Compression or tension? The stress distribution in the proximal femur

Comparative StudyEvaluation StudiesThis is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Questions regarding the distribution of stress in the proximal human femur have never been adequately resolved. Traditionally, by considering the femur in isolation, it has been believed that the effect of body weight on the projecting neck and head places the superior aspect of the neck in tension. A minority view has proposed that this region is in compression because of muscular forces pulling the femur into the pelvis. Little has been done to study stress distributions in the proximal femur. We hypothesise that under physiological loading the majority of the proximal femur is in compression and that the internal trabecular structure functions as an arch, transferring compressive stresses to the femoral shaft. METHODS: To demonstrate the principle, we have developed a 2D finite element model of the femur in which body weight, a representation of the pelvis, and ligamentous forces were included. The regions of higher trabecular bone density in the proximal femur (the principal trabecular systems) were assigned a higher modulus than the surrounding trabecular bone. Two-legged and one-legged stances, the latter including an abductor force, were investigated. RESULTS: The inclusion of ligamentous forces in two-legged stance generated compressive stresses in the proximal femur. The increased modulus in areas of greater structural density focuses the stresses through the arch-like internal structure. Including an abductor muscle force in simulated one-legged stance also produced compression, but with a different distribution. CONCLUSION: This 2D model shows, in principle, that including ligamentous and muscular forces has the effect of generating compressive stresses across most of the proximal femur. The arch-like trabecular structure transmits the compressive loads to the shaft. The greater strength of bone in compression than in tension is then used to advantage. These results support the hypothesis presented. If correct, a better understanding of the stress distribution in the proximal femur may lead to improvements in prosthetic devices and an appreciation of the effects of various surgical procedures affecting load transmission across the hip.We thank the Arthritis Research Campaign for financial support (Grant reference 15284) and Dr J.S. Gregory for providing the mean shape of the proximal femur

The in vivo assessment of thoracic vertebral shape from MRI data using a shape model

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Study design Feasibility study on characterising thoracic vertebral shape from magnetic resonance images using a shape model. Objectives Assess the reliability of characterising thoracic vertebral shape from magnetic resonance images and estimate the normal variation in vertebral shape using a shape model. Summary of background data The characterisation of thoracic vertebrae shape is important for understanding the initiation and progression of deformity and in developing surgical methods. Methods for characterising shape need to be comprehensive, reliable and suitable for use in vivo. Methods Magnetic resonance images of the thoracic vertebrae were acquired from 20 adults. Repeat scans were acquired, after repositioning the participants, for T4, T8 and T12. Landmark points were placed around the vertebra on the images and used to create a shape model. The reliability was assessed using relative error (E%) and intra-class correlation (ICC). The effect of vertebral level, sex and age on vertebral shape was assessed using repeated measures analysis of variance. Results Five modes of variation were retained from the shape model. Reliability was excellent for the first two modes (mode 1: E% = 7, ICC = 0.98; mode 2: E% = 11, ICC = 0.96). These modes described variation in the vertebral bodies, the pedicle width and orientation, and the facet joint position and orientation with respect to the pedicle axis. Variation in vertebral shape was found along the thoracic spine and between individuals, but there was little effect of age and sex. Conclusions Magnetic resonance images and shape modelling provides a reliable method for characterising vertebral shape in vivo. The method is able to identify differences between vertebral levels and between individuals. The use of these methods may be advantageous for performing repeated measurements in longitudinal studies

Muscle function and size in the lumbar spine before and after a four week exercise intervention

ArticleThis is the author accepted manuscript. The final version is available from IOS Press via the DOI in this record.BACKGROUND: Exercise of the spinal muscles is recommended for a variety of rehabilitative reasons but it is not always clear whether interventions are effective in improving the performance of the muscles or whether their benefit is elicited via other mechanisms. OBJECTIVE: To explore the effects of an exercise intervention on the size and exercise performance of the lumbar spine extensor muscles. METHODS: Eleven healthy participants undertook a four week programme of exercise. Magnetic resonance imaging and phosphorus spectroscopy were performed before and after the intervention to determine the time to fatigue and phosphocreatine (PCr) depletion during a muscle endurance test (modified Biering-Sørensen) together with muscle crosssectional area (CSA). RESULTS: The post intervention measures were significantly different to the preintervention results for the time to fatigue (post-pre: 20.5 ± 22.7 s (P=0.014)) and PCr depletion both at the point of fatigue (post-pre: 9.5 ± 11.9 % (P= 0.024)) and at a matched time-point (post-pre: 12.2 ± 11.9 % (P=0.007)). CSA was not significantly different in any muscle. CONCLUSIONS: Exercise improved the performance of the trunk muscles despite no impact on CSA. This demonstrated the importance of obtaining a wide range of measures when assessing the effectiveness of exercise intervention programmes.We thank the participants who volunteered to take part in our study and also thank the NIHR Clinical Research Facility, University of Exeter for funding J Fulford’s salary

Computer-aided detection in musculoskeletal projection radiography: A systematic review

