Is it possible to simulate physiologic loading conditions by applying puremoments? A comparison of in vivo and in vitro load components in an internal fixator
Hj. Wilke et al., Is it possible to simulate physiologic loading conditions by applying puremoments? A comparison of in vivo and in vitro load components in an internal fixator, SPINE, 26(6), 2001, pp. 636-642
Study Design. Loads acting in an internal fixator measured in vitro under t
he application of pure moments such as those commonly used for implant test
ing and basic research were compared with loads measured in 10 patients in
vivo.
Objectives. To investigate whether these recommended loading conditions are
valid by comparing in vivo measurements and those obtained in an in vitro
experiment.
Summary of Background Data. Pure bending moments are often preferred as loa
ding conditions for spinal in vitro testing, either for implant testing or
basic research. The advantage of this loading pattern is that the bending m
oment is uniform along the multisegmental specimen. However, functional loa
ding of the spine by muscles or external loads subjects the spine to a comb
ination of forces and moments.
Methods. In an in vivo experiment, loads acting on an internal spinal fixat
or in 10 patients were determined before and after anterior interbody fusio
n during flexion, extension, left and right lateral bending, and left and r
ight axial twisting of the upper body with the patient standing. For compar
ison, an equivalent in vitro data set was created with 7 human lumbar speci
mens in which the same type of fixator was used. All specimens were tested
under the application of pure bending moments in the three main motion plan
es in the intact state with fixator, after corpectomy, and with bone graft.
Results. Consistent qualitative agreement between in vivo and in vitro meas
urements for the loads acting in the internal spinal fixator were found for
axial rotation and lateral bending. For flexion and extension, reasonable
agreement was found only for the intact spines with fixators. After corpect
omy and after inserting a bone graft, the median values for axial force and
bending moment in the sagittal plane in vitro did not agree with in vivo m
easurements. An axial preload in the in vitro experiment slightly increased
the axial compression force and flexion bending moment in the fixators.
Conclusions, The application of pure moments to intact lumbar spinal specim
ens in vitro produces forces and moments in implants comparable with loads
observed in vivo. During basic research on intact specimens or implant test
ing involving a removed disc or corpectomy, muscle forces are necessary to
simulate realistic conditions.