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Nguyen AQ, Rodriguez C, Kumar R, Gupta S, Anderson DE, Saifi C. Biomechanical analysis of complications following T10-Pelvis spinal fusion: A population based computational study. J Biomech 2024; 165:111969. [PMID: 38394952 DOI: 10.1016/j.jbiomech.2024.111969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are challenging complications of long fusion constructs for the treatment of adult spinal deformity. The objective of this study is to understand the biomechanical stresses proximal to the upper instrumentation of a T10-pelvis fusion in a large patient cohort. The pre-fusion models were subject-specific thoracolumbar spine models that incorporate the height, weight, spine curvature, and muscle morphology of 250 individuals from the Framingham Heart Study Multidetector CT Study. To create post-fusion models, the subject-specific models were further modified to eliminate motion between the intervertebral joints from T10 to the pelvis. OpenSim analysis tools were used to calculate the medial lateral shear force, anterior posterior shear force, and compressive force on the T9 vertebra during the static postures. Differences between pre-fusion and post-fusion T9 biomechanics were consistent between increased segmental mobility and unchanged segmental mobility conditions. For all static postures, compression decreased (p < 0. 0005). Anterior-posterior shear force significantly increased (p < 0. 0005) during axial twist and significantly increased (p < 0. 0005) during trunk flexion. Medial lateral shear force significantly increased (p < 0. 0005) during axial twist. This computational study provided the first use of subject-specific models to investigate the biomechanics of long spinal fusions. Patients undergoing T10-Pelvis fusion were predicted to have increased shear forces and decreased compressive force at the T9 vertebra, independent of change in segmental mobility. The computational model shows potential for the investigation of spinal fusion biomechanics to reduce the risk of PJK or PJF.
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Affiliation(s)
- Austin Q Nguyen
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Christian Rodriguez
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Rachit Kumar
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Sachin Gupta
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Comron Saifi
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, United States.
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Banks JJ, Quirk DA, Chung J, Cherin JM, Walsh CJ, Anderson DE. The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts. ERGONOMICS 2024:1-14. [PMID: 38389220 DOI: 10.1080/00140139.2024.2320355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Back support exosuits aim to reduce tissue demands and thereby risk of injury and pain. However, biomechanical analyses of soft active exosuit designs have been limited. The objective of this study was to evaluate the effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading in participants performing stoop and squat lifts of 6 and 10 kg crates, using participant-specific musculoskeletal models. The exosuit did not change overall trunk motion but affected lumbo-pelvic motion slightly, and reduced peak compressive and shear vertebral loads at some levels, although shear increased slightly at others. This study indicates that soft active exosuits have limited kinematic effects during lifting, and can reduce spinal loading depending on the vertebral level. These results support the hypothesis that a soft exosuit can assist without limiting trunk movement or negatively impacting skeletal loading and have implications for future design and ergonomic intervention efforts.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David A Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Wang M, Tang H, Chen X, Liu J, Hu N, Cui W, Zhang C, Xie C, Chen X. Opportunistic Muscle Evaluation During Chest CT Is Associated With Vertebral Compression Fractures in Old Adults: A Longitudinal Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad162. [PMID: 37422853 DOI: 10.1093/gerona/glad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Sarcopenia and bone loss are both common in older individuals. However, the association between sarcopenia and bone fractures has not been evaluated longitudinally. In this study, we evaluated the association between computed tomography (CT)-based erector spinae muscle area and attenuation and vertebral compression fracture (VCF) in elderly individuals in a longitudinal study. METHODS This study recruited individuals 50 years of age and older, who did not have VCF and underwent CT imaging for lung cancer screening during January 2016 to December 2019. Participants were followed up annually until January 2021. Muscle CT value and muscle area of the erector spinae were determined for muscle assessment. Genant score was used to define new-onset VCF. Cox proportional hazards models were used to assess the association between muscle area/attenuation and VCF. RESULTS Of the 7 906 included participants, 72 developed new VCF over a median follow-up of 2 years. Large area of the erector spinae (adjusted hazard ratio [HR] = 0.2, 95% confidence interval [CI]: 0.1-0.7) and high bone attenuation (adjusted HR = 0.2, 95% CI: 0.1-0.5) were independently associated with VCF. High muscle attenuation was associated with severe VCF (adjusted HR = 0.46, 95% CI: 0.24-0.86). The addition of muscle area improved the area under the curve of bone attenuation from 0.79 (95% CI: 0.74-0.86) to 0.86 (95% CI: 0.82-0.91; p = .001). CONCLUSIONS CT-based muscle area/attenuation of the erector spinae was associated with VCF in elderly individuals, independently of bone attenuation. The addition of muscle area improved the performance of bone attenuation in predicting VCF.
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Affiliation(s)
- Miaomiao Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongye Tang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Chen
- Department of Radiology, Longhua Hospital Shanghai University of Chinese Traditional Medicine, Shanghai, China
| | - Jingjing Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Nandong Hu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Zhang
- Department of Orthopedics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Xie
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Yan C, Lynch AC, Alemi MM, Banks JJ, Bouxsein ML, Anderson DE. Validity of evaluating spinal kinetics without participant-specific kinematics. J Biomech 2023; 161:111821. [PMID: 37805384 DOI: 10.1016/j.jbiomech.2023.111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Musculoskeletal models are commonly used to estimate in vivo spinal loads under various loading conditions. Typically, participant-specific measured kinematics (PSMK) are coupled with participant-specific models, but obtaining PSMK data can be costly and infeasible in large studies or clinical practice. Thus, we evaluated two alternative methods to estimate spinal loads without PSMK: 1) ensemble average kinematics (EAK) based on kinematics from all participants; and 2) using separately measured individual kinematics (SMIK) from multiple other participants as inputs, then averaging the resulting loads. This study compares the dynamic spine loading patterns and peak loads in older adults performing five lifting tasks using PSMK, EAK and SMIK. Median root mean square errors of EAK and SMIK methods versus PSMK ranged from 18 to 72% body weight for compressive loads and from 2 to 25% body weight for shear loads, with median cross-correlations ranging from 0.931 to 0.991. The root mean square errors and cross-correlations between repeated PSMK trials fell within similar ranges. Compressive peak loads evaluated by EAK and SMIK were not different than PSMK in 12 of 15 cases, while by comparison repeated PSMK trials were not different in 13 of 15 cases. Overall, the resulting spine loading magnitudes and profiles using EAK or SMIK were not notably different than using a PSMK approach, and differences were not greater than between two PSMK trials. Thus, these findings indicate that these approaches may be used to make reasonable estimates of dynamic spinal loading without direct measurement of participant kinematics.
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Affiliation(s)
- Chenxi Yan
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States.
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Wang F, Sun R, Zhang SD, Wu XT. Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain. J Orthop Surg Res 2023; 18:643. [PMID: 37649026 PMCID: PMC10469467 DOI: 10.1186/s13018-023-04140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF). METHODS OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF. RESULTS A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was - 2.99 ± 1.11, - 3.24 ± 1.14, - 3.05 ± 1.40 in < 70, 70-80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior-posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1-2, and 2-4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1-2, 2-4, and > 4 weeks. CONCLUSIONS Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.
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Affiliation(s)
- Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
| | - Rui Sun
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
| | - Shao-Dong Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
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Li J, Gössel L, Kunze B, Kessler O, Alharbi Y, Gärtner O, Mihalca V, Krebs S, Dreimann M. Traumatic lumbar disc herniation: A systemic case review and meta-analysis. BRAIN & SPINE 2023; 3:102350. [PMID: 38021008 PMCID: PMC10668050 DOI: 10.1016/j.bas.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023]
Abstract
Introduction Traumatic lumbar disc herniation (TLDH) without fracture in the in-situ motion segment is a rare occurrence compared with degenerative herniation. Research question This study provides a systematic discussion of various aspects related to the diagnosis of TLDH. Material and methods This review includes 12 cases of TLDH with MR-images since 2009 published in the PubMed and one adjunct illustration. The cases were categorized into two groups for a comprehensive analysis, TLDH with or without in-situ segment fracture. Additionally, we reported a case of a 43-year-old female patient with a recent stenosing TLDH at L5/S1, accompanied by a large sequestration (disc herniation stage-4, and Michigan State University Classification: MSU 3-AB) and an endplate compression fracture at L2 (AO A1). Results Isolated traumatic lumbar disc herniation is possible, but it is required exclude cases with fractures in the in-situ motion segment. Discussion and conclusion Trauma with related injury mechanisms is the highest priority for the diagnosis of TLDH. Low-grade disc degeneration without significant instability could be accepted for diagnosing TLDH. A TLDH on MR images might show a slightly lower T2-signal compared to the CSF and a homogeneous T1-signal like the spinal cord, as well as a similar STIR-signal of the sequestration and CSF. If necessary, a histological examination could be performed to evaluate the degenerative changes in the injured disc, especially to assist the evaluation due to legal reasons.
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Affiliation(s)
- J. Li
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - L. Gössel
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - B. Kunze
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - O. Kessler
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - Y. Alharbi
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - O. Gärtner
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - V.A. Mihalca
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - S. Krebs
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - M. Dreimann
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
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Hess M, Allaire B, Gao KT, Tibrewala R, Inamdar G, Bharadwaj U, Chin C, Pedoia V, Bouxsein M, Anderson D, Majumdar S. Deep Learning for Multi-Tissue Segmentation and Fully Automatic Personalized Biomechanical Models from BACPAC Clinical Lumbar Spine MRI. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S139-S148. [PMID: 36315069 PMCID: PMC10403305 DOI: 10.1093/pm/pnac142] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
STUDY DESIGN In vivo retrospective study of fully automatic quantitative imaging feature extraction from clinically acquired lumbar spine magnetic resonance imaging (MRI). OBJECTIVE To demonstrate the feasibility of substituting automatic for human-demarcated segmentation of major anatomic structures in clinical lumbar spine MRI to generate quantitative image-based features and biomechanical models. SETTING Previous studies have demonstrated the viability of automatic segmentation applied to medical images; however, the feasibility of these networks to segment clinically acquired images has not yet been demonstrated, as they largely rely on specialized sequences or strict quality of imaging data to achieve good performance. METHODS Convolutional neural networks were trained to demarcate vertebral bodies, intervertebral disc, and paraspinous muscles from sagittal and axial T1-weighted MRIs. Intervertebral disc height, muscle cross-sectional area, and subject-specific musculoskeletal models of tissue loading in the lumbar spine were then computed from these segmentations and compared against those computed from human-demarcated masks. RESULTS Segmentation masks, as well as the morphological metrics and biomechanical models computed from those masks, were highly similar between human- and computer-generated methods. Segmentations were similar, with Dice similarity coefficients of 0.77 or greater across networks, and morphological metrics and biomechanical models were similar, with Pearson R correlation coefficients of 0.69 or greater when significant. CONCLUSIONS This study demonstrates the feasibility of substituting computer-generated for human-generated segmentations of major anatomic structures in lumbar spine MRI to compute quantitative image-based morphological metrics and subject-specific musculoskeletal models of tissue loading quickly, efficiently, and at scale without interrupting routine clinical care.
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Affiliation(s)
- Madeline Hess
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth T Gao
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Radhika Tibrewala
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Gaurav Inamdar
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Upasana Bharadwaj
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Cynthia Chin
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
| | - Mary Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, San Francisco, California
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Allaire BT, Mousavi SJ, James JN, Bouxsein ML, Anderson DE. Dependence of trunk muscle size and position on age, height, and weight in a multi-ethnic cohort of middle-aged and older men and women. J Biomech 2023; 157:111710. [PMID: 37437459 PMCID: PMC10470847 DOI: 10.1016/j.jbiomech.2023.111710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
Trunk muscle size and location relative to the spine are key factors affecting their capacity to assist in trunk movement, strength, and function. There remains limited information on how age, weight and height affect these measurements across multiple spinal levels, and prior studies had limited samples in terms of size and ethnicity. In this study, we measured trunk muscles in coronal plane slices at T4 - L4 of CT scans acquired in 507 participants, aged 40-90 years, from the community-based Framingham Heart Study. Mixed-effects linear regressions, stratified by sex, determined the contributions of age, height and weight, to muscle cross-sectional area (CSA), the distance from the vertebral body centroid (CD), and the in-plane angle of the line between the vertebral body and the muscle centroids (CA). Muscle CSA decreased with higher age by an average of -0.8% per year, but weight (average 0.8% per kg) and height (average -0.05% per cm) had mixed results, with both positive and negative effects depending on muscle group and level. Muscle CD increased with weight by an average of 0.3% per kg, but had mixed effects for age (average 0.8% per year) and height (average 0.1% per cm). Muscle CA had mixed associations with age (average 0.05% per year), weight (average 0.01% per kg) and height (average -0.05% per cm). A prediction program created with these results provides a simple approach for estimating probable values for trunk muscle size and position in the absence of medical imaging.
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Affiliation(s)
- Brett T Allaire
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Seyed Javad Mousavi
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Joanna N James
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States.
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Wang K, Deng Z, Chen X, Shao J, Qiu L, Jiang C, Niu W. The Role of Multifidus in the Biomechanics of Lumbar Spine: A Musculoskeletal Modeling Study. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010067. [PMID: 36671639 PMCID: PMC9854514 DOI: 10.3390/bioengineering10010067] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The role of multifidus in the biomechanics of lumbar spine remained unclear. PURPOSE This study aimed to investigate the role of multifidus in the modeling of lumbar spine and the influence of asymmetric multifidus atrophy on the biomechanics of lumbar spine. METHODS This study considered five different multifidus conditions in the trunk musculoskeletal models: group 1 (with entire multifidus), group 2 (without multifidus), group 3 (multifidus with half of maximum isometric force), group 4 (asymmetric multifidus atrophy on L5/S1 level), and group 5 (asymmetric multifidus atrophy on L4/L5 level). In order to test how different multifidus situations would affect the lumbar spine, four trunk flexional angles (0°, 30°, 60°, and 90°) were simulated. The calculation of muscle activation and muscle force was done using static optimization function in OpenSim. Then, joint reaction forces of L5/S1 and L4/L5 levels were calculated and compared among the groups. RESULTS The models without multifidus had the highest normalized compressive forces on the L4/L5 level in trunk flexion tasks. In extreme cases produced by group 2 models, the normalized compressive forces on L4/L5 level were 444% (30° flexion), 568% (60° flexion), and 576% (90° flexion) of upper body weight, which were 1.82 times, 1.63 times, and 1.13 times as large as the values computed by the corresponding models in group 1. In 90° flexion, the success rate of simulation in group 2 was 49.6%, followed by group 3 (84.4%), group 4 (89.6%), group 5 (92.8%), and group 1 (92.8%). CONCLUSIONS The results demonstrate that incorporating multifidus in the musculoskeletal model is important for increasing the success rate of simulation and decreasing the incidence of overestimation of compressive load on the lumbar spine. Asymmetric multifidus atrophy has negligible effect on the lower lumbar spine in the trunk flexion posture. The results highlighted the fine-tuning ability of multifidus in equilibrating the loads on the lower back and the necessity of incorporating multifidus in trunk musculoskeletal modeling.
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Affiliation(s)
- Kuan Wang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Zhen Deng
- Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Xinpeng Chen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Jiang Shao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Lulu Qiu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Chenghua Jiang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Wenxin Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
- Laboratory of Rehabilitation Engineering and Biomechanics, Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai 200092, China
- Correspondence: ; Tel.: +86-021-65982856
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Banks JJ, Alemi MM, Allaire BT, Lynch AC, Bouxsein ML, Anderson DE. Using static postures to estimate spinal loading during dynamic lifts with participant-specific thoracolumbar musculoskeletal models. APPLIED ERGONOMICS 2023; 106:103869. [PMID: 36055036 DOI: 10.1016/j.apergo.2022.103869] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Static biomechanical simulations are sometimes used to estimate in vivo kinetic demands because they can be solved efficiently, but this ignores any potential inertial effects. To date, comparisons between static and dynamic analyses of spinal demands have been limited to lumbar joint differences in young males performing sagittal lifts. Here we compare static and dynamic vertebral compressive and shear force estimates during axial, lateral, and sagittal lifting tasks across all thoracic and lumbar vertebrae in older men and women. Participant-specific thoracolumbar full-body musculoskeletal models estimated vertebral forces from recorded kinematics both with and without consideration of dynamic effects, at an identified frame of peak vertebral loading. Static analyses under-predicted dynamic compressive and resultant shear forces, by an average of about 16% for all three lifts across the thoracic and lumbar spine but were highly correlated with dynamic forces (average r2 > .95). The study outcomes have the potential to enable standard clinical and occupational estimates using static analyses.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.
