Experimental and Computational Comparison of Intervertebral Disc Bulge for Specimen-Specific Model Evaluation Based on Imaging

Finite element modelling of the spinal unit is a promising preclinical tool to assess the biomechanical outcome of emerging interventions. Currently, most models are calibrated and validated against range of motion and rarely directly against soft-tissue deformation. The aim of this contribution was to develop an in vitro methodology to measure disc bulge and assess the ability of different specimen-specific modelling approaches to predict disc bulge. Bovine bone-disc-bone sections (N = 6) were prepared with 40 glass markers on the intervertebral disc surface. These were initially magnetic resonance (MR)-imaged and then sequentially imaged using peripheral-qCT under axial compression of 1 mm increments. Specimen-specific finite-element models were developed from the CT data, using three different methods to represent the nucleus pulposus geometry with and without complementary use of the MR images. Both calibrated specimen-specific and averaged compressive material properties for the disc tissues were investigated. A successful methodology was developed to quantify the disc bulge in vitro, enabling observation of surface displacement on qCT. From the finite element model results, no clear advantage was found in using geometrical information from the MR images in terms of the models’ ability to predict stiffness or disc bulge for bovine intervertebral disc.

Is radius bone mineral density helpful for fracture risk assessment?

Although peripheral DXA is not recommended for the diagnosis of osteoporosis or to monitor osteoporotic treatments, its use for fracture risk assessment is supported by several studies. In addition, its potential interest is supported by the recent demonstration, in prospective cohorts, of the contribution of distal radius microstructure and strength, assessed by high-resolution peripheral QCT (HRpQCT), to predict incident fractures beyond the classical clinical tools (femoral neck BMD and FRAX). Indeed, areal BMD measured by DXA at the ultra-distal radius is highly correlated with bone strength derived from HRpQCT measurements at the same site. Ultra-distal radius areal BMD is therefore highly associated with fracture risk, with associations of higher magnitude than at the “classically recommended” one-third distal radius. Furthermore, ultra-distal radius areal BMD is also associated with incident fractures in non-osteoporotic women in women with T-score > –2.5 SD on hip and spine DXA or women with FRAX score below the intervention threshold for age. Since more than half of low-trauma fractures occur in individuals not identified as being at high risk by BMD testing at the spine or hip, radius bone mineral density may help to refine fracture risk in patients with osteopenia defined by central DXA (spine or hip), or relatively few clinical risk factors.