Percutaneous Cement Discoplasty: Biomechanical and clinical assessment of a minimally invasive treatment of lumbar intervertebral disc disease

With population ageing, spine diseases have an increasing prevalence and induce high economic and social costs. The development of minimally invasive surgeries allows reducing the surgery-associated risks in elderly and polymorbid patients, and save costs by treating more patients in shorter time and reducing the complications. Percutaneous Cement Discoplasty (PCD) is a minimally invasive technique developed to treat highly degenerated intervertebral discs exhibiting a vacuum phenomenon. Filling the disc with bone cement creates a stand-alone spacer which partially restores the disc height and re-opens the foraminal space. PCD has recently been introduced to clinical use. However, the spine biomechanics following this treatment remained unravelled. The aim of this PhD thesis is to bridge the clinical experience with in vitro methodologies, to provide a multilateral evaluation of PCD outcome and a better understanding of its impact on the spine biomechanics, and of its possible contraindications. Firstly, a suitable in vitro porcine model to test the biomechanics of discoplasty by comparing specimens in the preoperative and postoperative conditions was developed. The methodology was then applied to investigate the biomechanics of discoplasty in cadaveric human segments. The in vitro specimens were mechanically investigated in flexion and extension, while a DIC system quantified the range of motion, disc height, and strains on the disc surface. Then, a versatile tool to measure the impact of discoplasty on the foramen space was developed and applied both to clinical and experimental work. The vertebrae reconstructed from CT scans were registered to match the loading configuration, using ex vivo DIC measurements under loading. The foramen volumetric changes caused by PCD was measured using a 3D geometrical method clinically developed by the research group. In conclusion, this project significantly extended the understanding of PCD biomechanics, highlighting its benefits in the treatment of advanced cases of intervertebral disc degeneration.

Dynamics of the halo gas in disc galaxies

This Thesis studies the dynamics of hot and cold gas outside the plane in galaxies like the Milky-Way (extra-planar gas) and focuses on the interaction between disc and halo material. Stationary models for the cold phase of the extra-planar gas are presented. They show that the kinematics of this phase must be influenced by the interaction with an ambient medium that we identify as the hot cosmological corona that surrounds disc galaxies. To study this interaction a novel hydrodynamical code has been implemented and a series of hydrodynamical simulations has been run to investigate the mass and momentum exchange between the cold extra-planar gas clouds and the hot corona. These simulations show that the coronal gas can condense efficiently in the turbulent wakes that form behind the cold clouds and it can be accreted by the disc to sustain star formation. They also predict that the corona cannot be a static structure but it must rotate and lag by approximately 80-120 km/s with respect to the disc. Implications of the results of this Thesis for the evolution of star-forming galaxies and for the large-scale dynamics of galactic coronae are also briefly discussed.

Work and Family: a complex interplay. An Italian application of the DISC Model on health care workers

The present thesis investigates the issue of work-family conflict and facilitation in a sanitarian contest, using the DISC Model (De Jonge and Dormann, 2003, 2006). The general aim has been declined in two empirical studies reported in this dissertation chapters. Chapter 1 reporting the psychometric properties of the Demand-Induced Strain Compensation Questionnaire. Although the empirical evidence on the DISC Model has received a fair amount of attention in literature both for the theoretical principles and for the instrument developed to display them (DISQ; De Jonge, Dormann, Van Vegchel, Von Nordheim, Dollard, Cotton and Van den Tooren, 2007) there are no studies based solely on psychometric investigation of the instrument. In addition, no previous studies have ever used the DISC as a model or measurement instrument in an Italian context. Thus the first chapter of the present dissertation was based on psychometric investigation of the DISQ. Chapter 2 reporting a longitudinal study contribution. The purpose was to examine, using the DISC model, the relationship between emotional job characteristics, work-family interface and emotional exhaustion among a health care population. We started testing the Triple Match Principle of the DISC Model using solely the emotional dimension of the strain-stress process (i.e. emotional demands, emotional resources and emotional exhaustion). Then we investigated the mediator role played by w-f conflict and w-f facilitation in relation to emotional job characteristics and emotional exhaustion. Finally we compared the mediator model across workers involved in chronic illness home demands and workers who are not involved. Finally, a general conclusion, integrated and discussed the main findings of the studies reported in this dissertation.

Displacement Analysis of Under-Constrained Cable-Driven Parallel Robots

This dissertation studies the geometric static problem of under-constrained cable-driven parallel robots (CDPRs) supported by n cables, with n ≤ 6. The task consists of determining the overall robot configuration when a set of n variables is assigned. When variables relating to the platform posture are assigned, an inverse geometric static problem (IGP) must be solved; whereas, when cable lengths are given, a direct geometric static problem (DGP) must be considered. Both problems are challenging, as the robot continues to preserve some degrees of freedom even after n variables are assigned, with the final configuration determined by the applied forces. Hence, kinematics and statics are coupled and must be resolved simultaneously. In this dissertation, a general methodology is presented for modelling the aforementioned scenario with a set of algebraic equations. An elimination procedure is provided, aimed at solving the governing equations analytically and obtaining a least-degree univariate polynomial in the corresponding ideal for any value of n. Although an analytical procedure based on elimination is important from a mathematical point of view, providing an upper bound on the number of solutions in the complex field, it is not practical to compute these solutions as it would be very time-consuming. Thus, for the efficient computation of the solution set, a numerical procedure based on homotopy continuation is implemented. A continuation algorithm is also applied to find a set of robot parameters with the maximum number of real assembly modes for a given DGP. Finally, the end-effector pose depends on the applied load and may change due to external disturbances. An investigation into equilibrium stability is therefore performed.