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Ramchandran S, George S, Braun B, Spardy J, Coskun E, Errico T. Is there an anatomic basis for the different behavior of Lenke types 1AR and 1AL in idiopathic scoliosis? A study on facet joint tropism influence. Spine Deform 2024; 12:159-164. [PMID: 37606796 DOI: 10.1007/s43390-023-00758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION AIS type 1 Curves are sub-classified based on the tilt of L4 as 1AR and 1AL. These curves are different w.r.t their curve behavior, progression and level selection. Presently there is no known anatomic etiology for the different behavior. Facet tropism (FT) is defined as the asymmetry between the facet angle of the left and right facet joints. The purpose of this study was to evaluate the correlation between facet tropism in the lumbar segments and occurrence of type 1AR and 1AL curves in AIS patients. METHODS AIS patients with diagnosis of type 1 AR and 1AL right thoracic AIS curves who underwent posterior instrumented fusion were queried from a single institutions' database. Patients needed to have an MRI of their entire spine to be included. L2-3, L3-4 and L4-5 Facet angles (FA, angle made by the facet line with the mid-sagittal line at respected vertebral level) were calculated. FT was classified as follows: ≤ 5° (minimal), 6- 10° (mild) and ≥ 11° (severe). 1AR and 1AL curves were compared for FA, FT and FT grade at each lumbar segmental levels. RESULTS One hundred nineteen patients were included (77 females, mean age-13.85 years, mean BMI- 21.63, 73 1AL and 46 1AR). The mean thoracic Cobb was 52.5 ± 9.8°, thoracic kyphosis was 28.12 ± 12° and lumbar lordosis was 53.48 ± 12.6°. L3-4 FA on the right side was more coronally oriented in 1AR curves compared to 1AL curves (37° vs. 31°, p = 0.04). On comparing FT at each level, 1AR curves had a higher FT at L3-4 (1.5° vs. - 2.3°, p = 0.01) and L4-5 levels (5.8° vs. - 0.28°, p < 0.001) compared to 1AL patients. Similarly, 1AR patients had significantly more patients with severe FT at L3-4 (34.8% vs. 13.7%, p = 0.02) and at L4-5 (17.3% vs. 6.8%, p = 0.01) compared to 1ALcurves. CONCLUSION L3-4 joints are more coronally oriented in 1AR curves compared to 1AL curves. 1AR patients displayed higher FT at L3-4 and L4-5 compared to 1AL patients. 1AR curves also reveal a higher percentage of severe FT at L3-4 and L4-5 levels. This may influence the curve behavior and progression in these two curve types.
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Affiliation(s)
- Subaraman Ramchandran
- Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
| | - Stephen George
- Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Benjamin Braun
- Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Jeffrey Spardy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Ergin Coskun
- Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Thomas Errico
- Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
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Anderson B, Shahidi B. The Impact of Spine Pathology on Posterior Ligamentous Complex Structure and Function. Curr Rev Musculoskelet Med 2023; 16:616-626. [PMID: 37870725 PMCID: PMC10733250 DOI: 10.1007/s12178-023-09873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE OF REVIEW Spinal ligament is an important component of the spinal column in mitigating biomechanical stress. Particularly the posterior ligamentous complex, which is composed of the ligamentum flavum, interspinous, and supraspinous ligaments. However, research characterizing the biomechanics and role of ligament health in spinal pathology and clinical context are scarce. This article provides a comprehensive review of the implications of spinal pathology on the structure, function, and biomechanical properties of the posterior ligamentous complex. RECENT FINDINGS Current research characterizing biomechanical properties of the posterior ligamentous complex is primarily composed of cadaveric studies and finite element modeling, and more recently incorporating patient-specific anatomy into finite element models. The ultimate goal of current research is to understand the relative contributions of these ligamentous structures in healthy and pathological spine, and whether preserving ligaments may play an important role in spinal surgical techniques. At baseline, posterior ligamentous complex structures account for 30-40% of spinal stability, which is highly dependent on the intrinsic biomechanical properties of each ligament. Biomechanics vary widely with pathology and following rigid surgical fixation techniques and are generally maladaptive. Often secondary to morphological changes in the setting of spinal pathology, but morphological changes in ligament may also serve as a primary pathology. Biomechanical maladaptations of the spinal ligament adversely influence overall spinal column integrity and ultimately predispose to increased risk for surgical failure and poor clinical outcomes. Future research is needed, particularly in living subjects, to better characterize adaptations in ligaments that can provide targets for improved treatment of spinal pathology.
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Affiliation(s)
- Bradley Anderson
- Department of Orthopaedic Surgery, The University of California San Diego, 9500 Gilman Dr., MC0863, La Jolla, San Diego, CA, 92093, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, The University of California San Diego, 9500 Gilman Dr., MC0863, La Jolla, San Diego, CA, 92093, USA.
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Yue J, Han Q, Chen H, Zhang A, Liu Y, Gong X, Wang Y, Wang J, Wu M. Artificial lamina after laminectomy: Progress, applications, and future perspectives. Front Surg 2023; 10:1019410. [PMID: 36816003 PMCID: PMC9932198 DOI: 10.3389/fsurg.2023.1019410] [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: 08/15/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
In clinical practice, laminectomy is a commonly used procedure for spinal decompression in patients suffering from spinal disorders such as ossification of ligamentum flavum, lumbar stenosis, severe spinal fracture, and intraspinal tumors. However, the loss of posterior column bony support, the extensive proliferation of fibroblasts and scar formation after laminectomy, and other complications (such as postoperative epidural fibrosis and iatrogenic instability) may cause new symptoms requiring revision surgery. Implantation of an artificial lamina prosthesis is one of the most important methods to avoid post-laminectomy complications. Artificial lamina is a type of synthetic lamina tissue made of various materials and shapes designed to replace the resected autologous lamina. Artificial laminae can provide a barrier between the dural sac and posterior soft tissues to prevent postoperative epidural fibrosis and paravertebral muscle compression and provide mechanical support to maintain spinal alignment. In this paper, we briefly review the complications of laminectomy and the necessity of artificial lamina, then we review various artificial laminae from clinical practice and laboratory research perspectives. Based on a combination of additive manufacturing technology and finite element analysis for spine surgery, we propose a new designing perspective of artificial lamina for potential use in clinical practice.
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Affiliation(s)
- Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China,Correspondence: Minfei Wu Jincheng Wang
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China,Correspondence: Minfei Wu Jincheng Wang
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Wang H, Zhu J, Xia Y, Li Y, Fu C. Application of platelet-rich plasma in spinal surgery. Front Endocrinol (Lausanne) 2023; 14:1138255. [PMID: 37008931 PMCID: PMC10057539 DOI: 10.3389/fendo.2023.1138255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
With the aging of the population and changes in lifestyle, the incidence of spine-related diseases is increasing, which has become a major global public health problem; this results in a huge economic burden on the family and society. Spinal diseases and complications can lead to loss of motor, sensory, and autonomic functions. Therefore, it is necessary to identify effective treatment strategies. Currently, the treatment of spine-related diseases includes conservative, surgical, and minimally invasive interventional therapies. However, these treatment methods have several drawbacks such as drug tolerance and dependence, adjacent spondylosis, secondary surgery, infection, nerve injury, dural rupture, nonunion, and pseudoarthrosis. Further, it is more challenging to promote the regeneration of the interstitial disc and restore its biomechanical properties. Therefore, clinicians urgently need to identify methods that can limit disease progression or cure diseases at the etiological level. Platelet-rich plasma (PRP), a platelet-rich form of plasma extracted from venous blood, is a blood-derived product. Alpha granules contain a large number of cytokines, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor, platelet factor 4 (PF-4), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β (TGF-β). These growth factors allow stem cell proliferation and angiogenesis, promote bone regeneration, improve the local microenvironment, and enhance tissue regeneration capacity and functional recovery. This review describes the application of PRP in the treatment of spine-related diseases and discusses the clinical application of PRP in spinal surgery.
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HAN KAPSOO, KANG SEUNGROK, KWON TAEKYU. ANALYSIS OF MUSCLE STRENGTH EFFECTS ON EXERCISE PERFORMANCE USING DYNAMIC STABILIZATION EXERCISE DEVICE. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Muscle strength may vary depending on the pathological issues and static life habits. These conditions lead to abnormal spinal loads and change muscle strength as well as activation patterns, thereby causing spinal disorders. In this study, the effects of muscle strength on the spine stabilization exercise were analyzed using a whole-body tilt device. Musculoskeletal modeling was performed and the results were validated through a comparison with the electromyography (EMG) analysis results. Based on the validated basic model, modeling was performed for the whole-body tilt device. To examine the exercise effect and muscle activation while the maximum muscle force capacity (MFC) was varied from 30[Formula: see text]N/cm2 to 60[Formula: see text]N/cm2 and 90[Formula: see text]N/cm2, the muscle force was predicted through inverse dynamics analysis. When MFC was 30[Formula: see text]N/cm2, the posterior direction of the tilt could not be analyzed (no solution found). When MFC was 60[Formula: see text]N/cm2, it could be analyzed, but the muscle force was predicted to be higher compared to when MFC was 90[Formula: see text]N/cm2. It was confirmed that muscle strength is a very important element for maintaining postural activities and performing exercise. Therefore, for rehabilitation patients and elderly people with weak muscle strength, hard or extreme exercise may cause musculoskeletal injuries.
