Showing papers by "Patricia Dolan published in 2010"

Is activation of the back muscles impaired by creep or muscle fatigue

Abstract: STUDY DESIGN: Intervention study on healthy human subjects. OBJECTIVE: To determine whether reflex activation of the back muscles is influenced by muscle fatigue or soft tissue creep in the spine. SUMMARY OF BACKGROUND DATA: Reflex contraction of the back muscles normally acts to limit spinal flexion, and hence protect the underlying spine from injury. However, repeated flexion allows bending moments on the spine to increase. Impaired reflexes as a result of fatigue or soft tissue creep may be contributing factors. METHODS: A total of 15 healthy volunteers (8 females/7 males aged 23-55 years) underwent 2 interventions, on separate days: (a) sitting flexed for 1 hour to induce creep and (b) performing the Biering-Sorensen test to induce back muscle fatigue. Before and after each intervention, reflex activation of the erector spinae in response to sudden trunk flexion (initiated by a Kin-Com dynamometer) was monitored bilaterally at T10 and L3 using surface electromyography (EMG) electrodes. These recordings indicated the onset latency of reflex activation, the peak EMG, and time to peak, at each site. Measurements before and after each intervention and between muscle sites were compared using a 2-way repeated measures Analysis of Variance. RESULTS: Spinal creep was confirmed by an increase in maximum flexion of 2.3 degrees +/- 2.5 degrees (P = 0.003), and fatigue by a significant fall in median frequency at one or more sites. Following creep, onset latency increased from 60 +/- 12 milliseconds to 96 +/- 26 milliseconds (P < 0.001) but there was no change in peak EMG or time to peak EMG. Differences between sites (P = 0.004) indicated greater latencies in lumbar compared to thoracic regions, especially after creep. Muscle fatigue had no significant effects on any of the measured parameters. CONCLUSION: Prolonged spinal flexion can impair sensorimotor control mechanisms and reduce back muscle protection of the underlying spine. The effect is due to time-dependent "creep" in soft tissues rather than muscle fatigue.

Time-Dependent Compressive Deformation of the Ageing Spine : Relevance to Spinal Stenosis

Abstract: Study Design. Mechanical testing of cadaveric spines. Objective. To test the hypothesis that, in the ageing spine, vertebrae deform more than discs, and contribute to time-dependent creep. Summary of Background Data. Intervertebral discs and vertebrae deform under load, narrowing the intervertebral foramen and increasing the risk of nerve root entrapment. Little is known about compressive deformations when elderly spines are subjected to sustained physiologic loading. Methods. A total of 117 thoracolumbar motion segments, aged 19 to 96 yrs (mean, 69), were subjected to 1kN compressive loading for 0.5, 1, or 2 hours. Deformations during the first 7 seconds were designated “elastic” and subsequent deformations as “creep”. A 3-parameter model was fitted to experimental data in order to characterize their viscous modulus E1, elastic modulus E2 (initial stiffness), and viscosity η (resistance to fluid flow). Intradiscal pressure (IDP) was measured using a miniature needle-mounted transducer. In 17 specimens loaded for 0.5 hours, an optical MacReflex system measured compressive deformations separately in the disc and each vertebral body. Results. On average, the disc contributed 28% of the spine's elastic deformation, 51% of the creep deformation, and 38% of total deformation. Elastic, creep, and total deformations of 84 motion segments in 2-hour tests averaged 0.87, 1.37, and 2.24 mm respectively. Measured deformations were predicted accurately by the model (average r2 = 0.97), but E1, E2, and η depended on the duration of loading. E1 and η decreased with advancing age and disc degeneration, in proportion to falling IDP (P < 0.001). Total compressive deformation increased with age, but rarely exceeded 3 mm. Conclusion. When the ageing spine is compressed, vertebral bodies show greater elastic deformations than intervertebral discs, and creep by a similar amount. Responses to axial compression depend largely on IDP, but deformations appear to be limited by impaction of adjacent neural arches. Total compressive deformations are sufficient to cause foraminal stenosis in some individuals.

Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture

Abstract: Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture.