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Caimi A, Ferguson SJ, Ignasiak D. Evaluation of trunk muscle coactivation predictions in multi-body models. J Biomech 2024; 168:112039. [PMID: 38657434 DOI: 10.1016/j.jbiomech.2024.112039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
Musculoskeletal simulations with muscle optimization aim to minimize muscle effort, hence are considered unable to predict the activation of antagonistic muscles. However, activation of antagonistic muscles might be necessary to satisfy the dynamic equilibrium. This study aims to elucidate under which conditions coactivation can be predicted, to evaluate factors modulating it, and to compare the antagonistic activations predicted by the lumbar spine model with literature data. Simple 2D and 3D models, comprising of 2 or 3 rigid bodies, with simple or multi-joint muscles, were created to study conditions under which muscle coactivity is predicted. An existing musculoskeletal model of the lumbar spine developed in AnyBody was used to investigate the effects of modeling intra-abdominal pressure (IAP), linear/cubic and load/activity-based muscle recruitment criterion on predicted coactivation during forward flexion and lateral bending. The predicted antagonist activations were compared to reported EMG data. Muscle coactivity was predicted with simplified models when multi-joint muscles were present or the model was three-dimensional. During forward flexion and lateral bending, the coactivation ratio predicted by the model showed good agreement with experimental values. Predicted coactivation was negligibly influenced by IAP but substantially reduced with a force-based recruitment criterion. The conditions needed in multi-body models to predict coactivity are: three-dimensionality or multi-joint muscles, unless perfect antagonists. The antagonist activations are required to balance 3D moments but do not reflect other physiological phenomena, which might explain the discrepancies between model predictions and experimental data. Nevertheless, the findings confirm the ability of the multi-body trunk models to predict muscle coactivity and suggest their overall validity.
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Affiliation(s)
- Alice Caimi
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
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2
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Gould SL, Davico G, Liebsch C, Wilke HJ, Cristofolini L, Viceconti M. Variability of intervertebral joint stiffness between specimens and spine levels. Front Bioeng Biotechnol 2024; 12:1372088. [PMID: 38486868 PMCID: PMC10937554 DOI: 10.3389/fbioe.2024.1372088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction: Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the passive mechanical properties of the intervertebral joint is crucial. The intervertebral joint stiffness, in particular, is typically derived from the literature, and the differences between individuals and spine levels are often disregarded. Methods: This study tested if an optimisation method of personalising the intervertebral joint stiffnesses was able to capture expected stiffness variation between specimens and between spine levels and if the variation between spine levels could be accurately captured using a generic scaling ratio. Multibody models of six T12 to sacrum spine specimens were created from computed tomography data. For each specimen, two models were created: one with uniform stiffnesses across spine levels, and one accounting for level dependency. Three loading conditions were simulated. The initial stiffness values were optimised to minimize the kinematic error. Results: There was a range of optimised stiffnesses across the specimens and the models with level dependent stiffnesses were less accurate than the models without. Using an optimised stiffness substantially reduced prediction errors. Discussion: The optimisation captured the expected variation between specimens, and the prediction errors demonstrated the importance of accounting for level dependency. The inaccuracy of the predicted kinematics for the level-dependent models indicated that a generic scaling ratio is not a suitable method to account for the level dependency. The variation in the optimised stiffnesses for the different loading conditions indicates personalised stiffnesses should also be considered load-specific.
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Affiliation(s)
- Samuele L. Gould
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Davico
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Luca Cristofolini
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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3
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Akhavanfar M, Mir-Orefice A, Uchida TK, Graham RB. An Enhanced Spine Model Validated for Simulating Dynamic Lifting Tasks in OpenSim. Ann Biomed Eng 2024; 52:259-269. [PMID: 37741902 DOI: 10.1007/s10439-023-03368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
A fully articulated thoracolumbar spine model had been previously developed in OpenSim and had been extensively validated against experimental data during various static tasks. In the present study, we enhanced this detailed musculoskeletal model by adding the role of passive structures and adding kinematic constraints to make it suitable for dynamic tasks. We validated the spinal forces estimated by this enhanced model during nine dynamic lifting/lowering tasks. Moreover, we recently developed and evaluated five approaches in OpenSim to model the external loads applied to the hands during lifting/lowering tasks, and in the present study, we assessed which approach results in more accurate spinal forces. Regardless of the external load modeling approach, the maximum forces predicted by our enhanced spine model across all tasks, as well as the pattern of estimated spinal forces within each task, showed strong correlations (r-values and cross-correlation coefficients > 0.9) with experimental data. Given the biofidelity of our enhanced model, its accessibility via the open-source OpenSim software, and the extent to which this model has been validated, we recommend it for applications requiring estimation of spinal forces during lifting/lowering tasks using multibody-based models and inverse dynamic analyses.
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Affiliation(s)
| | - Alexandre Mir-Orefice
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Thomas K Uchida
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Canada.
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Bassani T, Ignasiak D, Cina A, Galbusera F. Prediction of trunk muscle activation and spinal forces in adolescent idiopathic scoliosis during simulated trunk motion: A musculoskeletal modelling study. J Biomech 2024; 163:111918. [PMID: 38199948 DOI: 10.1016/j.jbiomech.2023.111918] [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: 08/28/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
Due to lack of reference validation data, the common strategy in characterizing adolescent idiopathic scoliosis (AIS) by musculoskeletal modelling approach consists in adapting structure and parameters of validated body models of adult individuals with physiological alignments. Until now, only static postures have been replicated and investigated in AIS subjects. When aiming to simulate trunk motion, two critical factors need consideration: how distributing movement along the vertebral motion levels (lumbar spine rhythm), and if neglecting or accounting for the contribution of the stiffness of the motion segments (disc stiffness). The present study investigates the effect of three different lumbar spine rhythms and absence/presence of disc stiffness on trunk muscle imbalance in the lumbar region and on intervertebral lateral shear at different levels of the thoracolumbar/lumbar scoliotic curve, during simulated trunk motions in the three anatomical planes (flexion/extension, lateral bending, and axial rotation). A spine model with articulated ribcage previously developed in AnyBody software and adapted to replicate the spinal alignment in AIS subjects is employed. An existing dataset of 100 subjects with mild and moderate scoliosis is exploited. The results pointed out the significant impact of lumbar spine rhythm configuration and disc stiffness on changes in the evaluated outputs, as well as a relationship with scoliosis severity. Unfortunately, no optimal settings can be identified due to lack of reference validation data. According to that, extreme caution is recommended when aiming to adapt models of adult individuals with physiological alignments to adolescent subjects with scoliotic deformity.