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Affiliation(s)
- KAP-SOO HAN
- Research Institute of Clinical Medicine of Jeonbuk, National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do 561-712, Republic of Korea
| | - SEUNG-ROK KANG
- Research Institute of Clinical Medicine of Jeonbuk, National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do 561-712, Republic of Korea
| | - TAE-KYU KWON
- Division of Biomedical Engineering, College of Engineering, Jeonbuk National University, Jeonju-si, Jeollabuk-do 54896, Republic of Korea
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Design of a Lumbar Interspinous Fixation Device for Minimally Invasive Surgery and Spine Motion Stabilization. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schlager B, Niemeyer F, Galbusera F, Volkheimer D, Jonas R, Wilke HJ. Uncertainty analysis of material properties and morphology parameters in numerical models regarding the motion of lumbar vertebral segments. Comput Methods Biomech Biomed Engin 2018; 21:673-683. [DOI: 10.1080/10255842.2018.1508571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Benedikt Schlager
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Fabio Galbusera
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - David Volkheimer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - René Jonas
- 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
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Naserkhaki S, Arjmand N, Shirazi-Adl A, Farahmand F, El-Rich M. Effects of eight different ligament property datasets on biomechanics of a lumbar L4-L5 finite element model. J Biomech 2018; 70:33-42. [DOI: 10.1016/j.jbiomech.2017.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
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Azari F, Arjmand N, Shirazi-Adl A, Rahimi-Moghaddam T. A combined passive and active musculoskeletal model study to estimate L4-L5 load sharing. J Biomech 2018; 70:157-165. [DOI: 10.1016/j.jbiomech.2017.04.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Abstract
STUDY DESIGN A retrospective review of prospectively collected data. OBJECTIVE To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. MATERIALS AND METHODS Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. RESULTS Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. CONCLUSIONS Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.
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Masni-Azian, Tanaka M. Statistical factorial analysis approach for parameter calibration on material nonlinearity of intervertebral disc finite element model. Comput Methods Biomech Biomed Engin 2017; 20:1066-1076. [DOI: 10.1080/10255842.2017.1331345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Masni-Azian
- Faculty of Manufacturing Engineering, Department of Design Manufacturing, Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
- Division of Bioengineering, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Masao Tanaka
- Division of Bioengineering, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
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Moisik SR, Gick B. The Quantal Larynx: The Stable Regions of Laryngeal Biomechanics and Implications for Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:540-560. [PMID: 28241199 DOI: 10.1044/2016_jslhr-s-16-0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/28/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Recent proposals suggest that (a) the high dimensionality of speech motor control may be reduced via modular neuromuscular organization that takes advantage of intrinsic biomechanical regions of stability and (b) computational modeling provides a means to study whether and how such modularization works. In this study, the focus is on the larynx, a structure that is fundamental to speech production because of its role in phonation and numerous articulatory functions. METHOD A 3-dimensional model of the larynx was created using the ArtiSynth platform (http://www.artisynth.org). This model was used to simulate laryngeal articulatory states, including inspiration, glottal fricative, modal prephonation, plain glottal stop, vocal-ventricular stop, and aryepiglotto-epiglottal stop and fricative. RESULTS Speech-relevant laryngeal biomechanics is rich with "quantal" or highly stable regions within muscle activation space. CONCLUSIONS Quantal laryngeal biomechanics complement a modular view of speech control and have implications for the articulatory-biomechanical grounding of numerous phonetic and phonological phenomena.
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Affiliation(s)
- Scott Reid Moisik
- Division of Linguistics and Multilingual Studies, Nanyang Technological University, SingaporeThe Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | - Bryan Gick
- Department of Linguistics, University of British Columbia, Vancouver, CanadaHaskins Laboratories, New Haven, CT
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Xu M, Yang J, Lieberman IH, Haddas R. Lumbar spine finite element model for healthy subjects: development and validation. Comput Methods Biomech Biomed Engin 2016; 20:1-15. [DOI: 10.1080/10255842.2016.1193596] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ming Xu
- Human-Centric Design Research Lab, Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - James Yang
- Human-Centric Design Research Lab, Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | | | - Ram Haddas
- Texas Back Institute Research Foundation, Plano, TX, USA
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Butt AM, Gill C, Demerdash A, Watanabe K, Loukas M, Rozzelle CJ, Tubbs RS. A comprehensive review of the sub-axial ligaments of the vertebral column: part I anatomy and function. Childs Nerv Syst 2015; 31:1037-59. [PMID: 25930727 DOI: 10.1007/s00381-015-2729-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature. METHODS A literature search using online search engines was conducted. RESULTS Single comprehensive reviews of the spinal ligaments are not found in the extant medical literature. CONCLUSIONS This review will be useful to those who treat patients with pathology of the spine or who interpret imaging or investigate the anatomy of the ligaments of the vertebral column.
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Affiliation(s)
- Asma Mian Butt
- Batson Children's Hospital, University of Mississippi Medical Center, Jackson, USA
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HAN KAPSOO, YU CHANGHO, KO MYOUNGHWAN, KWON TAEKYU. ANALYSIS OF THE EFFECTS OF SPINE STABILIZATION EXERCISES USING A WHOLE BODY TILT DEVICE ON MUSCLE FORCES IN THE SPINE. J MECH MED BIOL 2014. [DOI: 10.1142/s021951941440003x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to investigate the effects of 3D stabilization exercises using a whole body tilt device on forces in the trunk, such as individual muscle forces and activation patterns, maximum muscle activities and spine loads. For this sake, a musculoskeletal (MS) model of the whole body was developed, and an inverse dynamics analysis was performed to predict the forces on the spine. An EMG measurement experiment was conducted to validate the muscle forces and activation patterns. The MS model was rotated and tilted in eight different directions: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R) and left (L), replicating the directions of the 3D spine balance exercise device, as performed in the experiment. The anterior directions of the tilt primarily induced the activation of long and superficial back muscles and the posterior directions activated the front muscles. However, deep muscles, such as short muscles and multifidi, were activated in all directions of the tilt. The resultant joint forces in the right and left directions of the tilt were the least among the directions, but higher muscle activations and more diverse muscle recruitments than other positions were observed. Therefore, these directions of tilt may be suitable for the elderly and rehabilitation patients who require muscle strengthening with less spinal loads. In the present investigation, it was shown that 3D stabilization exercises could provide considerable muscle exercise effects with a minimum perturbation of structure. The results of this study can be used to provide safety guidelines for muscle exercises using this type of tilting device. Therefore, the proposed direction of tilt can be used to strengthen targeted muscles, depending on the patients' muscular condition.
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Affiliation(s)
- KAP-SOO HAN
- Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - CHANG HO YU
- Division of Biomedical Engineering, Chonbuk National University, Jeonju, Republic of Korea
| | - MYOUNG-HWAN KO
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - TAE KYU KWON
- Division of Biomedical Engineering, Chonbuk National University, Jeonju, Republic of Korea
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Dreischarf M, Zander T, Shirazi-Adl A, Puttlitz CM, Adam CJ, Chen CS, Goel VK, Kiapour A, Kim YH, Labus KM, Little JP, Park WM, Wang YH, Wilke HJ, Rohlmann A, Schmidt H. Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together. J Biomech 2014; 47:1757-66. [PMID: 24767702 DOI: 10.1016/j.jbiomech.2014.04.002] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
Finite element (FE) model studies have made important contributions to our understanding of functional biomechanics of the lumbar spine. However, if a model is used to answer clinical and biomechanical questions over a certain population, their inherently large inter-subject variability has to be considered. Current FE model studies, however, generally account only for a single distinct spinal geometry with one set of material properties. This raises questions concerning their predictive power, their range of results and on their agreement with in vitro and in vivo values. Eight well-established FE models of the lumbar spine (L1-5) of different research centers around the globe were subjected to pure and combined loading modes and compared to in vitro and in vivo measurements for intervertebral rotations, disc pressures and facet joint forces. Under pure moment loading, the predicted L1-5 rotations of almost all models fell within the reported in vitro ranges, and their median values differed on average by only 2° for flexion-extension, 1° for lateral bending and 5° for axial rotation. Predicted median facet joint forces and disc pressures were also in good agreement with published median in vitro values. However, the ranges of predictions were larger and exceeded those reported in vitro, especially for the facet joint forces. For all combined loading modes, except for flexion, predicted median segmental intervertebral rotations and disc pressures were in good agreement with measured in vivo values. In light of high inter-subject variability, the generalization of results of a single model to a population remains a concern. This study demonstrated that the pooled median of individual model results, similar to a probabilistic approach, can be used as an improved predictive tool in order to estimate the response of the lumbar spine.
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Affiliation(s)
- M Dreischarf
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - T Zander
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Quebec, Canada
| | - C M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, USA
| | - C J Adam
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - C S Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - V K Goel
- Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, USA
| | - A Kiapour
- Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, USA
| | - Y H Kim
- Department of Mechanical Engineering, Kyung Hee University, Yongin 446-701, Republic of Korea
| | - K M Labus
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, USA
| | - J P Little
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - W M Park
- Department of Mechanical Engineering, Kyung Hee University, Yongin 446-701, Republic of Korea
| | - Y H Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - H J Wilke
- Institute of Orthopaedic Research and Biomechanics, Ulm, Germany
| | - A Rohlmann
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - H Schmidt
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Institute of Orthopaedic Research and Biomechanics, Ulm, Germany
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BRANDOLINI NICOLA, CRISTOFOLINI LUCA, VICECONTI MARCO. EXPERIMENTAL METHODS FOR THE BIOMECHANICAL INVESTIGATION OF THE HUMAN SPINE: A REVIEW. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414300026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro mechanical testing of spinal specimens is extremely important to better understand the biomechanics of the healthy and diseased spine, fracture, and to test/optimize surgical treatment. While spinal testing has extensively been carried out in the past four decades, testing methods are quite diverse. This paper aims to provide a critical overview of the in vitro methods for mechanical testing the human spine at different scales. Specimens of different type are used, according to the aim of the study: spine segments (two or more adjacent vertebrae) are used both to investigate the spine kinematics, and the mechanical properties of the spine components (vertebrae, ligaments, discs); single vertebrae (whole vertebra, isolated vertebral body, or vertebral body without endplates) are used to investigate the structural properties of the vertebra itself; core specimens are extracted to test the mechanical properties of the trabecular bone at the tissue-level; mechanical properties of spine soft tissue (discs, ligaments, spinal cord) are measured on isolated elements, or on tissue specimens. Identification of consistent reference frames is still a debated issue. Testing conditions feature different pre-conditioning and loading rates, depending on the simulated action. Tissue specimen preservation is a very critical issue, affecting test results. Animal models are often used as a surrogate. However, because of different structure and anatomy, extreme caution is required when extrapolating to the human spine. In vitro loading conditions should be based on reliable in vivo data. Because of the high complexity of the spine, such information (either through instrumented implants or through numerical modeling) is currently unsatisfactory. Because of the increasing ability of computational models in predicting biomechanical properties of musculoskeletal structures, a synergy is possible (and desirable) between in vitro experiments and numerical modeling. Future perspectives in spine testing include integration of mechanical and structural properties at different dimensional scales (from the whole-body-level down to the tissue-level) so that organ-level models (which are used to predict the most relevant phenomena such as fracture) include information from all dimensional scales.
