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Wang Y, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maitusong M, Chen Q, Rexiti P. Hybrid cortical bone trajectory and modified cortical bone trajectory techniques in transforaminal lumbar interbody fusion at L4-L5 segment: A finite element analysis. Heliyon 2024; 10:e26294. [PMID: 38434416 PMCID: PMC10906328 DOI: 10.1016/j.heliyon.2024.e26294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background The academia has increasingly acknowledged the superior biomechanical performance of the hybrid fixation technique in recent years. However, there is a lack of research on the hybrid fixation technique using BCS (Bilateral Cortical Screws) and BMCS (Bilateral Modified Cortical Screws). This study aims to investigate the biomechanical performance of the BCS and BMCS hybrid fixation technique in transforaminal lumbar interbody fusion (TLIF) at the L4-L5 segment in a complete lumbar-sacral finite element model. Methods Three cadaver specimens are used to construct three lumbar-sacral finite element models. The biomechanical properties of various fixation technologies (BCS-BCS, BMCS-BMCS, BMCS-BCS, and BCS-BMCS) are evaluated at the L4-5 segment with a TLIF procedure conducted, including the range of motion (ROM) of the L4-5 segment, as well as the stress experienced by the cage, screws, and rods. The testing is conducted under specific loading conditions, including a compressive load of 400 N and a torque of 7.5Nm, subjecting the model to simulate flexion, extension, lateral bending, and rotation. Results No significant variations are seen in the ROM at the L4-5 segment when comparing the four fixation procedures during flexion and extension. However, when it comes to lateral bending and rotation, the ROM is ordered in descending order as BCS-BCS, BCS-BMCS, BMCS-BMCS, and BMCS-BCS. The maximum stress experienced by the cage is observed to be highest within the BMCS-BCS technique during movements including flexion, extension, and lateral bending. Conversely, the BMCS-BMCS technique exhibits the highest cage stress levels during rotational movements. The stress applies to the screws and rods order the sequence of BCS-BCS, BCS-BMCS, BMCS-BCS, and BMCS-BMCS throughout all four working conditions. Conclusion The BMCS-BCS technique shows better biomechanical performance with less ROM and lower stress on the internal fixation system compared to other fixation techniques. BMCS-BMCS technology has similar mechanical performance to BMCS-BCS but has more contact area between screws and cortical bone, making it better for patients with severe osteoporosis.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Qihao Chen
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China
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Gould SL, Davico G, Liebsch C, Wilke HJ, Cristofolini L, Viceconti M. Variability of intervertebral joint stiffness between specimens and spine levels. Front Bioeng Biotechnol 2024; 12:1372088. [PMID: 38486868 PMCID: PMC10937554 DOI: 10.3389/fbioe.2024.1372088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction: Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the passive mechanical properties of the intervertebral joint is crucial. The intervertebral joint stiffness, in particular, is typically derived from the literature, and the differences between individuals and spine levels are often disregarded. Methods: This study tested if an optimisation method of personalising the intervertebral joint stiffnesses was able to capture expected stiffness variation between specimens and between spine levels and if the variation between spine levels could be accurately captured using a generic scaling ratio. Multibody models of six T12 to sacrum spine specimens were created from computed tomography data. For each specimen, two models were created: one with uniform stiffnesses across spine levels, and one accounting for level dependency. Three loading conditions were simulated. The initial stiffness values were optimised to minimize the kinematic error. Results: There was a range of optimised stiffnesses across the specimens and the models with level dependent stiffnesses were less accurate than the models without. Using an optimised stiffness substantially reduced prediction errors. Discussion: The optimisation captured the expected variation between specimens, and the prediction errors demonstrated the importance of accounting for level dependency. The inaccuracy of the predicted kinematics for the level-dependent models indicated that a generic scaling ratio is not a suitable method to account for the level dependency. The variation in the optimised stiffnesses for the different loading conditions indicates personalised stiffnesses should also be considered load-specific.
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Affiliation(s)
- Samuele L. Gould
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Davico
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Luca Cristofolini
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Xu F, Lin J, Jiang S, Sun Z, Zhou S, Li Z, Wang S, Li W. In vivo segmental vertebral kinematics in patients with degenerative lumbar scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:571-581. [PMID: 37831181 DOI: 10.1007/s00586-023-07974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study aimed to find a standard of the vertebra kinematics during functional weight-bearing activities in degenerative lumbar scoliosis (DLS) patients. METHODS Fifty-four patients were involved into this study with forty-two in DLS group and twelve in the control group. The three-dimensional (3D) vertebral models from L1 to S1 of each participant were reconstructed by computed tomography (CT). Dual-orthogonal fluoroscopic imaging, along with FluoMotion and Rhinoceros software, was used to record segmental vertebral kinematics during functional weight-bearing activities. The primary and coupled motions of each vertebra were analyzed in patients with DLS. RESULTS During flexion-extension of the trunk, anteroposterior (AP) translation and craniocaudal (CC) translation at L5-S1 were higher than those at L2-3 (9.3 ± 5.1 mm vs. 6.4 ± 3.5 mm; P < 0.05). The coupled mediolateral (ML) translation at L5-S1 in patients with DLS was approximately three times greater than that in the control group. During left-right bending of the trunk, the coupled ML rotation at L5-S1 was higher in patients with DLS than that in the control group (17.7 ± 10.3° vs. 8.4 ± 4.4°; P < 0.05). The AP and CC translations at L5-S1 were higher than those at L1-2, L2-3, and L3-4. During left-right torsion of the trunk, the AP translation at L5-S1 was higher as compared to other levels. CONCLUSIONS The greatest coupled translation was observed at L5-S1 in patients with DLS. Coupled AP and ML translations at L5-S1 were higher than those in healthy participants. These data improved the understanding of DLS motion characteristics.
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Affiliation(s)
- Fei Xu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Jialiang Lin
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Xu F, Zhou S, Li Z, Jiang S, Chen Z, Sun Z, Li W. The 6 degrees-of-freedom range of motion of the L1-S1 vertebrae in young and middle-aged asymptomatic people. Front Surg 2022; 9:1002133. [PMID: 36386544 PMCID: PMC9643460 DOI: 10.3389/fsurg.2022.1002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVE To determine the 6 degrees of freedom of lumbar vertebra in vivo during different functional activities in young and middle-aged asymptomatic subjects. METHODS A total of 26 asymptomatic subjects (M/F, 15/11; age, 20-55 years) were recruited in this study. They were divided into two groups: young group (number: 14; age: 20-30 years old) and middle-aged group (number: 12; age: 45-55 years old). The lumbar segment of each subject was scanned by computed tomography for the construction of three-dimensional (3D) models of the vertebra from L1 to S1. The lumbar spine was imaged by using a dual fluoroscopic system when the subjects performed different trunk postures. The 3D models of vertebrae were matched to two fluoroscopic images simultaneously in software. The range of motion (ROM) of vertebrae in the young and middle-aged groups was compared by using multiway analysis of variance, respectively. RESULTS During the supine to the upright posture, vertebral rotation of the L1-S1 occurred mainly around the mediolateral axis (mean: 3.9 ± 2.9°). Along the mediolateral axis, vertebral translation was significantly lower at L1-2 (7.7 ± 2.4 mm) and L2-3 (8.0 ± 3.5 mm) than at L3-4 (1.6 ± 1.2 mm), L4-5 (3.3 ± 2.6 mm), and L5-S1 (2.6 ± 1.9 mm). At the L4-5 level, the young group had a higher rotational ROM than the middle-aged group around all three axes during left-right bending. Along the anteroposterior axis, the young group had a lower translational ROM at L4-5 than the middle-aged group during left-right bending (4.6 ± 3.3 vs. 7.6 ± 4.8 mm; P < 0.05). At L5-S1, the young group had a lower translational ROM than the middle-aged group during flexion-extension, left-right bending, and left-right torsion. CONCLUSION This study explored the lumbar vertebral ROM at L1-S1 during different functional postures in both young and middle-aged volunteers. There were higher coupled translations at L3-4 and L4-5 than at the upper lumbar segments during supine to upright. The vertebral rotation decreased with age. In addition, the older subjects had a higher anteroposterior translation at the L4-5 segment and higher mediolateral translation at the L5-S1 segment than the young group. These data might provide basic data to be compared with spinal pathology.
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Affiliation(s)
- Fei Xu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Ze Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China,Correspondence: Weishi Li
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Motion of Lumbar Endplate in Degenerative Lumbar Scoliosis Patients with Different Cobb Angle In Vivo: Reflecting the Biomechanics of the Lumbar Disc. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8745683. [PMID: 36277876 PMCID: PMC9586789 DOI: 10.1155/2022/8745683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
Study Design. Controlled laboratory study. Objective. To evaluate the influence of degenerative lumbar scoliosis (DLS) with different Cobb angles and degenerative discs on the range of motion (ROM) of the lumbar endplates during functional weight-bearing activities in vivo. Summary of Background. DLS data might influence spinal stability and range of motion of the spine. Altered lumbar segment motion is thought to be related to disc degeneration. However, to date, no data have been reported on the motion patterns of the lumbar endplates in patients with DLS in vivo. Methods. We recorded 42 DLS patients with the apical disc at L2-L3 and L3-L4. Patients were divided into A group with a coronal Cobb angle >20° (number: 13;
years old) and group B with a coronal Cobb angle <20° (number: 28;
years old). Patients’ discs were divided into a degenerated disc group (III-V) and a nondegenerated disc group (I-II) according to the Pfirrmann classification. Computed tomography (CT) was performed on every subject to build 3-dimensional (3D) models of the lumbar vertebrae (L1–S1), and then the vertebras were matched according to the dual fluoroscopic imaging system. The kinematics of the endplate was compared between the different Cobb angle groups and the healthy group reported in a previous study and between the degenerative disc group and nondegenerative disc group by multiway analysis of variance. Results. Coupled translation at L5-S1 was higher than other levels during the three movements. During the flexion-extension of the trunk, around the anteroposterior axis, rotation in group A was higher than that in the control group at L2-L3 and L3-L4 (
mm vs
mm,
mm;
,
). During the left-right bending of the trunk, around the mediolateral axis, rotations in groups A and B were higher than those in the control group at L5-S1 (
°,
° vs
°;
,
). During the left-right torsion, around the anteroposterior axis, rotation in group A was higher than that in group B and the control group at L2-3 (
° vs
°,
°;
,
). In patients with Cobb angle <20°, coupled translation was higher in the degenerated disc group than in the nondegenerated disc group, especially along the anteroposterior axis. Conclusion. An increase in the coupled rotation of the endplate at the scoliotic apical level in patients with DLS was related to a larger Cobb angle. Moreover, segments with degenerative discs had higher coupled translations in the anteroposterior direction than segments with nondegenerative discs in DLS patients with Cobb angle <20°. These data might provide clues regarding the etiology of DLS and the basis for operative planning.
