Evaluation and Prediction of Human Lumbar Vertebrae Endplate Mechanical Properties Using Indentation and Computed Tomography.

Current implant materials and designs used in spinal fusion show high rates of subsidence. There is currently a need for a method to predict the mechanical properties of the endplate using clinically available tools. The purpose of this study was to develop a predictive model of the mechanical properties of the vertebral endplate at a scale relevant to the evaluation of current medical implant designs and materials. Twenty vertebrae (10 L1 and 10 L2) from 10 cadavers were studied using dual-energy X-ray absorptiometry to define bone status (normal, osteopenic, or osteoporotic) and computed tomography (CT) to study endplate thickness (µm), density (mg/mm3), and mineral density of underlying trabecular bone (mg/mm3) at discrete sites. Apparent Oliver-Pharr modulus, stiffness, maximum tolerable pressure (MTP), and Brinell hardness were measured at each site using a 3 mm spherical indenter. Predictive models were built for each measured property using various measures obtained from CT and demographic data. Stiffness showed a strong correlation between the predictive model and experimental values (r = 0.85), a polynomial model for Brinell hardness had a stronger predictive ability compared to the linear model (r = 0.82), and the modulus model showed weak predictive ability (r = 0.44), likely due the low indentation depth and the inability to image the endplate at that depth (≈0.15 mm). Osteoporosis and osteopenia were found to be the largest confounders of the measured properties, decreasing them by approximately 50%. It was confirmed that vertebral endplate mechanical properties could be predicted using CT and demographic indices.

Interbody Spacer Material Properties and Design Conformity for Reducing Subsidence During Lumbar Interbody Fusion.

There is a need to better understand the effects of intervertebral spacer material and design on the stress distribution in vertebral bodies and endplates to help reduce complications such as subsidence and improve outcomes following lumbar interbody fusion. The main objective of this study was to investigate the effects of spacer material on the stress and strain in the lumbar spine after interbody fusion with posterior instrumentation. A standard spacer was also compared with a custom-fit spacer, which conformed to the vertebral endplates, to determine if a custom fit would reduce stress on the endplates. A finite element (FE) model of the L4-L5 motion segment was developed from computed tomography (CT) images of a cadaveric lumbar spine. An interbody spacer, pedicle screws, and posterior rods were incorporated into the image-based model. The model was loaded in axial compression, and strain and stress were determined in the vertebra, spacer, and rods. Polyetheretherketone (PEEK), titanium, poly(para-phenylene) (PPP), and porous PPP (70% by volume) were used as the spacer material to quantify the effects on stress and strain in the system. Experimental testing of a cadaveric specimen was used to validate the model's results. There were no large differences in stress levels (<3%) at the bone-spacer interfaces and the rods when PEEK was used instead of titanium. Use of the porous PPP spacer produced an 8-15% decrease of stress at the bone-spacer interfaces and posterior rods. The custom-shaped spacer significantly decreased (>37%) the stress at the bone-spacer interfaces for all materials tested. A 28% decrease in stress was found in the posterior rods with the custom spacer. Of all the spacer materials tested with the custom spacer design, 70% porous PPP resulted in the lowest stress at the bone-spacer interfaces. The results show the potential for more compliant materials to reduce stress on the vertebral endplates postsurgery. The custom spacer provided a greater contact area between the spacer and bone, which distributed the stress more evenly, highlighting a possible strategy to decrease the risk of subsidence.

Monotonic and cyclic loading behavior of porous scaffolds made from poly(para-phenylene) for orthopedic applications.

Porous poly(para-phenylene) (PPP) scaffolds have tremendous potential as an orthopedic biomaterial; however, the underlying mechanisms controlling the monotonic and cyclic behavior are poorly understood. The purpose of this study was to develop a method to integrate micro-computed tomography (µCT), finite-element analysis (FEA), and experimental results to uncover the relationships between the porous structure and mechanical behavior. The µCT images were taken from porous PPP scaffolds with a porosity of 75vol% and pore size distribution between 420 and 500µm. Representative sections of the image were segmented and converted into finite-element meshes. It was shown through FEA that localized stresses within the microstructure were approximately 100 times higher than the applied global stress during the linear loading regime. Experimental analysis revealed the S-N fatigue curves for fully dense and porous PPP samples were parallel on log-log plots, with the endurance limit for porous samples in tension being approximately 100 times lower than their solid PPP counterparts (0.3-35MPa) due to the extreme stress concentrations caused by the porous microarchitecture. The endurance limit for porous samples in compression was much higher than in tension (1.60MPa). Through optical, laser-scanning, and scanning-electron microscopy it was found that porous tensile samples failed under Mode I fracture in both monotonic and cyclic loading. By comparison, porous compressive samples failed via strut buckling/pore collapse monotonically and by shearing fracture during cyclic loading. Monotonic loading showed that deformation behavior was strongly correlated with pore volume fraction, matching foam theory well; however, fatigue behavior was much more sensitive to local stresses believed to cause crack nucleation.