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Affiliation(s)
- NICOLA BRANDOLINI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- School of Mechanical Engineering, University of Leeds, Woodhouse Lane, LS2 9JT Leeds, UK
| | - LUCA CRISTOFOLINI
- Department of Industrial Engineering, School of Engineering and Architecture, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - MARCO VICECONTI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
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Abouhossein A, Weisse B, Ferguson SJ. Quantifying the centre of rotation pattern in a multi-body model of the lumbar spine. Comput Methods Biomech Biomed Engin 2013; 16:1362-73. [DOI: 10.1080/10255842.2012.671306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Computational Biomechanical Modeling of Scoliotic Spine: Challenges and Opportunities. Spine Deform 2013; 1:401-411. [PMID: 27927365 DOI: 10.1016/j.jspd.2013.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/24/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Biomechanical computer models of the spine have important roles in the treatment and correction of scoliosis by providing predictive information for surgeons and other clinicians. OBJECTIVES This article reviews computational models of intact and scoliotic spine and its components; vertebra, intervertebral disc, ligament, facet joints, and muscle. Several spine models, developed using multi-body modelling and finite element modelling schemes, and their pros and cons are discussed. CONCLUSIONS The review reveals that scoliosis modelling is performed for 3 main applications: 1) brace simulation; 2) analysis of surgical correction technique; and 3) patient positioning before surgical instrumentation. The models provide predictive information for a priori choice of brace configurations and mechanically effective surgical correction techniques and the expected degree of correction. However, they have many shortcomings: for instance, they do not fully reproduce the active behaviour of the spine and the models' properties are not personalized.
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Alapan Y, Demir C, Kaner T, Guclu R, İnceoğlu S. Instantaneous center of rotation behavior of the lumbar spine with ligament failure. J Neurosurg Spine 2013; 18:617-26. [DOI: 10.3171/2013.3.spine12923] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to investigate the effect of ligament failure on the instantaneous center of rotation (ICR) in the lower lumbar spine.
Methods
A 3D finite element model of the L4–5 segment was obtained and validated. Ligament failure was simulated by reducing ligaments in a stepwise manner from posterior to anterior. A pure bending moment of 7.5 Nm was applied to the model in 3 anatomical planes for the purpose of validation, and a 6-Nm moment was applied to analyze the effect of ligament failure. For each loading case, ligament reduction step, and load increment, the range of motion of the segment and the ICR of the mobile (L-4) vertebra were calculated and characterized.
Results
The present model showed a consistent increase in the range of motion as the ligaments were removed, which was in agreement with the literature reporting the kinematics of the L4–5 segment. The shift in the location of the ICR was below 5 mm in the sagittal plane and 3 mm in both the axial and coronal planes.
Conclusions
The location of the ICR changed in all planes of motion with the simulation of multiple ligament injury. The removal of the ligaments also changed the load sharing within the motion segment. The change in the center of rotation of the spine together with the change in the range of motion could have a diagnostic value, revealing more detailed information on the type of injury, the state of the ligaments, and load transfer and sharing characteristics of the segment.
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Affiliation(s)
- Yunus Alapan
- 1Department of Mechanical Engineering, Yildiz Technical University, Istanbul
| | - Cihan Demir
- 1Department of Mechanical Engineering, Yildiz Technical University, Istanbul
| | - Tuncay Kaner
- 2Department of Neurosurgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey; and
| | - Rahmi Guclu
- 1Department of Mechanical Engineering, Yildiz Technical University, Istanbul
| | - Serkan İnceoğlu
- 3Department of Orthopedic Surgery, Loma Linda University, Loma Linda, California
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Karadogan E, Williams RL. Three-dimensional static modeling of the lumbar spine. J Biomech Eng 2013; 134:084504. [PMID: 22938364 DOI: 10.1115/1.4007172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents three-dimensional static modeling of the human lumbar spine to be used in the formation of anatomically-correct movement patterns for a fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The mathematical model incorporates five lumbar vertebrae between the first lumbar vertebra and the sacrum, with dimensions of an average adult human spine. The vertebrae are connected to each other by elastic elements, torsional springs and a spherical joint located at the inferoposterior corner in the mid-sagittal plane of the vertebral body. Elastic elements represent the ligaments that surround the facet joints and the torsional springs represent the collective effect of intervertebral disc which plays a major role in balancing torsional load during upper body motion and the remaining ligaments that support the spinal column. The elastic elements and torsional springs are considered to be nonlinear. The nonlinear stiffness constants for six motion types were solved using a multiobjective optimization technique. The quantitative comparison between the angles of rotations predicted by the proposed model and in the experimental data confirmed that the model yields angles of rotation close to the experimental data. The main contribution is that the new model can be used for all motions while the experimental data was only obtained at discrete measurement points.
