Thomas Oxland

Professor

Relevant Degree Programs

 

Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - Mar 2019)
A biomechanical investigation of a dislocation spinal cord injury in a rat model (2018)

Traumatic spinal cord injuries clinically occur in a heterogeneous fashion, including at different spinal levels, injury velocities, and injury mechanisms. Clinical treatment options, such as early surgical decompression produce inconsistent recovery outcomes in the patient population, despite demonstrating effectiveness in preclinical animal models. The most common biomechanical factors, such as cervical level, high-energy impact and dislocation injury mechanism, are not adequately represented in preclinical models, which may explain the lack of agreement between clinical studies. The overall objective of this thesis was to investigate the biomechanics of a high-speed cervical dislocation rat model at acute stages, refine the model, and incorporate residual compression. The temporal progression of acute SCI was investigated in different injury mechanisms, where dislocation injuries demonstrated the fastest loss of white matter tissue. To refine the dislocation model, new vertebral injury clamps were designed with a feature allowing the clamps to pivot and self-align when tightened. The vertebral kinematics during a dislocation injury were analysed using high-speed x-ray and clamp slippage was significantly reduced with the self-aligning clamps, compared to the existing clamps. This study also emphasized the importance of validating injury displacements against input parameters, particularly when comparing results or reproducing injuries. In order to implement residual compression within the dislocation model, injury parameters were independently investigated. Electrophysiology techniques were implemented to determine a minimum residual compression depth that affects signal conduction following a traumatic injury. Continuously holding the residual compression following the initial injury induced a significantly different physiological response compared to when the injury was immediately reduced. Behavioural outcome was used to identify severities following a range of displacements, and four hours of residual compression was survivable following a ‘mild’ traumatic injury, indicating suitable parameters for future studies. Rats of the same weight were identified to have different anatomical dimensions and structural properties of the spinal column, potentially influencing injury outcomes in closed-column models. The continued development and implementation of the cervical dislocation injury model in the rat will deepen understanding of SCI biomechanics and provide an additional clinically-relevant injury model for testing the robustness of potential treatment therapies.

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Quantification of morphological changes of the cervical spinal cord during traumatic spinal cord injury in a rodent model (2015)

Traumatic spinal cord injury initiates a complex pathophysiological process that eventually manifests as persistent tissue damage and possible permanent loss of neurologic function. Current experimental models are limited to measuring the gross mechanical response of the spinal cord during injury; thus, little is known about how the internal tissues of the spinal cord deform during injury. The general aims of this research were to develop a method to observe the internal deformations of the in vivo rat spinal cord during clinically-relevant injury models and to determine if the patterns of deformation were correlated to tissue damage manifesting after the injury. To facilitate this work, a novel apparatus and a number of novel methods were developed. First, an apparatus that was capable of inducing contusion and dislocation spinal cord injuries in an in vivo rat model, inside of an MR scanner, was developed. The reported contusion and dislocation injury speeds were comparable with existing spinal cord injury devices, and contusion injury magnitudes showed good accuracy and precision. The device facilitated direct observation and differentiation of the morphological change of the spinal cord tissues during injury. The three-dimensional tissue motion was quantified using a state-of-the-art deformable image registration algorithm that produced displacement fields throughout the volume of the spinal cord around the site of the injury. Furthermore, the image registration methods were validated against a gold-standard. The displacement fields were used to generate transverse-plane mechanical finite strain fields in the spinal cord and the contusion and dislocation injury mechanisms produced distinctly different patterns of tissue deformation in the spinal cord. Lastly, the relationship between mechanical strain and the ensuing tissue damage was investigated in the ventral horns of the gray matter of the spinal cord. This work suggests that compressive strain contributes to the tissue damage in the ventral horns of the gray matter. However, the most important conclusion from this work is that internal observation of the spinal cord tissue during injury provides an invaluable experimental data set that can be used to improve our understanding of the relationship between deformation during injury and manifestation of damage.

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Biomechanics of cervical spine and spinal cord injury under combined axial compression and lateral bending loading (2014)

Cervical spine and spinal cord injuries are significant health concerns. Although lateralforces are present during real-world head-first impacts, there is a lack of information aboutcombined lateral bending moments with axial compression. The general aim of this researchwas to evaluate the effects of lateral bending in dynamic axial compression of the cervicalspine on kinetics, kinematics, canal occlusions, and injuries of the cervical spine and thisrequired the development of novel loading and measurement apparatus. We experiencedtechnical challenges in experimentally producing lateral bending moments requiring novelloading methods. Also, as acoustic emission (AE) signals could provide more objectiveestimates of the timing of injuries produced experimentally, these techniques were developedfor use in the spine.In Study 1, techniques were developed to measure the time of injury of isolated spinalcomponents using AE signals. Injuries to human cadaver vertebral bodies resulted in AEsignals with higher amplitudes and frequencies than those from ligamentum flavumspecimens.Study 2 presented a theoretical and experimental evaluation of the effects of testconfiguration on bending moments during eccentric axial compression. Designrecommendations were provided that allowed us to apply appropriate bending moments inthe subsequent studies.In Studies 3, 4, and 5 dynamic axial compression forces with lateral eccentricities wereapplied to human cadaver cervical spine segments and AE signals were used to detect thetime of injury. High lateral eccentricities resulted in lower peak axial forces, inferiordisplacements, and canal occlusions and greater peak ipsilateral bending moments, bendingrotations, displacements, and spinal flexibilities in lateral bending and axial rotationcompared to low eccentricity impacts. Also, low and high lateral eccentricities producedprimarily hard and soft tissue injuries, respectively. In this three-vertebra model, AE signalsfrom injuries to endplates and/or vertebral bodies had higher amplitudes and frequencies thanthose from injuries to the intertransverse ligament and/or facet capsule.The effects of lateral bending in dynamic axial compression on injury mechanisms of thecervical spine and the injury detection techniques demonstrated in this thesis may potentiallyassist in the development and improvement of injury prevention and treatment strategies.

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Master's Student Supervision (2010-2017)
Degeneration and mechanics of the segment adjacent to a lumbar spine fusion : a biomechanical analysis (2014)

Introduction: The development of adjacent segment degeneration (ASD) as a common complication of spinal fusion is believed by some clinicians and researchers to have roots in kinematic changes and altered loading at the intervertebral levels beside the fusion (i.e. adjacent). Dynamic spinal implants and minimally invasive surgeries were introduced to minimize such kinematic changes and load alterations in attempts to prevent ASD. However, little is known whether the kinematic changes at the adjacent level to a fusion are common in vivo occurrences. Further, the role of iatrogenic muscle damage on loading at the adjacent levels has not been investigated previously.Objectives: (1) To assess the current clinical evidence of in vivo kinematic changes at the levels adjacent to a lumbar spinal fusion. (2) To investigate the role of iatrogenic muscle damage on loading at the adjacent levels.Methods: (1) A systematic search in the PubMed database was performed for studies that addressed kinematics of the segment adjacent to a lumbar spine fusion or any other spinal implant. (2) A musculoskeletal model of the lumbar spine with 210 muscles was developed. Muscle damage was simulated by detaching the muscles from the posterior elements of the operated vertebrae and its effect on spinal loads at the adjacent levels was assessed during upright standing. Results: (1) The search identified 39 articles, among which 29 studied fusion. None of the studies observed any increase in range of motion (ROM) of the caudal adjacent segment, while for the rostral adjacent level the ROM was reported to increase in 10-30% of the patients. (2) The axial forces at the adjacent levels increased with muscle damage, with the largest increases being at the rostral adjacent level (73%) in comparison to the caudal level (32%).Discussion: The results of both studies imply higher susceptibility of the rostral adjacent level to disc degeneration, which is in harmony with the clinical prevalence of ASD occurring in 70 to 100% of the cases at the rostral level. The findings suggest that muscle damage secondary to spine surgery may play a key role in adjacent segment changes, independent of the spinal instrumentation.

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The effects of impact depth and velocity on spinal cord injury severity (2013)

Currently a treatment for spinal cord injury (SCI) remains elusive to clinicians and researchers. This is, in part, due to variation between primary injury mechanisms and diversity of mechanical impact factors such as impact velocity, depth, force, and acceleration. This research examines both the individual and combined effects of impact velocity and depth on the cervical spinal cord and also aims to understand the contribution of the energy applied, not only the impact factors. In this study, contusion spinal cord injuries were induced in 54 male, Sprague-Dawley rats at impact speeds of 8 mm/s, 80 mm/s, or 800 mm/s with displacements of 0.9 mm or 1.5 mm. Animals recovered for seven days followed by behavioural assessment and examination of the spinal cord tissue for demyelination and tissue sparing at 1 mm intervals ±3 mm rostrocaudally to the epicentre. In parallel, a finite element model of the rat spinal cord was used to examine the resulting maximum principal strains in the spinal cord during impact.Impact depth was a consistent factor in qualifying axonal damage in the spinal cord, tissue sparing, and resulting behavioural deficit. Increased impact velocity resulted in significantly different impact energies and measureable outcomes at the 1.5 mm impact depth, but not the 0.9 mm impact depth, identifying threshold interactions between the two factors. The difference of injury severity to velocity at different impact depths identifies the existence of threshold interactions between the two impact factors.Linear correlation analysis with finite element analysis (FEA) strain showed significant (p≪0.001) correlations with axonal damage in the ventral (R ²=0.86) and lateral (R²=0.74) regions of the spinal cord and with white matter (R²=0.90) and grey matter (R²=0.76) sparing. Non-parametric correlation analysis identified strong correlations between grey and white matter strain with open field behavioural scores (p=0.005,r_s=-0.94).The results shown by this work extend the research identifying significant correlation between maximum principal strain and neurologic tissue damage. Furthermore, a relationship between the impact depth and velocity of injury demonstrated a more rate sensitive response of the spinal cord at the 1.5 mm impact depth than at the 0.9 mm impact depth.