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Triantafyllou A, Papagiannis G, Stasi S, Bakalidou D, Kyriakidou M, Papathanasiou G, Papadopoulos EC, Papagelopoulos PJ, Koulouvaris P. Application of Wearable Sensors Technology for Lumbar Spine Kinematic Measurements during Daily Activities following Microdiscectomy Due to Severe Sciatica. BIOLOGY 2022; 11:biology11030398. [PMID: 35336772 PMCID: PMC8945562 DOI: 10.3390/biology11030398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary The recurrence rate after lumbar spine disc surgeries is estimated to be 5–15%. Lumbar spine flexion of more than 10° is mentioned in the literature as the most harmful load to the operated disc level that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify flexions during daily living following such surgeries, for six weeks postoperatively, using wearable sensors technology. These data determine the patients’ kinematic pattern, reflecting a high-risk factor for pathology recurrence. The operated patients were measured to have 30% normal lumbar motion after the first postoperative week, while they were restored to almost 75% at the end of the sixth, respectively. Further in vitro studies should be carried out using these data to identify if such kinematic patterns could lead to pathology recurrence. Abstract Background: The recurrence rate of lumbar spine microdiscectomies (rLSMs) is estimated to be 5–15%. Lumbar spine flexion (LSF) of more than 10° is mentioned as the most harmful load to the intervertebral disc that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify LSFs, following LSM, at the period of six weeks postoperatively. Methods: LSFs were recorded during the daily activities of 69 subjects for 24 h twice per week, using Inertial Measurement Units (IMU). Results: The mean number of more than 10 degrees of LSFs per hour were: 41.3/h during the 1st postoperative week (P.W.) (29.9% healthy subjects-H.S.), 2nd P.W. 60.1/h (43.5% H.S.), 3rd P.W. 74.2/h (53.7% H.S.), 4th P.W. 82.9/h (60% H.S.), 5th P.W. 97.3/h (70.4% H.S.) and 6th P.W. 105.5/h (76.4% H.S.). Conclusions: LSFs constitute important risk factors for rLDH. Our study records the lumbar spine kinematic pattern of such patients for the first time during their daily activities. Patients’ data report less sagittal plane movements than healthy subjects. In vitro studies should be carried out, replicating our results to identify if such a kinematic pattern could cause rLDH. Furthermore, IMU biofeedback capabilities could protect patients from such harmful movements.
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Affiliation(s)
- Athanasios Triantafyllou
- Orthopaedic Research and Education Center “P.N.Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, 1st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (E.C.P.); (P.J.P.); (P.K.)
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Egaleo, Greece; (S.S.); (D.B.); (G.P.)
- Correspondence:
| | - Georgios Papagiannis
- Orthopaedic Research and Education Center “P.N.Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, 1st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (E.C.P.); (P.J.P.); (P.K.)
- Physiotherapy Department, University of the Peloponnese, 23100 Sparta, Greece;
| | - Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Egaleo, Greece; (S.S.); (D.B.); (G.P.)
| | - Daphne Bakalidou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Egaleo, Greece; (S.S.); (D.B.); (G.P.)
| | - Maria Kyriakidou
- Physiotherapy Department, University of the Peloponnese, 23100 Sparta, Greece;
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Egaleo, Greece; (S.S.); (D.B.); (G.P.)
| | - Elias C. Papadopoulos
- Orthopaedic Research and Education Center “P.N.Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, 1st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (E.C.P.); (P.J.P.); (P.K.)
| | - Panayiotis J. Papagelopoulos
- Orthopaedic Research and Education Center “P.N.Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, 1st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (E.C.P.); (P.J.P.); (P.K.)
| | - Panayiotis Koulouvaris
- Orthopaedic Research and Education Center “P.N.Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, 1st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (E.C.P.); (P.J.P.); (P.K.)
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Zhang C, Sun X, Tang Y, Wang S, Ye D, Fu W, Liu Y, Huang L. Advances in the Application of the Dual Fluoroscopic Imaging System in Sports Medicine: A Literature Review. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The dual fluoroscopic imaging system (DFIS) is a new non-invasive motion analysis system that does not interfere with movement, has high precision and repeatability and is not affected by the errors caused by the relative movement of skin and soft tissues. DFIS has been recently used
in the field of sports medicine. This narrative review focuses on relevant literature on the origin, development and mechanism of action of DFIS and summarises the application of DFIS in injury and rehabilitation treatment, such as the reliability of test results; the position relationships
of bony structures in the shoulder, lumbar spine, knee joint and ankle joint during exercise and its six degree-of-freedom (6DOF) movement to calculate cartilage deformation, contact area/trajectory and ligament strain. This article puts forward the problems encountered in practice that need
to be solved and looks forward to the future applications of DFIS in the field of sports, especially in injury prevention and treatment.
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Affiliation(s)
- Cui Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Xiaole Sun
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Yunqi Tang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Shaobai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Dongqiang Ye
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Lingyan Huang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
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Mesbah M, Barkaoui A. Biomechanical investigation of the effect of pedicle-based hybrid stabilization constructs: A finite element study. Proc Inst Mech Eng H 2020; 234:931-941. [PMID: 32597299 DOI: 10.1177/0954411920934956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hybrid stabilization is widely performed for the surgical treatment of degenerative disk diseases. Pedicle-based hybrid stabilization intends to reduce fusion-associated drawbacks of adjacent segment degeneration, construct failure, and pseudoarthrosis. Recently, many types of pedicle-based hybrid stabilization systems have been developed and optimized, using polymeric devices as an adjunct for lumbar fusion procedures. Therefore, the purpose of this study was to evaluate the effect of new pedicle-based hybrid stabilization on bending stiffness and center of rotation at operated and adjacent levels in comparison with established semirigid and rigid devices in lumbar fusion procedures. A validated three-dimensional finite element model of the L3-S1 segments was modified to simulate postoperative changes during combined loading (moment of 7.5 N m + follower load of 400 N). Two models instrumented with pedicle-based hybrid stabilization (Dynesys Transition Optima, NFlex), semirigid system (polyetheretherketone), and rigid fixation system (titanium rod (Ti) were compared with those of the healthy and degenerated models. Contact force on the facet joint during extension increased in fusion (40 N) with an increase of bending stiffness in Dynesys and NFlex. The center of rotation shifted in posterior and cranial directions of the fused level. The centers of rotation in the lower lumbar spine is segment dependent and altered with the adopted construct. The bending stiffness was varied from 1.47 N m/° in lateral bending for the healthy model to 5.75 N m/° for the NFlex stabilization, which had the closest center of rotation, compared to the healthy center of rotation. Locations of center of rotation, stress, and strain distribution varied according to construct design and materials used. These data could help understand the biomechanical effects of current pedicle-based hybrid stabilization on the behavior of the lower lumbar spine.