This is the author accepted manuscript. The final version is available from WB Saunders via the DOI in this record.Objectives To investigated the accuracy of computer-aided detection (CAD) software in musculoskeletal projection radiography via a systematic review. Key findings Following selection screening, eligible studies were assessed for bias, and had their study characteristics extracted resulting in 22 studies being included. Of these 22 three studies had tested their CAD software in a clinical setting; the first study investigated vertebral fractures, reporting a sensitivity score of 69.3% with CAD, compared to 59.8% sensitivity without CAD. The second study tested dental caries diagnosis producing a sensitivity score of 68.8% and specificity of 94.1% with CAD, compared to sensitivity of 39.3% and specificity of 96.7% without CAD. The third indicated osteoporotic cases based on CAD, resulting in 100% sensitivity and 81.3% specificity. Conclusion The current evidence reported shows a lack of development into the clinical testing phase; however the research does show future promise in the variation of different CAD systems

Multifractal Dimensions for Branched Growth

A recently proposed theory for diffusion-limited aggregation (DLA), which models this system as a random branched growth process, is reviewed. Like DLA, this process is stochastic, and ensemble averaging is needed in order to define multifractal dimensions. In an earlier work [T. C. Halsey and M. Leibig, Phys. Rev. A46, 7793 (1992)], annealed average dimensions were computed for this model. In this paper, we compute the quenched average dimensions, which are expected to apply to typical members of the ensemble. We develop a perturbative expansion for the average of the logarithm of the multifractal partition function; the leading and sub-leading divergent terms in this expansion are then resummed to all orders. The result is that in the limit where the number of particles n -> \infty, the quenched and annealed dimensions are {\it identical}; however, the attainment of this limit requires enormous values of n. At smaller, more realistic values of n, the apparent quenched dimensions differ from the annealed dimensions. We interpret these results to mean that while multifractality as an ensemble property of random branched growth (and hence of DLA) is quite robust, it subtly fails for typical members of the ensemble.Comment: 82 pages, 24 included figures in 16 files, 1 included tabl

The relationship between sagittal curvature and extensor muscle volume in the lumbar spine.

This is the peer reviewed version of the article, which has been published in final form at doi: 10.1111/joa.12047. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.A previous modelling study predicted that the forces applied by the extensor muscles to stabilise the lumbar spine would be greater in spines that have a larger sagittal curvature (lordosis). Because the force-generating capacity of a muscle is related to its size, it was hypothesised that the size of the extensor muscles in a subject would be related to the size of their lumbar lordosis. Magnetic resonance imaging (MRI) data were obtained, together with age, height, body mass and back pain status, from 42 female subjects. The volume of the extensor muscles (multifidus and erector spinae) caudal to the mid-lumbar level was estimated from cross-sectional area measurements in axial T1-weighted MRIs spanning the lumbar spine. Lower lumbar curvature was determined from sagittal T1-weighted images. A stepwise linear regression model was used to determine the best predictors of muscle volume. The mean lower lumbar extensor muscle volume was 281 cm(3) (SD = 49 cm(3)). The mean lower lumbar curvature was 30 ° (SD = 7 °). Five subjects reported current back pain and were excluded from the regression analysis. Nearly half the variation in muscle volume was accounted for by the variables age (standardised coefficient, B = -3.2, P = 0.03) and lower lumbar curvature (B = 0.47, P = 0.002). The results support the hypothesis that extensor muscle volume in the lower lumbar spine is related to the magnitude of the sagittal curvature; this has implications for assessing muscle size as an indicator of muscle strength

The feasibility of using citizens to segment anatomy from medical images: Accuracy and motivation

This is the final version. Available from Public Library of Science via the DOI in this record.Data cannot be shared publicly because participants did not consent for their data to be made publicly available, however, consent was granted to make the data available to researchers for use in related studies. Further information about the data and details of how to request access are available from the University of Exeter's institutional repository at: https://doi.org/10.24378/exe.1703.The development of automatic methods for segmenting anatomy from medical images is an important goal for many medical and healthcare research areas. Datasets that can be used to train and test computer algorithms, however, are often small due to the difficulties in obtaining experts to segment enough examples. Citizen science provides a potential solution to this problem but the feasibility of using the public to identify and segment anatomy in a medical image has not been investigated. Our study therefore aimed to explore the feasibility, in terms of performance and motivation, of using citizens for such purposes. Public involvement was woven into the study design and evaluation. Twenty-nine citizens were recruited and, after brief training, asked to segment the spine from a dataset of 150 magnetic resonance images. Participants segmented as many images as they could within three one-hour sessions. Their accuracy was evaluated by comparing them, as individuals and as a combined consensus, to the segmentations of three experts. Questionnaires and a focus group were used to determine the citizens’ motivation for taking part and their experience of the study. Citizen segmentation accuracy, in terms of agreement with the expert consensus segmentation, varied considerably between individual citizens. The citizen consensus, however, was close to the expert consensus, indicating that when pooled, citizens may be able to replace or supplement experts for generating large image datasets. Personal interest and a desire to help were the two most common reasons for taking part in the study.Wellcome Trus

Effects of sex, age, body height and body weight on spinal loads: sensitivity analyses in a subject-specific trunk musculoskeletal model.

