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Vertebral deformity arising from an accelerated “creep” mechanism

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Abstract

Introduction

Vertebral deformities often occur in patients who recall no trauma, and display no evident fracture on radiographs. We hypothesise that vertebral deformity can occur by a gradual creep mechanism which is accelerated following minor damage. “Creep” is continuous deformation under constant load.

Materials and methods

Forty-five thoracolumbar spine motion segments were tested from cadavers aged 42–92 years. Vertebral body areal BMD was measured using DXA. Specimens were compressed at 1 kN for 30 min, while creep in each vertebral body was measured using an optical MacReflex system. After 30 min recovery, each specimen was subjected to a controlled overload event which caused minor damage to one of its vertebrae. The creep test was then repeated.

Results

Vertebral body creep was measurable in specimens with BMD <0.5 g/cm2. Creep was greater anteriorly than posteriorly (p < 0.001), so that vertebrae gradually developed a wedge deformity. Compressive overload reduced specimen height by 2.24 mm (STD 0.77 mm), and increased vertebral body creep by 800 % (anteriorly), 1,000 % (centrally) and 600 % (posteriorly). In 34 vertebrae with complete before-and-after data, anterior wedging occurring during the 1st creep test averaged 0.07° (STD 0.17°), and in the 2nd test (after minor damage) it averaged 0.79° (STD 1.03°). The increase was highly significant (P < 0.001). Vertebral body wedging during the 2nd creep test was proportional to the severity of damage, as quantified by specimen height loss during the overload event (r 2 = 0.51, p < 0.001, n = 34).

Conclusions

Minor damage to an old vertebral body, even if it is barely discernible on radiographs, can accelerate creep to such an extent that it makes a substantial contribution to vertebral deformity.

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Acknowledgments

This study was funded in the UK by Action Medical Research and the Annett Charitable Trust.

Conflict of interest

None of the authors has any potential conflict of interest.

Ethics approval

This study was approved by Frenchay NHS Research Ethics Committee, Bristol, UK

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Authors and Affiliations

  1. Centre for Comparative and Clinical Anatomy, University of Bristol, Southwell Street, Bristol, BS2 8EJ, UK

    Phillip Pollintine, Edward Gomm, Patricia Dolan & Michael A. Adams

  2. University of Roehampton, London, UK

    Jin Luo

Authors
  1. Jin Luo
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  2. Phillip Pollintine
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  3. Edward Gomm
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  4. Patricia Dolan
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  5. Michael A. Adams
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Correspondence to Michael A. Adams.

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Luo, J., Pollintine, P., Gomm, E. et al. Vertebral deformity arising from an accelerated “creep” mechanism. Eur Spine J 21, 1684–1691 (2012). https://doi.org/10.1007/s00586-012-2279-y

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  • DOI: https://doi.org/10.1007/s00586-012-2279-y

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