scholarly journals The 6-Plus–Person Lift Transfer Technique Compared With Other Methods of Spine Boarding

2008 ◽  
Vol 43 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Gianluca Del Rossi ◽  
Mary Beth H. Horodyski ◽  
Bryan P. Conrad ◽  
Christian P. Di Paola ◽  
Matthew J. Di Paola ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Linear Displacement ◽  
Angular Motion ◽  
Spinal Segment ◽  
Spinal Motion ◽  
Spinal Immobilization ◽  
Flexion Extension ◽  
Spine Board

Abstract Context: To achieve full spinal immobilization during on-the-field management of an actual or potential spinal injury, rescuers transfer and secure patients to a long spine board. Several techniques can be used to facilitate this patient transfer. Objective: To compare spinal segment motion of cadavers during the execution of the 6-plus–person (6+) lift, lift-and-slide (LS), and logroll (LR) spine-board transfer techniques. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Eight medical professionals (1 woman, 7 men) with 5 to 32 years of experience were enlisted to help carry out the transfer techniques. In addition, test conditions were performed on 5 fresh cadavers (3 males, 2 females) with a mean age of 86.2 ± 11.4 years. Main Outcomes Measure(s): Three-dimensional angular and linear motions initially were recorded during execution of transfer techniques, initially using cadavers with intact spines and then after C5-C6 spinal segment destabilization. The mean maximal linear displacement and angular motion obtained and calculated from the 3 trials for each test condition were included in the statistical analysis. Results: Flexion-extension angular motion, as well as anteroposterior and distraction-compression linear motion, did not vary between the LR and either the 6+ lift or LS. Compared with the execution of the 6+ lift and LS, the execution of the LR generated significantly more axial rotation (P  =  .008 and .001, respectively), more lateral flexion (P  =  .005 and .003, respectively), and more medial-lateral translation (P  =  .003 and .004, respectively). Conclusions: A small amount of spinal motion is inevitable when executing spine-board transfer techniques; however, the execution of the 6+ lift or LS appears to minimize the extent of motion generated across a globally unstable spinal segment.

scholarly journals Removal of the Long Spine Board From Clinical Practice: A Historical Perspective

2018 ◽  
Vol 53 (8) ◽  
pp. 752-755
Author(s):  
Francis X. Feld
Keyword(s):  
Cervical Spine ◽  
Historical Perspective ◽  
Spinal Injury ◽  
Position Statement ◽  
Spinal Motion ◽  
Initial Management ◽  
Injury Management ◽  
Spinal Immobilization ◽  
Growing Body ◽  
Spine Board

Since the early 1970s, initial management of patients with suspected spinal injuries has involved the use of a cervical collar and long spine board for full immobilization, which was thought to prevent additional injury to the cervical spine. Despite a growing body of literature demonstrating the detrimental effects and questionable efficacy of spinal immobilization, the practice continued until 2013, when the National Association of EMS Physicians issued a position statement calling for a reduction in the use of spinal immobilization and a shift to spinal-motion restriction. This article examines the literature that prompted the change in spinal-injury management and the virtual elimination of the long spine board as a tool for transport.

Total motion generated in the unstable thoracolumbar spine during management of the typical trauma patient: a comparison of methods in a cadaver model

2012 ◽  
Vol 16 (5) ◽  
pp. 504-508 ◽  
Author(s):  
Mark L. Prasarn ◽  
Haitao Zhou ◽  
Dewayne Dubose ◽  
Gianluca Del Rossi ◽  
Bryan P. Conrad ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Statistical Significance ◽  
Thoracolumbar Spine ◽  
Axial Rotation ◽  
Complete Sequence ◽  
Angular Motion ◽  
Neurological Injury ◽  
Operating Table ◽  
Flexion Extension ◽  
Spine Board