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A nonlinear finite element model of the rat cervical spine : validation and correlation with histological measures of spinal cord injury (2012)

Researchers and clinicians do not currently use the heterogeneity of the primary mechanism of spinal cord injury (SCI) to tailor treatment strategies because the effects of these distinct patterns of acute mechanical damage on long-term neuropathology have not been fully investigated. Computational modelling of SCI enables the analysis of mechanical forces and deformations within the spinal cord tissue that are not visible experimentally. I created a dynamic, hyperviscoelastic three-dimensional finite element (FE) model of the rat cervical spine and simulated contusion and dislocation SCI mechanisms. I investigated the relationship between maximum principal strain and previously published tissue damage patterns, and compared primary injury patterns between mechanisms.My model incorporates the spinal cord white and gray matter, dura mater, cerebrospinal fluid, spinal ligaments, intervertebral discs, a rigid indenter and vertebrae, and failure criteria for ligaments and vertebral endplates. High-speed (1 m/s) contusion and dislocation injuries were simulated between vertebral levels C3 and C6 to match previous animal experiments, and average peak maximum principal strains were calculated for several regions at the injury epicentre and at 1 mm intervals from +5 mm rostral to -5 mm caudal to the lesion. I compared average peak principal strains to tissue damage measured previously via axonal permeability to 10 kD fluorescein-dextran (Choo, 2007). Linear regression of tissue damage against peak maximum principal strain for pooled data within white matter regions yields significant (p
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Biomechanical comparison of two total ankle replacement designs : micromotion and kinematic patterns (2012)

Introduction: Arthritis is a degenerative disease that causes irreversible damage to a joint’s articular cartilage. Despite having high failure rates in early total ankle arthroplasty (TAA) models, recent improvements have increased the success of this procedure, providing end-stage ankle arthritis patients a viable alternative to fusion with better functional outcomes. Currently, the most prevalent cause of failure is aseptic loosening, which is believed to be affected by motion at the bone-implant interface. The objective of this study was to compare micromotion and kinematic patterns of two TAA designs. Methods: A mechanical simulator was designed to apply compressive loads and bending moments to human cadaveric ankles, intact and replaced. It induced a maximal range of motion in the ankle about 3 orthogonal axes: plantarflexion-dorsiflexion (PF-DF), inversion-eversion (INV-EV), and internal-external rotation (IR-ER). Six ankle pairs were tested and compared. The implants analyzed were the Agility™ and the Scandinavian Total Ankle Replacement (S.T.A.R.®). Using an optical motion capture system, tibiocalcaneal kinematics and the relative bone-implant motion for each implant were recorded and analyzed. Results: The Agility exhibited a greater amount of micromotion between the bone and prosthesis than the STAR for the tibial component in INV-EV (p=0.037), and for the talar component in PF-DF (p=0.002) and IR-ER (p=0.038). Micromotion magnitudes were affected by loading direction and compression. Kinematic changes were observed following replacement of the ankle joint. There were decreases in the amount of motion coupling for both implants when loaded in INV-EV and IR-ER. There were increases in joint translation for both implants in the medial/lateral direction under INV-EV loading, and for the STAR in the anterior/posterior and compression/distraction directions under PF-DF loading. No significant ROM differences were found. Discussion: Increased micromotion in the Agility supports the hypothesis that higher aseptic loosening rates are correlated with reduced initial post-op fixation. The effect of loading direction on micromotion magnitude confirms the need to apply a variety of loading conditions to obtain a comprehensive micromotion analysis. Kinematic differences between implanted and intact ankles show that there is still room for improvement towards an ankle replacement design that replicates the performance of a healthy ankle.