Subject-specific parameters influence spinal loads and the risk of back disorders but their relative effects are not well understood. The objective of this study is to investigate the effects of changes in age (35-60 years), sex (male, female), body height (BH: 150-190 cm) and body weight (BW: 50-120 kg) on spinal loads in a full factorial simulation using a personalized (spine kinematics, geometry, musculature and passive properties) kinematics driven musculoskeletal trunk finite element model. Segmental weight distribution (magnitude and location along the trunk) was estimated by a novel technique to accurately represent obesity. Five symmetric sagittal loading conditions were considered, and main effect plots and analyses of variance were employed to identify influential parameters. In all 5 tasks simulated, BW (98.9% in compression and 96.1% in shear) had the greatest effect on spinal loads at the L4-L5 and L5-S1 levels followed by sex (0.7% in compression and 2.1% in shear), BH (0.4% in compression and 1.5% in shear) and finally age (<5.4%). At identical BH and BW, spinal loads in females were slightly greater than those in males by ~4.7% in compression and ~8.7% in shear. In tasks with no loads in hands, BW-normalized spinal loads further increased with BW highlighting the exponential increase in spinal loads with BW that indicates the greater risk of back disorders especially in obese individuals. Uneven distribution of weight in obese subjects, with more BW placed at the lower trunk, further (though slightly <7.5%) increased spinal loads.This work was supported by the institut de recherche Robert-Sauvé en santé et en sécurité du travail 294 (IRSST-2014-0009) and the fonds de recherche du Québec en nature et technologies (FRQNT)

Increased radiation dose and projected radiation-related lifetime cancer risk in patients with obesity due to projection radiography

This is the final version. Available on open access from IOP Publishing via the DOI in this recordPurpose. Primarily to evaluate the radiation dose delivered to patients with obesity in projection radiography and its relationship to the patient's size. A secondary purpose is to estimate the subsequent projected radiation-related lifetime cancer risk to patients with obesity compared to normal-weight patients. Method and material. Data from 1964 patients from a bariatric clinic in the UK were reviewed with the relevant permission. 630 patients were identified to have a projection radiography history and were included in the study. Patients' dose area product (DAP) data were collected for all projection radiography. Multiple exams in one day including a single DAP reading and exams with no records of DAP and exposure factors were excluded. Correlations were calculated and data analysed to yield the third quartile for each examination using STATA 14. Absorbed doses were generated from PCXMC simulation, utilising DAP data from this study and the UK national diagnostic reference level (NDRL), to calculate the effective risk for patients with obesity compared to patients with normal-weight. Results. Patients with obesity received higher DAPs for all examinations included in this study compared to NDRL. Abdominal and lumbar spine radiographs DAPs were the highest (17.6 and 30.31 Gy cm2) compared to the NDRL (2.5 and 4 Gy cm2). Only moderate to low correlations were found between patient's size and DAPs in the abdomen and chest radiographs. The projected radiation-related lifetime cancer risk for patients with obesity is up to 153% higher than for adult patients with normal weight. Conclusion. Patients with obesity receive higher DAPs than normal-weight adults which may be in excess of that expected due to their size. Therefore, radiation-related lifetime cancer risk is increased in patients with obesity as a result of medical radiation exposures. This indicates more dose optimisation research is needed in this group of patients to reduce dose rate and variation.Najran Universit

A novel in-vitro model of intervertebral disc degeneration using hyperphysiological loading.

This is the final version. Available from Elsevier via the DOI in this record. Intervertebral disc (IVD) degeneration includes changes in tissue biomechanics, physical attributes, biochemical composition, disc microstructure, and cellularity, which can all affect the normal function of the IVD, and ultimately may lead to pain. The purpose of this research was to develop an in-vitro model of degeneration that includes the evaluation of physical, biomechanical, and structural parameters, and that does so over several load/recovery periods. Hyperphysiological loading was used as the degenerative initiator with three experimental groups employed using bovine coccygeal IVD specimens: Control; Single-Overload; and Double-Overload. An equilibrium stage comprising a static load followed by two load/recovery periods was followed by six further load/recovery periods. In the Control group all load/recovery periods were the same, comprising physiological cyclic loading. The overload groups differed in that hyperphysiological loading was applied during the 4th loading period (Single-Overload), or the 4th and 5th loading period (Double-Overload). Overloading led to a significant reduction in disc height compared to the Control group, which was not recovered in subsequent physiological load/recovery periods. However, there were no significant changes in stiffness. Overloading also led to significantly more microstructural damage compared to the Control group. Taking all outcome measures into account, the overload groups were evaluated as replicating clinically relevant aspects of moderate IVD degeneration. Further research into a potential dose-effect, and how more severe degeneration can be replicated would provide a model with the potential to evaluate new treatments and interventions for different stages of IVD degeneration