Intervertebral neural foramina deformation due to two types of repetitive combined loading.

BACKGROUND: Tissue compression and noxious stimuli are known to elicit pain from neural tissues in the spine. Compression of nerve roots due to decreases in the intervertebral foramina may be caused by posture, sustained loading and disc height loss, herniation, or altered mechanics. It has been established that non-neutral postures combined with repeated loading can cause disc herniations, however information regarding the effect of repetitive axial twist loading is limited. The objectives of this study were twofold; to measure the occlusion of the foramina due to two types of repetitive loading and to investigate whether repetitive combined axial twist loading can contribute to disc injury.
METHODS: Sixteen porcine cervical spine segments (C5/6) were subjected to 1500 N of compression combined with either repetitive flexion-extension motions or 16.4 degrees (Standard Deviation 2.1) of static flexion with repetitive axial twist motions. The foramina pressure was measured bilaterally using plastic tubing and a custom pressure monitoring system. Specimens were loaded until 10,000 cycles were reached or disc herniation occurred.
FINDINGS: Significantly larger pressure (pre-post difference) developed in the intervertebral foramina of specimens that were repetitively flexed-extended (P=0.028) compared to those that were repetitively twisted. All of the flexed-extended specimens herniated, whereas in the twisted specimens five (62.5%) had incomplete herniations, one (12.5%) sustained a facet fracture, and two (25%) had no damage. There was no difference between the loading groups for vertical height loss (P=0.994).
INTERPRETATION: Repetitive loading of flexion-extension motions are a viable pain generating pathway in absence of distinguishing height loss. This information may be useful to consider for the diagnosis and treatment of nerve root compression.