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Affiliation(s)
- Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Dominika Ignasiak
- Institute for Biomechanics, Department of Health Sciences and Technologies, ETH Zurich, Zurich, Switzerland
| | - Andrea Cina
- Spine Center, Schulthess Clinic, Zurich, Switzerland; Biomedical Data Science Lab, Department of Health Sciences and Technologies, ETH Zurich, Zurich, Switzerland
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Liu T, Hulleck AA, El-Rich M. Sensitivity of subject-specific upper body musculoskeletal model predictions to mass scaling methods. Comput Biol Med 2023; 165:107376. [PMID: 37611422 DOI: 10.1016/j.compbiomed.2023.107376] [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: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
Accurate predictions of spinal loads in subject-specific musculoskeletal models require precise body segment parameters, including segment mass and center of mass (CoM) locations. Existing upper body models often assume a constant percentage of total body mass to calculate segmental masses, disregarding inter-individual variability and limiting their predictive capacity. This study evaluated the sensitivity of subject-specific upper body musculoskeletal model predictions to body mass scaling methods. The upper body segmental masses and corresponding CoM of six male subjects with varying body mass indices were computed using two mass scaling methods: the constant-percentage-based (CPB) scaling method, commonly used in AnyBody software; and our recently developed body-shape-based (BSB) method. Subsequently, these values were used by a validated musculoskeletal model to predict the muscle and disc forces in upright and flexed postures. The discrepancies between the results of the two scaling methods were compared across subjects and postures. Maximum deviations in thorax masses reached up to 7.5% of total body weight (TBW) in overweight subjects, while maximum CoM location differences of up to 35 mm were observed in normal weight subjects. The root mean squared errors (RMSE) of the CPB results, calculated with the BSB results as baseline, showed that the muscle and shear forces of the two scaling methods were quite similar (<4.5% of TBW). Though, there were small to moderate differences in compressive forces (6.5-16.0% of TBW). Thus, the compressive forces predicted with CPB method should be used with caution, particularly for overweight and obese subjects.
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Affiliation(s)
- Tao Liu
- Faculty of Kinesiology, Human Performance Lab, University of Calgary, Alberta, Canada
| | - Abdul Aziz Hulleck
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates; Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates.
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Remus R, Selkmann S, Lipphaus A, Neumann M, Bender B. Muscle-driven forward dynamic active hybrid model of the lumbosacral spine: combined FEM and multibody simulation. Front Bioeng Biotechnol 2023; 11:1223007. [PMID: 37829567 PMCID: PMC10565495 DOI: 10.3389/fbioe.2023.1223007] [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: 05/15/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Most spine models belong to either the musculoskeletal multibody (MB) or finite element (FE) method. Recently, coupling of MB and FE models has increasingly been used to combine advantages of both methods. Active hybrid FE-MB models, still rarely used in spine research, avoid the interface and convergence problems associated with model coupling. They provide the inherent ability to account for the full interplay of passive and active mechanisms for spinal stability. In this paper, we developed and validated a novel muscle-driven forward dynamic active hybrid FE-MB model of the lumbosacral spine (LSS) in ArtiSynth to simultaneously calculate muscle activation patterns, vertebral movements, and internal mechanical loads. The model consisted of the rigid vertebrae L1-S1 interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, facet joints, and force actuators representing the muscles. Morphological muscle data were implemented via a semi-automated registration procedure. Four auxiliary bodies were utilized to describe non-linear muscle paths by wrapping and attaching the anterior abdominal muscles. This included an abdominal plate whose kinematics was optimized using motion capture data from upper body movements. Intra-abdominal pressure was calculated from the forces of the abdominal muscles compressing the abdominal cavity. For the muscle-driven approach, forward dynamics assisted data tracking was used to predict muscle activation patterns that generate spinal postures and balance the spine without prescribing accurate spinal kinematics. During calibration, the maximum specific muscle tension and spinal rhythms resulting from the model dynamics were evaluated. To validate the model, load cases were simulated from -10° extension to +30° flexion with weights up to 20 kg in both hands. The biomechanical model responses were compared with in vivo literature data of intradiscal pressures, intra-abdominal pressures, and muscle activities. The results demonstrated high agreement with this data and highlight the advantages of active hybrid modeling for the LSS. Overall, this new self-contained tool provides a robust and efficient estimation of LSS biomechanical responses under in vivo similar loads, for example, to improve pain treatment by spinal stabilization therapies.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Sascha Selkmann
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Lipphaus
- Biomechanics Research Group, Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Marc Neumann
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Beate Bender
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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Recent Advances in Coupled MBS and FEM Models of the Spine—A Review. Bioengineering (Basel) 2023; 10:bioengineering10030315. [PMID: 36978705 PMCID: PMC10045105 DOI: 10.3390/bioengineering10030315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the overall kinematics and kinetics of the spine and the inner stress distribution of flexible components. We reviewed studies that included MBS and FEM co-simulations of the spine. Thereby, we classified the studies into unidirectional and bidirectional co-simulation, according to their data exchange methods. Several studies have demonstrated that using unidirectional co-simulation models provides useful insights into spinal biomechanics, although synchronizing the two distinct models remains a key challenge, often requiring extensive manual intervention. The use of a bidirectional co-simulation features an iterative, automated process with a constant data exchange between integrated subsystems. It reduces manual corrections of vertebra positions or reaction forces and enables detailed modeling of dynamic load cases. Bidirectional co-simulations are thus a promising new research approach for improved spine modeling, as a main challenge in spinal biomechanics is the nonlinear deformation of the intervertebral discs. Future studies will likely include the automated implementation of patient-specific bidirectional co-simulation models using hyper- or poroelastic intervertebral disc FEM models and muscle forces examined by an optimization algorithm in MBS. Applications range from clinical diagnosis to biomechanical analysis of overload situations in sports and injury prediction.
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8
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Lerchl T, Nispel K, Baum T, Bodden J, Senner V, Kirschke JS. Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges. Bioengineering (Basel) 2023; 10:bioengineering10020202. [PMID: 36829696 PMCID: PMC9952620 DOI: 10.3390/bioengineering10020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.
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Affiliation(s)
- Tanja Lerchl
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-15365
| | - Kati Nispel
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Veit Senner
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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Madinei S, Nussbaum MA. Estimating lumbar spine loading when using back-support exoskeletons in lifting tasks. J Biomech 2023; 147:111439. [PMID: 36638578 DOI: 10.1016/j.jbiomech.2023.111439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
Low-back pain (LBP) continues as the leading cause of work-related musculoskeletal disorders, and the high LBP burden is attributed largely to physical risk factors prevalent in manual material handling tasks. Industrial back-support exoskeletons (BSEs) are a promising ergonomic intervention to help control/prevent exposures to such risk factors. While earlier research has demonstrated beneficial effects of BSEs in terms of reductions in superficial back muscle activity, limited evidence is available regarding the impacts of these devices on spine loads. We evaluated the effects of two passive BSEs (BackX™ AC and Laevo™ V2.5) on lumbosacral compression and shear forces during repetitive lifting using an optimization-based model. Eighteen participants (gender-balanced) completed four minutes of repetitive lifting in nine different conditions, involving symmetric and asymmetric postures when using the BSEs (along with no BSE as a control condition). Using both BSEs reduced estimated peak compression and anteroposterior shear forces (by ∼8-15%). Such reductions, however, were task-specific and depended on the BSE design. Laevo™ use reduced mediolateral shear forces during asymmetric lifting (by ∼35%). We also found that reductions in composite measures of trunk muscle activity may not correspond well with changes in spine forces when using a BSE. These results can help guide the proper selection and application of BSEs during repetitive lifting tasks. Future work is recommended to explore the viability of different biomechanical models to assess changes in spine mechanical loads when using BSEs and whether reasonable estimates would be obtained using such models.
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Affiliation(s)
- Saman Madinei
- Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), Blacksburg, VA 24061, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), Blacksburg, VA 24061, USA.
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Knapik GG, Mendel E, Bourekas E, Marras WS. Computational lumbar spine models: A literature review. Clin Biomech (Bristol, Avon) 2022; 100:105816. [PMID: 36435080 DOI: 10.1016/j.clinbiomech.2022.105816] [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: 07/28/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations. METHODS The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement. FINDINGS A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models. INTERPRETATION Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.
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Affiliation(s)
- Gregory G Knapik
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA.
| | - Ehud Mendel
- Department of Neurosurgery, Yale University, New Haven, CT 06510, USA
| | - Eric Bourekas
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA
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Anderson DE, Groff MW, Flood TF, Allaire BT, Davis RB, Stadelmann MA, Zysset PK, Alkalay RN. Evaluation of Load-To-Strength Ratios in Metastatic Vertebrae and Comparison With Age- and Sex-Matched Healthy Individuals. Front Bioeng Biotechnol 2022; 10:866970. [PMID: 35992350 PMCID: PMC9388746 DOI: 10.3389/fbioe.2022.866970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Vertebrae containing osteolytic and osteosclerotic bone metastases undergo pathologic vertebral fracture (PVF) when the lesioned vertebrae fail to carry daily loads. We hypothesize that task-specific spinal loading patterns amplify the risk of PVF, with a higher degree of risk in osteolytic than in osteosclerotic vertebrae. To test this hypothesis, we obtained clinical CT images of 11 cadaveric spines with bone metastases, estimated the individual vertebral strength from the CT data, and created spine-specific musculoskeletal models from the CT data. We established a musculoskeletal model for each spine to compute vertebral loading for natural standing, natural standing + weights, forward flexion + weights, and lateral bending + weights and derived the individual vertebral load-to-strength ratio (LSR). For each activity, we compared the metastatic spines' predicted LSRs with the normative LSRs generated from a population-based sample of 250 men and women of comparable ages. Bone metastases classification significantly affected the CT-estimated vertebral strength (Kruskal-Wallis, p < 0.0001). Post-test analysis showed that the estimated vertebral strength of osteosclerotic and mixed metastases vertebrae was significantly higher than that of osteolytic vertebrae (p = 0.0016 and p = 0.0003) or vertebrae without radiographic evidence of bone metastasis (p = 0.0010 and p = 0.0003). Compared with the median (50%) LSRs of the normative dataset, osteolytic vertebrae had higher median (50%) LSRs under natural standing (p = 0.0375), natural standing + weights (p = 0.0118), and lateral bending + weights (p = 0.0111). Surprisingly, vertebrae showing minimal radiographic evidence of bone metastasis presented significantly higher median (50%) LSRs under natural standing (p < 0.0001) and lateral bending + weights (p = 0.0009) than the normative dataset. Osteosclerotic vertebrae had lower median (50%) LSRs under natural standing (p < 0.0001), natural standing + weights (p = 0.0005), forward flexion + weights (p < 0.0001), and lateral bending + weights (p = 0.0002), a trend shared by vertebrae with mixed lesions. This study is the first to apply musculoskeletal modeling to estimate individual vertebral loading in pathologic spines and highlights the role of task-specific loading in augmenting PVF risk associated with specific bone metastatic types. Our finding of high LSRs in vertebrae without radiologically observed bone metastasis highlights that patients with metastatic spine disease could be at an increased risk of vertebral fractures even at levels where lesions have not been identified radiologically.
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Affiliation(s)
- Dennis E. Anderson
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Thomas F. Flood
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Brett T. Allaire
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Roger B. Davis
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Marc A. Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Philippe K. Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ron N. Alkalay
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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12
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Lerchl T, El Husseini M, Bayat A, Sekuboyina A, Hermann L, Nispel K, Baum T, Löffler MT, Senner V, Kirschke JS. Validation of a Patient-Specific Musculoskeletal Model for Lumbar Load Estimation Generated by an Automated Pipeline From Whole Body CT. Front Bioeng Biotechnol 2022; 10:862804. [PMID: 35898642 PMCID: PMC9309792 DOI: 10.3389/fbioe.2022.862804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Chronic back pain is a major health problem worldwide. Although its causes can be diverse, biomechanical factors leading to spinal degeneration are considered a central issue. Numerical biomechanical models can identify critical factors and, thus, help predict impending spinal degeneration. However, spinal biomechanics are subject to significant interindividual variations. Therefore, in order to achieve meaningful findings on potential pathologies, predictive models have to take into account individual characteristics. To make these highly individualized models suitable for systematic studies on spinal biomechanics and clinical practice, the automation of data processing and modeling itself is inevitable. The purpose of this study was to validate an automatically generated patient-specific musculoskeletal model of the spine simulating static loading tasks. Methods: CT imaging data from two patients with non-degenerative spines were processed using an automated deep learning-based segmentation pipeline. In a semi-automated process with minimal user interaction, we generated patient-specific musculoskeletal models and simulated various static loading tasks. To validate the model, calculated vertebral loadings of the lumbar spine and muscle forces were compared with in vivo data from the literature. Finally, results from both models were compared to assess the potential of our process for interindividual analysis. Results: Calculated vertebral loads and muscle activation overall stood in close correlation with data from the literature. Compression forces normalized to upright standing deviated by a maximum of 16% for flexion and 33% for lifting tasks. Interindividual comparison of compression, as well as lateral and anterior–posterior shear forces, could be linked plausibly to individual spinal alignment and bodyweight. Conclusion: We developed a method to generate patient-specific musculoskeletal models of the lumbar spine. The models were able to calculate loads of the lumbar spine for static activities with respect to individual biomechanical properties, such as spinal alignment, bodyweight distribution, and ligament and muscle insertion points. The process is automated to a large extent, which makes it suitable for systematic investigation of spinal biomechanics in large datasets.
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Affiliation(s)
- Tanja Lerchl
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Tanja Lerchl,
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Amirhossein Bayat
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luis Hermann
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Kati Nispel
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Veit Senner
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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13
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Malakoutian M, Sanchez CA, Brown SHM, Street J, Fels S, Oxland TR. Biomechanical Properties of Paraspinal Muscles Influence Spinal Loading—A Musculoskeletal Simulation Study. Front Bioeng Biotechnol 2022; 10:852201. [PMID: 35721854 PMCID: PMC9201424 DOI: 10.3389/fbioe.2022.852201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Paraspinal muscles are vital to the functioning of the spine. Changes in muscle physiological cross-sectional area significantly affect spinal loading, but the importance of other muscle biomechanical properties remains unclear. This study explored the changes in spinal loading due to variation in five muscle biomechanical properties: passive stiffness, slack sarcomere length (SSL), in situ sarcomere length, specific tension, and pennation angle. An enhanced version of a musculoskeletal simulation model of the thoracolumbar spine with 210 muscle fascicles was used for this study and its predictions were validated for several tasks and multiple postures. Ranges of physiologically realistic values were selected for all five muscle parameters and their influence on L4-L5 intradiscal pressure (IDP) was investigated in standing and 36° flexion. We observed large changes in IDP due to changes in passive stiffness, SSL, in situ sarcomere length, and specific tension, often with interesting interplays between the parameters. For example, for upright standing, a change in stiffness value from one tenth to 10 times the baseline value increased the IDP only by 91% for the baseline model but by 945% when SSL was 0.4 μm shorter. Shorter SSL values and higher stiffnesses led to the largest increases in IDP. More changes were evident in flexion, as sarcomere lengths were longer in that posture and thus the passive curve is more influential. Our results highlight the importance of the muscle force-length curve and the parameters associated with it and motivate further experimental studies on in vivo measurement of those properties.
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Affiliation(s)
- Masoud Malakoutian
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
| | - C. Antonio Sanchez
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - John Street
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Sidney Fels
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Thomas R. Oxland
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Thomas R. Oxland,
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14
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Rasmussen J, Iversen K, Engelund BK, Rasmussen S. Biomechanical Evaluation of the Effect of Minimally Invasive Spine Surgery Compared with Traditional Approaches in Lifting Tasks. Front Bioeng Biotechnol 2021; 9:724854. [PMID: 34733828 PMCID: PMC8558419 DOI: 10.3389/fbioe.2021.724854] [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: 06/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Fusion of spinal vertebrae can be accomplished by different surgical approaches. We investigated Traditional Open Spine Surgery (TOSS) versus Minimally Invasive Spine Surgery (MISS). While TOSS sacrifices spine muscles originating or inserting on the affected vertebrae, MISS seeks to minimize the approach-related morbidity and preserve the tendon attachments of the muscles in the area. We captured 3-D motions of the full body of one healthy subject performing a variety of 10 kg box lifting operations representing activities-of-daily-living that are likely to challenge the spine biomechanically. The motion data were transferred to a full-body biomechanical model with a detailed representation of the biomechanics of the spine, and simulations of the internal spine loads and muscle forces were performed under a baseline configuration and muscle configurations typical for TOSS respectively MISS for the cases of L3/L4, L4/L5, L5/S1, L4/S1 and L3/L5 fusions. The computational model was then used to investigate the biomechanical differences between surgeries. The simulations revealed that joint reaction forces are more affected by both surgical approaches for lateral lifting motions than for sagittal plane motions, and there are indications that individuals with fused joints, regardless of the approach, should be particularly careful with asymmetrical lifts. The MISS and TOSS approaches shift the average loads of different muscle groups in different ways. TOSS generally leads to higher post-operative muscle loads than MISS in the investigated cases, but the differences are smaller than could be expected, given the differences of surgical technique.
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Affiliation(s)
- John Rasmussen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | | | | | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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15
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Skals S, Bláfoss R, de Zee M, Andersen LL, Andersen MS. Effects of load mass and position on the dynamic loading of the knees, shoulders and lumbar spine during lifting: a musculoskeletal modelling approach. APPLIED ERGONOMICS 2021; 96:103491. [PMID: 34126573 DOI: 10.1016/j.apergo.2021.103491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Musculoskeletal models may enhance our understanding of the dynamic loading of the joints during manual material handling. This study used state-of-the-art musculoskeletal models to determine the effects of load mass, asymmetry angle, horizontal location and deposit height on the dynamic loading of the knees, shoulders and lumbar spine during lifting. Recommended weight limits and lifting indices were also calculated using the NIOSH lifting equation. Based on 1832 lifts from 22 subjects, we found that load mass had the most substantial effect on L5-S1 compression. Increments in asymmetry led to large increases in mediolateral shear, while load mass and asymmetry had significant effects on anteroposterior shear. Increased deposit height led to higher shoulder forces, while the horizontal location mostly affected the forces in the knees and shoulders. These results generally support the findings of previous research, but notable differences in the trends and magnitudes of the estimated forces were observed.
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Affiliation(s)
- Sebastian Skals
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, 9220 Aalborg East, Denmark.
| | - Rúni Bláfoss
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen East, Denmark; Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Mark de Zee
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, 9220 Aalborg East, Denmark.
| | - Lars Louis Andersen
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, 9220 Aalborg East, Denmark.
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, 9220 Aalborg, Denmark.
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16
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Gould SL, Cristofolini L, Davico G, Viceconti M. Computational modelling of the scoliotic spine: A literature review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3503. [PMID: 34114367 PMCID: PMC8518780 DOI: 10.1002/cnm.3503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
Scoliosis is a deformity of the spine that in severe cases requires surgical treatment. There is still disagreement among clinicians as to what the aim of such treatment is as well as the optimal surgical technique. Numerical models can aid clinical decision-making by estimating the outcome of a given surgical intervention. This paper provided some background information on the modelling of the healthy spine and a review of the literature on scoliotic spine models, their validation, and their application. An overview of the methods and techniques used to construct scoliotic finite element and multibody models was given as well as the boundary conditions used in the simulations. The current limitations of the models were discussed as well as how such limitations are addressed in non-scoliotic spine models. Finally, future directions for the numerical modelling of scoliosis were addressed.
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Affiliation(s)
- Samuele L. Gould
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Luca Cristofolini
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
| | - Giorgio Davico
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Marco Viceconti
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
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17
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Fasser MR, Jokeit M, Kalthoff M, Gomez Romero DA, Trache T, Snedeker JG, Farshad M, Widmer J. Subject-Specific Alignment and Mass Distribution in Musculoskeletal Models of the Lumbar Spine. Front Bioeng Biotechnol 2021; 9:721042. [PMID: 34532314 PMCID: PMC8438119 DOI: 10.3389/fbioe.2021.721042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/06/2021] [Indexed: 01/12/2023] Open
Abstract
Musculoskeletal modeling is a well-established method in spine biomechanics and generally employed for investigations concerning both the healthy and the pathological spine. It commonly involves inverse kinematics and optimization of muscle activity and provides detailed insight into joint loading. The aim of the present work was to develop and validate a procedure for the automatized generation of semi-subject-specific multi-rigid body models with an articulated lumbar spine. Individualization of the models was achieved with a novel approach incorporating information from annotated EOS images. The size and alignment of bony structures, as well as specific body weight distribution along the spine segments, were accurately reproduced in the 3D models. To ensure the pipeline’s robustness, models based on 145 EOS images of subjects with various weight distributions and spinopelvic parameters were generated. For validation, we performed kinematics-dependent and segment-dependent comparisons of the average joint loads obtained for our cohort with the outcome of various published in vivo and in situ studies. Overall, our results agreed well with literature data. The here described method is a promising tool for studying a variety of clinical questions, ranging from the evaluation of the effects of alignment variation on joint loading to the assessment of possible pathomechanisms involved in adjacent segment disease.