Object The proper prehospital and inpatient management of patients with unstable spinal injuries is critical for prevention of secondary neurological compromise. The authors sought to analyze the amount of motion generated in the unstable thoracolumbar spine during various maneuvers and transfers that a trauma patient would typically be subjected to prior to definitive fixation. Methods Five fresh cadavers with surgically created unstable L-1 burst fractures were tested. The amount of angular motion between the T-12 and L-2 vertebral segments was measured using a 3D electromagnetic motion analysis device. A complete sequence of maneuvers and transfers was then performed that a patient would be expected to go through from the time of injury until surgical fixation. These maneuvers and transfers included spine board placement and removal, bed transfers, lateral therapy, and turning the patient prone onto the operating table. During each of these, the authors performed what they believed to be the most commonly used versus the best techniques for preventing undesirable motion at the injury level. Results When placing a spine board there was more motion in all 3 planes with the log-roll technique, and this difference reached statistical significance for axial rotation (p = 0.018) and lateral bending (p = 0.003). Using logrolling for spine board removal resulted in increased motion again, and this was statistically significant for flexion-extension (p = 0.014). During the bed transfer and lateral therapy, the log-roll technique resulted in more motion in all 3 planes (p ≤ 0.05). When turning the cadavers prone for surgery there was statistically more angular motion in each plane for manually turning the patient versus the Jackson table turn (p ≤ 0.01). The total motion was decreased by almost 50% in each plane when using an alternative to the log-roll techniques during the complete sequence (p ≤ 0.007). Conclusions Although it is unknown how much motion in the unstable spine is necessary to cause secondary neurological injury, the accepted tenet is to minimize motion as much as possible. This study has demonstrated the angular motion incurred by the unstable thoracolumbar spine as experienced by the typical trauma patient from the field to positioning in the operating room using the best and most commonly used techniques. As previously reported, using the log-roll technique consistently results in unwanted motion at the injured spinal segment.

Is intervertebral disc degeneration related to segmental instability? An evaluation with two different grading systems based on clinical imaging

2017 ◽  
Vol 59 (3) ◽  
pp. 327-335 ◽  
Author(s):  
David Volkheimer ◽  
Fabio Galbusera ◽  
Christian Liebsch ◽  
Sabine Schlegel ◽  
Friederike Rohlmann ◽  
...  
Keyword(s):  
Intervertebral Disc Degeneration ◽  
Statistical Significance ◽  
Axial Rotation ◽  
Spinal Motion ◽  
X Ray ◽  
Grading Systems ◽  
Flexion Extension ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri

Background Several in vitro studies investigated how degeneration affects spinal motion. However, no consensus has emerged from these studies. Purpose To investigate how degeneration grading systems influence the kinematic output of spinal specimens. Material and Methods Flexibility testing was performed with ten human T12-S1 specimens. Degeneration was graded using two different classifications, one based on X-ray and the other one on magnetic resonance imaging (MRI). Intersegmental rotation (expressed by range of motion [ROM] and neutral zone [NZ]) was determined in all principal motion directions. Further, shear translation was measured during flexion/extension motion. Results The X-ray grading system yielded systematically lesser degeneration. In flexion/extension, only small differences in ROM and NZ were found between moderately degenerated motion segments, with only NZ for the MRI grading reaching statistical significance. In axial rotation, a significant increase in NZ for moderately degenerated segments was found for both grading systems, whereas the difference in ROM was significant only for the MRI scheme. Generally, the relative increases were more pronounced for the MRI classification compared to the X-ray grading scheme. In lateral bending, only relatively small differences between the degeneration groups were found. When evaluating shear translations, a non-significant increase was found for moderately degenerated segments. Motion segment segments tended to regain stability as degeneration progressed without reaching the level of statistical significance. Conclusion We found a fair agreement between the grading schemes which, nonetheless, yielded similar degeneration-related effects on intersegmental kinematics. However, as the trends were more pronounced using the Pfirrmann classification, this grading scheme appears superior for degeneration assessment.

scholarly journals Multiscale modelling of the human lumbar facet capsular ligament: analysing spinal motion from the joint to the neurons

2018 ◽  
Vol 15 (148) ◽  
pp. 20180550
Author(s):  
Vahhab Zarei ◽  
Rohit Y. Dhume ◽  
Arin M. Ellingson ◽  
Victor H. Barocas
Keyword(s):  
Axial Rotation ◽  
Fe Model ◽  
Spinal Motion ◽  
Capsular Ligament ◽  
Segment Model ◽  
Motion Segment ◽  
Flexion Extension ◽  
Vertebral Kinematics ◽  
High Level ◽  
Lumbar Facet

