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Hayward S, Keogh PS, Miles AW, Gheduzzi S. The effect of structural changes on the low strain rate behaviour of the intervertebral disc. Proc Inst Mech Eng H 2024:9544119241272915. [PMID: 39180367 DOI: 10.1177/09544119241272915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
The annuus fibrosus (AF) and nucleus pulposus (NP) of the intervertebral disc (IVD) work in conjunction to dissipate spinal loads. In this study we have isolated the contribution of the NP to the overall response of the disc and investigated the effect of extreme structural changes to the disc on the mechanical behaviour. Linear stiffness, overall load range, hysteresis area and total energy were used to evaluate the impact of these changes on the spine and surrounding structures. Six porcine lumbar isolated disc specimens were tested in 6 DOFs with a 400 N compressive axial preload at low strain rates in three conditions: intact (IN), after total nucleotomy (NN) and after the injection of bone cement into the nuclear void (SN). The latter two conditions, NN and SN, were chosen to emulate the effect of extreme changes to the NP on disc behaviour. When comparing with intact specimens, significant changes were noted primarily in axial compression-extension, mediolateral bending and flexion-extension. NN and SN cases demonstrated significant increases in linear stiffness, overall load range and total energy for mediolateral bending and flexion-extension compared to the intact (IN) state. SN also demonstrated a significant increase in total energy for axial compression-extension, and significant decreases in the elastic contribution to total energy in all axes except flexion-extension. These changes to total energy indicate that surrounding spinal structures would incur additional loading to produce the same motion in vivo after structural changes to the disc.
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Affiliation(s)
- Samantha Hayward
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Patrick S Keogh
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Anthony W Miles
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Sabina Gheduzzi
- Department of Mechanical Engineering, University of Bath, Bath, UK
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2
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Wu Z, Sun H, Zhang Y, Xiao L, Zhao Q. Biomechanical Finite Element Analysis of Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach. World Neurosurg 2024; 185:e291-e298. [PMID: 37898267 DOI: 10.1016/j.wneu.2023.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states. METHODS A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions. RESULTS Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process. CONCLUSIONS Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal.
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Affiliation(s)
- Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Hongzhou Sun
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China.
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Taçyıldız AE, İnceoğlu F. Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen. Tomography 2024; 10:618-631. [PMID: 38668404 PMCID: PMC11053472 DOI: 10.3390/tomography10040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. METHODS We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. RESULTS Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. CONCLUSIONS The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.
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Affiliation(s)
- Abdullah Emre Taçyıldız
- Department of Neurosurgery, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey
- Department of Neurosurgery, Faculty of Medicine, Karabuk University, Karabuk 78200, Turkey
| | - Feyza İnceoğlu
- Department of Biostatistics, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey;
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Alassaf A, AlMohimeed I, Alghannam M, Alotaibi S, Alhussaini K, Aleid A, Alolayan S, Sikkandar MY, Alhashim MM, Sheik SB, Sudharsan NM. Time-dependent biomechanical evaluation for corrective planning of scoliosis using finite element analysis - A comprehensive approach. Heliyon 2024; 10:e26946. [PMID: 38449653 PMCID: PMC10915377 DOI: 10.1016/j.heliyon.2024.e26946] [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: 11/23/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Scoliosis is a medical condition marked by an abnormal lateral curvature of the spine, typically forming a sideways "S" or "C" shape. Mechanically, it manifests as a three-dimensional deformation of the spine, potentially leading to diverse clinical issues such as pain, diminished lung capacity, and postural abnormalities. This research specifically concentrates on the Adolescent Idiopathic Scoliosis (AIS) population, as existing literature indicates a tendency for this type of scoliosis to deteriorate over time. The principal aim of this investigation is to pinpoint the biomechanical factors contributing to the progression of scoliosis by employing Finite Element Analysis (FEA) on computed tomography (CT) data collected from adolescent patients. By accurately modeling the spinal curvature and related deformities, the stresses and strains experienced by vertebral and intervertebral structures under diverse loading conditions can be simulated and quantified. The transient simulation incorporated damping and inertial terms, along with the static stiffness matrix, to enhance comprehension of the response. The findings of this study indicate a significant reduction in the Cobb angle, halving from its initial value, decreasing from 35° to 17°. In degenerative scoliosis, failure was predicted at 109 cycles, with the Polypropylene brace deforming by 10.34 mm, while the Nitinol brace exhibited significantly less deformation at 7.734 mm. This analysis contributes to a better understanding of the biomechanical mechanisms involved in scoliosis development and can assist in the formulation of more effective treatment strategies. The FEA simulation emerges as a valuable supplementary tool for exploring various hypothetical scenarios by applying diverse loads at different locations to enhance comprehension of the effectiveness of proposed interventions.
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Affiliation(s)
- Ahmad Alassaf
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Ibrahim AlMohimeed
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohammed Alghannam
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Saddam Alotaibi
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Khalid Alhussaini
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Adham Aleid
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Salem Alolayan
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohamed Yacin Sikkandar
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Maryam M. Alhashim
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | | | - Natteri M. Sudharsan
- Department of Mechanical Engineering, Rajalakshmi Engineering College, Chennai 602105, India
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Vanaclocha A, Vanaclocha V, Atienza CM, Clavel P, Jordá-Gómez P, Barrios C, Saiz-Sapena N, Vanaclocha L. Bionate Lumbar Disc Nucleus Prosthesis: Biomechanical Studies in Cadaveric Human Spines. ACS OMEGA 2022; 7:46501-46514. [PMID: 36570209 PMCID: PMC9774399 DOI: 10.1021/acsomega.2c05294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
DESIGN cadaveric spine nucleus replacement study. OBJECTIVE determining Bionate 80A nucleus replacement biomechanics in cadaveric spines. METHODS in cold preserved spines, with ligaments and discs intact, and no muscles, L3-L4, L4-L5, and L5-S1 nucleus implantation was done. Differences between customized and overdimensioned implants were compared. Flexion, extension, lateral bending, and torsion were measured in the intact spine, nucleotomy, and nucleus implantation specimens. Increasing load or bending moment was applied four times at 2, 4, 6, and 8 Nm, twice in increasing mode and twice in decreasing mode. Spine motion was recorded using stereophotogrammetry. Expulsion tests: cyclic compression of 50-550 N for 50,000 cycles, increasing the load until there was extreme flexion, implant extrusion, or anatomical structure collapse. Subsidence tests were done by increasing the compression to 6000 N load. RESULTS nucleotomy increased the disc mobility, which remained unchanged for the adjacent upper level but increased for the lower adjacent one, particularly in lateral bending and torsion. Nucleus implantation, compared to nucleotomy, reduced disc mobility except in flexion-extension and torsion, but intact mobility was no longer recovered, with no effect on upper or lower adjacent segments. The overdimensioned implant, compared to the customized implant, provided equal or sometimes higher mobility. Lamina, facet joint, and annulus removal during nucleotomy caused more damaged than that restored by nucleus implantation. No implant extrusion was observed under compression loads of 925-1068 N as anatomical structures collapsed before. No subsidence or vertebral body fractures were observed under compression loads of 6697.8-6812.3 N. CONCLUSIONS nucleotomized disc and L1-S1 mobility increased moderately after cadaveric spine nucleus implantation compared to the intact status, partly due to operative anatomical damage. Our implant had shallow expulsion and subsidence risks.
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Affiliation(s)
- Amparo Vanaclocha
- Biomechanical
Engineer, Biomechanics Institute of Valencia, Valencia 46022, Spain
| | | | - Carlos M. Atienza
- Biomechanical
Engineer, Biomechanics Institute of Valencia, Valencia 46022, Spain
| | - Pablo Clavel
- Instituto
Clavel, Hospital Quironsalud Barcelona, Barcelona 08023, Spain
| | - Pablo Jordá-Gómez
- Hospital
General Universitario de Castellón, Castellón de la Plana 12004, Spain
| | - Carlos Barrios
- Catholic
University of Valencia, Saint Vincent Martyr, Valencia 46001, Spain
| | | | - Leyre Vanaclocha
- Medius
Klinik, Ostfildern-Ruit Klinik für Urologie, Hedelfinger Strasse 166, Ostfildern 73760, Germany
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6
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Are rotational passive stiffness and translational passive stiffness correlated? A porcine in vitro study. Clin Biomech (Bristol, Avon) 2022; 94:105610. [PMID: 35279438 DOI: 10.1016/j.clinbiomech.2022.105610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Qualitative clinical assessments of spinal stiffness have been demonstrated to show moderate correlations with one-another. We hypothesized that these correlations would improve in an in vitro model of the functional spinal unit. If the stiffness of spinal units are different across loading regimes (e.g. flexion-extension versus shear), then it may provide one explanation as to the variability in findings from clinical assessments, since these tests tend not to discriminate rotational and translational degrees-of-freedom. Therefore, the purpose of this investigation was to quantify the relationships between rotational and translational stiffness measures in vitro. METHODS Forty-eight porcine cervical spine functional units were used in this investigation (20 C3-C4, 28 C5-C6). While under constant 300 N compressive load, range-of-motion tests for both flexion-extension (± 8 Nm, 0.5 deg./s) and anteroposterior shear (± 400 N, 0.2 mm/s) were conducted, to quantify moment-angle and force-deflection curves. Representative stiffness values were then obtained for flexion, extension, anterior shear, and posterior shear using segmented regression. The correlation matrix between these four measures was then used to explore their potential relationships. FINDINGS Of the six correlations conducted, only the relationship between posterior shear and extension stiffness was statistically significant (p = 0.014), despite featuring a low correlation coefficient (R2 = 0.123). INTERPRETATION The poor correlations between stiffness metrics in this study supports the disparate findings of tissue stiffness in vivo. Results from this investigation suggest that clinicians should be cognizant of which degrees-of-freedom they are assessing in the spine, as their stiffness values vary independently.
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7
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Vanaclocha-Saiz A, Vanaclocha V, Atienza CM, Clavel P, Jorda-Gomez P, Barrios C, Vanaclocha L. Finite Element Analysis of a Bionate Ring-Shaped Customized Lumbar Disc Nucleus Prosthesis. ACS APPLIED BIO MATERIALS 2022; 5:172-182. [PMID: 35014829 PMCID: PMC8767544 DOI: 10.1021/acsabm.1c01027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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Study design: Biomechanical study of a nucleus replacement
with a finite element model. Objective: To validate a
Bionate 80A ring-shaped nucleus replacement. Methods:
The ANSYS lumbar spine model made from lumbar spine X-rays and magnetic
resonance images obtained from cadaveric spine specimens were used.
All materials were assumed homogeneous, isotropic, and linearly elastic.
We studied three options: intact spine, nucleotomy, and nucleus implant.
Two loading conditions were evaluated at L3-L4, L4-L5, and L5-S1 discs:
a 1000 N axial compression load and this load after the addition of
8 Nm flexion moment in the sagittal plane plus 8 Nm axial rotation
torque. Results: Maximum nucleus implant axial compression
stresses in the range of 16–34 MPa and tensile stress in the
range of 5–16 MPa, below Bionate 80A resistance were obtained.
Therefore, there is little risk of permanent implant deformation or
severe damage under normal loading conditions. Nucleotomy increased
segment mobility, zygapophyseal joint and end plate pressures, and
annulus stresses and strains. All these parameters were restored satisfactorily
by nucleus replacement but never reached the intact status. In addition,
annulus stresses and strains were lower with the nucleus implant than
in the intact spine under axial compression and higher under complex
loading conditions. Conclusions: Under normal loading
conditions, there is a negligible risk of nucleus replacement, permanent
deformation or severe damage. Nucleotomy increased segmental mobility,
zygapophyseal joint pressures, and annulus stresses and strains. Nucleus
replacement restored segmental mobility and zygapophyseal joint pressures
close to the intact spine. End plate pressures were similar for the
intact and nucleus implant conditions under both loading modes. Manufacturing
customized nucleus implants is considered feasible, as satisfactory
biomechanical performance is confirmed.
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Affiliation(s)
- Amparo Vanaclocha-Saiz
- Escuela de Doctorado, Universitat Politècnica de Valencia, Camí de Vera, s/n, 46022 Valencia, Spain
| | - Vicente Vanaclocha
- University of Valencia, Avenida de Blasco Ibáñez, 13, 46010 Valencia, Spain
| | - Carlos M Atienza
- Instituto de Biomecánica (IBV), Universitat Politècnica de Valencia, Camí de Vera, s/n, 46022 Valencia. Spain.,Instituto de Biomecánica de Valencia-CIBER BBN, Grupo de Tecnología Sanitaria (GTS-IBV), Camí de Vera, s/n, 46022 Valencia, Spain
| | - Pablo Clavel
- Instituto Clavel, Hospital Quironsalud Barcelona, Plaça d'Alfonso Comín, 5, 08023 Barcelona, Spain
| | - Pablo Jorda-Gomez
- Hospital Politècnic i Universitari La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Carlos Barrios
- Catholic University of Valencia, Saint Vincent Martyr, Carrer de Quevedo, 2, 46001 Valencia, Spain
| | - Leyre Vanaclocha
- University College London, London, Gower St, London WC1E 6BT, U.K
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Yang B, Klineberg E, O'Connell GD. Intervertebral Disc Mechanics With Nucleotomy: Differences Between Simple and Dual Loading. J Biomech Eng 2021; 143:081002. [PMID: 33729477 DOI: 10.1115/1.4050538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Indexed: 11/08/2022]
Abstract
Painful herniated discs are treated surgically by removing extruded nucleus pulposus (NP) material (nucleotomy). NP removal through enzymatic digestion is also commonly performed to initiate degenerative changes to study potential biological repair strategies. Experimental and computational studies have shown a decrease in disc stiffness with nucleotomy under single loading modalities, such as compression-only or bending-only loading. However, studies that apply more physiologically relevant loading conditions, such as compression in combination with bending or torsion, have shown contradicting results. We used a previously validated bone-disc-bone finite element model (Control) to create a Nucleotomy model to evaluate the effect of dual loading conditions (compression with torsion or bending) on intradiscal deformations. While disc joint stiffness decreased with nucleotomy under single loading conditions, as commonly reported in the literature, dual loading resulted in an increase in bending stiffness. More specifically, dual loading resulted in a 40% increase in bending stiffness under flexion and extension and a 25% increase in stiffness under lateral bending. The increase in bending stiffness was due to an increase and shift in compressive stress, where peak stresses migrated from the NP-annulus interface to the outer annulus. In contrast, the decrease in torsional stiffness was due to greater fiber reorientation during compression. In general, large radial strains were observed with nucleotomy, suggesting an increased risk for delamination or degenerative remodeling. In conclusion, the effect of nucleotomy on disc mechanics depends on the type and complexity of applied loads.
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Affiliation(s)
- Bo Yang
- Department of Mechanical Engineering, University of California Berkeley, Etcheverry Hall, Berkeley, CA 94720
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis Medical Center, Sacramento, CA 95817
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California Berkeley, 5122 Etcheverry Hall, #1740, Berkeley, CA 94720; Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94142
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Lu Y, Cheng L, Zhu H. Influence of nucleotomy on the load sharing in the spinal facet joint under the loading scenarios of different human postures. Med Eng Phys 2021; 93:35-41. [PMID: 34154773 DOI: 10.1016/j.medengphy.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 03/02/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
One-in-five people suffer from chronic low back pain (LBP). The incidence of this disease has doubled since 1950s and affects not only the elderly, but also the young population. However, the mechanism of LBP is still unknown. A possible location where the LBP may develop is the facet joint and it has been revealed that the intervertebral disc (IVD) nucleotomy may be a trigger for LBP. The aim of the present study was to investigate the influence of IVD nucleotomy on the load sharing in the spinal facet joint under the loading scenarios of different postures. Finite element (FE) models of the intact and nucleotomised L4 - L5 spinal segments were generated from the clinical CT images. Seven human postures, including upright, 5° extension, 5° flexion, ± 6° lateral bending and ± 2° axial rotation, were simulated. The resultant forces in the fact joint were compared between the intact and the nucleotomised cases. It was revealed that the IVD nucleotomy significantly increased the forces in the facet joints under the loading scenarios of upright, 5° extension and 5° flexion. The IVD nucleotomy increased the force in the ipsilateral facet joint but decreased the force on the contralateral side under the loading scenarios of ± 2° axial rotation. However, the IVD nucleotomy made little influence on the resultant forces in both facet joints in the postures of ± 6° lateral bending. In conclusion, the IVD nucleotomy can cause an increase in the overall force in the facet joint, and thus may serve as a possible explanation for the LBP and a main contributing factor for the pain complaints.
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Affiliation(s)
- Yongtao Lu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian 116024, China; State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian 116024, China; DUT-BSU Joint Institute, Dalian University of Technology, Dalian, China.
| | - LiangLiang Cheng
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China.
| | - Hanxing Zhu
- School of Engineering, Cardiff University, Queen's Buildings, the Parade, CF24 3AA Cardiff, UK
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Internal load-sharing in the human passive lumbar spine: Review of in vitro and finite element model studies. J Biomech 2020; 102:109441. [DOI: 10.1016/j.jbiomech.2019.109441] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 01/08/2023]
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11
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Jiang C, Yang Y, Zhou J, Yang K, Yao S, Jiang Z, Wu R. Analysis of spinal stress analysis application in determining method for the pedicle screw placement under the guidance of X-Ray. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:147-155. [PMID: 31771087 DOI: 10.3233/xst-190566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the accuracy of a novel guidance method of pedicle screw implantation determined by spinal stress. METHODS We retrospectively analyzed patients underwent pedicle screw internal fixation between January 2015 and August 2018 in our hospital. Patients were divided into two groups according to the methods of pedicle screw implantation namely, the conventional nail placement and novel guidance method of pedicle screw implantation determined by spinal stress. Accuracy of spinal pedicle screw placements was evaluated using intraoperative and postoperative X-ray computed tomography (CT) examination and intraoperative touch of nerve root dissection pedicle bone. The success rate of intraoperative one-time screw placement was calculated according to Heary classification I. RESULTS A total of 785 patients underwent pedicle screw internal fixation were retrospectively analyzed. Among them 384 patients were treated using conventional nail placement (Group A) and 401 patients were treated using the technique according to analysis of spinal stress (Group B). There was no significant difference in terms of the characteristics between two groups. There were significant differences in terms of the success rate of total of screw placement (88.7% vs. 96.2%, P < 0.001) including thoracic screw placement (87.8% vs. 94.5%, P = 0.003) and lumbar screw placement (88.8% vs. 96.5%, P = 0.001) for Group A and Group B, respectively. CONCLUSIONS Using the novel guidance method of pedicle screw implantation determined by spinal stress might improve the accuracy of pedicle screw implantation.
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Affiliation(s)
- Chuanjie Jiang
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Yongjun Yang
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Jiping Zhou
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Kai Yang
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Shuqiang Yao
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Zewei Jiang
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
| | - Rui Wu
- Department of Spine and Spine Cord, Shandong Wendeng Orthopedic and Traumatic Hospital, Wendeng, Shandong, P.R. China
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12
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Calvo-Echenique A, Bashkuev M, Reitmaier S, Pérez-Del Palomar A, Schmidt H. Numerical simulations of bone remodelling and formation following nucleotomy. J Biomech 2019; 88:138-147. [PMID: 30948042 DOI: 10.1016/j.jbiomech.2019.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Nucleotomy is the gold standard treatment for disc herniation and has proven ability to restore stability by creating a bony bridge without any additional fixation. However, the evolution of mineral density in the extant and new bone after nucleotomy and fixation techniques has to date not been investigated in detail. The main goal of this study is to determine possible mechanisms that may trigger the bone remodelling and formation processes. With that purpose, a finite element model of the L4-L5 spinal segment was used. Bone mineral density (BMD), new tissue composition, and endplate deflection were determined as indicators of lumbar fusion. A bone-remodelling algorithm and a tissue-healing algorithm, both mechanically driven, were implemented to predict vertebral bone alterations and fusion patterns after nucleotomy, internal fixation, and anterior plate placement. When considering an intact disc height, neither nucleotomy nor internal fixation were able to provide the necessary stability to promote bony fusion. However, when 75% of the disc height was considered, bone fusion was predicted for both techniques. By contrast, an anterior plate allowed bone fusion at all disc heights. A 50% disc-height reduction led to osteophyte formation in all cases. Changes in the intervertebral disc tissue caused BMD alterations in the endplates. From this observations it can be drawn that fusion may be self-induced by controlling the mechanical stabilisation without the need of additional fixation. The amount of tissue to be removed to achieve this stabilisation remains to be determined.
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Affiliation(s)
- Andrea Calvo-Echenique
- Group of Biomaterials. Mechanical Engineering Department, Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Maxim Bashkuev
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Reitmaier
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amaya Pérez-Del Palomar
- Group of Biomaterials. Mechanical Engineering Department, Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Hendrik Schmidt
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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13
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Inoue N, Orías AAE, Segami K. Biomechanics of the Lumbar Facet Joint. Spine Surg Relat Res 2019; 4:1-7. [PMID: 32039290 PMCID: PMC7002062 DOI: 10.22603/ssrr.2019-0017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022] Open
Abstract
Zygapophyseal, or facet, joints are complicated biomechanical structures in the spine, with a complex three-dimensional (3D) anatomy, variable mechanical functions in different spinal movements, and effects on the overall spine mechanical behavior. The 3D morphology of the facet joint is linked to its biomechanical function. Failure of the biomechanical function of the facet joint leads to osteoarthritic changes in it and is implicated in other spinal disorders such as degenerative spondylolisthesis. Facet joints and intervertebral disk are part of an entity called the spinal motion segment, the three-joint complex, or the articular triad. Functioning together, the structures in the spinal motion segments provide physiological spinal motion, while protecting the spine by preventing activities that can be injurious. Loss of intervertebral disk height associated with disk degeneration affects the mechanical behavior of facet joints. Axial compressive load transmission through the tip of the inferior articular process can occur in the extended position, especially with reduced disk height, which may cause capsular impingement and low back pain. The 3D curvature of the articular surfaces and capsular ligaments play important roles in different spinal positions. In this review article, we will summarize the anatomy of the lumbar facet joint relevant to its biomechanical function and biomechanical behavior under different loading conditions.
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Affiliation(s)
- Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | | | - Kazuyuki Segami
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
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14
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Liu S, Yang DL, Zhao RY, Yang SD, Ma L, Wang H, Ding WY. Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. J Orthop Surg Res 2019; 14:94. [PMID: 30947714 PMCID: PMC6450001 DOI: 10.1186/s13018-019-1132-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/15/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives The aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. Methods In this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity). Results The prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2–7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up. Conclusions Overall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.