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Affiliation(s)
- Marie-Rosa Fasser
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Moritz Jokeit
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | | | - Tudor Trache
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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18
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Lopez Poncelas M, La Barbera L, Rawlinson JJ, Crandall D, Aubin CE. Credibility assessment of patient-specific biomechanical models to investigate proximal junctional failure in clinical cases with adult spine deformity using ASME V&V40 standard. Comput Methods Biomech Biomed Engin 2021; 25:543-553. [PMID: 34427119 DOI: 10.1080/10255842.2021.1968380] [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] [Indexed: 10/20/2022]
Abstract
Computational models are increasingly used to assess spine biomechanics and support surgical planning. However, varying levels of model verification and validation, along with characterization of uncertainty effects limit the level of confidence in their predictive potential. The objective was to assess the credibility of an adult spine deformity instrumentation model for proximal junction failure (PJF) analysis using the ASME V&V40:2018 framework. To assess model applicability, the surgery, erected posture, and flexion movement of actual clinical cases were simulated. The loads corresponding to PJF indicators for a group of asymptomatic patients and a group of PJF patients were compared. Model consistency was demonstrated by finding PJF indicators significantly higher for the simulated PJF vs. asymptomatic patients. A detailed sensitivity analysis and uncertainty quantification were performed to further establish the model credibility.
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Affiliation(s)
- M Lopez Poncelas
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Quebec, Canada.,Research Center, Sainte-Justine University Hospital Center, Montréal, Quebec, Canada
| | - L La Barbera
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Quebec, Canada.,Research Center, Sainte-Justine University Hospital Center, Montréal, Quebec, Canada.,Department of Chemistry and Chemical Engineering, Politecnico di Milano, Milano, Italy
| | - J J Rawlinson
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Quebec, Canada.,Applied Research, Medtronic Spine, Memphis, TN, USA
| | - D Crandall
- Sonoran Spine Center, Tempe, AZ, USA.,Mayo Clinic School of Medicine, Phoenix, AZ, USA.,School of Medicine, University of Arizona, Phoenix, AZ, USA
| | - C E Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Quebec, Canada.,Research Center, Sainte-Justine University Hospital Center, Montréal, Quebec, Canada
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19
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Alemi MM, Burkhart KA, Lynch AC, Allaire BT, Mousavi SJ, Zhang C, Bouxsein ML, Anderson DE. The Influence of Kinematic Constraints on Model Performance During Inverse Kinematics Analysis of the Thoracolumbar Spine. Front Bioeng Biotechnol 2021; 9:688041. [PMID: 34395398 PMCID: PMC8358679 DOI: 10.3389/fbioe.2021.688041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Motion analysis is increasingly applied to spine musculoskeletal models using kinematic constraints to estimate individual intervertebral joint movements, which cannot be directly measured from the skin surface markers. Traditionally, kinematic constraints have allowed a single spinal degree of freedom (DOF) in each direction, and there has been little examination of how different kinematic constraints affect evaluations of spine motion. Thus, the objective of this study was to evaluate the performance of different kinematic constraints for inverse kinematics analysis. We collected motion analysis marker data in seven healthy participants (4F, 3M, aged 27–67) during flexion–extension, lateral bending, and axial rotation tasks. Inverse kinematics analyses were performed on subject-specific models with 17 thoracolumbar joints allowing 51 rotational DOF (51DOF) and corresponding models including seven sets of kinematic constraints that limited spine motion from 3 to 9DOF. Outcomes included: (1) root mean square (RMS) error of spine markers (measured vs. model); (2) lag-one autocorrelation coefficients to assess smoothness of angular motions; (3) maximum range of motion (ROM) of intervertebral joints in three directions of motion (FE, LB, AR) to assess whether they are physiologically reasonable; and (4) segmental spine angles in static ROM trials. We found that RMS error of spine markers was higher with constraints than without (p < 0.0001) but did not notably improve kinematic constraints above 6DOF. Compared to segmental angles calculated directly from spine markers, models with kinematic constraints had moderate to good intraclass correlation coefficients (ICCs) for flexion–extension and lateral bending, though weak to moderate ICCs for axial rotation. Adding more DOF to kinematic constraints did not improve performance in matching segmental angles. Kinematic constraints with 4–6DOF produced similar levels of smoothness across all tasks and generally improved smoothness compared to 9DOF or unconstrained (51DOF) models. Our results also revealed that the maximum joint ROMs predicted using 4–6DOF constraints were largely within physiologically acceptable ranges throughout the spine and in all directions of motions. We conclude that a kinematic constraint with 5DOF can produce smooth spine motions with physiologically reasonable joint ROMs and relatively low marker error.
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Affiliation(s)
- Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Katelyn A Burkhart
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Seyed Javad Mousavi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Chaofei Zhang
- Department of Automotive Engineering, Tsinghua University, Beijing, China
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
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20
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Remus R, Lipphaus A, Neumann M, Bender B. Calibration and validation of a novel hybrid model of the lumbosacral spine in ArtiSynth-The passive structures. PLoS One 2021; 16:e0250456. [PMID: 33901222 PMCID: PMC8075237 DOI: 10.1371/journal.pone.0250456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 12/04/2022] Open
Abstract
In computational biomechanics, two separate types of models have been used predominantly to enhance the understanding of the mechanisms of action of the lumbosacral spine (LSS): Finite element (FE) and musculoskeletal multibody (MB) models. To combine advantages of both models, hybrid FE-MB models are an increasingly used alternative. The aim of this paper is to develop, calibrate, and validate a novel passive hybrid FE-MB open-access simulation model of a ligamentous LSS using ArtiSynth. Based on anatomical data from the Male Visible Human Project, the LSS model is constructed from the L1-S1 rigid vertebrae interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, and facet joints. A mesh convergence study, sensitivity analyses, and systematic calibration were conducted with the hybrid functional spinal unit (FSU) L4/5. The predicted mechanical responses of the FSU L4/5, the lumbar spine (L1-L5), and the LSS were validated against literature data from in vivo and in vitro measurements and in silico models. Spinal mechanical responses considered when loaded with pure moments and combined loading modes were total and intervertebral range of motions, instantaneous axes and centers of rotation, facet joint contact forces, intradiscal pressures, disc bulges, and stiffnesses. Undesirable correlations with the FE mesh were minimized, the number of crisscrossed collagen fiber rings was reduced to five, and the individual influences of specific anatomical structures were adjusted to in vitro range of motions. Including intervertebral motion couplings for axial rotation and nonlinear stiffening under increasing axial compression, the predicted kinematic and structural mechanics responses were consistent with the comparative data. The results demonstrate that the hybrid simulation model is robust and efficient in reproducing valid mechanical responses to provide a starting point for upcoming optimizations and extensions, such as with active skeletal muscles.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
| | - Andreas Lipphaus
- Biomechanics Research Group, Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Marc Neumann
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Beate Bender
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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21
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Skals S, Bláfoss R, Andersen LL, Andersen MS, de Zee M. Manual material handling in the supermarket sector. Part 2: Knee, spine and shoulder joint reaction forces. APPLIED ERGONOMICS 2021; 92:103345. [PMID: 33444883 DOI: 10.1016/j.apergo.2020.103345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
Manual material handling is common in supermarkets and may be a contributing factor to the high prevalence of work-related musculoskeletal disorders, particularly to the lower back. This cross-sectional study applied state-of-the-art musculoskeletal models driven by kinematic data obtained in two supermarkets to estimate joint reaction forces in the knees, shoulders and lumbar spine under dynamic lifting conditions. Based on 1479 lifts from 15 workers, 8 tasks for which the compression or shear forces in the L5-S1 joint exceeded well-known biomechanical tolerance limits were identified. High shoulder forces were associated with lifting relatively heavy merchandise to high shelves, while the weight of the handled merchandise was the main predictor of high knee forces. The study addressed well-known limitations associated with traditional lifting analysis tools and was the first to present a detailed analysis of the biomechanical loads during manual material handling tasks in the supermarket sector based on field measurements.
