Publications by authors named "Denis J Diangelo"

Background: BP are the most common means for carrying items and are used by a large population but transporting heavy loads (over extended periods of time) can lead to a variety of health-related problems. An ergonomic backpack (EBP) was designed as a potential solution to reduce the incidence of injuries associated with heavy backpack weight.

Objective: The objective of this study was to design a novel ergonomic offloading backpack that reduced loads on the shoulder and spine compared to a traditional modern day backpack (BP).

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  • Tibial bone stress injuries are common among runners and military cadets, and the study compares the effects of a dynamic ankle orthosis (DAO) versus a traditional orthopedic walking boot on tibial compressive force and ankle motion.
  • The research involved 20 young adults walking on a treadmill while wearing both the DAO and walking boot to measure various forces and motions.
  • Results showed that the DAO not only reduced peak tibial compressive force and Achilles tendon force but also allowed significantly more ankle movement compared to the walking boot.
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Background: Over two million Americans visit the doctor each year for foot and ankle pain stemming from a degenerative condition or injury. Ankle-foot orthoses can effectively manage symptoms, but traditional designs have limitations. This study investigates the acute impact of a novel "dynamic ankle-foot orthosis" ("orthosis") in populations with mechanical pain (from motion or weight-bearing).

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Patients who sustain irreversible cartilage damage or joint instability from ankle injuries are likely to develop ankle osteoarthritis (OA). A dynamic ankle orthosis (DAO) was recently designed with the intent to offload the foot and ankle using a distractive force, allowing more natural sagittal and frontal plane ankle motion during gait. To evaluate its efficacy, this study compared ankle joint kinematics and plantar pressures among the DAO, standard double upright ankle-foot orthosis (DUAFO), and a nonorthosis control (CON) condition in healthy adults during walking.

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Introduction: Thoracolumbar braces are used to treat Adolescent Idiopathic Scoliosis. The objective of this study was to design and validate a mechanical analog model of the spine to simulate a thoracolumbar, single-curve, scoliotic deformity in order to quantify brace structural properties and corrective force response on the spine.

Methods: The Scoliosis Analog Model used a linkage-based system to replicate 3D kinematics of spinal correction observed in the clinic.

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Velcro fastening straps are commonly used to secure a scoliosis brace around the upper body and apply corrective forces to the spine. However, strap loosening and tension loss have been reported that reduce spinal correction and treatment efficacy. A novel fastening device, or controlled tension unit (CTU), was designed to overcome these limitations.

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Purpose: Lumbar spinal orthoses are often used as non-surgical treatment and serve to support the spine and alleviate low back pain. More recently, dynamic orthoses claiming to decompress the spine have been introduced. A previously developed prototype of dynamic mobility orthosis (DMO1) was designed that provided a distractive load across the lumbar spine but required higher sagittal bending moments and was unable to maintain spinal off-loading throughout extended ranges of movement.

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Ankle instantaneous axis of rotation (IAR) measurements represent a more complete parameter for characterizing joint motion. However, few studies have implemented this measurement to study normal, injured, or pathological foot ankle biomechanics. A novel testing protocol was developed to simulate aspects of in vivo foot ankle mechanics during mid-stance gait in a human cadaveric specimen.

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Background: Extremely few in-vitro biomechanical studies have incorporated shear loads leaving a gap for investigation, especially when applied in combination with compression and bending under dynamic conditions. The objective of this study was to biomechanically compare sagittal plane application of two standard protocols, pure moment (PM) and follower load (FL), with a novel trunk weight (TW) loading protocol designed to induce shear in combination with compression and dynamic bending in a neutrally potted human cadaveric L4-L5 motion segment unit (MSU) model. A secondary objective and novelty of the current study was the application of all three protocols within the same testing system serving to reduce artifacts due to testing system variability.

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  • The study explored the impact of different fixed centers of rotation (CoRs) on cervical spine joints using a robotic testing protocol with human cadaver samples.
  • Significant variations in range of motion and forces were observed based on the location of the CoR, indicating that CoR placement is crucial for understanding spinal mechanics.
  • The findings highlight the sensitivity of cervical motion segments to CoR positioning, suggesting potential applications for optimizing CoR locations in spinal research and implant evaluations.
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  • The study explored a new fixation technique for the C1 vertebra using a posterior locking plate and compared it to traditional screw fixation methods in a cadaver model.
  • Both the novel and existing fixation methods were found to effectively reduce motion at the C1-C2 level, but no significant differences in performance between the two techniques were observed.
  • An anatomical assessment indicated that the new C1 locking plate provided a viable option with sufficient screw stability, potentially decreasing surgical risks associated with conventional methods.
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Study Design: A biomechanical testing protocol was used to study different lumbo-pelvic fixation techniques in a human cadaveric lumbar spine model.

