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Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement

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Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement Universität Ulm Zentrum für Chirurgie Institut für Unfallchirurgische Forschung und Biomechanik Direktor: Prof. Dr. A. Ignatius Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement Dissertation zur Erlangung des Doktorgrades der Medizin der Medizinischen Fakultät der Universität Ulm vorgelegt von: Konrad Appelt geboren in: Pforzheim 2012 Amtierender Dekan: Prof. Dr. Thomas Wirth 1. Berichterstatter: Prof. Dr. H.-J. Wilke 2. Berichterstatter: Prof. Dr. Tobias Böckers Tag der Promotion: 06.06.2013 Index List of abbreviations ......................................................................................IV 1 Introduction .............................................................................................. 1 1.1 Background ............................................................................................................. 1 1.2 State of Research .................................................................................................... 4 1.3 Objectives ............................................................................................................... 6 2 Material and methods .............................................................................. 7 2.1 Testing machines and devices ................................................................................. 7 2.1.1 Spine loading simulator ................................................................................... 7 2.1.2 Vicon – MX Motion Capture System .............................................................. 8 2.2 Specimen ................................................................................................................. 9 2.3 Experimental protocol ............................................................................................. 9 2.3.1 Specimen preparation ...................................................................................... 9 2.3.2 Marker positioning ........................................................................................ 11 2.3.3 Initial Conditions ........................................................................................... 12 2.4 Test protocol ......................................................................................................... 14 2.4.1 The first two measures for both experiments ................................................ 14 2.4.2 Experiment A ................................................................................................. 15 2.4.3 Experiment B ................................................................................................. 16 2.5 Data analysis ......................................................................................................... 20 2.5.1 Three-Dimensional Reconstruction ............................................................... 20 2.5.2 Spine .............................................................................................................. 20 2.5.3 Ribs ................................................................................................................ 22 2.5.4 Sternum .......................................................................................................... 24 3 Results ...................................................................................................... 25 3.1 Spine Experiment A .............................................................................................. 25 3.1.1 Flexion/extension .......................................................................................... 25 3.1.2 Lateral bending .............................................................................................. 27 3.1.3 Axial rotation ................................................................................................. 29 3.2 Spine Experiment B; Step 1 to Step 5B ................................................................ 31 3.2.1 Flexion/extension .......................................................................................... 31 3.2.2 Lateral bending .............................................................................................. 32 3.2.3 Axial rotation ................................................................................................. 32 I 3.3 Spine Experiment B; Step 6B to Step 9B ............................................................. 33 3.3.1 Flexion/extension .......................................................................................... 33 3.3.2 Lateral bending .............................................................................................. 36 3.3.3 Axial rotation ................................................................................................. 38 3.4 Rib movement ....................................................................................................... 40 3.4.1 Rib movement of the polysegmental specimen ............................................. 40 3.4.2 Rib Movement of the monosegmental specimen .......................................... 42 3.5 Sternal movement ................................................................................................. 46 4 Discussion ................................................................................................ 47 4.1 Material and Methods ........................................................................................... 47 4.1.1 Specimen ....................................................................................................... 47 4.1.2 Specimen preparation .................................................................................... 49 4.1.3 Flexibility measurement ................................................................................ 50 4.1.4 Experiment duration ...................................................................................... 50 4.2 Results ................................................................................................................... 51 4.2.1 Spine Experiment A ...................................................................................... 51 4.2.2 Spine Experiment B; Step 1 to Step 5B ......................................................... 51 4.2.3 Experiment B; Step 6B to Step 9B ................................................................ 52 4.2.4 Ribs ................................................................................................................ 52 4.2.5 Sternum .......................................................................................................... 53 4.3 Literature Review and Clinical Relevance ........................................................... 54 4.4 Limitations of the study ........................................................................................ 55 4.5 Conclusions ........................................................................................................... 55 5 Summary ................................................................................................. 57 References ...................................................................................................... 58 Acknowledgement ......................................................................................... 61 II List of abbreviations C Vertebra of the cervical spine °C Degree Celsius CT Computer tomography cm Centimetre FSU Functional Spinal Unit; The FSU consists of two vertebrae with intervertebral disc and connecting ligaments Hz Hertz L Vertebra of the lumbar spine mm Millimetre n Number of specimen nm Nanometre Nm Newton metre NZ Neutral Zone P Markerpoint of the Spine P0 Markerpoint of the Rib ROM Range Of Motion s Second Th Vertebra of the thoracic spine Th1-Th6/ Th1-6 The vertebrae Th1 to Th6 with the corresponding intervertebral discs and interconnecting ligaments # Number ° Degree III 1 Introduction 1.1 Background Due to the high prevalence of having lower back pain among the population, research has been concentrated on the lumbar spine. However over the past few years the interest of the thoracic spine research has been growing, not merely because of developing new methods of biomechanical testing. Another important issue of the actual matter mainly concerning the thoracic spine is scoliosis (Figure 1). Depending on the severity and association with thorax deformation, these patients not only suffer from a lack of quality of life, but also detraction of their lung function (Smith et al, 1991; Aebi, 2005). For severe conditions with a Cobb angle > 50° (Cobb J.R., 1984), the second choice of therapy, followed by the medical corset, is the surgical correction of the deformity with internal fixation. For this surgical approach not only is it necessary to have knowledge about anatomy and biomechanical behavior of the thoracic spine for optimal implantation and excellent results, but this knowledge is also important to develop and advance new implants. Figure 1: a) A scoliosis patient with b) a 50° Cobb Angle (modified after Liljenqvist et al., 2007). 1 In addition to internal fixation, biomechanical tests have already proven that partial resection of certain anatomical structures like the intervertebral disc lead to destabilization and antagonize some of the scoliosis shape (Takeuchi et al., 1999; Oda et al., 2002). Scheuermann’s disease is a congenital skeletal disorder of the thoracic spine. Because it is the most frequent spinal disorder in adolescence, it has a huge
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