The diagnostic performance of vertebral displacement measurements derived from ultrasonic indentation in an in vivo model of degenerative disc disease.

STUDY DESIGN: The diagnostic performance of a newly described variable was assessed in an in vivo model of disc degeneration using a split-pair experimental design. OBJECTIVE: To determine if vertebral displacement measures generated from ultrasonic indentation could distinguish between experimental and control groups of animals. SUMMARY OF BACKGROUND DATA: Few procedures are available that noninvasively assess subcutaneous vertebral mechanics. Information from such a procedure would be of value in determining potential clinical relevance of spinal mechanics with respect to low back pain. METHODS: Eight adolescent pigs underwent endplate perforation surgery to initiate lumbar disc degeneration. After 4 months of recovery, these and eight age-matched controls were assessed by ultrasonic indentation, a noninvasive procedure that quantifies vertebral displacements in the plane of loading-indentation. Each animal then received a facetectomy and was reindented at the same location as confirmed by ultrasonic imaging. Discal materials were removed postmortem for analysis. RESULTS: Degenerative discs exhibited morphologic changes consistent with early degenerative disc disease. Prefacetectomy comparison of vertebral displacement measures between control and experimental animals resulted in sensitivity, specificity, and diagnostic accuracy values of 75.0%, 83.3%, and 77%, respectively. After facetectomy these values increased to 87.5%, 83.3%, and 85%, respectively. These measures of diagnostic performance were comparable or superior to those of existing clinical techniques (invasive or otherwise) used to assess degenerative conditions of the spine. CONCLUSIONS: The results of this study suggest that noninvasive measures of vertebral displacement are clinically significant and possess the additional advantages of being objective and noninvasive.

1997 Volvo Award winner in biomechanical studies. Kinematic behavior of the porcine lumbar spine: a chronic lesion model.

STUDY DESIGN: Experimental models of intervertebral disc and facet joint degeneration were created in vivo in the porcine lumbar spine for studying spinal kinematics, using a dynamic technique. OBJECTIVES: To quantify the changes in spinal kinematics and the stabilizing capacity of the lumbar musculature caused by chronic lesions in the intervertebral disc and facet joints. SUMMARY OF BACKGROUND DATA: Segmental kinematics are detrimentally altered by acute injury to passive structures of the motion segment. However, stimulation of the surrounding musculature adds stability to the motion segment. The in vivo kinematics of a degenerated lumbar motion segment and the stabilizing function of the surrounding musculature have not been quantified dynamically. METHODS: Forty-four pigs were used in six chronic lesions models: sham, disc anulus, disc nucleus, facet capsule, facet joint slit, and facet joint wedge. Three months after injury, an instrumented linkage was used to measure continuously the sagittal kinematics of the L3-L4 motion segment during flexion-extension, with and without stimulation of the lumbar paraspinal musculature. Flexion-extension end point and maximum ranges of motion, and hysteresis were analyzed. RESULTS: Significant alterations in the kinematics caused by chronic lesions were observed, particularly when using the maximum range of motion and when comparing changes in axial translation. Muscular stimulation reduced the hysteresis in the sham, facet capsule, and disc nucleus groups; however, increased hysteresis was observed in the remaining lesion groups. CONCLUSIONS: The kinematic behavior of motion segments with chronic lesions was established. The maximum range of motion, which must be measured using a dynamic technique, was a more sensitive parameter for identifying changes in segmental kinematics caused by chronic lesions than was the end range of motion. The lumbar musculature was less efficient overall in stabilizing the motion segment, possibly because of altered mechanisms in the neuromuscular feedback system.

Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles.

STUDY DESIGN: A porcine model was used to study whether muscular activation in the paraspinal muscles caused by nerve stimulation in the anulus fibrosus of a lumbar intervertebral disc could be altered by saline injection into the zygapophysial (facet) joint. OBJECTIVES: To elucidate possible mechanisms regarding the nerve pathways and interactions between the intervertebral disc, zygapophysial joints, and the paraspinal musculature. SUMMARY OF BACKGROUND DATA: The physiologic basis for chronic low back pain, including muscular spasm, is uncertain. Although extensive research involving the lumbar motion segments and the surrounding tissues has been performed, the neuromuscular connection has not been sufficiently investigated. MATERIALS AND METHODS: Twenty-three adolescent pigs were used to measure the electromyographic response in the paraspinal musculature to electrical stimulation of the posterolateral L3-L4 anulus fibrosus, before and after introduction of physiologic saline into the zygapophysial joint. Motor unit action potentials were recorded using three sets of needle electrodes placed into the deepest fascicles of the multifidus, bilateral to the L4 and L5 spinous processes, and into the central longissimus musculature, bilateral to the L4 spinous process. RESULTS: Stimulation of the nerves within the posterolateral anulus of the disc elicited reactions in the paraspinal muscles, namely the lumbar multifidus and longissimus. Introduction of physiologic saline into the zygapophysial joint resulted in a reduction in the motor unit action potential amplitude. This reduction was manifested as an immediate and constant reduction, a graded reduction, or a delayed reaction, during which the reduction occurred an average of 5 minutes after the saline injection. CONCLUSIONS: Introduction of physiologic saline into the zygapophysial joint reduced the stimulation pathway from the intervertebral disc to the paraspinal musculature. The zygapophysial joints may therefore have a regulating function, controlling the intricate neuromuscular balance in the lumbar motion segment.

