Engineering topics
Hendershot, Brad D.
Publications and source records attributed to Hendershot, Brad D..
Hooks versus Pedicle Screws at the Upper Instrumented Level: An In Vitro Biomechanical Comparison
Study Design. Controlled laboratory study Objective. To compare motions at the upper instrumented vertebra (UIV) and supra-adjacent level (UIV+1) between two fixation techniques in thoracic posterior spinal fusion (PSF) constructs. We hypothesized there would be greater motion at UIV+1 after cyclic loading across all constructs and bilateral pedicle screws (BPS) with posterior ligamentous compromise would demonstrate the greatest UIV+1 range of motion (ROM). Summary of Background Data. Proximal junctional kyphosis (PJK) is a well-recognized complication following long thoraco-lumbar PSF, however its mechanism is poorly understood. Methods. Twenty-seven thoracic functional spine units (FSU) were randomly divided into three UIV fixation groups (n=9): (1) BPS, (2) bilateral transverse process hooks (TPH), and (3) BPS with compromise of the posterior elements between UIV and UIV+1 (BPS-C). Specimens were tested on a servohydraulic materials testing system in native state, following instrumentation, and after cyclic loading. FSUs were loaded in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Results. After cyclic testing, the TPH group had a mean 29.4% increase in FE ROM at UIV+1 versus 76.6% in the BPS group ( P <0.05). The BPS-C group showed an increased FE of 49.9% and 62.19% with sectioning of the facet joints and interspinous ligament respectively prior to cyclic testing. Conclusion. Bilateral pedicle screws at the UIV led to greater motion at UIV+1 compared to bilateral TPH after cyclic loading. This is likely due to the increased rigidity of BPS compared to TPH leading to a “softer” transition between the TPH construct and native anatomy at the supra-adjacent level. Facet capsule compromise led to a 49.9% increase in UIV+1 motion, underscoring the importance of preserving the posterior ligamentous complex. Clinical studies that account for fusion rates are warranted to determine if constructs with a “soft transition” result in less PJK in vivo.
Trunk muscle forces and spinal loads while walking in persons with lower limb amputation: Influences of chronic low back pain
Persons with lower limb amputation (LLA) are at high risk for developing chronic low back pain (LBP), often with biomechanical factors considered as likely contributors. Here, trunk and pelvis kinematics, muscle forces, and resultant spinal loads were characterized in persons with LLA, with and without chronic LBP. Thirty-five persons with unilateral LLA – 19 with chronic LBP (“LLA-cLBP”), 16 without LBP (“LLA-nLBP”) – and 15 (uninjured) persons without LBP (“CTR-nLBP”) walked overground (1.3 m/s) while thorax and pelvis kinematics were tracked (and ranges of motion [ROM] computed), and used as inputs for a non-linear finite element model of the spine to estimate global and local muscle forces, and resultant spinal loads. In the frontal and transverse planes, thorax ROM were up to 66.6% smaller in LLA-nLBP versus LLA-cLBP (P < 0.001) and CTR-nLBP (P < 0.001). In the sagittal plane, pelvis ROM was 50.4% smaller in LLA-nLBP versus LLA-cLBP (P = 0.014). LLA-cLBP exhibited 45.5% and 34.2% greater peak local and global muscle forces, respectively, versus CTR-nLBP (P < 0.011). Up to 48.1% greater spinal loads were observed in LLA-cLBP versus CTR-nLBP (P < 0.013); peak compression and local muscle forces were respectively 20.2% and 41.0% larger in LLA-nLBP versus CTR-nLBP (P < 0.005). Despite differences in trunk and pelvis kinematics between LLA-cLBP and LLA-nLBP, trunk muscle forces and spinal loads were similar (P > 0.101) between these groups. Similar loading parameters regardless of LBP presence, while highly dependent on trunk muscle activation strategies, may mitigate further accumulation of mechanical fatigue. Finally, it remains important to understand the temporality of loading with respect to LBP onset following LLA.