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Biomedical subjects

M H Pope

Publications and source records attributed to M H Pope.

At least 55 records · Page 3Linked to original sources

Study provides new evidence of back belts' effectiveness.

A major new study conducted by the UCLA School of Public Health has bolstered the claim that back support devices reduce low-back injuries. The study involved nearly 36,000 employees at Home Depot stores in California who logged 101 million work hours from 1989 through 1994. The company implemented mandatory wearing of belts in early 1990, and the study's authors reported that the workers' rate of acute low back injuries fell from 30.6 per million hours before implementation to 20.2 per million hours. UCLA Professor of Epidemiology Jess F. Kraus, the study's lead author, told The Wall Street Journal. "The study found a pretty big effect with a simple countermeasure. It is pretty hard to argue that it is a chance phenomenon." Kraus, who is the director of UCLA's Southern California injury Prevention Research Center, began his research by visiting 30 Home Depot stores to see whether employees were wearing the belts consistently. Compliance with the mandatory policy was quite high overall-above 98 percent, as calculated during an unannounced walk-through of all 77 stores in late 1993 and early 1994, according to the study. Back support manufactures hailed the Home Depot study as the largest long-term epidemiological study yet undertaken of the supports. It is proof, they said, that back supports are effective personal protective equipment-a contention at odds with the position of NIOSH the National institute for Occupational Safety and Health. In 1994, NIOSH reviewed the scientific literature and concluded there was not enough evidence to recommend that the supports be worn by uninjured workers. Sales plunged after NIOSH released its findings, according to the manufactures. The UCLA researchers found that low-back injuries declined in workers of both sexes, in younger workers as well as those older than 55, and among those with low levels of lifting as well as those with higher levels. The researchers concluded that mandatory use of back supports significantly reduces acute low-back work injuries. Low-back injuries account for one-fourth of all workers' compensation claims paid by U.S. employers-$11 billion in 1990 alone. NIOSH's ergonomic coordinator, Lawrence Fine, told The Journal, "for many companies this is the largest health and safety issue they are wrestling with." NIOSH has embarked on its own, smaller study of back supports' effectiveness among Wal-Mart workers.

Adult↗

Biomechanics of fusion and stabilization.

STUDY DESIGN: Literature review. OBJECTIVES: To assess the state of the art in the biomechanics of fusions, fusion materials, and the use of instrumentation by critically reviewing the literature as modified by group discussion. SUMMARY OF BACKGROUND DATA: A considerable body of knowledge addresses these issues based on in vitro biomechanical testing and mathematical models. Much biomechanical information is available regarding the biomechanical behavior of the graft material, the fusion, and the instrumentation. Biomechanical testing and finite element analyses remain to be done on semirigid devices, interbody spacers, and artificial discs. METHODS: The literature was reviewed to analyze papers written on the following topics: graft material, in vitro tests of instrumentation, device evaluation using artificial spine models, in vivo human studies, animal models, finite element studies, effects of rigidity, and bone adaptive remodeling. RESULTS: One hundred forty-one modern articles were reviewed and their data analyzed. Much important insight has come from biomechanical studies. CONCLUSIONS: Fusions are largely successful. Biomechanical data is complete except for some of the latest devices.

Biomechanical Phenomena↗

Biomechanical testing of the spine. Load-controlled versus displacement-controlled analysis.

Mechanical testing of the spine can be carried out in either a load-controlled or a displacement-controlled manner. Each method requires certain assumptions and offers different advantages. Dr. W. Thomas Edwards believes that displacement-controlled testing most accurately reflects the in vivo environment, while Drs. Vijay Goel, David Wilder, and Malcolm Pope support the use of the load-controlled method as most logical and easily standardized.

Biomechanical Phenomena↗

The use of expanded polytetrafluoroethylene as an interpositional membrane after lumbar laminectomy.

STUDY DESIGN: Prevention of post-laminectomy membrane formation was evaluated in a canine model. Fat graft, Silastic sheeting and expanded polytetrafluoroethylene were compared with nonimplanted control sites. OBJECTIVES: The development of an effective barrier to peridural scar invasion is of major importance in optimizing results after lumbar laminectomy. SUMMARY OF BACKGROUND DATA: Postoperative peridural fibrosis represents a normal biologic response after lumbar spinal surgery. A variety of biologic and nonbiologic interpositional materials have been studied. Expanded polytetrafluoroethylene has been shown to limit scar adhesion in the pericardium and peritoneum and has not been studied previously as a postlaminectomy interpositional membrane. METHODS: Eleven adult female cross-bred hounds underwent multilevel standardized laminotomies. Three materials--fat graft, Silastic sheeting, and expanded polytetrafluoroethylene--were compared with nonimplanted controls. The animals were killed 12 weeks after surgery and were evaluated histologically and using gadolinium-enhanced magnetic resonance imaging. RESULT: The magnetic resonance imaging studies were inconclusive in assessing peridural scar extension or identifying the implanted membranes. Histology revealed dense scar tissue at all control sites and replacement of all fat grafts by scar. Scar density was significantly less for the expanded polytetrafluoroethylene membrane surgical sites than for the control, fat graft, and Silastic sheeting sites. CONCLUSIONS: Expanded polytetrafluoroethylene membrane is biocompatible, maintains its structural integrity, and is impervious to fibrous ingrowth. These findings support further investigation of expanded polytetrafluoroethylene membrane as an interpositional material to prevent post-laminectomy peridural fibrosis.

Adipose Tissue↗

Biomechanical analysis of the ankle anterior drawer test for anterior talofibular ligament injuries.

The effect of sectioning the anterior talofibular ligament on the load-displacement behavior of the ankle was evaluated in vitro during the anterior drawer test using the flexibility approach. Controlled forces were applied across the ankle joint in the anterior-posterior direction, and the resulting displacements were measured at four flexion angles (10 degrees of dorsiflexion, neutral, and 10 degrees and 20 degrees of plantar flexion). The anterior talofibular ligament then was sectioned, and the anterior-posterior loadings were repeated at the four flexion angles. Two parameters were developed to describe the nonlinear load-displacement response of the ankle joint: neutral zone laxity (joint displacement between +/- 2.5 N) and flexibility (a measure of the nonlinear load-displacement response of the ankle between 10 and 50 N of anterior drawer loading). After sectioning the anterior talofibular ligament, significant increases in neutral zone laxity were observed at all angles of ankle flexion. The largest increases in neutral zone laxity were found with the ankle in 10 degrees of plantar flexion (76.3% increase) and 20 degrees of plantar flexion (89.7% increase). After sectioning the ligament, a significant increase (19.3%) in flexibility of the ankle was observed at 10 degrees of dorsiflexion, but no change in flexibility was observed with the ankle in the neutral and plantar flexed positions. These findings indicate that anterior drawer testing of the anterior talofibular ligament-deficient ankle between 10 degrees and 20 degrees of plantar flexion results in the largest increase in neutral zone laxity compared with the normal ankle with intact ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Effect of anterior cruciate ligament reconstruction with patellar tendon or prosthetic ligament on the morphology of the other ligaments of the knee joint. An experimental study in dogs.

The effect of anterior cruciate ligament replacement on the other ligaments of the knee, including the medial or lateral collateral and posterior cruciate ligaments, was studied histologically in the canine knee. The anterior cruciate ligament was replaced either with the medial third of the patellar tendon or with a prosthetic ligament. Histologic analysis was performed 3 months after prosthetic ligament implantation and 1 year after patellar ligament reconstruction. In all ligaments, numerous pathologic alterations were found. Degenerative changes such as glycosaminoglycan accumulation, metachromasia, collagenolysis, collagen necrosis, and lipomatosis were similar after 3 months and after 1 year. Granulation tissue, a sign that characterizes tissue repair, was seen only in those ligaments taken 3 months after anterior cruciate ligament surgery. Similar degenerative changes also were found in the ligaments of the knees with only a large medial arthrotomy (sham). In the contralateral control knees, the pathologic alterations were rare. Thus, open arthrotomy alone or with anterior cruciate ligament reconstruction seems to result in longstanding degenerative changes in all ligaments of the canine knee joint.

Animals↗

Does hyperextension have an unloading effect on the intervertebral disc?

A stadiometer (a device to measure the overall height of a subject) was used to determine the effect of hyperextension in rehydration of the intervertebral disc. Hyperextension for 20 minutes in a prone posture was compared with the prone posture alone for 20 minutes. The stadiometer measurement was made after the subject was exposed to 10 kg of loading applied to the shoulders for five minutes and after each of the recovery postures. It was found that hyperextension gave a significantly increased height recovery compared with the prone posture.

Adult↗

A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain.

STUDY DESIGN: A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain. OBJECTIVES: The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS. SUMMARY OF BACKGROUND DATA: Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and Biering-Sorensen fatigue test. The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group. RESULTS: After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension. CONCLUSION: None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.

Adult↗

Multidirectional stability of the Graf system.

STUDY DESIGN: To assess the biomechanical influences of the Graf fixation system on the spine, motion segments were tested. In normal spines, destabilized and restabilized with the Graf system conditions, the range of motion and flexibilities were found under various loading conditions. OBJECTIVES: These results should explain how the Graf Fixation system affects the biomechanical response of a motion segment. METHODS: Motion segments (L2-3) and (L4-5) were subjected to these loading conditions: compressive loading, flexion-extension, lateral bending, and axial rotation moments. During the loading, the main and coupled motions were measured, and flexibilities were computed. The position of the balance point in axial loading was also determined. The motion segments were tested under three conditions: intact, destabilized, and restabilized. The destabilization consisted of a bilateral total laminectomy (pedicle-to-pedicle). Restabilization was affected with the Graf stabilization system, consisting of polyester bands between pedicle screw implants. RESULTS: The total laminectomy significantly changed the balance point location by moving it forward. The restabilized motion segment had a balance point more similar to normal conditions. The mean compressive compliance was significantly less after application of the Graf system compared with destabilization. The range of motion for flexion-extension and axial rotation was significantly reduced for the main motion with the Graf system. For lateral bending, the main and coupled rotations were affected significantly, with lateral bending and flexion-extension motion reduced and axial rotation increased after restabilization. Restabilization decreased the flexibility of the destabilized motion segment for all of the moments. CONCLUSIONS: The Graf fixation system reduced the range of motion and the flexibility values in some loading conditions. These results only assess the immediate stabilization characteristics of this implant system in cadaveric material. Further research should address the fatigue characteristics.

Biomechanical Phenomena↗

L4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L4-5 and L5-S1 isthmic spondylolisthesis.

The authors have previously reported that the L4-5 isthmic spondylolisthesis lesion often progresses more than the L5-S1 lesion in adult patients. This biomechanical study compares the in vitro stability of the L4-5 isthmic spondylolisthesis lesion compared with the L5-S1 isthmic lesion. The authors also analyzed the role of the L5 iliolumbar ligament as a contributing factor to stability. Six fresh frozen human cadaveric specimens (L4 to the sacrum including the iliolumbar ligamentous complex) were tested by applying 10 Nm flexion-extension moments. Sagittal plane motion was measured with the specimens intact and after sequential transection of the pars interarticulares at L4 and L5 and finally with the iliolumbar ligaments cut at L5-S1. L4-5 and L5-S1 both showed significant increases in rotation with the pars defect compared with normal (L4-5 = +2.0, L5-S1 = +3.2 degrees). Decreased translation of L5-S1 occurred with pars defect at this level. There were no significant differences at the L5-S1 level after sectioning of the iliolumbar ligament. Calculating the percentage difference from normal, L4-5 with a pars defect exhibited significantly greater relative motion compared with L5-S1 with the same defect; 12% more rotation, 33% more shear, and 43% more axial translation. The iliolumbar ligament did not appear to contribute to these differences because there was no significant change in the L5-S1 kinematics after its transection. These results support the hypothesis that L4-5 pars defects are more unstable than L5-S1 lesions. The iliolumbar ligament could not be implicated as the major contributing factor in these differences.

Biomechanical Phenomena↗

Determination of a zero strain reference for the anteromedial band of the anterior cruciate ligament.

The objective of this study was to verify a method previously used to determine a reference length for calculations of anterior cruciate ligament strain. In nine knee specimens, an arthroscopic force probe and a Hall effect transducer were placed in the anteromedial band of the ligament. Anteroposterior-directed shear loads then were applied to the knee joint with the knee flexed to 30 degrees. From the sigmoidal curve for shear load versus displacement of the anterior cruciate ligament midsubstance, the length of the transducer at the inflection point was determined graphically by two independent examiners. Previous studies suggested that the inflection point corresponds to the slack-taut transition of the anteromedial band. The force probe was used to determine the actual length of the transducer when the anteromedial band became load bearing. No significant differences were found between the reference lengths determined by the inflection point method and the force probe. The force probe demonstrated that the anterior cruciate ligament became load bearing when an anterior shear load of 8.8 N was applied to the tibia with the knee at 30 degrees of flexion. Furthermore, multiple cycles of anteroposterior shear loading did not influence these values. The force probe verified that the inflection method provides a reasonable estimate of the absolute strain reference (within 0.7% strain).

Adult↗