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Affiliation(s)
- Sebastian Skals
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Rúni Bláfoss
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Lars Louis Andersen
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, 9220, Aalborg, Denmark.
| | - Mark de Zee
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
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22
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Favier CD, Finnegan ME, Quest RA, Honeyfield L, McGregor AH, Phillips ATM. An open-source musculoskeletal model of the lumbar spine and lower limbs: a validation for movements of the lumbar spine. Comput Methods Biomech Biomed Engin 2021; 24:1310-1325. [PMID: 33641546 DOI: 10.1080/10255842.2021.1886284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Musculoskeletal models of the lumbar spine have been developed with varying levels of detail for a wide range of clinical applications. Providing consistency is ensured throughout the modelling approach, these models can be combined with other computational models and be used in predictive modelling studies to investigate bone health deterioration and the associated fracture risk. To provide precise physiological loading conditions for such predictive modelling studies, a new full-body musculoskeletal model including a detailed and consistent representation of the lower limbs and the lumbar spine was developed. The model was assessed against in vivo measurements from the literature for a range of spine movements representative of daily living activities. Comparison between model estimations and electromyography recordings was also made for a range of lifting tasks. This new musculoskeletal model will provide a comprehensive physiological mechanical environment for future predictive finite element modelling studies on bone structural adaptation. It is freely available on https://simtk.org/projects/llsm/.
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Affiliation(s)
- C D Favier
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - M E Finnegan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - R A Quest
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - L Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - A H McGregor
- Musculoskeletal Lab in the Department of Surgery and Cancer, Imperial College London, London, UK
| | - A T M Phillips
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, UK
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Rajaee MA, Arjmand N, Shirazi-Adl A. A novel coupled musculoskeletal finite element model of the spine - Critical evaluation of trunk models in some tasks. J Biomech 2021; 119:110331. [PMID: 33631665 DOI: 10.1016/j.jbiomech.2021.110331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
Spine musculoskeletal (MS) models make simplifying assumptions on the intervertebral joint degrees-of-freedom (rotational and/or translational), representation (spherical or beam-like joints), and properties (linear or nonlinear). They also generally neglect the realistic structure of the joints with disc nuclei/annuli, facets, and ligaments. We aim to develop a novel MS model where trunk muscles are incorporated into a detailed finite element (FE) model of the ligamentous T12-S1 spine thus constructing a gold standard coupled MS-FE model. Model predictions are compared under some tasks with those of our earlier spherical joints, beam joints, and hybrid (uncoupled) MS-FE models. The coupled model predicted L4-L5 intradiscal pressures (R2 ≅ 0.97, RMSE ≅ 0.27 MPa) and L1-S1 centers of rotation (CoRs) in agreement to in vivo data. Differences in model predictions grew at larger trunk flexion angles; at the peak (80°) flexion the coupled model predicted, compared to the hybrid model, much smaller global/local muscle forces (~38%), segmental (~44%) and disc (~22%) compression forces but larger segmental (~9%) and disc (~17%) shear loads, ligament forces at the lower lumbar levels (by up to 57%) and facet forces at all levels. The spherical/beam joints models predicted much greater muscle forces and segmental loads under larger flexion angles. Unlike the spherical joints model with fixed CoRs, the beam joints model predicted CoRs closer (RMSE = 2.3 mm in flexion tasks) to those of the coupled model. The coupled model offers a great potential for future studies towards improvement of surgical techniques, management of musculoskeletal injuries and subject-specific simulations.
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Affiliation(s)
- M A Rajaee
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique, Montréal, Québec, Canada
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24
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Development of a multiscale model of the human lumbar spine for investigation of tissue loads in people with and without a transtibial amputation during sit-to-stand. Biomech Model Mechanobiol 2020; 20:339-358. [PMID: 33026565 DOI: 10.1007/s10237-020-01389-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/19/2020] [Indexed: 01/14/2023]
Abstract
Quantification of lumbar spine load transfer is important for understanding low back pain, especially among persons with a lower limb amputation. Computational modeling provides a helpful solution for obtaining estimates of in vivo loads. A multiscale model was constructed by combining musculoskeletal and finite element (FE) models of the lumbar spine to determine tissue loading during daily activities. Three-dimensional kinematic and ground reaction force data were collected from participants with ([Formula: see text]) and without ([Formula: see text]) a unilateral transtibial amputation (TTA) during 5 sit-to-stand trials. We estimated tissue-level load transfer from the multiscale model by controlling the FE model with intervertebral kinematics and muscle forces predicted by the musculoskeletal model. Annulus fibrosis stress, intradiscal pressure (IDP), and facet contact forces were calculated using the FE model. Differences in whole-body kinematics, muscle forces, and tissue-level loads were found between participant groups. Notably, participants with TTA had greater axial rotation toward their intact limb ([Formula: see text]), greater abdominal muscle activity ([Formula: see text]), and greater overall tissue loading throughout sit-to-stand ([Formula: see text]) compared to able-bodied participants. Both normalized (to upright standing) and absolute estimates of L4-L5 IDP were close to in vivo values reported in the literature. The multiscale model can be used to estimate the distribution of loads within different lumbar spine tissue structures and can be adapted for use with different activities, populations, and spinal geometries.