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Fleps I, Morgan EF. A Review of CT-Based Fracture Risk Assessment with Finite Element Modeling and Machine Learning. Curr Osteoporos Rep 2022; 20:309-319. [PMID: 36048316 PMCID: PMC10941185 DOI: 10.1007/s11914-022-00743-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We reviewed advances over the past 3 years in assessment of fracture risk based on CT scans, considering methods that use finite element models, machine learning, or a combination of both. RECENT FINDINGS Several studies have demonstrated that CT-based assessment of fracture risk, using finite element modeling or biomarkers derived from machine learning, is equivalent to currently used clinical tools. Phantomless calibration of CT scans for bone mineral density enables accurate measurements from routinely taken scans. This opportunistic use of CT scans for fracture risk assessment is facilitated by high-quality automated segmentation with deep learning, enabling workflows that do not require user intervention. Modeling of more realistic and diverse loading conditions, as well as improved modeling of fracture mechanisms, has shown promise to enhance our understanding of fracture processes and improve the assessment of fracture risk beyond the performance of current clinical tools. CT-based screening for fracture risk is effective and, by analyzing scans that were taken for other indications, could be used to expand the pool of people screened, therefore improving fracture prevention. Finite element modeling and machine learning both provide valuable tools for fracture risk assessment. Future approaches should focus on including more loading-related aspects of fracture risk.
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Affiliation(s)
- Ingmar Fleps
- College of Mechanical Engineering, Boston University, Boston, USA.
| | - Elise F Morgan
- College of Mechanical Engineering, Boston University, Boston, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
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Anderson DE, Groff MW, Flood TF, Allaire BT, Davis RB, Stadelmann MA, Zysset PK, Alkalay RN. Evaluation of Load-To-Strength Ratios in Metastatic Vertebrae and Comparison With Age- and Sex-Matched Healthy Individuals. Front Bioeng Biotechnol 2022; 10:866970. [PMID: 35992350 PMCID: PMC9388746 DOI: 10.3389/fbioe.2022.866970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Vertebrae containing osteolytic and osteosclerotic bone metastases undergo pathologic vertebral fracture (PVF) when the lesioned vertebrae fail to carry daily loads. We hypothesize that task-specific spinal loading patterns amplify the risk of PVF, with a higher degree of risk in osteolytic than in osteosclerotic vertebrae. To test this hypothesis, we obtained clinical CT images of 11 cadaveric spines with bone metastases, estimated the individual vertebral strength from the CT data, and created spine-specific musculoskeletal models from the CT data. We established a musculoskeletal model for each spine to compute vertebral loading for natural standing, natural standing + weights, forward flexion + weights, and lateral bending + weights and derived the individual vertebral load-to-strength ratio (LSR). For each activity, we compared the metastatic spines' predicted LSRs with the normative LSRs generated from a population-based sample of 250 men and women of comparable ages. Bone metastases classification significantly affected the CT-estimated vertebral strength (Kruskal-Wallis, p < 0.0001). Post-test analysis showed that the estimated vertebral strength of osteosclerotic and mixed metastases vertebrae was significantly higher than that of osteolytic vertebrae (p = 0.0016 and p = 0.0003) or vertebrae without radiographic evidence of bone metastasis (p = 0.0010 and p = 0.0003). Compared with the median (50%) LSRs of the normative dataset, osteolytic vertebrae had higher median (50%) LSRs under natural standing (p = 0.0375), natural standing + weights (p = 0.0118), and lateral bending + weights (p = 0.0111). Surprisingly, vertebrae showing minimal radiographic evidence of bone metastasis presented significantly higher median (50%) LSRs under natural standing (p < 0.0001) and lateral bending + weights (p = 0.0009) than the normative dataset. Osteosclerotic vertebrae had lower median (50%) LSRs under natural standing (p < 0.0001), natural standing + weights (p = 0.0005), forward flexion + weights (p < 0.0001), and lateral bending + weights (p = 0.0002), a trend shared by vertebrae with mixed lesions. This study is the first to apply musculoskeletal modeling to estimate individual vertebral loading in pathologic spines and highlights the role of task-specific loading in augmenting PVF risk associated with specific bone metastatic types. Our finding of high LSRs in vertebrae without radiologically observed bone metastasis highlights that patients with metastatic spine disease could be at an increased risk of vertebral fractures even at levels where lesions have not been identified radiologically.
