Abstract
Effects of disc degeneration (DD) on mobility under loads have been demonstrated, but they are not taken into account when providing experimental corridors for ranges of motion (ROM); this could explain that these corridors are usually very large. Other influencing factors such as lumbar level or geometry have seldom been studied, and never conjointly. The objectives of the study were to understand relationships between intervertebral discs (IVDs) mobility disparity and disc characteristics using medical imaging. For that purpose, an in vitro biomechanical and imaging protocol was conducted on human lumbar IVDs: 22 specimens (14 L1-L2 and eight L4-L5) were considered. Radiography, MRI, discography and macroscopic slices were obtained. Flexion/extension, lateral bending and torsion 10 Nm moments were applied on each specimen, with and without posterior elements. 3D motion of the upper vertebra was recorded. After testing, morphometric data was measured, DD was assessed and pathological singularities were identified. Mobility corridors for each spinal level in all loading modes were very large. For example, lateral bending ROMs within L1-L2 group ranged from 0.5° to 10.5°. Abnormal behaviours such as excessive ROMs or extension greater than flexion were listed. In most cases, imaging could identify the reasons of these erratic behaviours (scoliosis, calcification, retrolisthesis, etc.). After discarding six discs carrying major anomalies identified by imagery, mobility corridors were drastically reduced (min 3°, max 6.5° for the same L1-L2 lateral bending example). In specimens without abnormalities, relationship between geometry and ROMs could be revealed. As a conclusion, this study provided more relevant data for ROM of lumbar spine functional units. For the first time relationships could be considered between image attributes and mechanical properties.
Résumé
Les effets de la dégénérescence discale sur la mobilité rachidienne ont été démontrés; ceux-ci ne sont pourtant pas considérés dans les corridors expérimentaux de la littérature rapportant des amplitudes de mobilité. Ceci constitue la raison probable pour laquelle ces corridors sont souvent très grands. D’autre facteurs d’influences, tels que le niveau lombaire ou la géométrie, ont rarement été étudiés et jamais conjointement. Les objectifs de cette étude étaient de comprendre les relations existant entre les disparités de mobilité du disque intervertébral et les caractéristiques discales associées, en utilisant l’imagerie médicale. A cette fin, un protocole expérimental in vitro (biomécanique et imagerie) a été conduit sur des disques intervertébraux lombaires humains : 22 spécimens (14 L1-L2 and 8 L4-L5) ont été considérés. Radiographies, IRM, discographies et coupes macroscopiques ont été obtenues. Des moments de flexion/extension, inflexion latérale et torsion (max 10 Nm) ont été appliqués sur chaque spécimen, avec et sans arcs postérieurs; le mouvement 3D de la vertèbre supérieure a été enregistré. Après ces tests, des données morphométriques ont été mesurées, l’état de dégénérescence discale a été évalué et les singularités pathologiques ont été identifiées. Les corridors de mobilité pour chaque niveau lombaire étaient très grands dans toutes les directions de chargement. Par exemple, les amplitudes en inflexion latérale au sein du groupe L1-L2 s’échelonnaient de 0.5 à 10.5 degrés. Les comportements anormaux, comme des amplitudes excessives ou une extension supérieure à la flexion, ont été répertoriés. Dans la plupart des cas, l’imagerie a pu identifier les raisons de ces comportements erratiques (scoliose, calcifications, rétrolisthésis, etc.). En retranchant à l’échantillon 6 disques porteurs d’anomalies majeures décelées par l’imagerie, les corridors de mobilité ont été fortement réduits (min 3, max 6.5 degrés pour le même exemple du groupe L1-L2 en inflexion latérale). Chez les spécimens exempts d’anomalies, des relations entre géométrie et amplitudes de mobilité ont pu être mises en évidence. En conclusion, cette étude a permis de préciser et d’affiner les corridors de mobilité au niveau lombaire. Pour la première fois, des relations ont pu être considérées entre des attributs extraits de l’image et des propriétés mécaniques.
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Notes
The test device and protocol are labelled by a quality certification NF EN ISO/CEI 17025.
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Acknowledgements
The authors thank A. Feydy and the radiologists of the Beaujon Hospital (Paris), the Center of body donation of the Saints-Pères (Paris), J. Magnier, M. Thourot, L. Moraud, and Biospace company. This work was partly founded by Valorisation Recherche Québec, Fondation Canadienne pour l’Innovation and French Fonds de la Recherche Technologique (N 01B0171).
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Campana, S., de Guise, J.A., Rillardon, L. et al. Lumbar intervertebral disc mobility: effect of disc degradation and of geometry. Eur J Orthop Surg Traumatol 17, 533–541 (2007). https://doi.org/10.1007/s00590-007-0243-z
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DOI: https://doi.org/10.1007/s00590-007-0243-z