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Mechanical and Structural Characterization of the Spinal Entheses: a Multimodal Approach

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Mechanical and Structural Characterization of the Spinal Entheses: a Multimodal Approach Marseille, France Berlin, Germany Marseille, France Master Thesis (Travail de Fin d’Études) From April, 9th 2012 to September, 28th 2012 Mechanical and structural characterization of the spinal entheses: a multimodal approach Quentin Léguillette Final-year student, Promotion 2012 Specialization: Mechanical Modelling of Materials and Structures (M3S) Academic tutor : Laboratory tutors : Thierry Désoyer Kay Raum Jean-Philippe Berteau Cécile Baron Quentin Léguillette Promotion 2012 Table of contents Acknowledgements .......................................................................................................... 3 Glossary ............................................................................................................................ 4 Abstract ............................................................................................................................ 5 Résumé ............................................................................................................................ 6 General introduction......................................................................................................... 7 1- Presentation of the laboratories and of the work environment ........................................... 8 1-1- Involved institutes in this partnership ................................................................... 8 1-1-1- The Julius Wolff Institute ......................................................................... 8 1-1-2- The Institute of Movement Sciences ....................................................... 9 1-2- Work environment ............................................................................................... 10 2- Assignment realization ......................................................................................................... 11 2-1- Clinical introduction to the problem ..................................................................... 11 2-1-1- General anatomical recalls .................................................................... 12 2-1-2- State of art about entheses ................................................................... 14 2-2- Aim of the assignment .......................................................................................... 19 2-3- Experimental characterization of spinal entheses ................................................ 21 2-3-1- Materials ................................................................................................ 21 2-3-2- Methods ................................................................................................. 23 2-3-3- Results ................................................................................................... 33 2-3-4- Discussion ............................................................................................... 50 2-3-5- Synthesis ................................................................................................ 51 2-4- Numerical modeling of spinal entheses ................................................................ 52 2-4-1- Presentation of the generic model ........................................................ 52 2-4-2- Developed models: description and results .......................................... 53 2-4-3- Discussion ............................................................................................... 58 2-4-4- Prospects: description of the forthcoming models ............................... 59 Technical and scientific conclusions ................................................................................. 60 Personal perspectives ..................................................................................................... 61 Bibliography ................................................................................................................... 62 Appendices ..................................................................................................................... 64 Page 2 Quentin Léguillette Promotion 2012 Acknowledgements Before starting this report, I would like to thank warmly the following people who played an important role during my master internship: First of all, I express my entire gratitude to my supervisor in Berlin, Herr Professor Doktor Kay Raum, for having let me the opportunity to realize my internship within the Julius Wolff Institute. Besides that, Kay, thank you so much for your precious advices and your will to integrate me as much as possible in the ISS team. Of course, I would also like to thank my two other laboratory tutors, Cécile Baron from the GIBOC team in Marseille and Jean-Philippe Berteau from the Institute of Biomechanics in the Technische Universität Hamburg Harburg, without whom this partnership and thus this internship would never have existed. Thank you for having given me the possibility to work on such an interesting topic! A special thank to Peter Varga for the many rewarding discussions about the development of the finite-element models of the spinal entheses, it was a real pleasure to work with you. In my daily work I also had the chance to work with Daniel Rohrbach, who I would like to kindly thank for his precious help on Matlab and his availability. My gratitude also goes to Martin Schöne, Nils Männicke and Susanne Schrof for their constant very good mood, their practical tricks and advices and their excellent team spirit. I also would like to thank Anne Slawig and the Johannes team. I could not forget to thank Anke Kadow- Romacker as well for her availability and her concern about my samples. Finally, I would like to thank the following people for their precious help in their respective fields and their availability: Marzena Princ, Gabriela Korus and Zienab Kronbach, Mario Thiele and Paul Zaslansky. Last but not least, I also express my gratitude to the European Commission for the Erasmus scholarship for internship I was granted. Page 3 Quentin Léguillette Promotion 2012 Glossary Arthritis : inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. Fibrosis : formation of fibrous tissue Joint capsule : sac-like fibrous tissue that envelopes a synovial joint. Sacroiliac joint : joint formed by the sacrum and ilium where they meet on either side of the lower back Syndesmophyte : bony growth attached to a ligament, found between adjacent vertebrae in ankylosing spondylitis Proprioception : unconscious perception of movement and spatial orientation arising from stimuli within the body itself Thoracolumbar fascia : sheet of connective tissue covering the deep muscles of the back Enthesitis : Traumatic disease occurring at the point of attachment of skeletal muscles to bone, where recurring stress causes inflammation and often fibrosis and calcification Process : projection or outgrowth of tissue from a larger body Collagen : fibrous protein constituent of bone, cartilage, tendon, and other connective tissue Cytoplasm : material between the nuclear and cell membranes; includes fluid organelles, and various membranes Fibroblast : large, flat, oval cell found in connective tissue and responsible for the formation of fibers Aggrecan : glycoprotein with heteropolysaccharide side chains, major component of cartilage Acetabulum : cup-shaped cavity at the base of the hipbone into which the ball-shaped head of the femur fit Periodontal ligament : connective-tissue layer covering the cementum of a tooth and holding it in place in the jawbone Cementum : thin layer of calcified (tough calcium deposits) tissue covering the dentine of the root Endochondral ossification : formation of bone in which a cartilage template is gradually replaced by a bone matrix, as in the formation of long bones Page 4 Quentin Léguillette Promotion 2012 Abstract Low back pain treatments represent today a serious public healthcare issue and are associated with many joint diseases of the vertebral column, or spondyarthropathies. Among them, ankylosing spondylitis (AS) causes destruction and fusion of the spine and sacroiliac joints. In this specific disease, transitional tissues performing the attachment of spinal ligaments to the bone, also called spinal entheses, are believed to play a primary role in the ligament calcification process, which results in pain and can lead to a complete loss of the spine´s mobility. Accordingly there is a need for further knowledge of these transitional tissues in order to provide a better understanding of the operating mechanisms of AS and find treatment suggestions. The objective of this research project was the gain of both structural and mechanical properties of spinal entheses in order to model the ligament calcification process occurring during AS. To achieve this goal, firstly we experimentally tested spinal entheses samples -extracted from growing pigs- with three techniques, Scanning Acoustic Microscopy, histology and Micro Computerized Tomography; secondly we developed two two- dimensional finite-element models of spinal entheses by using the properties deduced from the experimental step. Each model included a healthy and a pathological version. The first model used literature data, and the second the mechanical properties deduced from the experimental phase. For each pathological version, the models predicted a higher stretching of the interspinous ligament, which may lead to the onset of low back pain since it provokes the disrupting of the pain receptors in this ligament.
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