Due to its high level of innervation, the lumbar facet capsular ligament (FCL) is suspected to play a role in low back pain (LBP). The nociceptors in the lumbar FCL may experience excessive deformation and generate pain signals. As such, understanding the mechanical behaviour of the FCL, as well as that of its underlying nerves, is critical if one hopes to understand its role in LBP. In this work, we constructed a multiscale structure-based finite-element (FE) model of a lumbar FCL on a spinal motion segment undergoing physiological motions of flexion, extension, ipsilateral and contralateral bending, and ipsilateral axial rotation. Our FE model was created for a generic FCL geometry by morphing a previously imaged FCL anatomy onto an existing generic motion segment model. The fibre organization of the FCL in our models was subject-specific based on previous analysis of six dissected specimens. The fibre structures from those specimens were mapped onto the FCL geometry on the motion segment. A motion segment model was used to determine vertebral kinematics under specified spinal loading conditions, providing boundary conditions for the FCL-only multiscale FE model. The solution of the FE model then provided detailed stress and strain fields within the tissue. Lastly, we used this computed strain field and our previous studies of deformation of nerves embedded in fibrous networks during simple deformations (e.g. uniaxial stretch, shear) to estimate the nerve deformation based on the local tissue strain and fibre alignment. Our results show that extension and ipsilateral bending result in largest strains of the lumbar FCL, while contralateral bending and flexion experience lowest strain values. Similar to strain trends, we calculated that the stretch of the microtubules of the nerves, as well as the forces exerted on the nerves' membrane are maximal for extension and ipsilateral bending, but the location within the FCL of peak microtubule stretch differed from that of peak membrane force.

Kinematics and Laxity of Ulnohumeral Joint Under Valgus-Varus Stress

1998 ◽  
Vol 02 (01) ◽  
pp. 45-54 ◽  
Author(s):  
Shinji Tanaka ◽  
Kai-Nan An ◽  
Bernard F. Morrey
Keyword(s):  
Elbow Joint ◽  
Three Dimensional ◽  
Elbow Flexion ◽  
Axial Rotation ◽  
Joint Laxity ◽  
Treatment Modalities ◽  
Trochlear Groove ◽  
Flexion Extension ◽  
Varus Stress ◽  
Baseline Information

Three-dimensional kinematics of the ulnohumeral joint under simulated active elbow joint flexion-extension was obtained by using an electromagnetic tacking device. The joint motion was analyzed based on Eulerian angle description. In order to minimize the effect of "downstream cross-talk" on calculation of the three Eulerian angles, an optimal axis to best represent flexion-extension of the elbow joint was established. This axis, on average, is close to the line joining the centers of the capitellum and the trochlear groove. Furthermore, joint laxity under valgus-varus stress was also examined. With the weight of the forearm as the stress, maximums of 7.6° valgus-varus laxity and 5.3° axial rotation laxity were observed within a range of elbow flexion. The results of this study provide useful baseline information on joint laxity for the evaluation of elbow joints with implant replacements and other surgical treatment modalities.

scholarly journals Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model

2020 ◽  
Vol 10 (18) ◽  
pp. 6413
Author(s):  
Ji-Won Kwon ◽  
Hwan-Mo Lee ◽  
Tae-Hyun Park ◽  
Sung Jae Lee ◽  
Young-Woo Kwon ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Element Model ◽  
Axial Rotation ◽  
Biomechanical Analysis ◽  
Flexion Extension ◽  
Hybrid Motion ◽  
Anterior Cervical Discectomy Fusion ◽  
Flexion And Extension ◽  
Additional Fixation ◽  
Lateral Walls

The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary.