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Proximal junctional kyphosis following surgical treatment of global sagittal imbalance : predictive analysis using mathematical and in vitro biomechanical models (2012)

Introduction: Sagittal realignment using posterior spinal fixation and fusion, with or without corrective osteotomy, is the current treatment for global sagittal imbalance. Patients may develop proximal junctional kyphosis (PJK) through failure of the uppermost instrumented or adjacent vertebra. The effects of surgical and patient variables on the development of PJK have not been studied biomechanically. Objectives: (1) To analyze pre- and post-operative intervertebral loading and the effect of osteotomy location and extensor muscle function on intervertebral spine loading using a 2D equilibrium model of sagittally imbalanced adult spine, and (2) to characterize pure moment loading pathways of multi-segment human cadaveric spines following posterior spinal fixation and in a number of surgical conditions.Methods: (1) Pre- and post-operative lateral radiographic measurements were taken of patients (N=7) and used to predict intervertebral compressive loading patterns. From pre-operative curves, the changes in loading behaviour due to simulated osteotomies and decreasing levels of extensor muscle function were assessed. (2) Six human cadaver five-segment spines in six surgical states were tested in pure flexion-extension bending to represent the post-operative loading of patients without extensor muscle function. Vertebral strain, rod strain, and specimen kinematics were measured and rod loading was used to predict load-sharing between the implant and the spine.Results: (1) Predicted intervertebral compressive loads increased up to 29% after development of PJK. Predicted compressive loads were not notably affected by the chosen level of the osteotomy but increased up to 42% after intra-operative extensor muscle loss. (2) A force couple existed between the vertebral column and the implant, supporting the majority of the applied moment. The additional compressive force on the spine due to the applied moment was predicted based on rod load measurements, found to agree with model predictions. Specimen condition had minimal or no significance on measurements.Discussion: The developed equilibrium model introduced a predictive tool for surgical planning and deformity progression. Predicted intervertebral compressive loads were higher in sagitally-imbalanced spines than asymptomatic spines (96), worsened by loss of extensor muscle function. Simulating muscle loss by applying a pure moment in vitro may provide insight to the resulting additional spine loading.

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Design and biomechanical evaluation of a rodent spinal fixation device (2010)

Previous experimental studies of spinal cord injury (SCI) in rodents established the importance of fixation of the spine in survival models following a mechanical injury. However, no fixation device has been designed to provide spinal stabilization, prevent additional damage to the cord, and promote fusion at the site of injury. The present study aims to design a novel rat spinal fixation device, which will be used in future survival studies and investigates its biomechanical effectiveness in stabilizing the spine up to eight weeks post injury.A custom-made magnetic resonance imaging (MRI) compatible fixation device was designed to stabilize the C5/C6 joint. This was achieved in an animal model by creating a 1.5 mm fracture-dislocation injury between C5 and C6 spinal segments of Sprague-Dawley rats using a multimechanism SCI test system. A biomechanical evaluation of the device-spine system was conducted at these segments. Cycles of stepwise directed shear forces with a maximum of 0.98 N were applied at a known distance from the injured site producing flexion and extension bending moments, while the resulting two-dimensional motions between C5 and C6 were measured and presented in the form of load-displacement curves. This was implemented at two time points: immediately (n = 6), and eight weeks post-injury (n = 9) and the results were compared to an intact group (n = 6).Average ± S.D. flexion/extension ranges of motion (ROM) were 18.1 ± 3.3º, 19.9 ± 7.5º, and 1.5 ± 0.7º, and neutral zones (NZ) were 3.4 ± 2.8º, 5.0 ± 2.4º, and 0.7 ± 0.5º, respectively for the intact, injured/fixed, and injured/8-week groups. The results show that there is a significant difference in ROM and NZ between the injured/fixed and injured/8-week groups (p-values = 0.0002, and 0.006, respectively). The device acutely stabilizes the spine by restoring its stiffness to the initial stiffness of the intact specimen. It also proves that along with the biological factors over time, fusion is promoted at the site of injury. This study presents the design and evaluation of a novel well-characterized spinal fixation device for rats, which will be used in future experimental SCI survival models.

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Recent Tri-Agency Grants

The following is a selection of grants for which the faculty member was principal investigator or co-investigator. Currently, the list only covers Canadian Tri-Agency grants from years 2013/14-2016/17 and excludes grants from any other agencies.

  • Biomechanical Factors in SCI - relevance to the timing of decompression - Canadian Institutes of Health Research (CIHR) - Operating Grant (2014/2015)
  • Towards a cervical spine injury tolerance criterion that incorporates lateral bending loading - Canadian Institutes of Health Research (CIHR) - Operating Grant (2013/2014)
  • Biomechanical behaviour of the spinal cord - Natural Sciences and Engineering Research Council of Canada (NSERC) - Discovery Grants Program - Individual (2013/2014)
  • Engineers in scrubs - fostering innovation in medical technologies through deep understanding of clinical needs - Natural Sciences and Engineering Research Council of Canada (NSERC) - Collaborative Research and Training Experience (CREATE) Program (2013/2014)

Current Students & Alumni

This is a small sample of students and/or alumni that have been supervised by this researcher. It is not meant as a comprehensive list.
 
 

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