Localized Trabecular Damage Adjacent to Interbody Fusion Devices

The success of an orthopaedic implant depends, in part, on the interaction between the implant and the bone at the interface. Interbody fusion devices must safely and effectively transfer load between the device and the neighboring vertebral cancellous bone on which the device is supported. This dissertation serves as an initial investigation into the consequences of damage accumulation in the vertebral cancellous bone due to two interbody fusion devices with differing interface geometries.

The degradation of mechanical properties due to damage processes was investigated using human cadaveric vertebrae and interbody fusion devices with differing interface geometries. Permanent deformation, decreased structural stiffness or altered viscoelastic properties were found in all specimens at nominal loads. The overall changes in the structural properties were inconsistent with regard to the device interface geometry.

The presence of damage in the experimental specimens was investigated using a polychromatic labeling scheme. An image processing method was developed to segment bone tissue and regions of diffuse damage in an automated fashion. Diffuse damage was the predominant form of damage found and in all specimens this was located in a very localized region immediately adjacent to the implant.

A continuum finite element model was developed and used to examine the interaction between the interbody fusion devices and the adjacent cancellous bone. The cancellous bone was modeled with inelastic material behaviors and damage zones within the cancellous bone were predicted under the assumption that damage accumulation and plastic flow were concomitant. When the cancellous bone was modeled using a viscoplastic material model, the finite element predictions corresponded more closely to the structural mechanical and local histological results of the experimental specimens. The interface geometry of the interbody fusion devices affected the local damage zones more than the structural properties. Changes in the cancellous bone mineral density affected the structural mechanical properties significantly more than the predicted patterns of local damage.

