have therapeutic potential to prevent or to treat periprosthetic osteolysis and aseptic loosening of implants.

Recombinant osteogenic protein-1 upregulates extracellular matrix metabolism by rabbit annulus fibrosus and nucleus pulposus cells cultured in alginate beads.

This study was performed to determine if recombinant human osteogenic protein-1 (rhOP-1) is effective in promoting matrix synthesis and matrix formation by rabbit nucleus pulposus (NP) and annulus fibrosus (AF) cells cultured in alginate beads. The effects of culturing the cells in the presence of various concentrations of rhOP-1 were assessed by measuring changes in cell proliferation, proteoglycan (PG) and collagen synthesis and mRNA expression, and in the matrix contents of PG and collagen, as indicators of matrix accumulation. At high concentrations, rhOP-1 had a moderate mitogenic effect on both NP and AF cells. It also stimulated the synthesis of PG and collagen in a dose-dependent manner: this was associated with a corresponding increase in the expression of mRNA for aggrecan core protein and collagen type II. The stimulatory effect of rhOP-1 on PG synthesis was more pronounced than that on collagen synthesis. Continuous treatment with rhOP-1 led to an increase in the total DNA, PG and collagen contents in both NP and AF cultures. The results presented here provide evidence of the ability of rhOP-1 to stimulate the metabolism of both rabbit AF and NP cells cultured in alginate beads.

Effect of annular incision type on the change in biomechanical properties in a herniated lumbar intervertebral disc.

The technique used to incise the disc during discectomy may play a role in the subsequent healing and change in biomechanical stiffness of the disc. Several techniques of lumbar disc annulotomy have been described in clinical reports. The purpose of this paper was to study the influence of annulotomy technique on motion segment stiffness using a finite element model. Four incision methods (square, circular, cross, and slit) were compared. The analyses showed that each of the annular incisions produced increase in motions under axial moment loadings with circular incision producing the largest change in the corresponding rotational motion. Under shear loading mode, cross and slit-type annular incisions produced slightly larger changes in the principal motions of the disc than square and circular incisions. All other incision types considered in the current study produced negligibly small increase in motion under rest of the loading conditions. In addition to annulotomy, when nucleotomy was also included in the analyses, once again cross and slit incisions produced larger change in motion under shear loading mode as compared to the other two incision types. A comparison between the four types of annular incisions showed that cross incision produced an increase in motion larger than those produced by the other three incisions under flexion/extension and lateral moment loading and both shear force loadings. Circular incision produced the largest increase in motion under axial moment load in comparison to those produced by square, cross, and slit incisions. Sagittal plane symmetry was influenced by the incision injury to the motion segment leading to coupled motions as well as increased facet loads. From the study it can be concluded that the increase inflexibility of the disc due to annulotomy depends on the type of annulotomy and the annulotomy also produce asymmetrical deformations leading to increased facet loading.