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25
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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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26
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Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity. J Biomech 2020; 110:109946. [DOI: 10.1016/j.jbiomech.2020.109946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
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Nowakowska-Lipiec K, Michnik R, Linek P, Myśliwiec A, Jochymczyk-Woźniak K, Gzik M. A numerical study to determine the effect of strengthening and weakening of the transversus abdominis muscle on lumbar spine loads. Comput Methods Biomech Biomed Engin 2020; 23:1287-1296. [DOI: 10.1080/10255842.2020.1795840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Katarzyna Nowakowska-Lipiec
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Robert Michnik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Sciences, Laboratory of Physiotherapy and Physioprevention, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Katarzyna Jochymczyk-Woźniak
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Marek Gzik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
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Black RA, Houston G. 40th Anniversary Issue: Reflections on papers from the archive on "Biomechanics". Med Eng Phys 2020; 72:70-71. [PMID: 31554579 DOI: 10.1016/j.medengphy.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard A Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
| | - Gregor Houston
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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Wang W, Wang D, De Groote F, Scheys L, Jonkers I. Implementation of physiological functional spinal units in a rigid-body model of the thoracolumbar spine. J Biomech 2020; 98:109437. [DOI: 10.1016/j.jbiomech.2019.109437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/14/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
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30
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Kuai S, Guan X, Liu W, Ji R, Xiong J, Wang D, Zhou W. Prediction of the Spinal Musculoskeletal Loadings during Level Walking and Stair Climbing after Two Types of Simulated Interventions in Patients with Lumbar Disc Herniation. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:6406813. [PMID: 31929870 PMCID: PMC6935826 DOI: 10.1155/2019/6406813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022]
Abstract
Background Low back pain (LBP) continues to be a severe global healthy problem, and a lot of patients would undergo conservative or surgical treatments. However, the improving capacity of spinal load sharing during activities of daily living (ADLs) after interventions is largely unknown. The objective of this study was to quantitatively predict the improvement of spinal musculoskeletal loadings during level walking and stair climbing after two simulated interventions. Material and Methods Twenty-six healthy adults and seven lumbar disc herniation patients performed level walking and stair climbing in sequence. The spinal movement was recorded using a motion capture system. The experimental data were applied to drive a musculoskeletal model to calculate all the lumbar joint resultant forces and muscle activities of seventeen main trunk muscle groups. Rehabilitation and reconstruction were selected as the representative of conservative and surgical treatment, respectively. The spinal load sharing after rehabilitation and reconstruction was predicted by replacing the patients' spine rhythm with healthy subjects' spine rhythm and altering the center of rotation at the L5S1 level, respectively. Results During both level walking and stair climbing, the joint resultant forces of the lower lumbar intervertebral discs were predicted to reduce after the two simulated inventions. In addition, the maximum muscle activities of the most trunk muscle groups decreased after simulated rehabilitation and conversely increased after simulated reconstruction. Conclusion The predictions revealed the different compensatory responses on the spinal load sharing after two simulated interventions, severing as guidance for making preoperative planning and rehabilitation planning.
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Affiliation(s)
- Shengzheng Kuai
- Department of Orthopedics, Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
- Shenzhen University School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
- Department of Orthopedics, First Affiliated Hospital Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Xinyu Guan
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Run Ji
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Jianyi Xiong
- Department of Orthopedics, Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Daping Wang
- Department of Orthopedics, Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Wenyu Zhou
- Department of Orthopedics, Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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31
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Zhang C, Mannen EM, Sis HL, Cadel ES, Wong BM, Wang W, Cheng B, Friis EA, Anderson DE. Moment-rotation behavior of intervertebral joints in flexion-extension, lateral bending, and axial rotation at all levels of the human spine: A structured review and meta-regression analysis. J Biomech 2019; 100:109579. [PMID: 31911050 DOI: 10.1016/j.jbiomech.2019.109579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Spinal intervertebral joints are complex structures allowing motion in multiple directions, and many experimental studies have reported moment-rotation response. However, experimental methods, reporting of results, and levels of the spine tested vary widely, and a comprehensive assessment of moment-rotation response across all levels of the spine is lacking. This review aims to characterize moment-rotation response in a consistent manner for all levels of the human spine. A literature search was conducted in PubMed for moment versus rotation data from mechanical testing of intact human cadaveric intervertebral joint specimens in flexion-extension, lateral bending, and axial rotation. A total of 45 studies were included, providing data from testing of an estimated 1,648 intervertebral joints from 518 human cadavers. We used mixed-effects regression analysis to create 75 regression models of moment-rotation response (25 intervertebral joints × 3 directions). We found that a cubic polynomial model provides a good representation of the moment-rotation behavior of most intervertebral joints, and that compressive loading increases rotational stiffness throughout the spine in all directions. The results allow for the direct evaluation of intervertebral ranges of motion across the whole of the spine for given loading conditions. The random-effects outcomes, representing standard deviations of the model coefficients across the dataset, can aid understanding of normal variations in moment-rotation responses. Overall these results fill a large gap, providing the first realistic and comprehensive representations of moment-rotation behavior at all levels of the spine, with broad implications for surgical planning, medical device design, computational modeling, and understanding of spine biomechanics.
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Affiliation(s)
- Chaofei Zhang
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Tsinghua University, Beijing, China
| | - Erin M Mannen
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | - Bo Cheng
- Tsinghua University, Beijing, China
| | | | - Dennis E Anderson
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Larsen FG, Svenningsen FP, Andersen MS, de Zee M, Skals S. Estimation of Spinal Loading During Manual Materials Handling Using Inertial Motion Capture. Ann Biomed Eng 2019; 48:805-821. [PMID: 31748833 DOI: 10.1007/s10439-019-02409-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/09/2019] [Indexed: 01/23/2023]
Abstract
Musculoskeletal models have traditionally relied on measurements of segment kinematics and ground reaction forces and moments (GRF&Ms) from marked-based motion capture and floor-mounted force plates, which are typically limited to laboratory settings. Recent advances in inertial motion capture (IMC) as well as methods for predicting GRF&Ms have enabled the acquisition of these input data in the field. Therefore, this study evaluated the concurrent validity of a novel methodology for estimating the dynamic loading of the lumbar spine during manual materials handling based on a musculoskeletal model driven exclusively using IMC data and predicted GRF&Ms. Trunk kinematics, GRF&Ms, L4-L5 joint reaction forces (JRFs) and erector spinae muscle forces from 13 subjects performing various lifting and transferring tasks were compared to a model driven by simultaneously recorded skin-marker trajectories and force plate data. Moderate to excellent correlations and relatively low magnitude differences were found for the L4-L5 axial compression, erector spinae muscle and vertical ground reaction forces during symmetrical and asymmetrical lifting, but discrepancies were also identified between the models, particularly for the trunk kinematics and L4-L5 shear forces. Based on these results, the presented methodology can be applied for estimating the relative L4-L5 axial compression forces under dynamic conditions during manual materials handling in the field.
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Affiliation(s)
- Frederik Greve Larsen
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Mark de Zee
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sebastian Skals
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. .,Musculoskeletal Disorders, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark.
