Bone mineral content and fatigue failure of lumbar motion segments in simulated flexed lifting: Does specimen age influence the relationship?

This paper describes a comparison of the fatigue failure responses of older versus younger lumbar spine cadaver motion segment specimens. These specimens were repeatedly subjected to loads simulating those experienced by the spine in lifting a 9 kg load in different torso flexion postures (0, 22.5, and 45 degrees of flexion). An older sample of 36 motion segments (average age 81 years + 8 SD) is compared with a younger sample of 18 motion segments (average age: 47 years + 9 SD) with respect to the number of cycles to failure and results of survival analyses evaluating the effects of flexion and bone mineral content with and without the younger data set. Compared to the older sample of spines, the younger sample exhibited many more cycles to fatigue failure in all the torso flexion conditions (10020 versus 8267 average cycles to failure in 0 degrees flexion, 7124 versus 3262 in 22.5 degrees flexion, and 3229 versus 263 cycles to failure in 45 degrees flexion). The increased cycles to failure in young specimens is likely due to the increased bone mineral content (BMC) in younger motion segments (30.7 g + 11.1 g per motion segment versus 27.8 + 9.4 g). Cox regression analyses modeling both flexion effects and BMC indicate that betas are similar when just older spines are modeled and when younger specimens are included in the analysis. Betas for survival analysis models with and without younger specimens generally show little change for flexion (2.716 versus 2.756 for 22.5 degrees [0 degrees referent], 3.926 versus 3.380 for 45 degrees [0 degrees referent]). Bone mineral content shows a similar protective effect in both models (Betas: -0.127 versus -0.087). Overall, comparison of the models indicate that risk ratios are similar for 22.5 degrees flexion, slightly increased for 45 degrees flexion and slightly more protective influence predicted for BMC in the combined sample versus the older sample alone.