Moment-rotation behavior of intervertebral joints in flexion-extension, lateral bending, and axial rotation at all levels of the human spine: A structured review and meta-regression analysis.

Spinal intervertebral joints are complex structures allowing motion in multiple directions, and many experimental studies have reported moment-rotation response. However, experimental methods, reporting of results, and levels of the spine tested vary widely, and a comprehensive assessment of moment-rotation response across all levels of the spine is lacking. This review aims to characterize moment-rotation response in a consistent manner for all levels of the human spine. A literature search was conducted in PubMed for moment versus rotation data from mechanical testing of intact human cadaveric intervertebral joint specimens in flexion-extension, lateral bending, and axial rotation. A total of 45 studies were included, providing data from testing of an estimated 1,648 intervertebral joints from 518 human cadavers. We used mixed-effects regression analysis to create 75 regression models of moment-rotation response (25 intervertebral joints × 3 directions). We found that a cubic polynomial model provides a good representation of the moment-rotation behavior of most intervertebral joints, and that compressive loading increases rotational stiffness throughout the spine in all directions. The results allow for the direct evaluation of intervertebral ranges of motion across the whole of the spine for given loading conditions. The random-effects outcomes, representing standard deviations of the model coefficients across the dataset, can aid understanding of normal variations in moment-rotation responses. Overall these results fill a large gap, providing the first realistic and comprehensive representations of moment-rotation behavior at all levels of the spine, with broad implications for surgical planning, medical device design, computational modeling, and understanding of spine biomechanics.

The rib cage stiffens the thoracic spine in a cadaveric model with body weight load under dynamic moments.

The thoracic spine presents a challenge for biomechanical testing. With more segments than the lumbar and cervical regions and the integration with the rib cage, experimental approaches to evaluate the mechanical behavior of cadaveric thoracic spines have varied widely. Some researchers are now including the rib cage intact during testing, and some are incorporating follower load techniques in the thoracic spine. Both of these approaches aim to more closely model physiological conditions. To date, no studies have examined the impact of the rib cage on thoracic spine motion and stiffness in conjunction with follower loads. The purpose of this research was to quantify the mechanical effect of the rib cage on cadaveric thoracic spine motion and stiffness with a follower load under dynamic moments. It was hypothesized that the rib cage would increase stiffness and decrease motion of the thoracic spine with a follower load. Eight fresh-frozen human cadaveric thoracic spines with rib cages (T1-T12) were loaded with a 400 N compressive follower load. Dynamic moments of ±â€¯5 N m were applied in lateral bending, flexion/extension, and axial rotation, and the motion and stiffness of the specimens with the rib cage intact have been previously reported. This study evaluated the motion and stiffness of the specimens after rib cage removal, and compared the data to the rib cage intact condition. Range-of-motion and stiffness were calculated for the upper, middle, and lower segments of the thoracic spine. Range-of-motion significantly increased with the removal of the rib cage in lateral bending, flexion/extension, and axial rotation by 63.5%, 63.0%, and 58.8%, respectively (p < 0.05). Neutral and elastic zones increased in flexion/extension and axial rotation, and neutral zone stiffness decreased in axial rotation with rib cage removal. Overall, the removal of the rib cage increases the range-of-motion and decreases the stiffness of cadaveric thoracic spines under compressive follower loads in vitro. This study suggests that the rib cage should be included when testing a cadaveric thoracic spine with a follower load to optimize clinical relevance.

The rib cage reduces intervertebral disc pressures in cadaveric thoracic spines by sharing loading under applied dynamic moments.

The effects of the rib cage on thoracic spine loading are not well studied, but the rib cage may provide stability or share loads with the spine. Intervertebral disc pressure provides insight into spinal loading, but such measurements are lacking in the thoracic spine. Thus, our objective was to examine thoracic intradiscal pressures under applied pure moments, and to determine the effect of the rib cage on these pressures. Human cadaveric thoracic spine specimens were positioned upright in a testing machine, and Dynamic pure moments (0 to ±5 N·m) with a compressive follower load of 400 N were applied in axial rotation, flexion - extension, and lateral bending. Disc pressures were measured at T4-T5 and T8-T9 using needle-mounted pressure transducers, first with the rib cage intact, and again after the rib cage was removed. Changes in pressure vs. moment slopes with rib cage removal were examined. Pressure generally increased with applied moments, and pressure-moment slope increased with rib cage removal at T4-T5 for axial rotation, extension, and lateral bending, and at T8-T9 for axial rotation. The results suggest the intact rib cage carried about 62% and 56% of axial rotation moments about T4-T5 and T8-T9, respectively, as well as 42% of extension moment and 36-43% of lateral bending moment about T4-T5 only. The rib cage likely plays a larger role in supporting moments than compressive loads, and may also play a larger role in the upper thorax than the lower thorax.

Effect of follower load on motion and stiffness of the human thoracic spine with intact rib cage.

Researchers have reported on the importance of the rib cage in maintaining mechanical stability in the thoracic spine and on the validity of a compressive follower preload. However, dynamic mechanical testing using both the rib cage and follower load has never been studied. An in vitro biomechanical study of human cadaveric thoracic specimens with rib cage intact in lateral bending, flexion/extension, and axial rotation under varying compressive follower preloads was performed. The objective was to characterize the motion and stiffness of the thoracic spine with intact rib cage and follower preload. The hypotheses tested for all modes of bending were (i) range of motion, elastic zone, and neutral zone will be reduced with a follower load, and (ii) neutral and elastic zone stiffness will be increased with a follower load. Eight human cadaveric thoracic spine specimen (T1-T12) with intact rib cage were subjected to 5Nm pure moments in lateral bending, flexion/extension, and axial rotation under follower loads of 0-400N. Range of motion, elastic and neutral zones, and elastic and neutral zone stiffness values were calculated for functional spinal units and segments within the entire thoracic section. Combined segmental range of motion decreased by an average of 34% with follower load for every mode. Application of a follower load with intact rib cage impacts the motion and stiffness of the human cadaveric thoracic spine. Researchers should consider including both aspects to better represent the physiologic implications of human motion and improve clinically relevant biomechanical thoracic spine testing.

Effects of follower load and rib cage on intervertebral disc pressure and sagittal plane curvature in static tests of cadaveric thoracic spines.

The clinical relevance of mechanical testing studies of cadaveric human thoracic spines could be enhanced by using follower preload techniques, by including the intact rib cage, and by measuring thoracic intervertebral disc pressures, but studies to date have not incorporated all of these components simultaneously. Thus, this study aimed to implement a follower preload in the thoracic spine with intact rib cage, and examine the effects of follower load, rib cage stiffening and rib cage removal on intervertebral disc pressures and sagittal plane curvatures in unconstrained static conditions. Intervertebral disc pressures increased linearly with follower load magnitude. The effect of the rib cage on disc pressures in static conditions remains unclear because testing order likely confounded the results. Disc pressures compared well with previous reports in vitro, and comparison with in vivo values suggests the use of a follower load of about 400N to approximate loading in upright standing. Follower load had no effect on sagittal plane spine curvature overall, suggesting successful application of the technique, although increased flexion in the upper spine and reduced flexion in the lower spine suggest that the follower load path was not optimized. Rib cage stiffening and removal both increased overall spine flexion slightly, although with differing effects at specific spinal locations. Overall, the approaches demonstrated here will support the use of follower preloads, intact rib cage, and disc pressure measurements to enhance the clinical relevance of future studies of the thoracic spine.