Visualisation en temps réel du disque intervertébral lors de fractures vertébrales à haute énergie

Abstract

Spinal cord injuries due to spinal fractures can have very severe neurological consequences for the quality of life of the patients. These traumatisms are induced by high energy loadings. Therefore, Spinal fractures are complex, they occur very quickly, and their pathomechanisms and the instability of the spine caused by such fractures are poorly understood. Many published research studies have tried to investigate these pathomechanisms but there isn’t any final consensus and there is a lack of real evidences in their argumentations. Several of the assumptions involve the intervertebral disc and the action of its core, the nucleus pulposus, as a potential critical factor. The main objective of this report is to develop and to evaluate the potential of high speed cineradiography in order to visualize the vertebrae and discs components such as the nucleus pulposus during experimental modeling of high energy spinal fractures. In order to reach the objectives, injections of a minimum quantity of liquid radiopaque contrast agent in porcine intervertebral disks are investigated. Visualization of the nucleus pulposus and the impact of the injections on intradiscal pressure are studied. Furthermore, high speed cineradiographs of spinal compression fractures are presented and commented. The injection in porcine intervertebral disk of 0,15 mL of liquid contrast agent followed by a 24 hours spread period appears from the results to be the best compromise between visualization of the entire nucleus pulposus and minimum impact on the intradiscal pressure. The high speed cineradiography shows a great potential for the studies of high energy spinal fractures, as it allows a dynamic view on the fractures’ propagation and on the order of failure of the different elements. The visualization of the nucleus pulposus gives new evidences on its implication in high energy spinal fractures. Long-term expected benefits of the proposed method are to develop dynamic understanding of high energy spinal fracture patterns, numerical predictive models and finally improved medical care with less complication for the patients.

Date	21 Jul 2017
Original language	French
Awarding Institution	École de technologie supérieure
Supervisor	Yvan Petit (Supervisor) & Éric Wagnac (Co-supervisor)