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Affiliation(s)
- Moustafa Mesbah
- Laboratory of Numerical and Experimental Modeling of Mechanical Phenomena, Department of Mechanical Engineering, University of Abdelhamid Ibn Badis, Mostaganem, Algeria
| | - Abdelwahed Barkaoui
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat (UIR), Rocade de Rabat-Salé, Morocco
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Affolter C, Kedzierska J, Vielma T, Weisse B, Aiyangar A. Estimating lumbar passive stiffness behaviour from subject-specific finite element models and in vivo 6DOF kinematics. J Biomech 2020; 102:109681. [DOI: 10.1016/j.jbiomech.2020.109681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/15/2020] [Accepted: 02/18/2020] [Indexed: 12/25/2022]
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10
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Caelers IJ, Boselie TF, Rijkers K, Van Hemert WL, De Bie RA, Van Santbrink H. Lumbar Intervertebral Motion Analysis During Flexion and Extension Cinematographic Recordings in Healthy Male Participants: Protocol. JMIR Res Protoc 2020; 9:e14741. [PMID: 32130199 PMCID: PMC7078620 DOI: 10.2196/14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/02/2022] Open
Abstract
Background Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. Objective This study aims to define the lumbar spines’ physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. Methods Cinematographic recordings will be performed on 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. Results The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of Applied Sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. Conclusions If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. Trial Registration ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID) DERR1-10.2196/14741
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Affiliation(s)
- Inge Jmh Caelers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Department of Neurosurgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Toon Fm Boselie
- Department of Neurosurgery, Zuyderland Medical Centre, Heerlen, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Zuyderland Medical Centre, Heerlen, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Wouter Lw Van Hemert
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Rob A De Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Henk Van Santbrink
- Department of Neurosurgery, Zuyderland Medical Centre, Heerlen, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
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11
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Kage CC, Akbari-Shandiz M, Foltz MH, Lawrence RL, Brandon TL, Helwig NE, Ellingson AM. Validation of an automated shape-matching algorithm for biplane radiographic spine osteokinematics and radiostereometric analysis error quantification. PLoS One 2020; 15:e0228594. [PMID: 32059007 PMCID: PMC7021291 DOI: 10.1371/journal.pone.0228594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/18/2020] [Indexed: 11/19/2022] Open
Abstract
Biplane radiography and associated shape-matching provides non-invasive, dynamic, 3D osteo- and arthrokinematic analysis. Due to the complexity of data acquisition, each system should be validated for the anatomy of interest. The purpose of this study was to assess our system’s acquisition methods and validate a custom, automated 2D/3D shape-matching algorithm relative to radiostereometric analysis (RSA) for the cervical and lumbar spine. Additionally, two sources of RSA error were examined via a Monte Carlo simulation: 1) static bead centroid identification and 2) dynamic bead tracking error. Tantalum beads were implanted into a cadaver for RSA and cervical and lumbar spine flexion and lateral bending were passively simulated. A bead centroid identification reliability analysis was performed and a vertebral validation block was used to determine bead tracking accuracy. Our system’s overall root mean square error (RMSE) for the cervical spine ranged between 0.21–0.49mm and 0.42–1.80° and the lumbar spine ranged between 0.35–1.17mm and 0.49–1.06°. The RMSE associated with RSA ranged between 0.14–0.69mm and 0.96–2.33° for bead centroid identification and 0.25–1.19mm and 1.69–4.06° for dynamic bead tracking. The results of this study demonstrate our system’s ability to accurately quantify segmental spine motion. Additionally, RSA errors should be considered when interpreting biplane validation results.
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Affiliation(s)
- Craig C. Kage
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Mohsen Akbari-Shandiz
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mary H. Foltz
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rebekah L. Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Taycia L. Brandon
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nathaniel E. Helwig
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
- School of Statistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arin M. Ellingson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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12
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Abstract
Individuals with back pain are often diagnosed with spine instability, even though it is unclear whether the spine is susceptible to unstable behavior. The spine is a complex system with many elements that cannot be directly observed, which makes the study of spine function and direct assessment of spine instability difficult. What is known is that trunk muscle activation is adjusted to meet stability demands, which highlights that the central nervous system closely monitors threats to spine stability. The spine appears to be protected by neural coupling and mechanical coupling that prevent erroneous motor control from producing segmental instability; however, this neural and mechanical coupling could be problematic in an injured spine. Finally, instability traditionally contemplated from a mechanical and control perspective could potentially be applied to study processes involved in pain sensitization, and possibly back pain that is iatrogenic in nature. This commentary argues for a more contemporary and broadened view of stability that integrates interdisciplinary knowledge in order to capture the complexity of back pain. J Orthop Sports Phys Ther 2019;49(6):415-424. Epub 25 Apr 2019. doi:10.2519/jospt.2019.8144.
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13
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Berry DB, Hernandez A, Onodera K, Ingram N, Ward SR, Gombatto SP. Lumbar spine angles and intervertebral disc characteristics with end-range positions in three planes of motion in healthy people using upright MRI. J Biomech 2019; 89:95-104. [PMID: 31047693 DOI: 10.1016/j.jbiomech.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
Understanding changes in lumbar spine (LS) angles and intervertebral disc (IVD) behavior in end-range positions in healthy subjects can provide a basis for developing more specific LS models and comparing people with spine pathology. The purposes of this study are to quantify 3D LS angles and changes in IVD characteristics with end-range positions in 3 planes of motion using upright MRI in healthy people, and to determine which intervertebral segments contribute most in each plane of movement. Thirteen people (average age = 24.4 years, range 18-51 years; 9 females; BMI = 22.4 ± 1.8 kg/m2) with no history of low back pain were scanned in an upright MRI in standing, sitting flexion, sitting axial rotation (left, right), prone on elbows, prone extension, and standing lateral bending (left, right). Global and local intervertebral LS angles were measured. Anterior-posterior length of the IVD and location of the nucleus pulposus was measured. For the sagittal plane, lower LS segments contribute most to change in position, and the location of the nucleus pulposus migrated from a more posterior position in sitting flexion to a more anterior position in end-range extension. For lateral bending, the upper LS contributes most to end-range positions. Small degrees of intervertebral rotation (1-2°) across all levels were observed for axial plane positions. There were no systematic changes in IVD characteristics for axial or coronal plane positions.
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Affiliation(s)
- David B Berry
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Alejandra Hernandez
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Keenan Onodera
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Noah Ingram
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Samuel R Ward
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Sara P Gombatto
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA.
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14
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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15
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Senteler M, Aiyangar A, Weisse B, Farshad M, Snedeker JG. Sensitivity of intervertebral joint forces to center of rotation location and trends along its migration path. J Biomech 2018; 70:140-148. [DOI: 10.1016/j.jbiomech.2017.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/04/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022]
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16
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Endoscopic Surgical Treatment of Lumbar Synovial Cyst: Detailed Account of Surgical Technique and Report of 11 Consecutive Patients. World Neurosurg 2017; 103:122-132. [DOI: 10.1016/j.wneu.2017.02.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 02/02/2023]
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17
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Fu M, Ye Q, Jiang C, Qian L, Xu D, Wang Y, Sun P, Ouyang J. The segment-dependent changes in lumbar intervertebral space height during flexion-extension motion. Bone Joint Res 2017; 6:245-252. [PMID: 28450317 PMCID: PMC5415903 DOI: 10.1302/2046-3758.64.bjr-2016-0245.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/07/2017] [Indexed: 11/09/2022] Open
Abstract
Objectives Many studies have investigated the kinematics of the lumbar spine and the morphological features of the lumbar discs. However, the segment-dependent immediate changes of the lumbar intervertebral space height during flexion-extension motion are still unclear. This study examined the changes of intervertebral space height during flexion-extension motion of lumbar specimens. Methods First, we validated the accuracy and repeatability of a custom-made mechanical loading equipment set-up. Eight lumbar specimens underwent CT scanning in flexion, neural, and extension positions by using the equipment set-up. The changes in the disc height and distance between adjacent two pedicle screw entry points (DASEP) of the posterior approach at different lumbar levels (L3/4, L4/5 and L5/S1) were examined on three-dimensional lumbar models, which were reconstructed from the CT images. Results All the vertebral motion segments (L3/4, L4/5 and L5/S1) had greater changes in disc height and DASEP from neutral to flexion than from neutral to extension. The change in anterior disc height gradually increased from upper to lower levels, from neutral to flexion. The changes in anterior and posterior disc heights were similar at the L4/5 level from neutral to extension, but the changes in anterior disc height were significantly greater than those in posterior disc height at the L3/4 and L5/S1 levels, from neutral to extension. Conclusions The lumbar motion segment showed level-specific changes in disc height and DASEP. The data may be helpful in understanding the physiologic dynamic characteristics of the lumbar spine and in optimising the parameters of lumbar surgical instruments. Cite this article: M. Fu, Q. Ye, C. Jiang, L. Qian, D. Xu, Y. Wang, P. Sun, J. Ouyang. The segment-dependent changes in lumbar intervertebral space height during flexion-extension motion. Bone Joint Res 2017;6:245–252. DOI: 10.1302/2046-3758.64.BJR-2016-0245.R1.
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Affiliation(s)
- M Fu
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - Q Ye
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Tianhe District, Guangzhou, Guangdong, China
| | - C Jiang
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - L Qian
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - D Xu
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - Y Wang
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - P Sun
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
| | - J Ouyang
- Director of Department of Anatomy, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
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18
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In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension. Spine (Phila Pa 1976) 2017; 42:359-365. [PMID: 27379419 PMCID: PMC5203984 DOI: 10.1097/brs.0000000000001758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo patient biomechanical study. OBJECTIVE To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body. SUMMARY OF BACKGROUND DATA LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown. METHODS Nine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was magnetic resonance imaging scanned for construction of three-dimensional lumbar vertebral models, and fluoroscopically imaged when the body extended from 45 flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segments L4/5 and L5/S1 were compared with a normal control group at 45 flexion, upright, and full extension of the body. RESULTS The mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (P <0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (P <0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (P >0.05). CONCLUSION Similar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment. LEVEL OF EVIDENCE N/A.
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19
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Aiyangar A, Zheng L, Anderst W, Zhang X. Instantaneous centers of rotation for lumbar segmental extension in vivo. J Biomech 2017; 52:113-121. [DOI: 10.1016/j.jbiomech.2016.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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20
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Abstract
Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.
