Assessment of spinal alignment in standing position using Biplanar X-ray images and three-dimensional vertebral models.

We developed two methods for three-dimensional (3D) evaluation of spinal alignment in standing position by image matching between biplanar x-ray images and 3D vertebral models. One used a Slot-Scanning 3D x-ray Imager (sterEOS) to obtain biplanar x-ray images, and the other used a conventional x-ray system and a rotating table. The 3D vertebral model was constructed from the CT scan data. The spatial position of the vertebral model was determined by minimizing the contour difference between the projected image of the model and the biplanar x-ray images. Verification experiments were conducted using a torso phantom. The relative positions of the upper vertebrae to the lowest vertebrae of the cervical, thoracic, and lumbar vertebrae were evaluated. The mean, standard deviation, and mean square error of the relative position were less than 1° and 1 mm in all cases for sterEOS. The maximum mean squared errors of the conventional x-ray system and the rotating table were 0.7° and 0.4 mm for the cervical spine, 1.0° and 1.2 mm for the thoracic spine, and 1.1° and 1.2 mm for the lumbar spine. Therefore, both methods could be useful for evaluating the spinal alignment in standing position.

Effect of corrective stresses on rods in adult spinal deformity surgery-finite element analysis.

BACKGROUND: The incidence of rod fracture after corrective surgery for adult spinal deformity (ASD) is high. Although many reports have investigated the effects of rod bending considering postoperative body motion, and countermeasures, there are no reports investigating the effects during intraoperative correction. The purpose of this study was to investigate the effect of ASD correction on rods by using finite element analysis (FEA) based on the rod shape changes before and after spinal corrective fusion. METHODS: Five ASD patients (mean age 73 years, all female) who underwent thoracic to pelvic fusion were included in this study. A 3D rod model was created using computer-aided design software from digital images of the intraoperatively bended rod and intraoperative X-ray images after corrective fusion. The 3D model of the bent rod was meshed by dividing each of the screw head intervals into 20 sections and cross-section of the rod into 48 sections. Two surgical fusion methods of stepwise fixation as the cantilever method and parallel fixation as the translational method were simulated to evaluate stress and bending moments on the rods during intraoperative correction. RESULTS: The stresses on the rods were 1500, 970, 930, 744, and 606 MPa in the five cases for stepwise fixation and 990, 660, 490, 508, and 437 MPa for parallel fixation, respectively, with parallel fixation having lower stresses in all cases. In all cases, maximum stress was found around the apex of the lumbar lordosis and near L5/S1. The bending moment was high around L2-4 in most cases. CONCLUSIONS: The external forces of intraoperative correction had the greatest effect on the lower lumbar region, especially around the apex of the lumbar lordosis.

Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study.

STUDY DESIGN: A finite element analysis study. OBJECTIVE: Of proximal junctional failure, upper instrumented vertebra (UIV) fracture can causes severe spinal cord injury. Previously, we reported that higher occupancy rate of pedicle screw (ORPS) at UIV prevented UIV fracture in adult spinal deformity surgery; we had not yet tested this finding using a biomechanical study. The purpose of present study was to measure the differences in loads on the UIV according to the length of PS and ORPS. METHODS: We designed an FE model of a lumbar spine (L1-S1) using FE software. The PS was set from L2 to S1 and connected the rod. The FE model simulated flexion (8 Nm) to investigate the loads at UIV (L2) according to the length of the PS. There were 5 screw lengths examined: 40 (ORPS 36.4%), 45 (48.5%), 50 (66.7%), 55 (81.8%), and 60 mm (93.9%). RESULTS: Stress with bending motion was likely to occur at the upper front edge of the vertebral body, the pedicles, and the screw insertion point. The maximum equivalent stress according to screw lengths of 40, 45, 50, 55, and 60 mm were 45.6, 37.2, 21.6, 13.3, and 14.8 MPa, respectively. The longer screw, the less stress was applied to UIV. No remarkable change was observed between the screw lengths of 55 and 60 mm. CONCLUSIONS: Increasing ORPS to 81.8% or more reduced the load on the UIV. To prevent UIV fracture, the PS length in the UIV should be more than ORPS 81.8%.

Wear transition of solid-solution-strengthened Ti-29Nb-13Ta-4.6Zr alloys by interstitial oxygen for biomedical applications.

In previous studies, it has been concluded that volume losses (V loss) of the Ti-29Nb-13Ta-4.6Zr (TNTZ) discs and balls are larger than those of the respective Ti-6Al-4V extra-low interstitial (Ti64) discs and balls, both in air and Ringer's solution. These results are related to severe subsurface deformation of TNTZ, which is caused by the lower resistance to plastic shearing of TNTZ than that of Ti64. Therefore, it is necessary to further increase the wear resistance of TNTZ to satisfy the requirements as a biomedical implant. From this viewpoint, interstitial oxygen was added to TNTZ to improve the plastic shear resistance via solid-solution strengthening. Thus, the wear behaviors of combinations comprised of a new titanium alloy, TNTZ with high oxygen content of 0.89 mass% (89O) and a conventional titanium alloy, Ti64 were investigated in air and Ringer's solution for biomedical implant applications. The worn surfaces, wear debris, and subsurface damage were analyzed using a scanning electron microscopy and an electron probe microanalysis. V loss of the 89O discs and balls are smaller than those of the respective TNTZ discs and balls in both air and Ringer's solution. It can be concluded that the solid-solution strengthening by oxygen effectively improves the wear resistance for TNTZ materials. However, the 89O disc/ball combination still exhibits higher V loss than the Ti64 disc/ball combination in both air and Ringer's solution. Moreover, V loss of the disc for the 89O disc/Ti64 ball combination significantly decreases in Ringer's solution compared to that in air. This decrease for the 89O disc/Ti64 ball combination in Ringer's solution can be explained by the transition in the wear mechanism from severe delamination wear to abrasive wear.

Mechanical properties and cytocompatibility of oxygen-modified ß-type Ti-Cr alloys for spinal fixation devices.

In this study, various amounts of oxygen were added to Ti-10Cr (mass%) alloys. It is expected that a large changeable Young's modulus, caused by a deformation-induced ω-phase transformation, can be achieved in Ti-10Cr-O alloys by the appropriate oxygen addition. This "changeable Young's modulus" property can satisfy the otherwise conflicting requirements for use in spinal implant rods: high and low moduli are preferred by surgeons and patients, respectively. The influence of oxygen on the microstructures and mechanical properties of the alloys was examined, as well as the bending springback and cytocompatibility of the optimized alloy. Among the Ti-10Cr-O alloys, Ti-10Cr-0.2O (mass%) alloy shows the largest changeable Young's modulus following cold rolling for a constant reduction ratio. This is the result of two competing factors: increased apparent ß-lattice stability and decreased amounts of athermal ω phase, both of which are caused by oxygen addition. The most favorable balance of these factors for the deformation-induced ω-phase transformation occurred at an oxygen concentration of 0.2mass%. Ti-10Cr-0.2O alloy not only exhibits high tensile strength and acceptable elongation, but also possesses a good combination of high bending strength, acceptable bending springback and great cytocompatibility. Therefore, Ti-10Cr-0.2O alloy is a potential material for use in spinal fixture devices.

Predominant factor determining wear properties of ß-type and (α+ß)-type titanium alloys in metal-to-metal contact for biomedical applications.

The predominant factor determining the wear properties of a new titanium alloy, Ti-29Nb-13Ta-4.6Zr (TNTZ) and a conventional titanium alloy, Ti-6Al-4V extra-low interstitial (Ti64) was investigated for TNTZ and Ti64 combinations in metal-to-metal contacting bio-implant applications. The worn surfaces, wear debris, and subsurface damages were analyzed using a scanning electron microscopy combined with energy-dispersive spectroscopy and electron-back scattered diffraction analysis. The volume loss of TNTZ is found to be larger than that of Ti64, regardless of the mating material. The wear track of TNTZ exhibits the galled regions and severe plastic deformation with large flake-like debris, indicative of delamination wear, which strongly suggests the occurrence of adhesive wear. Whereas, the wear track of Ti64 have a large number of regular grooves and microcuttings with cutting chip-like wear debris and microfragmentation of fine oxide debris, indicative of abrasive wear combined with oxidative wear. This difference in the wear type is caused by severe and mild subsurface deformations of TNTZ and Ti64, respectively. The lower resistance to plastic shearing for TNTZ compared to that of Ti64 induces delamination, resulting in a higher wear rate.

Effects of micro- and nano-scale wave-like structures on fatigue strength of a beta-type titanium alloy developed as a biomaterial.

Some newly developed ß-type titanium alloys for biomedical applications exhibit distinctive heterogeneous structures. The formation mechanisms for these structures have not been completely revealed; however, understanding these mechanisms could lead to improving their properties. In this study, the heterogeneous structures of a Ti-29Nb-13Ta-4.6Zr alloy (TNTZ), which is a candidate for next-generation metallic biomaterials, were analyzed. Furthermore, the effects of such heterogeneous structures on the mechanical strength of this alloy, including fatigue strength, were revealed by comparing its strength to that of homogenous TNTZ. The heterogeneous structures were characterized micro-, submicro- and nano-scale wave-like structures. The formation mechanisms of these wave-like structures are found to be different from each other even though their morphologies are similar. It is revealed that the micro-, submicro- and nano-scale wave-like structures are caused by elemental segregation, crystal distortion related to kink band and phase separation into ß and ß', respectively. However, these structures have no significant effect on both tensile properties and fatigue strength comparison with homogeneous structure in this study.

Development of thermo-mechanical processing for fabricating highly durable ß-type Ti-Nb-Ta-Zr rod for use in spinal fixation devices.

The mechanical strength of a beta titanium alloy such as Ti-Nb-Ta-Zr alloy (TNTZ) can be improved significantly by thermo-mechanical treatment. In this study, TNTZ was subjected to solution treatment, cold caliber rolling, and cold swaging before aging treatment to form a rod for spinal fixation. The {110}(ß) are aligned parallel to the cross-section with two strong peaks approximately 180° apart, facing one another, in the TNTZ rods subjected to cold caliber rolling and six strong peaks at approximately 60° intervals, facing one another, in the TNTZ rods subjected to cold swaging. Therefore, the TNTZ rods subjected to cold swaging have a more uniform structure than those subjected to cold caliber rolling. The orientation relationship between the α and ß phases is different. A [110](ß)//[121](α), (112)(ß)//(210)(α) orientation relationship is observed in the TNTZ rods subjected to aging treatment at 723 K after solution treatment and cold caliber rolling. On the other hand, a [110](ß)//[001](α), (112)(ß)//(200)(α) orientation relationship is observed in TNTZ rod subjected to aging treatment at 723 K after cold swaging. A high 0.2% proof stress of about 1200 MPa, high elongation of 18%, and high fatigue strength of 950 MPa indicate that aging treatment at 723 K after cold swaging is the optimal thermo-mechanical process for a TNTZ rod.