Year	Entry
1987	Mosekilde L, Mosekilde L, Danielsen CC. Biomechanical competence of vertebral trabecular bone in relation to ash density and age in normal individuals. Bone. 1987;8(2):79-85.
1998	Silva MJ, Keaveny TM, Hayes WC. Computed tomography-based finite element analysis predicts failure loads and fracture patterns for vertebral sections. J Orthop Res. May 1998;16(3):300-308.
1980	Cann CE, Genant HK. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr. 1980;4(4):493-500.
2005	Nagaraja S, Couse TL, Guldberg RE. Trabecular bone microdamage and microstructural stresses under uniaxial compression. J Biomech. 2005;38(4):707-716.
1977	Urban JPG, Holm S, Maroudas A, Nachemson A. Nutrition of the intervertebral disk: an in vivo study of solute transport. Clin Orthop Relat Res. November 1977;129:101-114.
1994	Silva MJ, Wang C, Keaveny TM, Hayes WC. Direct and computed tomography thickness measurements of the human, lumbar vertebral shell and endplate. Bone. July 8, 1994;15(4):409-414.
1999	Kopperdahl DL, Roberts AD, Keaveny TM. Localized damage in vertebral bone is most detrimental in regions of high strain energy density. J Biomech Eng. December 1999;121(6):622-628.
2002	O’Brien FJ, Taylor D, Lee TC. An improved labelling technique for monitoring microcrack growth in compact bone. J Biomech. April 2002;35(4):523-526.
1970	Nachemson A, Lewin T, Maroudas A, Freeman MAR. In vitro diffusion of dye through the end-plates and the annulus fibrosus of human lumbar inter-vertebral discs. Acta Orthop Scand. 1970;41(3):589-607.
1960	Frost HM. Presence of microscopic cracks in vivo in bone. Henry Ford Hosp Med Bull. 1960;8(1):25-35.
1992	Martin B. A theory of fatigue damage accumulation and repair in cortical bone. J Orthop Res. November 1992;10(6):818-825.
1974	Schoenfeld CM, Lautenschlager EP, Meyer PR. Mechanical properties of human cancellous bone in the femoral head. Med Biol Eng. 1974;12(3):313-317.
2003	Crawford RP, Rosenberg WS, Keaveny TM. Quantitative computed tomography-based finite element models of the human lumbar vertebral body: effect of element size on stiffness, damage, and fracture strength predictions. J Biomech Eng. August 2003;125(4):434-438.
1997	Jepsen KJ, Davy DT. Comparison of damage accumulation measures in human cortical bone. J Biomech. September 1997;30(9):891-894.
1994	Prendergast P, Taylor D. Prediction of bone adaptation using damage accumulation. J Biomech. August 1994;27(8):1067-1076.
1988	Fondrk M, Bahniuk E, Davy DT, Michaels C. Some viscoplastic characteristics of bovine and human cortical bone. J Biomech. 1988;21(8):623-630.
1980	Zilch H, Rohlmann A, Bergmann G, Kölbel R. Material properties of femoral cancellous bone in axial loading, II: time dependent properties. Arch Orthop Trauma Surg. December 1980;97(4):257-262.
1999	Keaveny TM, Wachtel EF, Kopperdahl DL. Mechanical behavior of human trabecular bone after overloading. J Orthop Res. May 1999;17(3):346-353.
2002	Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res. July 2002;20(4):801-805.
2003	Bredbenner TL. Damage Modeling of Vertebral Trabecular Bone [PhD thesis]. Cleveland, OH: Case Western Reserve University; January 2003.
2000	Kopperdahl DL, Pearlman JL, Keaveny TM. Biomechanical consequences of an isolated overload on the human vertebral body. J Orthop Res. September 2000;18(5):685-690.
1997	Silva MJ, Keaveny TM, Hayes WC. Load sharing between the shell and centrum in the lumbar vertebral body. Spine. January 1997;22(2):140-150.
1991	Faulkner KG, Cann CE, Hasegawa BH. Effect of bone distribution on vertebral strength: assessment with patient-specific nonlinear finite element analysis. Radiology. June 1991;179(3):669-674.
1998	Kopperdahl DL. Structural Consequences of Damage on the Mechanical Behavior of the Human Vertebral Body [PhD thesis]. Berkeley, CA: Berkeley, University of California; 1998.
1989	Turner CH. Yield behavior of bovine cancellous bone [published correction appears in J Biomech Eng. 1989;111(4):335]. J Biomech Eng. August 1989;111(3):256-260.
