title: Flexion-extension response of the thoracolumbar spine under compressive follower preload.
abstract: METHODS
  The authors conducted an in vitro biomechanical flexibility study of T2-S1 specimens in flexion-extension under compressive follower preloads of physiological magnitudes.
  
  
  OBJECTIVE
  The objectives of this study were to test the hypotheses that 1) the thoracolumbar spine will support compressive preloads of in vivo magnitudes and 2) allow physiological mobility under flexion-extension moments if the preload is applied along an optimized follower load path that approximates the kypholordotic curve of the thoracolumbar spine.
  
  
  BACKGROUND
  In the absence of muscle forces, the ligamentous thoracolumbar spine specimens cannot support the compressive loads expected in vivo. As a result, the flexibility of the thoracolumbar spine in flexion-extension has not been studied in vitro under physiological compressive preloads.
  
  
  METHODS
  Seven human thoracolumbar spines (T2-sacrum) were subjected to flexion and extension moments (up to 8 and 6 Nm, respectively) under compressive preloads from 0 to 800 N applied along an optimized follower preload path. The experimental technique applied the compressive preload such that: 1) it minimized the internal shear forces and bending moments resulting from the preload application, 2) made the internal force resultant compressive, and 3) caused the preload path to approximate the tangent to the curve of the thoracolumbar spine. The range of motion was measured in the T2-sacrum, T2-T11, T11-L1, and L1-sacrum regions.
  
  
  RESULTS
  All thoracolumbar specimens supported the compressive follower preload up to 800 N without damage or instability. At 800 N preload, the total flexion-extension range of motion of the T2-sacrum region decreased by 22%, from a mean of 73 degrees to 57 degrees (P < 0.05). The range of motion of the T2-T11 and L1-sacrum regions decreased from the baseline value by 23% and 30%, respectively, at a preload of 800 N. The sagittal mobility of the thoracolumbar junction (T11-L1) was not affected by the preload. The follower preload did not significantly affect the proportion of the total T2-sacrum flexion-extension range of motion contributed by the T2-T11 and L1-sacrum regions of the thoracolumbar spine.
  
  
  CONCLUSIONS
  The optimized follower preload vector minimizes the effects of artifact moment and shear force on the range of motion of the thoracolumbar spine in flexion-extension. This model allows the entire thoracolumbar spine to be investigated under physiological loading for different clinical applications.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois 60153, USA.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Stanley
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Ghanayem
authors.forename: Leonard I
authors.initials: LI
authors.lastname: Voronov
authors.forename: Robert M
authors.initials: RM
authors.lastname: Havey
authors.forename: Odysseas
authors.initials: O
authors.lastname: Paxinos
authors.forename: Gerard
authors.initials: G
authors.lastname: Carandang
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zindrick
authors.forename: Avinash G
authors.initials: AG
authors.lastname: Patwardhan
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018583:Pliability; D012447:Sacrum / Q000502:physiology; D013117:Spinal Cord Compression / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology