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19 pages, 6704 KiB

Open AccessArticle

AI-Assisted Image Recognition of Cervical Spine Vertebrae in Dynamic X-Ray Recordings

by Esther van Santbrink, Valérie Schuermans, Esmée Cerfonteijn, Marcel Breeuwer, Anouk Smeets, Henk van Santbrink and Toon Boselie

Bioengineering 2025, 12(7), 679; https://doi.org/10.3390/bioengineering12070679 - 20 Jun 2025

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Abstract

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating a mean sensitivity of 90% and specificity of [...] Read more.

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating a mean sensitivity of 90% and specificity of 85%. However, the extensive time that is required limits its applicability. This study investigated the feasibility of implementing a deep-learning model to analyze qualitative cervical motion. Methods: A U-Net architecture was implemented as 2D and 2D+t models. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to assess the performance of the models. Intraclass Correlation Coefficient (ICC) was used to compare the relative rotation of individual vertebrae and segments to the ground truth. Results: IoU ranged from 0.37 to 0.74 and DSC ranged from 0.53 to 0.80. The ICC scores for relative rotation ranged from 0.62 to 0.96 for individual vertebrae and from 0.28 to 0.72 for vertebral segments. For segments, 2D+t models presented higher ICC scores compared to 2D models. Conclusions: This study showed the feasibility of implementing deep-learning models to analyze qualitative cervical motion in dynamic X-ray recordings. Future research should focus on improving model segmentation by enhancing recording contrast and applying post-processing methods. Improved segmentation accuracy will enable routine use of the analysis of motion patterns in clinical research. The absence or presence of a motion pattern, or identification of new patterns has the potential to aid in clinical decision-making. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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13 pages, 1801 KiB

Open AccessArticle

Finite Element Analysis of Biomechanical Assessment: Traditional Bilateral Pedicle Screw System vs. Novel Reverse Transdiscal Screw System for Lumbar Degenerative Disc Disease

by Utpal K. Dhar, Kamran Aghayev, Hadi Sultan, Saahas Rajendran, Chi-Tay Tsai and Frank D. Vrionis

Bioengineering 2025, 12(6), 671; https://doi.org/10.3390/bioengineering12060671 - 19 Jun 2025

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Abstract

The traditional bilateral pedicle screw system has been used for the treatment of various lumbar spine conditions including advanced degenerative disc disease. However, there is an ongoing need to develop more effective and less invasive techniques. The purpose of this study was to [...] Read more.

The traditional bilateral pedicle screw system has been used for the treatment of various lumbar spine conditions including advanced degenerative disc disease. However, there is an ongoing need to develop more effective and less invasive techniques. The purpose of this study was to compare the traditional bilateral pedicle screw system (BPSS) with the novel reverse transdiscal screw system (RTSS) for lumbar disc degenerative disease. A 3D solid lumbar L1–L5 spine model was developed and validated based on a human CT scan. Fusions were simulated at L3–L4. The first scenario comprised a transforaminal lumbar interbody cage in combination with the bilateral pedicle screw-rod system (BPSS-TLIF). In the second scenario, the same TLIF cage was combined with reverse L3–L4 transdiscal screws (RTSS-TLIF). Testing parameters included range of motion (ROM) in three orthogonal axes, hardware (cage and screw) stress, and shear load resistance. The ROM of the surgical model was reduced by approximately 90% compared to the intact model at the fused level. The RTSS model demonstrated less ROM compared to the BPSS model at the fused level for all loading conditions. Overall, the RTSS model exhibited lower stress on both screws and cage compared with the BPSS model in all biomechanical testing conditions. The RTSS model also exhibited higher anterior and posterior shear load resistance than the BPSS model. In conclusion, the RTSS model proved superior to the BPSS model in all respects. These findings indicate that the RTSS could serve as a feasible option for patients undergoing lumbar fusion, especially for adjacent segment disease, potentially enhancing surgical outcomes for disc degeneration. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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15 pages, 9680 KiB

