Flexible growing rods: polymer rods provide stability to -skeletally immature spines

Introduction: Surgical treatments for early onset scoliosis typically require multiple operations and many complications. A more flexible growing rod construct might result in a more flexible spine with fewer complications. Polymer rods (polyetheretherketone, PEEK) are relatively flexible in bending, and therefore might allow for greater range of motion (ROM) during treatment. The purpose of this study was to determine changes in spine ROM after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. Methods: Biomechanical tests were conducted on six skeletally immature porcine thoracic spines (domestic pigs, age 2–4 months, 35–40 kg, T1–T13). Paired pedicle screws were inserted into T3 and T4 proximally, and T10 and T11 distally. Specimens were tested under the following conditions: (i) control, then dual rods of (ii) PEEK (6.25 mm, n = 6), (3) titanium (4 mm, n = 6), and (4) CoCr alloy (5 mm, n = 4). Lateral bending (LB) and flexion--extension (FE) moments of ±5 Nm were applied. Vertebral rotations were measured using video analysis. ROM for the treated region was determined by averaging all maximum side-to-side rotations at each instrumented level. Differences were determined by t-tests and Bonferroni posthoc. Results: In LB, ROM of specimens with PEEK rods was lower than control at each instrumented level. ROM was greater for PEEK rods than both Ti and CoCr at every instrumented level. Mean ROM at proximal and distal uninstrumented levels was lower for PEEK than for Ti and CoCr. In FE, mean ROM at proximal and distal uninstrumented levels was lower for PEEK than for Ti and CoCr. Combining treated levels, in LB ROM for PEEK rods was 35% of control (p \u3c 0.0001) and 270% of CoCr rods (p \u3c 0.05). In FE, ROM for PEEK rods was 27% of control (p \u3c 0.005) and 180% of CoCr rods (p \u3c 0.05). Conclusions: PEEK rods provided increased flexibility versus metal rods, but also significantly greater stiffness than controls. Smaller increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared with the metal rods, which may decrease probability of junctional kyphosis. This biomechanical feasibility study of flexible polymer rod constructs showed that PEEK rods provided increased flexibility compared with CoCr and Ti rods, but also significantly greater stiffness than uninstrumented controls. Acknowledgments: Surgical technical assistanceby Max F. DeCarvalo MD; student support by Charlotte Schmidlapp Women’s Scholar Program and UC/CCHMC SURF Program

Flexible growing rods: a pilot study to determine if polymer rod constructs may provide stability to skeletally immature spines

Abstract Background Surgical treatments for early onset scoliosis (EOS), including growing rod constructs, involve many complications. Some are due to biomechanical factors. A construct that is more flexible than current instrumentation systems may reduce complications. The purpose of this preliminary study was to determine spine range of motion (ROM) after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. The hypothesis was that ROM of spines instrumented with polyetheretherketone (PEEK) rods would be greater than metal rods and lower than noninstrumented controls. Further, adjacent segment motion was expected to be lower with polymer rods compared to conventional systems. Methods Biomechanical tests were conducted on 6 skeletally immature porcine thoracic spines (domestic swine, 35-40 kg). Spines were harvested after death from swine that had been utilized for other studies (IACUC approved) which had not involved the spine. Paired pedicle screws were used as anchors at proximal and distal levels. Specimens were tested under the following conditions: control, then dual rods of PEEK (6.25 mm), titanium (4 mm), and CoCr (5 mm) alloy. Lateral bending (LB) and flexion-extension (FE) moments of ±5 Nm were applied. Vertebral rotations were measured using video. Differences were determined by two-tailed t-tests and Bonferroni correction with four primary comparisons: PEEK vs control and PEEK vs CoCr, in LB and FE (α=0.05/4). Results In LB, ROM of specimens with PEEK rods was lower than control at each instrumented level. ROM was greater for PEEK rods than both Ti and CoCr at every instrumented level. Mean ROM at proximal and distal noninstrumented levels was lower for PEEK than for Ti and CoCr. In FE, mean ROM at proximal and distal noninstrumented levels was lower for PEEK than for metal. Combining treated levels, in LB, ROM for PEEK rods was 35% of control (p<0.0001) and 270% of CoCr rods (p<0.01). In FE, ROM with PEEK was 27% of control (p<0.001) and 180% of CoCr (p<0.01). Conclusions PEEK rods decreased flexibility versus noninstumented controls, and increased flexibility versus metal rods. Smaller increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared to metal rods, which may help decrease junctional kyphosis. Flexible growing rods may eventually help improve treatment options for young patients with severe deformity.http://deepblue.lib.umich.edu/bitstream/2027.42/134537/1/13013_2015_Article_967.pd

Flexible growing rods: a biomechanical pilot study of polymer rod constructs in the stability of skeletally immature spines

