[Show abstract][Hide abstract] ABSTRACT: Metastatic spine lesions frequently require corpectomy in order to achieve decompression of the spinal cord and restoration of spinal stability. A variety of systems have been developed for vertebral body replacement. In patients with prolonged life expectancy due to an improvement of both systemic and local therapy, treatment results can be impaired by a loosening at the implant-bone interface or mechanical failure. Furthermore, early detection of a metastatic recurrence using sensitive imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) is possible in these patients without artefact interference. The aim of our pilot study was to evaluate the clinical applicability and results of a new radiolucent system for vertebral body replacement in the lumbar spine. The system consists of bone-integrating biocompatible materials - a polyetherurethane/bioglass composite (PU-C) replacement body and an integrated plate of carbon-fibre reinforced polyetheretherketone (CF-PEEK) - and provides high primary stability with anterior instrumentation alone. In a current prospective study, five patients with metastatic lesions of the lumbar spine were treated by corpectomy and reconstruction using this new system. Good primary stability was achieved in all cases. Follow-up (median 15 months) using CT and MRI revealed progressive osseous integration of the PU-C spacer in four patients surviving more than 6 months. Results obtained from imaging methods were confirmed following autopsy by biomechanical investigation of an explanted device. From these data, it can be concluded that implantation of the new radiolucent system provides sufficient long-term stability for the requirements of selected tumour patients with improved prognosis.
European Spine Journal 11/2000; 9(5):437-44. DOI:10.1007/s005860000162 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Interfragmentary movement and size of the fracture gap influence fracture healing. Limited movements promote callus formation and may result in increased mechanical stability. Although larger movements still promote callus formation, the bony consolidation of the fracture is hampered. Fracture healing is also hampered if the size of the fracture gap is too large. A combination of large movement and large gap bears the risk of non-union. Therefore, having in mind a minimally invasive surgical approach, one should strive for good reduction of the fracture ends and flexible yet stable osteosynthesis. Dynamization of the fracture by enabling axial movement will close the fracture gap, stimulate tissue differentiation and possibly accelerate the healing process. External mechanical stimulation, however, has not been shown to effectively enhance the healing process under flexible fixation or in load-bearing patients.
Der Chirurg 10/2000; 71(9):989-94. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Kleine interfragmentäre Bewegungen stimulieren die Callusheilung während zu große Bewegungen häufig eine knöcherne Überbrückung
verhindern. Bei großen Frakturspalten kommt es zu einer Verzögerung von Callusbildung und Frakturüberbrückung. Die Gefahr
einer Pseudarthrose besteht bei zu großer interfragmentärer Bewegung (Instabilität) und zu großen Frakturspalten. Trotz aller
Bestrebungen zu gewebeschonenden Operationstechniken ist deshalb eine gute Reposition und eine flexible aber stabile Osteosynthese
die Voraussetzung für eine komplikationsfreie Callusheilung. Eine Dynamisierung durch zusätzliche axiale Bewegung kann sich
positiv auswirken, weil dadurch Frakturspalten geschlossen werden und der Reiz zur Callusdifferenzierung erhöht wird. Eine
externe mechanische Stimulation scheint bei flexiblen Osteosynthesen und aktiven Patienten nicht erforderlich.
Interfragmentary movement and size of the fracture gap influence fracture healing. Limited movements promote callus formation
and may result in increased mechanical stability. Although larger movements still promote callus formation, the bony consolidation
of the fracture is hampered. Fracture healing is also hampered if the size of the fracture gap is too large. A combination
of large movement and large gap bears the risk of non-union. Therefore, having in mind a minimally invasive surgical approach,
one should strive for good reduction of the fracture ends and flexible yet stable osteosynthesis. Dynamization of the fracture
by enabling axial movement will close the fracture gap, stimulate tissue differentiation and possibly accelerate the healing
process. External mechanical stimulation, however, has not been shown to effectively enhance the healing process under flexible
fixation or in load-bearing patients.
Der Chirurg 08/2000; 71(9):989-994. DOI:10.1007/s001040051172 · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To characterize the site-specific mechanical and histological properties in fracture repair and to relate these properties to the initial mechanical situation, an experimental fracture model was used in the metatarsus of 42 sheep. The mechanical situation of a transverse osteotomy was described by three gap sizes (1, 2, or 6 mm) and two amounts of strain (7 or 31%). An external fixator that allowed a defined axial movement provided control of these settings. Nine weeks following surgery, the healing area was dissected and tensile and compressive properties were measured in subregions of the fracture gap and the periosteal callus. The central, sagittal section was used for quantitative histology. We found the quality of the tissue along the osteotomy line to be most important for regaining mechanical stability. Increasing the size of osteotomy gaps resulted in poorer mechanical and histological qualities, and the repair process was less complete. Interfragmentary strain did not significantly influence the repair process. The smaller strain levels had already stimulated the secondary repair process, and this stimulatory effect could not be further enhanced by increasing the amount of strain. Our finding that large gaps between bone segments were not as well healed as were smaller gaps suggests that it is advantageous to avoid large gaps in fracture treatment.