Open AccessArticle

Upper Limb Neural Tension Test and Spinal Biomechanics: Insights from a Longitudinal Pilot Study

by Massimo Rossi, Marianna Signorini, Ali Baram, Mario De Robertis, Gabriele Capo, Marco Riva, Maurizio Fornari, Federico Pessina and Carlo Brembilla

Bioengineering 2025, 12(5), 487; https://doi.org/10.3390/bioengineering12050487 - 2 May 2025

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Abstract

Background: The Upper Limb Neural Tension Test (ULNTT) is a common assessment for neurodynamic function, yet the relationship between ULNTT findings and specific spinal biomechanical patterns remains poorly understood, particularly in the context of cervicobrachial neuralgia. This study aimed to investigate the association [...] Read more.

Background: The Upper Limb Neural Tension Test (ULNTT) is a common assessment for neurodynamic function, yet the relationship between ULNTT findings and specific spinal biomechanical patterns remains poorly understood, particularly in the context of cervicobrachial neuralgia. This study aimed to investigate the association between ULNTT asymmetry and cervicothoracic spine biomechanics using advanced motion capture analysis. Methods: A longitudinal experimental study was conducted on two groups of asymptomatic participants: one with ULNTT asymmetry > 10° (AS group, n = 12) and another with symmetrical ULNTT (S group, n = 11). Neurodynamic testing and 3D motion capture of spinal kinematics during head lateral bending were performed at baseline. The AS group then underwent manual medicine intervention targeting spinal mobility impairments, followed by post-intervention reassessment. Spine biomechanics data, focusing on the C5-T4 region, were analyzed using the least squares approximation method to derive parameters describing upper thoracic (T1-T4_VERT) and lower cervical (C5-T1_CONC) lateral bending, and their interrelationship (ANGLE_TANG). Results: At baseline, the AS group showed significant differences between sides in neurodynamic parameters and T1-T4_VERT, with limited upper thoracic lateral bending contralateral to the side of the restricted ULNTT. Significant intergroup differences were also observed for these parameters. Following intervention in the AS group, significant improvements were noted in neurodynamic parameters and T1-T4_VERT, with no significant between-side differences post-intervention. Conclusions: These are preliminary results and preliminary conclusions based on the first study on a small group of patients. Given the limitations, this study provides evidence for a relationship between ULNTT asymmetry and upper thoracic spine biomechanics, specifically a contralateral limitation in lateral bending. These findings suggest a functional link between brachial plexus neurodynamics and upper thoracic spine mobility, offering potential insights into the pathophysiology of cervicobrachial conditions and highlighting the potential role of manual therapy in addressing both neurodynamic and biomechanical impairments. The developed motion capture analysis method offers a novel approach to quantify fine spinal motion patterns. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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15 pages, 3452 KiB

Open AccessArticle

Using Surface Topography to Visualize Spinal Motion During Gait—Examples of Possible Applications and All Tools for Open Science

by Jürgen Konradi, Ulrich Betz, Janine Huthwelker, Claudia Wolf, Irene Schmidtmann, Ruben Westphal, Meghan Cerpa, Lawrence G. Lenke and Philipp Drees

Bioengineering 2025, 12(4), 348; https://doi.org/10.3390/bioengineering12040348 - 28 Mar 2025

Viewed by 478

Abstract

Precise segmental spinal analysis during gait has various implications for clinical use and basic research. Here, we report the use of Surface Topography (ST) to analyze three-dimensional spinal segment movements, in combination with foot pressure measuring, to describe individual vertebral bodies’ motion relative [...] Read more.

Precise segmental spinal analysis during gait has various implications for clinical use and basic research. Here, we report the use of Surface Topography (ST) to analyze three-dimensional spinal segment movements, in combination with foot pressure measuring, to describe individual vertebral bodies’ motion relative to specific phases of gait. Using Statistical Analysis System (SAS) scripts, single files were merged into one raw data table and were used to generate a standardized gait cycle (SGC) for each measurement, including all measured gait cycles for each individual patient, with a spline function to obtain smooth curve progressions. Graph templates from Statistical Package for the Social Sciences create detailed visualizations of the SGCs. Previously obtained measurements from healthy participants were used to demonstrate possible applications of our method. An impressive inter-individual variability as well as intra-individual consistency of spinal motion is shown. The transformation into an SGC facilitates intra- and inter-individual comparisons for qualitative and quantitative analyses. In future studies, we want to use this method to distinguish between physiologic and pathologic spinal motion. Artificial intelligence-based analysis can facilitate this process. All tools and visualizations used are freely available in repositories to enable the replication and validation of our findings. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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10 pages, 1266 KiB

Open AccessArticle

Augmenting Screw Technique to Prevent TLIF Cage Subsidence: A Biomechanical In Vitro Study

by Alina Jacob, Alicia Feist, Ivan Zderic, Boyko Gueorguiev, Jan Caspar, Christian R. Wirtz, Geoff Richards, Markus Loibl, Daniel Haschtmann and Tamas F. Fekete

Bioengineering 2025, 12(4), 337; https://doi.org/10.3390/bioengineering12040337 - 24 Mar 2025

Viewed by 499

Abstract

(1) Cage subsidence in spine surgery is a frequent clinical challenge. This study aimed to assess a novel screw augmentation technique for Transforaminal Lumbar Interbody Fusion in cadavers of reduced bone mineral density (BMD). (2) Forty human lumbar vertebrae (BMD 84.2 ± 24.4 [...] Read more.

(1) Cage subsidence in spine surgery is a frequent clinical challenge. This study aimed to assess a novel screw augmentation technique for Transforaminal Lumbar Interbody Fusion in cadavers of reduced bone mineral density (BMD). (2) Forty human lumbar vertebrae (BMD 84.2 ± 24.4 mgHA/cm³, range 51–119 mgHA/cm³) were assigned to two groups: augmenting screw group and control group. The augmentation technique comprised placement of two additional subcortical screws. Ten constructs per group were loaded with a quasi-static load-to-failure protocol and other ten were cyclically loaded. Failure modes were documented. (3) During the quasi-static load-to-failure testing, the augmenting screw technique showed a significantly higher failure load (1426.0 ± 863.6 N) versus the conventional technique in the control group (682.2 ± 174.5 N, p = 0.032). Cyclic loading revealed higher number of cycles and corresponding load until reaching 5 mm subsidence and significantly higher number of cycles and corresponding load until reaching 10 mm subsidence for the augmenting screw technique (9645 ± 3050; 1164.5 ± 305.0 N) versus the conventional technique in the control group (5395 ± 2340; 739.5 ± 234.0 N, p < 0.05). Failure modes were different and showed bending of the augmenting screws, followed by cut-out. (4) The investigated augmenting screw technique demonstrated higher failure loads and cycles to failure against cage subsidence compared to conventional cage placement. Failure modes were different between the two techniques and may lead to a different kind of complications. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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19 pages, 3495 KiB

Open AccessArticle

Dynamic Surface Topography for Thoracic and Lumbar Pain Patients—Applicability and First Results

by Johanna Kniepert, Henriette Rönsch, Ulrich Betz, Jürgen Konradi, Janine Huthwelker, Claudia Wolf, Ruben Westphal and Philipp Drees

Bioengineering 2025, 12(3), 289; https://doi.org/10.3390/bioengineering12030289 - 13 Mar 2025

Viewed by 520

Abstract

Current routine diagnostic procedures for back pain mainly focus on static spinal analyses. Dynamic Surface Topography (DST) is an easy-to-use, radiation-free addition, allowing spine analyses under dynamic conditions. Until now, it is unclear if this method is applicable to back pain patients, and [...] Read more.