Abstract Background Surgical treatments for early onset scoliosis (EOS) correct curvatures and improve respiratory function but involve many complications. A distractible, or ‘growing rod,’ implant construct that is more flexible than current metal rod systems may sufficiently correct curves in small children and reduce complications due to biomechanical factors. The purpose of this pilot study was to determine ranges of motion (ROM) after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. The hypothesis was that ROM of spines instrumented with polymer rods would be greater than conventional metal rods and lower than non-instrumented controls. Methods Biomechanical tests were conducted on six thoracic spines from skeletally immature domestic swines (35–40 kg). Paired pedicle screws were used as anchors at proximal and distal levels. Specimens were tested under the following conditions: control, then dual rods of polyetheretherketone (PEEK) (diameter 6.25 mm), titanium (4 mm), and cobalt-chrome alloy (CoCr) (5 mm). Lateral bending (LB) and flexion-extension (FE) moments were applied, and vertebral rotations were measured. Differences were determined by two-tailed t-tests and Bonferroni for four primary comparisons: PEEK vs control and PEEK vs CoCr, in LB and FE (α = 0.05/4). Results In LB, ROM of spine segments after instrumenting with PEEK rods was lower than the non-instrumented control condition at each instrumented level. ROM was greater with PEEK rods than with Ti and CoCr rods at every instrumented level. Combining treated levels, in LB, ROM for PEEK rods was 35 % of control (p < 0.0001) and 270 % of CoCr rods (p < 0.01). In FE, ROM with PEEK was 27 % of control (p < 0.001) and 180 % of CoCr (p < 0.01). At proximal and distal adjacent non-instrumented levels in FE, mean ROM was lower for PEEK than for either metal. Conclusions PEEK rods increased flexibility versus metal rods, and decreased flexibility versus non-instrumented controls, both over the entire instrumented segment and at each individual level. Smaller mean increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared to metal rods, which may help decrease complications, such as junctional kyphosis. Flexible growing rods may eventually help improve treatment options for young patients with severe deformity.http://deepblue.lib.umich.edu/bitstream/2027.42/134642/1/13013_2016_Article_87.pd

Mechanical behavior of fetal dura mater under large deformation biaxial tension

The mechanical behavior of fetal dura mater was investigated by means of a biaxial tension test designed to simulate the constraints imposed on the membrane by the cranial bones. The experimental results are compared with the theoretical results obtained by using two published strain energy functions: one defined by Mooney and Rivlin (MR) and the other by Skalak, Tozeren, Zarda and Chien (STZC). The latter constitutive relations fit the experimental results consistently well. The STZC stiffness values from this series of tests are compared with those from membrane inflation tests performed previously and reported elsewhere by the authors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26319/1/0000406.pd

Mechanical behavior of fetal dura mater under largeaxisymmetric inflation

The nonlinear mechanical behavior of fetal dura mater was tested experimentally and compared to two published nonlinear material strain energy functions, the Mooney-Rivlin and the Skalak, Tozeren, Zarda, and Chien (STZC

Biomechanical spinal growth modulation and progressive adolescent scoliosis – a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE

There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this debate was written by Dr Ian A Stokes. It evaluates the hypothesis that in progressive scoliosis vertebral body wedging during adolescent growth results from asymmetric muscular loading in a "vicious cycle" (vicious cycle hypothesis of pathogenesis) by affecting vertebral body growth plates (endplate physes). A frontal plane mathematical simulation tested whether the calculated loading asymmetry created by muscles in a scoliotic spine could explain the observed rate of scoliosis increase by measuring the vertebral growth modulation by altered compression. The model deals only with vertebral (not disc) wedging. It assumes that a pre-existing scoliosis curve initiates the mechanically-modulated alteration of vertebral body growth that in turn causes worsening of the scoliosis, while everything else is anatomically and physiologically 'normal' The results provide quantitative data consistent with the vicious cycle hypothesis. Dr Stokes' biomechanical research engenders controversy. A new speculative concept is proposed of vertebral symphyseal dysplasia with implications for Dr Stokes' research and the etiology of AIS. What is not controversial is the need to test this hypothesis using additional factors in his current model and in three-dimensional quantitative models that incorporate intervertebral discs and simulate thoracic as well as lumbar scoliosis. The growth modulation process in the vertebral body can be viewed as one type of the biologic phenomenon of mechanotransduction. In certain connective tissues this involves the effects of mechanical strain on chondrocytic metabolism a possible target for novel therapeutic intervention

In Situ Measurement of Meniscal Mechanics in Human Knee Joints (Semilunar Cartilage, Biomechanics, Strain, Displacement).

The objectives of this study were to develop methods to measure the displacements and surface strains of normal cadaver menisci in situ as a function of applied physiological loads and measured joint position. An apparatus was designed to apply quasistatic loads to the knee with constraints which allowed the knee to passively assume a position of minimum potential energy. Compression, anterior and posterior shear, and axial torsion were applied to the tibia. The femoral component had four degrees of freedom in addition to a fixed, but variable, flexion angle. Each of these could be locked in any position. The apparatus was also designed to allow radiographic and optical exposure of the knee from above during loading. All joint displacements and applied loads were measured electronically. The signals were sampled and stored by a microcomputer. Displacements of the menisci were measured radiographically in intact cadaver knees by attaching flat lead markers to their superior surfaces. Eleven load cases were imposed on each knee for each of three flexion angles. Radiographs were taken parallel to the tibial plateau. Meniscal surface strains on one knee were measured optically. The femur was disarticulated, and replaced with a geometric replica of clear polyester-acrylic which was cast from a silicone rubber mold of the original femur. A grid was stained on the menisci and photographs taken from above during loading. Meniscal displacement results from three fresh frozen knees showed that under 1 kN of joint compression the menisci displaced with the changing location of the contacting femoral condyles. The menisci moved posteriorly with flexion; large meniscal displacements were induced by large axial joint rotations. Anterior and posterior shear forces produced insignificant meniscal displacements. The lateral meniscus moved approximately three times further than the medial; this difference was correlated with the location of the axis of rotation. Large strains were measured on the meniscal surfaces. Qualitatively, they correlated with clinically observed lesion patterns. Medial strains were greater than lateral strains; radial strains tended to be greater than circumferential strains. Contact areas were on the posterior and lateral aspects of the menisci.Ph.D.Biomedical engineeringUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161073/1/8621257.pd