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21
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Naserkhaki S, El-Rich M. Sensitivity of lumbar spine response to follower load and flexion moment: finite element study. Comput Methods Biomech Biomed Engin 2016; 20:550-557. [PMID: 27848266 DOI: 10.1080/10255842.2016.1257707] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The follower load (FL) combined with moments is commonly used to approximate flexed/extended posture of the lumbar spine in absence of muscles in biomechanical studies. There is a lack of consensus as to what magnitudes simulate better the physiological conditions. Considering the in-vivo measured values of the intradiscal pressure (IDP), intervertebral rotations (IVRs) and the disc loads, sensitivity of these spinal responses to different FL and flexion moment magnitudes was investigated using a 3D nonlinear finite element (FE) model of ligamentous lumbosacral spine. Optimal magnitudes of FL and moment that minimize deviation of the model predictions from in-vivo data were determined. Results revealed that the spinal parameters i.e. the IVRs, disc moment, and the increase in disc force and moment from neutral to flexed posture were more sensitive to moment magnitude than FL magnitude in case of flexion. The disc force and IDP were more sensitive to the FL magnitude than moment magnitude. The optimal ranges of FL and flexion moment magnitudes were 900-1100 N and 9.9-11.2 Nm, respectively. The FL magnitude had reverse effect on the IDP and disc force. Thus, magnitude for FL or flexion that minimizes the deviation of all the spinal parameters together from the in-vivo data can vary. To obtain reasonable compromise between the IDP and disc force, our findings recommend that FL of low magnitude must be combined with flexion moment of high intensity and vice versa.
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Affiliation(s)
- Sadegh Naserkhaki
- a Department of Civil and Environmental Engineering , University of Alberta , Edmonton , Canada
| | - Marwan El-Rich
- a Department of Civil and Environmental Engineering , University of Alberta , Edmonton , Canada
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22
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Meng X, Bruno AG, Cheng B, Wang W, Bouxsein ML, Anderson DE. Incorporating Six Degree-of-Freedom Intervertebral Joint Stiffness in a Lumbar Spine Musculoskeletal Model-Method and Performance in Flexed Postures. J Biomech Eng 2016; 137:101008. [PMID: 26299207 DOI: 10.1115/1.4031417] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Indexed: 11/08/2022]
Abstract
Intervertebral translations and rotations are likely dependent on intervertebral stiffness properties. The objective of this study was to incorporate realistic intervertebral stiffnesses in a musculoskeletal model of the lumbar spine using a novel force-dependent kinematics approach, and examine the effects on vertebral compressive loading and intervertebral motions. Predicted vertebral loading and intervertebral motions were compared to previously reported in vivo measurements. Intervertebral joint reaction forces and motions were strongly affected by flexion stiffness, as well as force-motion coupling of the intervertebral stiffness. Better understanding of intervertebral stiffness and force-motion coupling could improve musculoskeletal modeling, implant design, and surgical planning.
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23
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du Rose A, Breen A. Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study. BMC Musculoskelet Disord 2016; 17:121. [PMID: 26964535 PMCID: PMC4785734 DOI: 10.1186/s12891-016-0975-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/04/2016] [Indexed: 12/26/2022] Open
Abstract
Background Intervertebral motion impairment is widely thought to be related to chronic back disability, however, the movements of inter-vertebral pairs are not independent of each other and motion may also be related to morphology. Furthermore, maximum intervertebral range of motion (IV-RoMmax) is difficult to measure accurately in living subjects. The purpose of this study was to explore possible relationships between (IV-RoMmax) and lordosis, initial attainment rate and IV-RoMmax at other levels during weight-bearing flexion using quantitative fluoroscopy (QF). Methods Continuous QF motion sequences were recorded during controlled active sagittal flexion of 60° in 18 males (mean age 27.6 SD 4.4) with no history of low back pain in the previous year. IV-RoMmax, lordotic angle, and initial attainment rate at all inter-vertebral levels from L2-S1 were extracted. Relationships between IV-RoMmax and the other variables were explored using correlation coefficients, and simple linear regression was used to determine the effects of any significant relationships. Within and between observer repeatability of IV-RoMmax and initial attainment rate measurements were assessed in a sub-set of ten participants, using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM). Results QF measurements were highly repeatable, the lowest ICC for IV-RoMmax, being 0.94 (0.80–0.99) and highest SEM (0.76°). For initial attainment rate the lowest ICC was 0.84 (0.49–0.96) and the highest SEM (0.036). The results also demonstrated significant positive and negative correlations between IV-RoMmax and IV-RoMmax at other lumbar levels (r = −0.64–0.65), lordosis (r = −0.52–0.54), and initial attainment rate (r = −0.64–0.73). Simple linear regression analysis of all significant relationships showed that these predict between 28 and 42 % of the variance in IV-RoMmax. Conclusions This study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. These effects, when combined, may be important when such levels are being considered by healthcare professionals as potential sources of pain generation. Multivariate investigations in larger samples are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0975-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alister du Rose
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth, BH5 2DF, UK. .,Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK.
