Load-Carrying Capacity of the Human Cervical Spine in Compression Is Increased Under a Follower Load

Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL 60153, USA.
Spine (Impact Factor: 2.3). 06/2000; 25(12):1548-54. DOI: 10.1097/00007632-200006150-00015
Source: PubMed


An experimental approach was used to test human cadaveric cervical spine specimens.
To assess the response of the cervical spine to a compressive follower load applied along a path that approximates the tangent to the curve of the cervical spine.
The compressive load on the human cervical spine is estimated to range from 120 to 1200 N during activities of daily living. Ex vivo experiments show it buckles at approximately 10 N. Differences between the estimated in vivo loads and the ex vivo load-carrying capacity have not been satisfactorily explained.
A new experimental technique was developed for applying a compressive follower load of physiologic magnitudes up to 250 N. The experimental technique applied loads that minimized the internal shear forces and bending moments, loading the specimen in nearly pure compression.
A compressive vertical load applied in the neutral and forward-flexed postures caused large changes in cervical lordosis at small load magnitudes. The specimen collapsed in extension or flexion at a load of less than 40 N. In sharp contrast, the cervical spine supported a load of up to 250 N without damage or instability in both the sagittal and frontal planes when the load path was tangential to the spinal curve. The cervical spine was significantly less flexible under a compressive follower load compared with the hypermobility demonstrated under a compressive vertical load (P < 0.05).
The load-carrying capacity of the ligamentous cervical spine sharply increased under a compressive follower load. This experiment explains how a whole cervical spine can be lordotic and yet withstand the large compressive loads estimated in vivo without damage or instability.