FINITE ELEMENT MODELING OF HUMAN THORACIC SPINE

2004 ◽  
Vol 08 (04) ◽  
pp. 133-144 ◽  
Author(s):  
Tian-Xia Qiu ◽  
Ee-Chon Teo
Keyword(s):  
Finite Element ◽  
Thoracic Spine ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Torsional Stiffness ◽  
Fe Model ◽  
Thoracic Vertebrae ◽  
Fundamental Information ◽  
Flexion Extension ◽  
Scoliosis Correction

Mathematical models, which can accurately represent the geometric, material and physical characteristics of the human spine structure, are useful in predicting biomechanical behaviors of the spine. In this study, a three-dimensional finite element (FE) model of thoracic spine (T1–T12) was developed, based on geometrical data of embalmed thoracic vertebrae (T1–T12) obtained from a precise flexible digitizer, and validated against published thoracolumbar experimental results in terms of the torsional stiffness of the whole thoracic spine (T1–T12) under axial torque alone and combined with distraction and compression loads. The torsional stiffness was increased by over 60% with application of a 425 N distraction force. A trend in increasing torsional stiffness with increasing distraction forces was detected. The validated model was then loaded under moment rotation in three anatomical planes to determine the ranges of motion (ROMs). The ROMs were approximately 37°, 31°, 32°, 51° for flexion, extension, lateral bending and axial rotation, respectively. These results may offer an insight to better understanding the kinematics of the human thoracic spine and provide clinically relevant fundamental information for the evaluation of spinal stability and instrumented devices functionality for optimal scoliosis correction.

A biomechanical comparison of three anterior thoracolumbar implants after corpectomy: are two screws better than one?

2006 ◽  
Vol 4 (3) ◽  
pp. 213-218 ◽  
Author(s):  
Dean Chou ◽  
Adolfo Espinoza Larios ◽  
Robert H. Chamberlain ◽  
Mary S. Fifield ◽  
Roger Hartl ◽  
...  
Keyword(s):  
Biomechanical Testing ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Single Screw ◽  
Flexion Extension ◽  
Rod System ◽  
Mesh Cage ◽  
Left And Right ◽  
Plate System ◽  
Better Than

Object A flexibility experiment using human cadaveric thoracic spine specimens was performed to determine biomechanical differences among thoracolumbar two-screw plate, single-screw plate, and dual-rod systems. A secondary goal was to investigate differences in the ability of the systems to stabilize the spine after a one- or two-level corpectomy. Methods The authors evaluated 21 cadaveric spines implanted with a titanium mesh cage and three types of anterior thoracolumbar supplementary instrumentation after one-level thoracic corpectomies. Pure moments were applied quasistatically while three-dimensional motion was measured optoelectronically. The lax zone, stiff zone, and range of motion (ROM) were measured during flexion, extension, left and right lateral bending, and left and right axial rotation. Corpectomies were expanded to two levels, and testing was repeated with longer hardware. Biomechanical testing showed that the single-bolt plate system was no different from the dual-rod system with two screws in limiting ROM. The single-bolt plate system performed slightly better than the two-screw plate system. Across the same two levels, there was an average of 19% more motion after a two-level corpectomy than after a one-level corpectomy. In general, however, the difference across the different loading modes was insignificant. Conclusions Biomechanically, the single-screw plate system is equivalent to a two-screw dual-rod and a two-screw plate system. All three systems performed similarly in stabilizing the spine after one- or two-level corpectomies.

scholarly journals Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fracture

2020 ◽  
Author(s):  
Xiao-Hua Zuo ◽  
Ying-Bing Chen ◽  
Peng Xie ◽  
Wen-Dong Zhang ◽  
Xiang-Yun Xue ◽  
...  
Keyword(s):  
Finite Element ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Neutral Position ◽  
Element Analysis ◽  
Flexion Extension ◽  
Dimensional Finite Element ◽  
Von Mises ◽  
Three Dimensional Finite Element ◽  
Wedge Fracture

Abstract Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture; Whereas restored or not in biconcave deformity.

scholarly journals Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiao-Hua Zuo ◽  
Yin-Bing Chen ◽  
Peng Xie ◽  
Wen-Dong Zhang ◽  
Xiang-Yun Xue ◽  
...  
Keyword(s):  
Finite Element ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Vertebral Compression Fractures ◽  
Neutral Position ◽  
Element Analysis ◽  
Flexion Extension ◽  
Dimensional Finite Element ◽  
Von Mises ◽  
Three Dimensional Finite Element

Abstract Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.

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