Journal of Orthopaedic Research 08/1998; 16(4):475-81. DOI:10.1002/jor.1100160413 · 2.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The purpose of this study was to investigate the effect of an externally applied mechanical stimulus on fracture healing under flexible fixation. DESIGN: Stimulation of fracture healing under various conditions of interfragmentary movement in an in vivo fracture model on 41 sheep. BACKGROUND: It is generally accepted that small interfragmentary movements (IFMs) yield better bone healing results than larger IFMs (> 1 mm). However, the optimal size of IFM within the 1-mm range remains undetermined. METHODS: Standardized transverse osteotomy of 3 mm gap size in the left ovine tibia was fixed with an unilateral external fixator. The sheep were divided into four IFM groups of 0.0, 0.2, 0.4 and 0.8 mm and stimulated with this amplitude for 1200 cycles per day at 1 Hz. After a healing period of 6 weeks, bone mineral density and biomechanical stability were evaluated to determine the quality of healing. RESULTS: The amount of callus formation increased significantly with increasing IFM (P <0.05). However, highest biomechanical stability of the healed bone and mineral density of the gap tissue was achieved with an IFM of 0.4 mm, although the differences were not significant. CONCLUSIONS: These results suggest that the optimal interfragmentary movement for acceleration of delayed fracture healing is in the range of 0.5 mm. However, the enhancement of the healing of flexibly-fixed fractures by external application of interfragmentary movement is limited. RELEVANCE: In this model the external application of a mechanical stimulus in addition to the stimulation caused by normal loading and the flexibility of the fixation did not enhance the healing process significantly. It appears that the external application of interfragmentary motion is promising perhaps only for patients unable to stimulate their fracture healing by weight-bearing.
[Show abstract][Hide abstract] ABSTRACT: The effect of speech rate reduction on speech and pause characteristics during a reading task was examined for speakers with Parkinson's disease (PD) and a group of control speakers. Duration of utterances and characteristics of pausing (duration, interpause phrase length, and location) were determined. At habitual reading rate, subjects with PD had shorter speech duration and greater time per pause than control subjects. At reduced reading rates, subjects with PD increased speech duration so that it was equivalent to the control speakers at habitual rate. Both groups had the majority of their pause occurring at appropriate syntactic boundaries. Subjects with PD had a greater proportion of pauses occurring at syntactically inappropriate locations than did the controls. When speech rates were reduced, both groups showed a decrease in pauses located at appropriate syntactic boundaries. The implication of these findings on speech intelligibility is discussed.
Journal of Communication Disorders 01/1996; 29(6). DOI:10.1016/0021-9924(95)00037-2 · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated the influence of five different muscle groups on the monosegmental motion (L4-L5) during pure flexion/extension, lateral bending, and axial rotation moments.
The results showed and compared the effect of different muscle groups acting in different directions on the stability of a single motion segment to find loading conditions for in vitro experiments that simulate more physiologically reasonable loads.
In spine biomechanics research, most in vitro experiments have been carried out without applying muscle forces, even though these forces stabilize the spinal column in vivo.
Seven human lumbosacral spines were tested in a spine tester that allows simulation of up to five symmetrical muscle forces. Changing pure flexion/extension, lateral bending, and axial rotation moments up to +/- 3.75 Nm were applied without muscle forces, with different muscle groups and combinations. The three-dimensional monosegmental motion was determined using an instrumented spatial linkage system.
Simulated muscle forces were found to strongly influence load-deformation characteristics. Muscle action generally decreased the range of motion and the neutral zone of the motion segments. This was most evident for flexion and extension. After five pairs of symmetrical, constant muscle forces were applied (80 N per pair), the range of motion decreased about 93% in flexion and 85% in extension. The total neutral zone for flexion and extension was decreased by 83% muscle action. The multifidus muscle group had the strongest influence.
This experiment showed the importance of including at least some of the most important muscle groups in in vitro experiments on lumbar spine specimens.
[Show abstract][Hide abstract] ABSTRACT: We report a new apparatus to determine the quasistatic, three-dimensional, load-displacement characteristics of spines including muscle forces. The loading frame can be adapted to mono- and polysegmental specimens from the lumbar or cervical spine as well as to entire spines. Three force and three moment components can be applied in either direction individually or in combination with no constraint on the resulting motion; the loads can be applied at user-chosen rates of application and release with continuous recording of displacements, so as to study either creep or relaxation. The loads and displacement-measuring devices are computer-controlled. Thus, this testing device provides a tool for many kinds of stability tests and for basic research of spine biomechanics. A first experiment shows that the application of muscle forces significantly affects the load-deformation characteristics and intradiscal pressure.
European Spine Journal 02/1994; 3(2):91-7. DOI:10.1007/BF02221446 · 2.47 Impact Factor