Available from: Robert M Havey, Apr 28, 2015
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    • "Comparing the follower load to a simple vertical load, Patwardhan et al. [13] demonstrated that cervical spine segments could support a compressive load of 250 N without instability whereas pure vertical compressive load resulted in great changes in lordosis angle at only 20-to 40-N loading. Putting each spinal segment in nearly pure compression, a follower load increased the load-carrying capacity of the spine specimens. "
    [Show abstract] [Hide abstract] ABSTRACT: Simulating compressive action of muscles, a follower load attends to reproduce a more physiological biomechanical behaviour of the cervical spine. Only few experimental studies reported its influence on kinematics and intradiscal pressure in the cervical spine. In vitro human cadaveric and numerical simulating evaluation of a compressive preload in the cervical spine. To analyse the influence of a compressive follower preload on the biomechanical behaviour of the cervical spine. The present study was divided into two parts: part 1: in vitro investigation; part 2: numerical simulating analysis. Part 1: Twelve human cadaveric spines from C2 to T2 were evaluated intact and after application of a 50-N follower load. All tests were performed under load control by applying pure moments loading of 2 Nm in flexion/extension (FE), axial rotation (AR) and lateral bending (LB). Three-dimensional displacements were measured using an optoelectronic system, and intradiscal pressures were measured at two levels. Part 2: Using a 3D finite element model, we evaluated the influence of a 50- and 100-N compressive preload on intradiscal loads, facets forces and ranges of motion. Different positions of the follower load along the anteroposterior axis (±5 mm) were also simulated. Part 1: Mean variation of cervical lordosis was 5° ± 3°. The ROM slightly increased in FE, whereas it consistently decreased in AR and LB. Coupled lateral bending during AR was also reduced. Increase in hysteresis was observed on load-displacement curves only for AR and LB. Intradiscal pressures increased, but the aspect of load-pressure curves was altered in AR and LB. Part 2: Using the FE model, only minimal changes in ROM were noted following the simulation of a 50-N compressive load for the three loading conditions. Compared to intact condition, <10 % variation was observed with regard to the different magnitude and positioning simulated. Intradiscal loads and facets forces were systematically increased by applying compressive preload. Although the follower load represents an attractive option to apply compressive preload during experimental tests, we found that this method could affect the native biomechanical behaviour of spine specimen depending on which movement was considered. Only minimal effects were observed in FE, whereas significant changes in kinematics and intradiscal pressures were observed for AR and LB.
    Full-text · Article · Apr 2015 · European Journal of Orthopaedic Surgery & Traumatology
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    • "No follower or compressive loads were used in this study. Geometric limitations would have prevented the application of a follower load if the methods utilized in the cervical or lumbar regions were used (Patwardhan et al., 2000), as the anterior portions of the vertebral column were obstructed by the rib cage. To the authors' knowledge, only one study with an intact rib cage has used compressive loads, and only in axial rotation (Watkins et al., 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: The goal of this study was to characterize the overall in-plane and basic coupled motion of a cadaveric human thoracic spine with intact true ribs. Researchers are becoming increasingly interested in the thoracic spine due to both the high prevalence of injury and pain in the region and also innovative surgical techniques that utilize the rib cage. Computational models can be useful tools to predict loading patterns and understand effects of surgical procedures or medical devices, but they are often limited by insufficient cadaveric input data. In this study, pure moments to ±5Nm were applied in flexion-extension, lateral bending, and axial rotation to seven human cadaveric thoracic spine specimens (T1-T12) with intact true ribs to determine symmetry of in-plane motion, differences in neutral and elastic zone motion and stiffness, and significance of out-of-plane rotations and translations. Results showed that lateral bending and axial rotation exhibited symmetric motion, neutral and elastic zone motion and stiffness values were significantly different for all modes of bending (p<0.05), and out-of-plane rotations and translations were greater than zero for most rotations and translations. Overall in-plane rotations were 7.7±3.4° in flexion, 9.6±3.7° in extension, 23.3±8.4° in lateral bending, and 26.3±12.2° in axial rotation. Results of this study could provide inputs or validation comparisons for computational models. Future studies should characterize coupled motion patterns and local and regional level biomechanics of cadaveric human thoracic spines with intact true ribs. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Journal of Biomechanics
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    • "Therefore, we showed the values for ROM and IDP not only as absolute data but also as relative changes in percentage which are expected to demonstrate the same tendency with or without any load application. However, under the influence of muscle simulation or with the use of a preload the absolute values of ROM should be decreased whereas the absolute values of IDP should be increased which is known from literature313233. The applied loads in form of a pure moment with ±2.0 Nm and without an axial preload are in the lower range for an in vitro testing set-up for cervical spines. "
    [Show abstract] [Hide abstract] ABSTRACT: As an alternative technique to arthrodesis of the cervical spine, total disc replacement (TDR) has increasingly been used with the aim of restoration of the physiological function of the treated and adjacent motions segments. The purpose of this experimental study was to analyze the kinematics of the target level as well as of the adjacent segments, and to measure the pressures in the proximal and distal disc after arthrodesis as well as after arthroplasty with two different semi-constrained types of prosthesis. Twelve cadaveric ovine cervical spines underwent polysegmental (C2-5) multidirectional flexibility testing with a sensor-guided industrial serial robot. Additionally, pressures were recorded in the proximal and distal disc. The following three conditions were tested: (1) intact specimen, (2) single-level arthrodesis C3/4, (3) single-level TDR C3/4 using the Discover® in the first six specimens and the activ® C in the other six cadavers. Statistical analysis was performed for the total range of motion (ROM), the intervertebral ROM (iROM) and the intradiscal pressures (IDP) to compare both the three different conditions as well as the two disc prosthesis among each other. The relative iROM in the target level was always lowered after fusion in the three directions of motion. In almost all cases, the relative iROM of the adjacent segments was almost always higher compared to the physiologic condition. After arthroplasty, we found increased relative iROM in the treated level in comparison to intact state in almost all cases, with relative iROM in the adjacent segments observed to be lower in almost all situations. The IDP in both adjacent discs always increased in flexion and extension after arthrodesis. In all but five cases, the IDP in each of the adjacent level was decreased below the values of the intact specimens after TDR. Overall, in none of the analyzed parameters were statistically significantly differences between both types of prostheses investigated. The results of this biomechanical study indicate that single-level implantation of semi-constrained TDR lead to a certain hypermobility in the treated segments with lowering the ROM in the adjacent levels in almost all situations.
    Full-text · Article · Mar 2015 · BioMedical Engineering OnLine
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