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Affiliation(s)
- Dennis E. Anderson
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Thomas F. Flood
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Brett T. Allaire
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Roger B. Davis
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Marc A. Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Philippe K. Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ron N. Alkalay
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Mokhtarzadeh H, Jiang F, Zhao S, Malekipour F. OpenColab project: OpenSim in Google colaboratory to explore biomechanics on the web. Comput Methods Biomech Biomed Engin 2022:1-9. [PMID: 35930042 DOI: 10.1080/10255842.2022.2104607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OpenSim is an open-source biomechanical package with a variety of applications. It is available for many users with bindings in MATLAB, Python, and Java via its application programming interfaces (APIs). Although the developers described well the OpenSim installation on different operating systems (Windows, Mac, and Linux), it is time-consuming and complex since each operating system requires a different configuration. This project aims to demystify the development of neuro-musculoskeletal modeling in OpenSim with zero configuration on any operating system for installation (thus cross-platform), easy to share models while accessing free graphical processing units (GPUs) on a web-based platform of Google Colab. To achieve this, OpenColab was developed where OpenSim source code was used to build a Conda package that can be installed on the Google Colab with only one block of code in less than 7 min. To use OpenColab, one requires a connection to the internet and a Gmail account. Moreover, OpenColab accesses vast libraries of machine learning methods available within free Google products, e.g. TensorFlow. Next, we performed an inverse problem in biomechanics and compared OpenColab results with OpenSim graphical user interface (GUI) for validation. The outcomes of OpenColab and GUI matched well (r≥0.82). OpenColab takes advantage of the zero-configuration of cloud-based platforms, accesses GPUs, and enables users to share and reproduce modeling approaches for further validation, innovative online training, and research applications. Step-by-step installation processes and examples are available at: https://simtk.org/projects/opencolab.
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Affiliation(s)
- Hossein Mokhtarzadeh
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
| | - Fangwei Jiang
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Shengzhe Zhao
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Fatemeh Malekipour
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
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Dolenec A, Svetina M, Strojnik V. Electromyographic Comparison of an Abdominal Rise on a Ball with a Traditional Crunch. SENSORS 2022; 22:s22051979. [PMID: 35271124 PMCID: PMC8915105 DOI: 10.3390/s22051979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
We propose a new exercise, the abdominal rise on the ball, to replace the traditional crunch in exercise programs. The aim of this study is to compare the activity of the abdominal muscles when performing an ARB with the same activity when performing a traditional crunch. Twenty healthy adults participated in the study. Surface electromyography (EMG) was recorded from the upper and lower rectus abdominis (URA, LRA), internal oblique (IO), external oblique (EO), transversus abdominis (TrA), and erector spinae (ES). EMG values were normalized to maximal voluntary isometric contraction. A paired t-test, nonparametric Wilcoxon test and correlation coefficient were used for statistical analysis. The normalized EMG values of EO, TrA and ES, were statistically significantly higher during the abdominal rise on the ball compared to the traditional crunch, while URA, LRA and IO were significantly lower during the abdominal rise on the ball compared to the traditional crunch. TrA, EO and IO are sufficiently activated during an abdominal rise on a ball, so the exercise could be deemed effective for strengthening these muscles.
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Abstract
This is a review of evidence and practical tips on exercise for individuals with osteoporosis, including individuals with hip and vertebral fractures. Balance and functional training, with or without strength training, can prevent falls. Several types of exercise can improve outcomes that are important to patients, such as physical functioning or quality of life. Individuals with osteoporosis should prioritize balance, functional and resistance training ≥ twice weekly, where exercises, volume, intensity, and progression are aligned with the patient's goals and abilities. Patients who want to participate in other activities (e.g., walking, impact exercise, yoga, Pilates) can do them in addition to, but not instead of, balance and functional or strength training, if they can be done safely or modified. Avoid generic advice like "Don't bend or twist", which is difficult or impossible to operationalize, and may create fear and activity avoidance. Instead, be specific about the types of activities to avoid or modify, and provide tips on how to make daily activities safer, or signpost to resources from national osteoporosis societies. For example, not all bending or twisting is bad; it is activities that involve rapid, repetitive, sustained, weighted, or end range of motion twisting or flexion of the spine that may need to be modified, especially in individuals at high risk of fracture.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada
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