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Affiliation(s)
- Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Ruo-Yu Zhao
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China. .,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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15
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O'Leary SA, Paschos NK, Link JM, Klineberg EO, Hu JC, Athanasiou KA. Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annu Rev Biomed Eng 2018; 20:145-170. [DOI: 10.1146/annurev-bioeng-062117-120924] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The zygapophysial joint, a diarthrodial joint commonly referred to as the facet joint, plays a pivotal role in back pain, a condition that has been a leading cause of global disability since 1990. Along with the intervertebral disc, the facet joint supports spinal motion and aids in spinal stability. Highly susceptible to early development of osteoarthritis, the facet is responsible for a significant amount of pain in the low-back, mid-back, and neck regions. Current noninvasive treatments cannot offer long-term pain relief, while invasive treatments can relieve pain but fail to preserve joint functionality. This review presents an overview of the facet in terms of its anatomy, functional properties, problems, and current management strategies. Furthermore, this review introduces the potential for regeneration of the facet and particular engineering strategies that could be employed as a long-term treatment.
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Affiliation(s)
- Siobhan A. O'Leary
- Department of Biomedical Engineering, University of California, Davis, California 95616, USA
| | - Nikolaos K. Paschos
- Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts 02115, USA
| | - Jarrett M. Link
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California 95816, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
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16
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Load-sharing in the lumbosacral spine in neutral standing & flexed postures – A combined finite element and inverse static study. J Biomech 2018; 70:43-50. [DOI: 10.1016/j.jbiomech.2017.10.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022]
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17
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Fan W, Guo LX. Finite element investigation of the effect of nucleus removal on vibration characteristics of the lumbar spine under a compressive follower preload. J Mech Behav Biomed Mater 2018; 78:342-351. [DOI: 10.1016/j.jmbbm.2017.11.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/13/2017] [Accepted: 11/22/2017] [Indexed: 01/08/2023]
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18
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Naserkhaki S, Jaremko JL, Adeeb S, El-Rich M. On the load-sharing along the ligamentous lumbosacral spine in flexed and extended postures: Finite element study. J Biomech 2015; 49:974-982. [PMID: 26493346 DOI: 10.1016/j.jbiomech.2015.09.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/11/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
A harmonic synergy between the load-bearing and stabilizing components of the spine is necessary to maintain its normal function. This study aimed to investigate the load-sharing along the ligamentous lumbosacral spine under sagittal loading. A 3D nonlinear detailed Finite Element (FE) model of lumbosacral spine with realistic geometry was developed and validated using wide range of numerical and experimental (in-vivo and in-vitro) data. The model was subjected to 500 N compressive Follower Load (FL) combined with 7.5 Nm flexion (FLX) or extension (EXT) moments. Load-sharing was expressed as percentage of total internal force/moment developed along the spine that each spinal component carried. These internal forces and moments were determined at the discs centres and included the applied load and the resisting forces in the ligaments and facet joints. The contribution of the facet joints and ligaments in supporting bending moments produced additional forces and moments in the discs. The intervertebral discs carried up to 81% and 68% of the total internal force in case of FL combined with FLX and EXT, respectively. The ligaments withstood up to 67% and 81% of the total internal moment in cases of FL combined with EXT and FLX, respectively. Contribution of the facet joints in resisting internal force and moment was noticeable at levels L4-S1 only particularly in case of FL combined with EXT and reached up 29% and 52% of the internal moment and force, respectively. This study demonstrated that spinal load-sharing depended on applied load and varied along the spine.
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Affiliation(s)
- Sadegh Naserkhaki
- Department of Civil and Environmental Engineering, University of Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Canada
| | - Marwan El-Rich
- Department of Civil and Environmental Engineering, University of Alberta, Canada.
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