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Affiliation(s)
- Ernur Karadogan
- Mechanical Engineering Department, Ohio University, Athens, OH 45701-2979, USA
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22
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Han KS, Kim K, Park WM, Lim DS, Kim YH. Effect of centers of rotation on spinal loads and muscle forces in total disk replacement of lumbar spine. Proc Inst Mech Eng H 2013; 227:543-50. [DOI: 10.1177/0954411912474742] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The placement of artificial disks can alter the center of rotation and kinematic pattern; therefore, forces in the spine during the motion will be affected as a result. The relationship between the location of joint center of artificial disks and forces in the spinal components is not investigated. A musculoskeletal model of the spine was developed, and three location cases of center of rotation were investigated varying 5 mm anteriorly and posteriorly from the default center. Resultant joint forces, ligament forces, facet forces, and muscle forces for each case were predicted during sagittal motion. No considerable difference was observed for joint force (maximum 14%). Anterior shift of center of rotation induced the most ligament forces (200 N) and facet forces (130 N) among the three cases. Posterior and anterior shifts of centers of rotation from the default location caused considerable changes in muscle forces, respectively: 108% and 70% of increase in multifidi muscle and 157% and 187% of increase in short segmental muscle. This study showed that the centers of rotation due to the design and the surgical placement of artificial disk can affect the kinetic results in the spine.
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Affiliation(s)
- Kap-Soo Han
- Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Yongin-si, Republic of Korea
| | - Kyungsoo Kim
- Department of Applied Mathematics, College of Applied Science, Kyung Hee University, Yongin-si, Republic of Korea
| | - Won Man Park
- Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Yongin-si, Republic of Korea
| | - Dae Seop Lim
- Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Yongin-si, Republic of Korea
| | - Yoon Hyuk Kim
- Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Yongin-si, Republic of Korea
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23
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Abouhossein A, Weisse B, Ferguson SJ. Letters to the Editor. Comput Methods Biomech Biomed Engin 2012. [DOI: 10.1080/10255842.2011.566419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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An enhanced and validated generic thoraco-lumbar spine model for prediction of muscle forces. Med Eng Phys 2012; 34:709-16. [DOI: 10.1016/j.medengphy.2011.09.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 07/08/2011] [Accepted: 09/04/2011] [Indexed: 11/23/2022]
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Kim H, Lim DH, Oh HJ, Lee KY, Lee SJ. Effects of nonlinearity in the materials used for the semi-rigid pedicle screw systems on biomechanical behaviors of the lumbar spine after surgery. Biomed Mater 2011; 6:055005. [PMID: 21849724 DOI: 10.1088/1748-6041/6/5/055005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently, various types of semi-rigid pedicle screw fixation systems have been developed for the surgical treatment of the lumbar spine. They were introduced to address the adverse issues commonly found in traditional rigid spinal fusion--abnormally large motion at the adjacent level and subsequent degeneration. The semi-rigid system uses more compliant materials (nitinol or polymers) and/or changes in rod design (coiled or twisted rods) as compared to the conventional rigid straight rods made of Ti alloys (E = 114 GPa, υ = 0.32). However, biomechanical studies on the semi-rigid pedicle screw systems were usually limited to linear modeling of the implant and anatomic elements, which may not be capable of reflecting realistic post-operative motions of the spine. In this study, we evaluated the effects of nonlinearity in materials used for semi-rigid pedicle screw fixation systems to evaluate the changes in biomechanical behaviors using finite element analysis. Changes in range of motion (ROM) and center of rotation (COR) were assessed at the operated and adjacent levels. Actual load-displacement results of the semi-rigid rod from mechanical test were carried out to reflect the nonlinearity of the implant. In addition, nonlinear material properties of various spinal ligaments studies were used for the finite element modeling. The post-operative models were constructed by modifying the previously validated intact model of the L1-S1 spine. Eight different post-operative models were made to address the effects of nonlinearity-with a traditional stiffness modulus rod (with linear ligaments, case 1; with nonlinear ligaments, case 5), with a rigid rod (with linear ligaments, case 2; with nonlinear ligaments, case 6), with a soft rod (with linear ligaments, case 3; with nonlinear ligaments, case 7), and with a nonlinear rod (with linear ligaments, case 4; with nonlinear ligaments, case 8). To simulate the load on the lumbar spine in a neutral posture, follower load (400 N) was applied and then the hybrid loading condition was applied to measure the ROM and COR in the sagittal plane. The more the nonlinearity was included in the model the closer the motion behavior of the device was to that of the intact spine. Furthermore, our results showed that the nonlinearity of the semi-rigid rod was a more sensitive factor than the nonlinearity of the spinal ligaments on biomechanical behavior of the lumbar spine after surgery. Therefore, for better understanding of the surgical effectiveness of the spinal device, more realistic material properties such as nonlinearity of the device and anatomic elements should be considered. In particular, the nonlinear properties of the semi-rigid rod were considered more than the nonlinearity of spinal ligaments.