Objective: To compare the in vitro biomechanics of a novel four-rod lumbo-pelvic reconstruction technique with and with out cross-links, to that of a conventional cross-linked two-rod technique.

Summary Of Background Data: Numerous lumbo-pelvic reconstruction methods based on the Galveston two-rod technique have been proposed for cases involving total sacrectomy.

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Study Design: A virtual simulation model of the subaxial cervical spine was used to study the biomechanical effects of various disc prosthesis designs.

Objective: To study the biomechanics of different design features of cervical disc arthroplasty devices.

Summary Of Background Data: Disc arthroplasty is an alternative approach to cervical fusion surgery for restoring and maintaining motion at a diseased spinal segment.

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  • The article presents a computer model that simulates the cervical spine to conduct virtual biomechanical testing, enhancing research accuracy.
  • The model is built using detailed imaging of human vertebrae and simulates joint dynamics to evaluate spinal movement under various conditions.
  • Results from the simulations validate real-life test findings, offering a cost-effective and consistent way to analyze spinal biomechanics.
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  • The study tested seven adult human cadaveric cervical spines to investigate the biomechanical effects of single-level fusion at different cervical spine levels.
  • The objective was to understand how fusion impacts adjacent segments, especially since there is a known correlation between fusion and degeneration in nearby discs.
  • Results showed that motion compensation occurred primarily at segments adjacent to the fusion site, with significant increases noted at different levels depending on the fusion location, highlighting the variation in compensation dynamics based on whether upper or lower cervical segments were fused.
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The advent of cervical intervertebral disc replacement represents an exciting and new frontier in the treatment of myelopathy and discogenic pain. The goal of most disc arthroplasty designs is to attempt to approximate the normal spinal motion as much as possible. This survey article provides a general overview as to the goals of cervical disc replacement, the current state of knowledge concerning how these devices have been evaluated, and a commentary on future work that should be performed to characterize these devices fully.

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  • The study compared the effects of disc arthroplasty and anterior cervical fusion on spinal biomechanics using human cadaver models, focusing on three conditions: harvested, single-level disc arthroplasty, and single-level fusion.
  • A programmable testing setup simulated various spinal movements while measuring alterations in vertebral motion, load, and bending moments across different motion segment units (MSUs).
  • Results showed that fusion reduced motion at the treated site but increased motion at adjacent segments, while disc arthroplasty maintained motion patterns similar to the harvested condition, except during extension.
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Object: An experimental study was performed to determine the biomechanical end-mounting configurations that replicate in vivo physiological motion of the cervical spine in a multiple-level human cadaveric model. The vertebral motion response for the modified testing protocol was compared to in vivo motion data and traditional pure-moment testing methods.

Methods: Biomechanical tests were performed on fresh human cadaveric cervical spines (C2-T1) mounted in a programmable testing apparatus.

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An in vitro biomechanical study was conducted to determine the effects of fusion and nonfusion anterior cervical instrumentation on cervical spine biomechanics in a multilevel human cadaveric model. Three spine conditions were studied: harvested, single-level artificial cervical joint, and single-level graft with anterior cervical plate. A programmable testing apparatus was used that replicated physiologic flexion/extension and lateral bending.

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Object: An in vitro biomechanical study was conducted to determine the effects of anterior stabilization on cage-assisted lumbar interbody fusion biomechanics in a multilevel human cadaveric lumbar spine model.

Methods: Three spine conditions were compared: harvested, bilateral multilevel cages (CAGES), and CAGES with bioabsorbable anterior plates (CBAP), tested under flexion-extension, lateral bending, and axial rotation. Measurements included vertebral motion, applied load, and bending/rotational moments.

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An in vitro biomechanical study was conducted to determine the effects of anterior stabilization on lumbar interbody cage fusion biomechanics in a multilevel human cadaveric lumbar model. Three spine conditions were compared: harvested, bilateral multilevel cages (CAGES), and CAGES with bioabsorbable anterior plates (CBAP), tested under flexion/extension, lateral bending, and axial rotation. Measurements included vertebral motion, applied load, and bending/rotational moments.

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