Current routine diagnostic procedures for back pain mainly focus on static spinal analyses. Dynamic Surface Topography (DST) is an easy-to-use, radiation-free addition, allowing spine analyses under dynamic conditions. Until now, it is unclear if this method is applicable to back pain patients, and data reports are missing. Within a prospective observational study, 32 patients suffering from thoracic and lumbar back pain were examined while walking, randomized at four speeds (2, 3, 4, 5 km/h), using a DST measuring device (DIERS 4Dmotion^® Lab). The measurement results were compared with those of a healthy reference group. We calculated the intrasegmental rotation for every subject and summed up the spinal motion in a standardized gait cycle. The Mann–Whitney U Test was used to compare the painful and healthy reference groups at the four different speeds. In a subgroup analysis, the painful group was divided into two groups: one with less pain (≤3 points on the Visual Analogue Scale) and one with more pain (>3 points on the Visual Analogue Scale). The Kruskal–Wallis Test was used to compare these subgroups with the healthy reference group. Of the 32 included patients, not all could walk at the intended speeds (5 km/h: 28/32). At speeds of 2–4 km/h, our results point to greater total segmental rotation of back pain patients compared to the healthy reference group. At a speed of 3 km/h, we observed more movement in the patients with more pain. Overall, we monitored small differences on average between the groups but large standard deviations. We conclude that the DST measuring approach is eligible for back pain patients when they feel confident enough to walk on a treadmill. Initial results suggest that DST can be used to obtain interesting therapeutic information for an individual patient. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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30 pages, 5862 KiB

Open AccessArticle

A Muscle-Driven Spine Model for Predictive Simulations in the Design of Spinal Implants and Lumbar Orthoses

by Robin Remus, Andreas Lipphaus, Marisa Ritter, Marc Neumann and Beate Bender

Bioengineering 2025, 12(3), 263; https://doi.org/10.3390/bioengineering12030263 - 6 Mar 2025

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Abstract

Knowledge of realistic loads is crucial in the engineering design process of medical devices and for assessing their interaction with the spinal system. Depending on the type of modeling, current numerical spine models generally either neglect the active musculature or oversimplify the passive [...] Read more.

Knowledge of realistic loads is crucial in the engineering design process of medical devices and for assessing their interaction with the spinal system. Depending on the type of modeling, current numerical spine models generally either neglect the active musculature or oversimplify the passive structural function of the spine. However, the internal loading conditions of the spine are complex and greatly influenced by muscle forces. It is often unclear whether the assumptions made provide realistic results. To improve the prediction of realistic loading conditions in both conservative and surgical treatments, we modified a previously validated forward dynamic musculoskeletal model of the intact lumbosacral spine with a muscle-driven approach in three scenarios. These exploratory treatment scenarios included an extensible lumbar orthosis and spinal instrumentations. The latter comprised bisegmental internal spinal fixation, as well as monosegmental lumbar fusion using an expandable interbody cage with supplementary posterior fixation. The biomechanical model responses, including internal loads on spinal instrumentation, influences on adjacent segments, and effects on abdominal soft tissue, correlated closely with available in vivo data. The muscle forces contributing to spinal movement and stabilization were also reliably predicted. This new type of modeling enables the biomechanical study of the interactions between active and passive spinal structures and technical systems. It is, therefore, preferable in the design of medical devices and for more realistically assessing treatment outcomes. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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12 pages, 3813 KiB

Open AccessArticle

Bilateral Iliosacral and Transsacral Screws Are Biomechanically Favorable and Reduce the Risk for Fracture Progression in Fragility Fractures of the Pelvis—A Finite Element Analysis

by Moritz F. Lodde, Matthias Klimek, Elmar Herbst, Christian Peez, Oliver Riesenbeck, Michael J. Raschke and Steffen Roßlenbroich

Bioengineering 2025, 12(1), 27; https://doi.org/10.3390/bioengineering12010027 - 1 Jan 2025

Cited by 1 | Viewed by 985

Abstract

(1) Background: The incidence of fragility fractures of the pelvis (FFP) has increased significantly over the past decades. Unilateral non-displaced fractures, defined as FFP II, are the most common type of fracture. When conservative treatment fails, surgical treatment is indicated. We hypothesize that [...] Read more.