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Affiliation(s)
- Hyun Kim
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
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Abouhossein A, Weisse B, Ferguson SJ. A multibody modelling approach to determine load sharing between passive elements of the lumbar spine. Comput Methods Biomech Biomed Engin 2011; 14:527-37. [DOI: 10.1080/10255842.2010.485568] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ayturk UM, Garcia JJ, Puttlitz CM. The micromechanical role of the annulus fibrosus components under physiological loading of the lumbar spine. J Biomech Eng 2011; 132:061007. [PMID: 20887032 DOI: 10.1115/1.4001032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To date, studies that have investigated the kinematics of spinal motion segments have largely focused on the contributions that the spinal ligaments play in the resultant motion patterns. However, the specific roles played by intervertebral disk components, in particular the annulus fibrosus, with respect to global motion is not well understood in spite of the relatively large literature base with respect to the local ex vivo mechanical properties of the tissue. The primary objective of this study was to implement the nonlinear and orthotropic mechanical behavior of the annulus fibrosus in a finite element model of an L4/L5 functional spinal unit in the form of a strain energy potential where the individual mechanical contributions of the ground substance and fibers were explicitly defined. The model was validated biomechanically under pure moment loading to ensure that the individual role of each soft tissue structure during load bearing was consistent throughout the physiologically relevant loading range. The fibrous network of the annulus was found to play critical roles in limiting the magnitude of the neutral zone and determining the stiffness of the elastic zone. Under flexion, lateral bending, and axial rotation, the collagen fibers were observed to bear the majority of the load applied to the annulus fibrosus, especially in radially peripheral regions where disk bulging occurred. For the first time, our data explicitly demonstrate that the exact fiber recruitment sequence is critically important for establishing the range of motion and neutral zone magnitudes of lumbar spinal motion segments.
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Affiliation(s)
- Ugur M Ayturk
- Department of Mechanical Engineering, Orthopaedic Bioengineering Research Laboratory, and School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523-1374, USA
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28
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Ezquerro F, Vacas FG, Postigo S, Prado M, Simón A. Calibration of the finite element model of a lumbar functional spinal unit using an optimization technique based on differential evolution. Med Eng Phys 2011; 33:89-95. [DOI: 10.1016/j.medengphy.2010.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
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29
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Kuo CS, Hu HT, Lin RM, Huang KY, Lin PC, Zhong ZC, Hseih ML. Biomechanical analysis of the lumbar spine on facet joint force and intradiscal pressure--a finite element study. BMC Musculoskelet Disord 2010; 11:151. [PMID: 20602783 PMCID: PMC2913991 DOI: 10.1186/1471-2474-11-151] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 07/05/2010] [Indexed: 11/16/2022] Open
Abstract
Background Finite element analysis results will show significant differences if the model used is performed under various material properties, geometries, loading modes or other conditions. This study adopted an FE model, taking into account the possible asymmetry inherently existing in the spine with respect to the sagittal plane, with a more geometrically realistic outline to analyze and compare the biomechanical behaviour of the lumbar spine with regard to the facet force and intradiscal pressure, which are associated with low back pain symptoms and other spinal disorders. Dealing carefully with the contact surfaces of the facet joints at various levels of the lumbar spine can potentially help us further ascertain physiological behaviour concerning the frictional effects of facet joints under separate loadings or the responses to the compressive loads in the discs. Methods A lumbar spine model was constructed from processes including smoothing the bony outline of each scan image, stacking the boundary lines into a smooth surface model, and subsequent further processing in order to conform with the purpose of effective finite element analysis performance. For simplicity, most spinal components were modelled as isotropic and linear materials with the exception of spinal ligaments (bilinear). The contact behaviour of the facet joints and changes of the intradiscal pressure with different postures were analyzed. Results The results revealed that asymmetric responses of the facet joint forces exist in various postures and that such effect is amplified with larger loadings. In axial rotation, the facet joint forces were relatively larger in the contralateral facet joints than in the ipsilateral ones at the same level. Although the effect of the preloads on facet joint forces was not apparent, intradiscal pressure did increase with preload, and its magnitude increased more markedly in flexion than in extension and axial rotation. Conclusions Disc pressures showed a significant increase with preload and changed more noticeably in flexion than in extension or in axial rotation. Compared with the applied preloads, the postures played a more important role, especially in axial rotation; the facet joint forces were increased in the contralateral facet joints as compared to the ipsilateral ones at the same level of the lumbar spine.
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Affiliation(s)
- Ching-Sung Kuo
- Department of Civil Engineering, National Cheng Kung University, Tainan, Taiwan.
