Schaefer Samuel D, Davies Benjamin M, Newcombe Virginia F J, Sutcliffe Michael P F
Department of Engineering, University of Cambridge, UK.
Department of Medicine, University of Cambridge, UK.
Brain Spine. 2023 Apr 13;3:101743. doi: 10.1016/j.bas.2023.101743. eCollection 2023.
INTRODUCTION: Degenerative Cervical Myelopathy [DCM] is a slow-motion spinal cord injury. Compression and dynamic compression have been considered disease hallmarks. However, this is likely an oversimplification, as compression is more commonly incidental and has only modest correlation to disease severity. MRI studies have recently suggested spinal cord oscillation could play a role. RESEARCH QUESTION: To determine if spinal cord oscillation could contribute to spinal cord injury in degenerative cervical myelopathy. MATERIAL AND METHODS: A computational model of an oscillating spinal cord was developed from imaging of a healthy volunteer. Using finite element analysis, the observed implications of stress and strain, were measured in the context of a simulated disc herniation. The significance was bench marked by comparison to a more recognised dynamic injury mechanism; a flexion extension model of dynamic compression. RESULTS: Spinal cord oscillation altered both compressive and shear strain on the spinal cord. Following initial compression, compressive strain moves from within the spinal cord to the spinal cord surface, whilst shear strain is magnified by 0.1-0.2, depending on the amplitude of oscillation. These orders of magnitude are equivalent to a dynamic compression model. DISCUSSION AND CONCLUSION: Spinal cord oscillation could significantly contribute to spinal cord damage across DCM. Its repeated occurrence with every heartbeat, draws parallels to the concept of fatigue damage, which could reconcile differing theories on the origins of DCM. This remains hypothetical at this stage, and further investigations are required.
引言:退行性颈椎病脊髓病(DCM)是一种缓慢进展的脊髓损伤。压迫和动态压迫一直被视为该病的标志。然而,这可能过于简单化了,因为压迫更常见的是偶然发生的,并且与疾病严重程度仅有适度的相关性。MRI研究最近表明脊髓振荡可能起作用。 研究问题:确定脊髓振荡是否会导致退行性颈椎病脊髓病中的脊髓损伤。 材料与方法:从一名健康志愿者的成像数据建立了一个振荡脊髓的计算模型。使用有限元分析,在模拟椎间盘突出的情况下测量观察到的应力和应变影响。通过与一种更公认的动态损伤机制——动态压迫的屈伸模型进行比较来确定其显著性。 结果:脊髓振荡改变了脊髓上的压缩应变和剪切应变。初始压迫后,压缩应变从脊髓内部转移到脊髓表面,而剪切应变根据振荡幅度放大0.1 - 0.2倍。这些数量级与动态压迫模型相当。 讨论与结论:脊髓振荡可能在DCM中对脊髓损伤有显著影响。它随着每次心跳反复发生,类似于疲劳损伤的概念,这可能调和关于DCM病因的不同理论。在现阶段这仍然是假设性的,需要进一步研究。
Biomech Model Mechanobiol. 2023-12