(1) Background: The incidence of fragility fractures of the pelvis (FFP) has increased significantly over the past decades. Unilateral non-displaced fractures, defined as FFP II, are the most common type of fracture. When conservative treatment fails, surgical treatment is indicated. We hypothesize that the use of bilateral SI screws (BSIs) or a transsacral screw (TSI) is superior compared to a unilateral screw (USI) because of a significant reduction in the risk of adjacent fractures and a reduction in fracture progression. (2) Methods: A finite element model of a female pelvic ring was constructed. The ligaments were simulated as tension springs. The load was applied through the sacrum with the pelvis fixed to both acetabula. An FFP IIc was simulated and fixed with either a USI or BSI or TSI. The models were analyzed for a quantitative statement of stress and fracture dislocation. (3) Results: The BSI and TSI resulted in less dislocation compared to the USI. The stress distribution on both sides of the sacrum was favorable in the BSI and TSI groups. The BSI resulted in a higher rotational stability compared to the TSI. (4) Conclusions: The use of either a BSI or TSI for fixation of unilateral FFP is biomechanically favorable compared to the use of a USI. In addition, the use of a BSI or TSI reduces the stress on the contralateral uninjured side of the sacrum. This may reduce the risk of an adjacent fracture or fracture progression. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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13 pages, 4257 KiB

Open AccessArticle

Evaluation of Load on Cervical Disc Prosthesis by Imposing Complex Motion: Multiplanar Motion and Combined Rotational–Translational Motion

by Hossein Ansaripour, Stephen J. Ferguson and Markus Flohr

Bioengineering 2024, 11(8), 857; https://doi.org/10.3390/bioengineering11080857 - 22 Aug 2024

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Abstract

(1) Background: The kinematic characteristics of disc prosthesis undergoing complex motion are not well understood. Therefore, examining complex motion may provide an improved understanding of the post-operative behavior of spinal implants. (2) Methods: The aim of this study was to develop kinematic tests [...] Read more.

(1) Background: The kinematic characteristics of disc prosthesis undergoing complex motion are not well understood. Therefore, examining complex motion may provide an improved understanding of the post-operative behavior of spinal implants. (2) Methods: The aim of this study was to develop kinematic tests that simulate multiplanar motion and combined rotational–translational motion in a disc prosthesis. In this context, five generic zirconia-toughened alumina (BIOLOX^®delta, CeramTec, Germany) ball and socket samples were tested in a 6 DOF spine simulator under displacement control with an axial compressive force of 100 N in five motion modes: (1) flexion–extension (FE = ± 7.5°), (2) lateral bending (LB = ± 6°), (3) combined FE-LB (4) combined FE and anteroposterior translation (AP = 3 mm), and (5) combined LB and lateral motion (3 mm). For combined rotational–translational motion, two scenarios were analyzed: excessive translational movement after sample rotation (scenario 1) and excessive translational movement during rotation (scenario 2). (3) Results: For combined FE-LB, the resultant forces and moments were higher compared to the unidirectional motion modes. For combined rotational–translational motion (scenario 1), subluxation occurred at FE = 7.5° with an incremental increase in AP translation = 1.49 ± 0.18 mm, and LB = 6° with an incremental increase of lateral translation = 2.22 ± 0.16 mm. At the subluxation point, the incremental increase in AP force and lateral force were 30.4 ± 3.14 N and 40.8 ± 2.56 N in FE and LB, respectively, compared to the forces at the same angles during unidirectional motion. For scenario 2, subluxation occurred at FE = 4.93° with an incremental increase in AP translation = 1.75 mm, and LB = 4.52° with an incremental increase in lateral translation = 1.99 mm. At the subluxation point, the incremental increase in AP force and lateral force were 39.17 N and 38.94 N in FE and LB, respectively, compared to the forces in the same angles during the unidirectional motion. (4) Conclusions: The new test protocols improved the understanding of in vivo-like behavior from in vitro testing. Simultaneous translation–rotation motion was shown to provoke subluxation at lower motion extents. Following further validation of the proposed complex motion testing, these new methods can be applied future development and characterization of spinal motion-preserving implants. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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12 pages, 10066 KiB