Experimental instability in the lumbar spine.

STUDY DESIGN: An in vivo animal model of lumbar segmental instability, involving both passive and active stabilizing components of the spine, was developed. OBJECTIVE: The aim of this investigation was to dynamically study the alterations in segmental kinematics as a result of interventions to the passive stabilizing components and to the lumbar musculature. SUMMARY OF BACKGROUND DATA: Segmental instability in the lumbar spine is associated with abnormal intervertebral motion. The majority of biomechanical studies have examined the in vitro effects of transecting individual stabilizing structures (i.e., intervertebral disc, facet joints, and ligaments), and have not simultaneously considered the effects of active musculature on spinal kinematics, which exist in the in vivo environment. Also, few studies have evaluated the kinematic behavior in the neutral region, for example, the transition phase between flexion and extension. METHODS: Four experimental groups comprised 33 pigs, each of which followed different surgical injury sequences to the L3-L4 motion segment. An instrumented linkage attached to the L3-L4 motion segment was used to measure the sagittal kinematics during dynamic flexion-extension after each surgical injury and after bilateral stimulation of the lumbar paraspinal musculature. RESULTS: Injuries to the disc resulted in greater overall axial translation. Graded injuries to the facet joint mainly caused changes in sagittal rotation and shear translation. When the facet injuries were compounded by removal of the transverse processes, there was significantly greater coupled motion and increased hysteresis in the neutral region for rotation. Extensive muscular stimulation after each of the injuries caused significantly greater rotation and shear translation, along with a tendency toward reduced axial translation, when compared to the unstimulated case. Although increasing the range of motion, increased muscular activity stabilized the injured motion segment by smoothing the erratic rotation pattern of motion, particularly in the neutral region. CONCLUSIONS: Because of the direct attachment to the vertebrae, both passive and active strain from the musculature influence the spinal kinematics in normal or destabilized motion segments. Although increasing the range of motion, stimulation of the musculature surrounding the injured motion segment has a stabilizing effect by reducing abrupt kinematic behavior, particularly in the neutral region where the muscles are under reduced tension. A facetectomy produces a paradoxical kinematic behavior, which enhances the unstable condition of the motion segment. Surgical and rehabilitative treatments for patients with segmental instability need to consider the physiologic influences of the spinal musculature.

1990 Volvo Award in experimental studies. The dependence of intervertebral disc mechanical properties on physiologic conditions.

In vivo creep-recovery and disc pressure measurements were performed on the lumbar spine of immature and mature swine. The creep-recovery measurements were performed using a custom materials testing apparatus designed to apply static or dynamic loads to the spine of anesthetized animals. A series of three separate experiments were performed to assess the effects of: (I) animal death, (II) graded injury to the disc anulus, and (III) respiratory mechanics on the biomechanical response of the porcine L1-L3 vertebral unit (VU). In Experiments I and II, creep rate, modulus, and viscosity parameters were computed using a three-parameter solid rheological analysis of the displacement-time response recorded during the application of a 300-N load. In Experiment III, the effects of respiratory volume and frequency changes on disc pressure were assessed in the unloaded, statically loaded, and immobilized porcine VU. Our results indicated that the adult VU tended to be stiffer, deform or creep more slowly, and had a significantly higher viscosity than the VU of immature pigs. The results of Experiment I demonstrated that the biomechanical response for the VU was significantly altered by the death of the animal; the VU of the living animal (adolescent or mature) was more compliant and deformed at a faster rate than the VU of the same animal after death. Disc injury produced changes in stiffness, viscosity, and creep rate analogous to that of aging, and on the basis of the graded injuries created in this study, it appears that a small defect in the annulus is just as deleterious as removing a large section of anular material. The results of Experiment III indicated that respiration plays an important role in the normal, in vivo mechanical and nutritional behavior of the porcine VU. Altogether, these results demonstrate that, in the absence of normal physiologic conditions, one may not be able to reliably predict the mechanical response of the lumbar spine, and suggest that standards for the testing, handling, and storage of biologic tissue should be established.

In vivo creep behavior of the normal and degenerated porcine intervertebral disk: a preliminary report.

The viscoelastic properties of normal and surgically altered lumbar intervertebral disks from eight immature swine were examined in vivo. Rheological models were used to mathematically characterize the compressive creep-relation behavior of the disks before and after alteration by either chemonucleolysis [chymopapain (Chymodyactin) injection] or denucleation. In the normal disks, a significant modulating effect of respiration was observed that tended to increase the creep deformation response in comparison to that observed during similar in vitro and in situ studies. These results suggest that, in terms of assessing the absolute magnitude of the viscoelastic properties of lumbar disks, the influence of normal physiological function on adjacent vertebrae and surrounding tissues cannot be neglected. Preliminary results obtained from the experimentally altered disks indicated that partial denucleation primarily affected the initial stiffness behavior of the disk (24% decrease in elastic modulus), whereas chemonucleolysis caused changes in both the time-dependent (15% increase in creep rate) and instantaneous (23% decrease in elastic modulus) properties of the disk. Both partial denucleation and acute chemonucleolysis produced biomechanical changes that were comparable to grade II or slightly degenerative, age-related changes found in human lumbar intervertebral disks.