| | - Alan Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth, BH5 2DF, UK.,Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK
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Driscoll SJ, Zhong W, Torriani M, Mao H, Wood KB, Cha TD, Li G. In-vivo T2-relaxation times of asymptomatic cervical intervertebral discs. Skeletal Radiol 2016; 45:393-400. [PMID: 26643385 PMCID: PMC4718756 DOI: 10.1007/s00256-015-2307-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/24/2015] [Accepted: 11/29/2015] [Indexed: 02/02/2023]
Abstract
Limited research exists on T2-mapping techniques for cervical intervertebral discs and its potential clinical utility. The objective of this research was to investigate the in-vivo T2-relaxation times of cervical discs, including C2-C3 through C7-T1. Ten asymptomatic subjects were imaged using a 3.0 T MR scanner and a sagittal multi-slice multi-echo sequence. Using the mid-sagittal image, intervertebral discs were divided into five regions-of-interest (ROIs), centered along the mid-line of the disc. Average T2 relaxation time values were calculated for each ROI using a mono-exponential fit. Differences in T2 values between disc levels and across ROIs of the same disc were examined. For a given ROI, the results showed a trend of increasing relaxation times moving down the spinal column, particularly in the middle regions (ROIs 2, 3 and 4). The C6-C7 and C7-T1 discs had significantly greater T2 values compared to superior discs (discs between C2 and C6). The results also showed spatial homogeneity of T2 values in the C3-C4, C4-C5, and C5-C6 discs, while C2-C3, C6-C7, and C7-T1 showed significant differences between ROIs. The findings indicate there may be inherent differences in T2-relaxation time properties between different cervical discs. Clinical evaluations utilizing T2-mapping techniques in the cervical spine may need to be level-dependent.
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Affiliation(s)
- Sean J. Driscoll
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114
| | - Weiye Zhong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114,Department of Spinal Surgery, Second Xiangya Hospital and Central South University, 139 Middle Renmin Road, Changsha, Hunan, P.R. China
| | - Martin Torriani
- Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, YAW 6E, Boston MA, 02114
| | - Haiqing Mao
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114
| | - Kirkham B. Wood
- Spine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, YAW 3A, Boston, MA, 02114
| | - Thomas D. Cha
- Spine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, YAW 3A, Boston, MA, 02114
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114
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Liu Z, Tsai TY, Wang S, Wu M, Zhong W, Li JS, Cha T, Wood K, Li G. Sagittal plane rotation center of lower lumbar spine during a dynamic weight-lifting activity. J Biomech 2015; 49:371-5. [PMID: 26805460 DOI: 10.1016/j.jbiomech.2015.12.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
This study investigated the center of rotation (COR) of the intervertebral segments of the lower lumbar spine (L4-L5 and L5-S1 segments) in sagittal plane during a weight-lifting (3.6 kg in each hand) extension activity performed with the pelvis constrained. Seven healthy subjects were studied using a dual fluoroscopic imaging technique. Using the non-weightbearing, supine position during MRI scan as a reference, the average intervertebral flexion angles of the L4-L5 and L5-S1 were 6.6° and 5.3° at flexion position of the body, respectively, and were -1.8° and -3.5° at extension position of the body, respectively. The CORs of the lower lumbar spine were found segment-dependent and changed with the body postures. The CORs of the L4-L5 segment were at the location about 75% posterior from the anterior edge of the disc at flexion positions of the body, and moved to about 92% of the posterior portion of the disc at extension positions of the body. The CORs of the L5-S1 segment were at 95% posterior portion of the disc at flexion positions of the body, and moved outside of the posterior edge of the disc by about 12% of the disc length at extension positions of the body. These results could help understand the physiological motion characters of the lower lumbar spine. The data could also provide important insights for future improvement of artificial disc designs and surgical implantation of the discs that are aimed to reproduce normal spinal functions.
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Affiliation(s)
- Zhan Liu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA; Provincial Key Laboratory of Biomechanical Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Shaobai Wang
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Minfei Wu
- The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Weiye Zhong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Jing-Sheng Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Thomas Cha
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Kirk Wood
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA.
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Shojaei I, Arjmand N, Bazrgari B. An optimization-based method for prediction of lumbar spine segmental kinematics from the measurements of thorax and pelvic kinematics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2015; 31:e02729. [PMID: 26037214 DOI: 10.1002/cnm.2729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
Given measurement difficulties, earlier modeling studies have often used some constant ratios to predict lumbar segmental kinematics from measurements of total lumbar kinematics. Recent imaging studies suggested distribution of lumbar kinematics across its vertebrae changes with trunk rotation, lumbar posture, and presence of load. An optimization-based method is presented and validated in this study to predict segmental kinematics from measured total lumbar kinematics. Specifically, a kinematics-driven biomechanical model of the spine is used in a heuristic optimization procedure to obtain a set of segmental kinematics that, when prescribed to the model, were associated with the minimum value for the sum of squared predicted muscle stresses across all the lower back muscles. Furthermore, spinal loads estimated using the predicted kinematics by the present method were compared with those estimated using constant ratios. Predicted segmental kinematics were in good agreement with those obtained by imaging with an average error of ~10%. Compared with those obtained using constant ratios, predicted spinal loads using segmental kinematics obtained here were in general smaller. In conclusion, the proposed method offers an alternative tool for improving model-based estimates of spinal loads where image-based measurement of lumbar kinematics is not feasible.
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Affiliation(s)
- I Shojaei
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - B Bazrgari
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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O'Connell GD, Leach JK, Klineberg EO. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation. Biores Open Access 2015; 4:431-45. [PMID: 26634189 PMCID: PMC4652242 DOI: 10.1089/biores.2015.0034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine.