2003	Yeni YN, Hou FJ, Ciarelli T, Vashishth D, Fyhrie DP. Trabecular shear stresses predict in vivo linear microcrack density but not diffuse damage in human vertebral cancellous bone. Ann Biomed Eng. June 2003;31(6):726-732.
2003	Lee TC, Mohsin S, Taylor D, Parkesh R, Gunnlaugsson T, O'Brien FJ, Giehl M, Gowin W. Detecting microdamage in bone. J Anat. August 2003;203(2):161-172.
1998	Lund T, Oxland TR, Jost B, Cripton P, Grassmann S, Etter C, Nolte L-P. Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg. March 1998;80B(2):351-359.
1990	Thompson JP, Pearce RH, Schechter MT, Adams ME, Tsang IK, Bishop PB. Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc. Spine. May 1990;15(5):411-415.
1996	Pattin CA, Caler WE, Carter DR. Cyclic mechanical property degradation during fatigue loading of cortical bone. J Biomech. January 1996;29(1):69-79.
1994	Keaveny TM, Wachtel EF, Guo XE, Hayes WC. Mechanical behavior of damaged trabecular bone. J Biomech. November 1994;27(11):1309-1318.
2000	Vashishth D, Koontz J, Qiu SJ, Lundin-Cannon D, Yeni YN, Schaffler MB, Fyhrie DP. In vivo diffuse damage in human vertebral trabecular bone. Bone. February 2000;26(2):147-152.
1999	Jepsen KJ, Davy DT, Krzypow DJ. The role of the lamellar interface during torsional yielding of human cortical bone. J Biomech. March 1999;32(3):303-310.
1988	Miller JAA, Schmatz C, Schultz AB. Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine. February 1988;13(2):173-178.
1992	Choi K, Goldstein SA. A comparison of the fatigue behavior of human trabecular and cortical bone tissue. J Biomech. 1992;25(12):1371-1381.
1994	Guo X-DE, McMahon TA, Keaveny TM, Hayes WC, Gibson LJ. Finite element modeling of damage accumulation in trabecular bone under cyclic loading. J Biomech. February 1994;27(2):145-155.
2001	Edwards WT, Zheng Y, Ferrara LA, Yuan HA. Structural features and thickness of the vertebral cortex in the thoracolumbar spine. Spine. January 15, 2001;26(2):218-225.
2001	Niebur GL, Yuen JC, Burghardt AJ, Keaveny TM. Sensitivity of damage predictions to tissue level yield properties and apparent loading conditions. J Biomech. May 2001;34(5):699-706.
2000	Niebur GL, Feldstein MJ, Yuen JC, Chen TJ, Keaveny TM. High-resolution finite element models with tissue strength asymmetry accurately predict failure of trabecular bone. J Biomech. December 2000;33(12):1575-1583.
1983	Baron R, Vignery A, Neff L, Silvergate A, Santa Maria A. Processing of undecalcified bone specimens for bone histomorphometry. In: Recker RR, ed. Bone Histomorphometry: Techniques and Interpretation. Boca Raton, FL: Inc., CRC Press; 1983:13-35.
2006	Guedes RM, Simões JA, Morais JL. Viscoelastic behaviour and failure of bovine cancellous bone under constant strain rate. J Biomech. 2006;39(1):49-60.
1994	Bowman SM, Keaveny TM, Gibson LJ, Hayes WC, McMahon TA. Compressive creep behavior of bovine trabecular bone. J Biomech. March 1994;27(3):301-310.
1994	Deligianni DD, Maris A, Missirlis YF. Stress relaxation behaviour of trabecular bone specimens. J Biomech. December 1994;27(12):1469-1476.
1988	Harrigan TP, Jasty M, Mann RW, Harris WH. Limitations of the continuum assumption in cancellous bone. J Biomech. 1988;21(4):269-275.
2002	Arthur Moore TL, Gibson LJ. Microdamage accumulation in bovine trabecular bone in uniaxial compression. J Biomech Eng. February 2002;124(1):63-71.
1960	Nachemson A. Lumbar intradiscal pressure: experimental studies on post-mortem material. Acta Orthop Scand. 1960;31(suppl 43):1-104.
1996	Wenzel TE, Schaffler MB, Fyhrie DP. In vivo trabecular microcracks in human vertebral bone. Bone. August 1996;19(2):89-95.
2006	Joo W. Cross-Modal Effects of Damage on Mechanical Behavior of Human Cortical Bone [PhD thesis]. Cleveland, OH: Case Western Reserve University; January 2006.
1998	Fazzalari NL, Forwood MR, Manthey BA, Smith K, Kolesik P. Three-dimensional confocal images of microdamage in cancellous bone. Bone. October 1998;23(4):373-378.
2003	Taylor D, Lee TC. Microdamage and mechanical behaviour: predicting failure and remodelling in compact bone. J Anat. August 2003;203(2):203-211.