Open AccessArticle

Primary Stability of Kyphoplasty in Incomplete Vertebral Body Burst Fractures in Osteoporosis: A Biomechanical Investigation

by Oliver Riesenbeck, Niklas Czarnowski, Michael Johannes Raschke, Simon Oeckenpöhler and René Hartensuer

Bioengineering 2024, 11(8), 798; https://doi.org/10.3390/bioengineering11080798 - 7 Aug 2024

Viewed by 1341

Abstract

Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11–L3). First, acquisition of the native [...] Read more.

Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11–L3). First, acquisition of the native multisegmental kinematics in our robot-based spine tester with three-dimensional motion analysis was set as a baseline for each sample. Then, an incomplete burst fracture was generated in the vertebral body L1 with renewed kinematic testing. After subsequent kyphoplasty was performed on the fractured vertebral body, primary stability was examined again. Results: Initially, a significant increase in the range of motion after incomplete burst fracture generation in all three directions of motion (extension–flexion, lateral tilt, axial rotation) was detected as proof of post-traumatic instability. There were no significant changes to the native state in the adjacent segments. Radiologically, a significant loss of height in the fractured vertebral body was also shown. Traumatic instability was significantly reduced by kyphoplasty. However, native kinematics were not restored. Conclusions: Although post-traumatic segmental instability was significantly reduced by kyphoplasty in our in vitro model, native kinematics could not be reconstructed, and significant instability remained. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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18 pages, 4509 KiB

Open AccessArticle

Biomechanical Comparisons between One- and Two-Compartment Devices for Reconstructing Vertebrae by Kyphoplasty

by Oliver Riesenbeck, Niklas Czarnowski, Michael Johannes Raschke, Simon Oeckenpöhler and René Hartensuer

Bioengineering 2024, 11(8), 795; https://doi.org/10.3390/bioengineering11080795 - 5 Aug 2024

Viewed by 1481

Abstract

Background: This biomechanical in vitro study compared two kyphoplasty devices for the extent of height reconstruction, load-bearing capacity, cement volume, and adjacent fracture under cyclic loading. Methods: Multisegmental (T11–L3) specimens were mounted into a testing machine and subjected to compression, creating an incomplete [...] Read more.

Background: This biomechanical in vitro study compared two kyphoplasty devices for the extent of height reconstruction, load-bearing capacity, cement volume, and adjacent fracture under cyclic loading. Methods: Multisegmental (T11–L3) specimens were mounted into a testing machine and subjected to compression, creating an incomplete burst fracture of L1. Kyphoplasty was performed using a one- or two-compartment device. Then, the testing machine was used for a cyclic loading test of load-bearing capacity to compare the two groups for the amount of applied load until failure and subsequent adjacent fracture. Results: Vertebral body height reconstruction was effective for both groups but not statistically significantly different. After cyclic loading, refracture of vertebrae that had undergone kyphoplasty was not observed in any specimen, but fractures were observed in adjacent vertebrae. The differences between the numbers of cycles and of loads were not statistically significant. An increase in cement volume was strongly correlated with increased risks of adjacent fractures. Conclusion: The two-compartment device was not substantially superior to the one-compartment device. The use of higher cement volume correlated with the occurrence of adjacent fractures. Full article

(This article belongs to the Special Issue Spine Biomechanics)

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