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Affiliation(s)
- Grace D. O'Connell
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, California
| | - J. Kent Leach
- Department of Biomedical Engineering, University of California, Davis, Davis, California
- Department of Orthopedic Surgery, University of California, Davis Medical Center, Davis, California
| | - Eric O. Klineberg
- Department of Orthopedic Surgery, University of California, Davis Medical Center, Davis, California
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Letter to the Editor concerning "Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography" by I. Yugue et al. (2015) Eur Spine J Aug 14 [Epub ahead of print]. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1293-4. [PMID: 26507321 DOI: 10.1007/s00586-015-4291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/11/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
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Apportionment of lumbar L2–S1 rotation across individual motion segments during a dynamic lifting task. J Biomech 2015; 48:3709-15. [DOI: 10.1016/j.jbiomech.2015.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
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30
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Trabecular metal spacers as standalone or with pedicle screw augmentation, in posterior lumbar interbody fusion: a prospective, randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2597-606. [DOI: 10.1007/s00586-015-4229-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 01/22/2023]
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Zhong W, Driscoll SJ, Tsai TY, Wang S, Mao H, Cha TD, Wood KB, Li G. In vivo dynamic changes of dimensions in the lumbar intervertebral foramen. Spine J 2015; 15:1653-9. [PMID: 25797808 PMCID: PMC4475422 DOI: 10.1016/j.spinee.2015.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/14/2015] [Accepted: 03/16/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have reported position-dependent changes of the lumbar intervertebral foramen (LIVF) dimensions at different static flexion-extension postures. However, the changes of the LIVF dimensions during dynamic body motion have not been reported. PURPOSE The objective of this study was to investigate the in vivo dimensions of the LIVF during a dynamic weight-lifting activity. STUDY DESIGN/SETTING This was a retrospective study. METHODS Ten asymptomatic subjects were recruited for this study. Three-dimensional (3D) vertebral models of the lumbar segments from L2 to S1 were constructed for each subject using magnetic resonance images. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed a dynamic weight-lifting activity from an upper body position of 45° to a maximal extension position. The in vivo positions of the vertebrae along the motion path were reproduced using the 3D vertebral models and the fluoroscopic images. The minimal area, height, and width of each LIVF during the dynamic body motion were analyzed. RESULTS The LIVF area and width monotonically decreased with lumbar extension at all levels except L5-S1 (p<.05). On average, the LIVF area decreased by 7.4±6.7%, 10.8±7.7%, and 10.0±8.0% at the L2-L3, L3-L4, and L4-L5 levels, respectively, from the flexion to the upright standing position, and by 6.4±5.0%, 7.7±7.4%, and 5.1±5.1%, respectively, from the upright standing to the extension position. The LIVF height remained relatively constant at all segments during the dynamic activity. The foramen area, height, and width of the L5-S1 remained relatively constant throughout the activity. CONCLUSIONS Human lumbar foramen dimensions show segment-dependent characteristics during the dynamic weight-lifting activity.
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Affiliation(s)
- Weiye Zhong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA; Department of Spinal Surgery, Second Xiangya Hospital and Central South University, 139 Middle of Renmin Road, Changsha, Hunan, 410011, P.R. China
| | - Sean J Driscoll
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA
| | - Shaobai Wang
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA
| | - Haiqing Mao
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA; Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Thomas D Cha
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA
| | - Kirkham B Wood
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, GRJ 1215, Boston, MA 02114, USA.
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Shen Y, Zhong W. Can biomechanical studies make no distinction between different lumbar levels? J Neurosurg Spine 2015; 23:259-60. [PMID: 25955803 DOI: 10.3171/2014.11.spine141156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yi Shen
- Second Xiangya Hospital and Central South University Hunan, People's Republic of China
| | - Weiye Zhong
- Second Xiangya Hospital and Central South University Hunan, People's Republic of China
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Re: Could biomechanics studies make no distinction between different segmental levels? Spine (Phila Pa 1976) 2015; 40:272. [PMID: 25494312 DOI: 10.1097/brs.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Recent biomechanics studies have revealed distinct kinematic behavior of different lumbar segments. The mechanisms behind these segment-specific biomechanical features are unknown. This study investigated the in vivo geometric characteristics of human lumbar intervertebral discs. Magnetic resonance images of the lumbar spine of 41 young Chinese individuals were acquired. Disc geometry in the sagittal plane was measured for each subject, including the dimensions of the discs, nucleus pulposus (NP), and annulus fibrosus (AF). Segmental lordosis was also measured using the Cobb method.In general, the disc length increased from upper to lower lumbar levels, except that the L4/5 and L5/S1 discs had similar lengths. The L4/5 NP had a height of 8.6±1.3 mm, which was significantly higher than all other levels (P<0.05). The L5/S1 NP had a length of 21.6±3.1 mm, which was significantly longer than all other levels (P<0.05). At L4/5, the NP occupied 64.0% of the disc length, which was significantly less than the NP of the L5/S1 segment (72.4%) (P<0.05). The anterior AF occupied 20.5% of the L4/5 disc length, which was significantly greater than that of the posterior AF (15.6%) (P<0.05). At the L5/S1 segment, the anterior and posterior AFs were similar in length (14.1% and 13.6% of the disc, respectively). The height to length (H/L) ratio of the L4/5 NP was 0.45±0.06, which was significantly greater than all other segments (P<0.05). There was no correlation between the NP H/L ratio and lordosis. Although the lengths of the lower lumbar discs were similar, the geometry of the AF and NP showed segment-dependent properties. These data may provide insight into the understanding of segment-specific biomechanics in the lower lumbar spine. The data could also provide baseline knowledge for the development of segment-specific surgical treatments of lumbar diseases.
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Affiliation(s)
- Weiye Zhong
- From the Bioengineering Laboratory (WZ, SJD, MW, SW, ZL, TDC, KBW, GL), Department of Orthopedic Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, MA; Department of Spinal Surgery (WZ), Second Xiangya Hospital and Central South University, Changsha, Hunan; and Department of Orthopedics (MW), China-Japan Union Hospital of Jilin University, Jilin, P.R. China
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