1966	Nachemson A. The load on lumbar disks in different positions of the body. Clin Orthop Relat Res. March–March 1966;45:107-122.
1997	Wachtel EF, Keaveny TM. Dependence of trabecular damage on mechanical strain. J Orthop Res. September 1997;15(5):781-787.
1998	Fazzalari NL, Forwood MR, Smith K, Manthey BA, Herreen P. Assessment of cancellous bone quality in severe osteoarthrosis: bone mineral density, mechanics, and microdamage. Bone. 1998;22(4):381-388.
1998	Kopperdahl DL, Keaveny TM. Yield strain behavior of trabecular bone. J Biomech. July 1998;31(7):601-608.
1993	Mosekilde L. Vertebral structure and strength in vivo and in vitro. Calcif Tiss Int. February 1993;53(suppl 1):S121-S126.
1988	Yahia LH, Drouin G, Duval P. A methodology for mechanical measurements of technical constants of trabecular bone. Eng Med. October 1988;17(4):169-173.
2003	Crawford RP, Cann CE, Keaveny TM. Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone. 2003;33(4):744-750.
1996	Zysset PK, Curnier A. A 3D damage model for trabecular bone based on fabric tensors. J Biomech. December 1996;29(12):1549-1558.
2000	Lee TC, O'Brien FJ, Taylor D. The nature of fatigue damage in bone. Int J Fract. November 2000;22(10):847-853.
1999	Ulrich D, van Rietbergen B, Laib A, Rüegsegger P. The ability of three-dimensional structural indices to reflect mechanical aspects of trabecular bone. Bone. 1999;25(1):55-60.
2001	Jee WSS. Integrated bone tissue physiology: anatomy and physiology. In: Cowin SC, ed. Bone Mechanics Handbook. 2nd ed. Boca Raton, FL: CRC Press; 2001:1-1–1-68.
1994	Fyhrie DP, Schaffler MB. Failure mechanisms in human vertebral cancellous bone. Bone. 1994;15(1):105-109.
1997	Burr DB, Forwood MR, Fyhrie DP, Martin RB, Schaffler MB, Turner CH. Bone microdamage and skeletal fragility in osteoporotic and stress fractures. J Bone Miner Res. January 1997;12(1):6-15.
1990	White AA III, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, PA: J.B. Lippincott Company; 1990.
1994	Zysset P. A Constitutive Law for Trabecular Bone [PhD thesis]. Lausanne, Switzerland: École Polytechnique Fédérale de Lausanne; 1994.
1993	Burr DB. Remodeling and the repair of fatigue damage. Calcif Tiss Int. February 1993;53(suppl 1):S75-S81.
1990	Burr DB, Stafford T. Validity of the bulk-staining technique to separate artifactual from in vivo bone microdamage. Clin Orthop Relat Res. November 1990;260:305-308.
1995	van Rietbergen B, Weinans H, Huiskes R, Odgaard A. A new method to determine trabecular bone elastic properties and loading using micromechanical finite-element models. J Biomech. January 1995;28(1):69-81.
2000	Lee TC, Arthur TL, Gibson LJ, Hayes WC. Sequential labelling of microdamage in bone using chelating agents. J Orthop Res. March 2000;18(2):322-325.
1989	Keller TS, Hansson TH, Abram AC, Spengler DM, Panjabi MM. Regional variations in the compressive properties of lumbar vertebral trabeculae: effects of disc degeneration. Spine. September 1989;14(9):1012-1019.
1999	Huja SS, Hasan MS, Pidaparti R, Turner CH, Garetto LP, Burr DB. Development of a fluorescent light technique for evaluating microdamage in bone subjected to fatigue loading. J Biomech. November 1999;32(11):1243-1249.
1995	Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine. June 1995;20(11):1307-1314.

Year

Entry

1987

Mosekilde L, Mosekilde L, Danielsen CC. Biomechanical competence of vertebral trabecular bone in relation to ash density and age in normal individuals. Bone. 1987;8(2):79-85.

1998

Silva MJ, Keaveny TM, Hayes WC. Computed tomography-based finite element analysis predicts failure loads and fracture patterns for vertebral sections. J Orthop Res. May 1998;16(3):300-308.

1980

Cann CE, Genant HK. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr. 1980;4(4):493-500.

2005

Nagaraja S, Couse TL, Guldberg RE. Trabecular bone microdamage and microstructural stresses under uniaxial compression. J Biomech. 2005;38(4):707-716.

1977

Urban JPG, Holm S, Maroudas A, Nachemson A. Nutrition of the intervertebral disk: an in vivo study of solute transport. Clin Orthop Relat Res. November 1977;129:101-114.