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30
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Kurutz M, Oroszváry L. Finite element analysis of weightbath hydrotraction treatment of degenerated lumbar spine segments in elastic phase. J Biomech 2010; 43:433-41. [DOI: 10.1016/j.jbiomech.2009.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 10/04/2009] [Accepted: 10/05/2009] [Indexed: 12/15/2022]
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31
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Tran D, King-Wei Hor, Kamani A, Lessoway V, Rohling R. Instrumentation of the Loss-of-Resistance Technique for Epidural Needle Insertion. IEEE Trans Biomed Eng 2009; 56:820-7. [DOI: 10.1109/tbme.2008.2011475] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Moutzouri M, Billis E, Strimpakos N, Kottika P, Oldham JA. The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system. BMC Musculoskelet Disord 2008; 9:131. [PMID: 18828921 PMCID: PMC2569938 DOI: 10.1186/1471-2474-9-131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 10/01/2008] [Indexed: 11/18/2022] Open
Abstract
Background Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure. Methods 49 asymptomatic volunteers participated in this double-blinded study. Subjects were randomly assigned to receive either SNAG mobilisation (n = 25), or a sham mobilisation (n = 24). The SNAG technique was applied at the L3and L4 spinal levels with active flexion in sitting by an experienced manual therapist. Three sets of 10 repetitions at each of the two spinal levels were performed. The sham mobilisation was similar to the SNAG but did not apply the appropriate direction or force. Lumbar ROM was measured by a three dimensional electronic goniometer (Zebris CMS20), before and after each technique. For the reliability, five measurements in two different days (one week apart) were performed in 20 healthy subjects. Results When both interventions were compared, independent t tests yielded no statistically significant results in ROM between groups (p = 0.673). Furthermore no significant within group differences were observed: SNAG (p = 0.842), sham (p = 0.169). Intra- and inter-day reliability of flexion measurements was high (ICC1,1 > 0.82, SEM < 4.0°, SDD<16.3%) indicating acceptable clinical applicability. Conclusion While the Zebris proved to be a reliable device for measuring lumbar flexion ROM, SNAG mobilisation did not demonstrate significant differences in flexion ROM when compared to sham mobilisation. Trial registration Current Controlled Trials NCT00678093.
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Affiliation(s)
- Maria Moutzouri
- Centre for Rehabilitation Science, ARC Epidemiology Unit, School of Translational Medicine-Epidemiology Research Group, University of Manchester, Stopford Building, 2nd Floor, Oxford Road, Manchester, M13 9PT, UK.
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Schmidt H, Heuer F, Drumm J, Klezl Z, Claes L, Wilke HJ. Application of a calibration method provides more realistic results for a finite element model of a lumbar spinal segment. Clin Biomech (Bristol, Avon) 2007; 22:377-84. [PMID: 17204355 DOI: 10.1016/j.clinbiomech.2006.11.008] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 11/13/2006] [Accepted: 11/14/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND An important step in finite element modeling is the process of validation to derive clinical relevant data. It can be assumed that defect states of a finite element model, which have not been validated before, may predict wrong results. The purpose of this study was to show the differences in accuracy between a calibrated and a non-calibrated finite element model of a lumbar spinal segment for different clinical defects. METHODS For this study, two geometrically identical finite element models were used. An in vitro experiment was designed, deriving data for the calibration. Frequently used material properties were obtained from the literature and transferred into the non-calibrated model. Both models were validated on three clinical defects: bilateral hemifacetectomy, nucleotomy and interspinous defects, whereas in vitro range of motion data served as control points. Predictability and accuracy of the calibrated and non-calibrated finite element model were evaluated and compared. FINDINGS Both finite element models could mimic the intact situation with a good agreement. In the defects, the calibrated model predicted motion behavior with excellent agreement, whereas the non-calibrated model diverged greatly. INTERPRETATION Investigating the biomechanical performance of implants and load distribution of different spinal structures by numerical analysis requires not only good agreement with the intact segment, but also with the defect states, which are initiated prior to implant insertion. Because of more realistic results the calibration method may be recommended, however, it is more time consuming.
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Affiliation(s)
- Hendrik Schmidt
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany
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Guan Y, Yoganandan N, Zhang J, Pintar FA, Cusick JF, Wolfla CE, Maiman DJ. Validation of a clinical finite element model of the human lumbosacral spine. Med Biol Eng Comput 2006; 44:633-41. [PMID: 16937205 DOI: 10.1007/s11517-006-0066-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 04/20/2006] [Indexed: 10/24/2022]
Abstract
Very few finite element models on the lumbosacral spine have been reported because of its unique biomechanical characteristics. In addition, most of these lumbosacral spine models have been only validated with rotation at single moment values, ignoring the inherent nonlinear nature of the moment-rotation response of the spine. Because a majority of lumbar spine surgeries are performed between L4 and S1 levels, and the confidence in the stress analysis output depends on the model validation, the objective of the present study was to develop a unique finite element model of the lumbosacral junction. The clinically applicable model was validated throughout the entire nonlinear range. It was developed using computed tomography scans, subjected to flexion and extension, and left and right lateral bending loads, and quantitatively validated with cumulative variance analyses. Validation results for each loading mode and for each motion segment (L4-L5, L5-S1) and bisegment (L4-S1) are presented in the paper.
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Affiliation(s)
- Yabo Guan
- Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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