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Wang K, Wang L, Deng Z, Jiang C, Niu W, Zhang M. Influence of passive elements on prediction of intradiscal pressure and muscle activation in lumbar musculoskeletal models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 177:39-46. [PMID: 31319959 DOI: 10.1016/j.cmpb.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to investigate the effect of incorporating various passive elements, which could represent combined or individual effects of intervertebral disc, facet articulation and ligaments, on the prediction of lumbar muscle activation and L4-L5 intradiscal pressure. METHODS The passive elements representing the intervertebral disc, facet articulations, and ligaments were added to the existed lumbar musculoskeletal model with nonlinear rotational stiffness or force-strain relationships. The model was fed with kinematics of trunk flexion, extension, axial rotation and lateral bending to calculate muscle activation and L4-L5 intradiscal pressure. RESULTS In the trunk axial rotation, the intradiscal pressure values predicted by the models with elements representing facet articulation were much higher than that predicated by models removing these elements. In the trunk flexion, the models with passive elements showed lower muscle activation of extensors than model with no passive elements. At the end of trunk flexion, extension, axial rotation and lateral bending, the intradiscal pressure values predicted by model with intact passive elements were 120.6%, 92.5%, 334.8% and 74.9% of the values predicted by model with no passive elements, respectively. CONCLUSIONS Caution must be taken while modeling facet articulation as elements with rotational stiffness, as they may lead to overestimation of intradiscal pressure in trunk axial rotation. The inclusion of ligaments as spring-like elements may improve the simulation of flexion-relaxation phenomenon in trunk flexion. Future models considering detailed properties of passive elements are needed to allow more access to understanding the mechanics of the lumbar spine.
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Affiliation(s)
- Kuan Wang
- Yangzhi Rehabilitation Hospital, Sunshine Rehabilitation Centre, Tongji University School of Medicine, Shanghai 201619, China; Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai 200092, China
| | - Lejun Wang
- Sport and Health Research Center, Physical Education Department, Tongji University, Shanghai 200092, China
| | - Zhen Deng
- Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
| | - Chenghua Jiang
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai 200092, China
| | - Wenxin Niu
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai 200092, China.
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Bayoglu R, Galibarov PE, Verdonschot N, Koopman B, Homminga J. Twente Spine Model: A thorough investigation of the spinal loads in a complete and coherent musculoskeletal model of the human spine. Med Eng Phys 2019; 68:35-45. [PMID: 31010615 DOI: 10.1016/j.medengphy.2019.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/12/2019] [Accepted: 03/30/2019] [Indexed: 12/28/2022]
Abstract
Although in vivospinal loads have been previously measured, existing data are limited to certain lumbar and thoracic levels. A detailed investigation of spinal loads would assist with injury prevention and implant design but is unavailable. In this study, we developed a complete and coherent musculoskeletal model of the entire human spine and studied the intervertebral disc compression forces for physiological movements on three anatomical planes. This model incorporates the individual vertebrae at the cervical, thoracic, and lumbar regions, a flexible ribcage, and complete muscle anatomy. Intradiscal pressures were estimated from predicted compressive forces, and these were generally in close agreement with previously measured data. We found that compressive forces at the trunk discs increased during trunk lateral bending and axial rotation of the trunk. During flexion, compressive forces increased in the thoracolumbar and lumbar regions and slightly decreased at the middle thoracic discs. In extension, the forces generally decreased at the thoracolumbar and lumbar discs whereas they slightly increased at the upper and middle thoracic discs. Furthermore, similar to a previous biomechanical model of the cervical spine, our model predicted increased compression forces in neck flexion, lateral bending, and axial rotation, and decreased forces in neck extension.
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Affiliation(s)
- Riza Bayoglu
- Department of Biomechanical Engineering, University of Twente, P.O. Box 217, AE Enschede 7500, the Netherlands.
| | | | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, P.O. Box 217, AE Enschede 7500, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, the Netherlands
| | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, P.O. Box 217, AE Enschede 7500, the Netherlands
| | - Jasper Homminga
- Department of Biomechanical Engineering, University of Twente, P.O. Box 217, AE Enschede 7500, the Netherlands
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Beaucage-Gauvreau E, Robertson WSP, Brandon SCE, Fraser R, Freeman BJC, Graham RB, Thewlis D, Jones CF. Validation of an OpenSim full-body model with detailed lumbar spine for estimating lower lumbar spine loads during symmetric and asymmetric lifting tasks. Comput Methods Biomech Biomed Engin 2019; 22:451-464. [DOI: 10.1080/10255842.2018.1564819] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Erica Beaucage-Gauvreau
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
- Spinal Research Group, Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - William S. P. Robertson
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Robert Fraser
- Affiliate Professor, The University of Adelaide, Adelaide, South Australia, Australia
- Spinal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brian J. C. Freeman
- Spinal Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Research Fellow, South Australian Health and Medical Research Institute, Spinal Unit Administration, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ryan B. Graham
- School of Human Kinetics, The University of Ottawa, Ottawa, Ontario, Canada
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Claire F. Jones
- Spinal Research Group, Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
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The effect of muscle ageing and sarcopenia on spinal segmental loads. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2650-2659. [DOI: 10.1007/s00586-018-5729-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/09/2018] [Accepted: 08/09/2018] [Indexed: 12/18/2022]
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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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38
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Actis JA, Honegger JD, Gates DH, Petrella AJ, Nolasco LA, Silverman AK. Validation of lumbar spine loading from a musculoskeletal model including the lower limbs and lumbar spine. J Biomech 2018; 68:107-114. [DOI: 10.1016/j.jbiomech.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022]
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Bruno AG, Mokhtarzadeh H, Allaire BT, Velie KR, De Paolis Kaluza MC, Anderson DE, Bouxsein ML. Incorporation of CT-based measurements of trunk anatomy into subject-specific musculoskeletal models of the spine influences vertebral loading predictions. J Orthop Res 2017; 35:2164-2173. [PMID: 28092118 PMCID: PMC5511782 DOI: 10.1002/jor.23524] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
We created subject-specific musculoskeletal models of the thoracolumbar spine by incorporating spine curvature and muscle morphology measurements from computed tomography (CT) scans to determine the degree to which vertebral compressive and shear loading estimates are sensitive to variations in trunk anatomy. We measured spine curvature and trunk muscle morphology using spine CT scans of 125 men, and then created four different thoracolumbar spine models for each person: (i) height and weight adjusted (Ht/Wt models); (ii) height, weight, and spine curvature adjusted (+C models); (iii) height, weight, and muscle morphology adjusted (+M models); and (iv) height, weight, spine curvature, and muscle morphology adjusted (+CM models). We determined vertebral compressive and shear loading at three regions of the spine (T8, T12, and L3) for four different activities. Vertebral compressive loads predicted by the subject-specific CT-based musculoskeletal models were between 54% lower to 45% higher from those estimated using musculoskeletal models adjusted only for subject height and weight. The impact of subject-specific information on vertebral loading estimates varied with the activity and spinal region. Vertebral loading estimates were more sensitive to incorporation of subject-specific spinal curvature than subject-specific muscle morphology. Our results indicate that individual variations in spine curvature and trunk muscle morphology can have a major impact on estimated vertebral compressive and shear loads, and thus should be accounted for when estimating subject-specific vertebral loading. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2164-2173, 2017.
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Affiliation(s)
- Alexander G. Bruno
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hossein Mokhtarzadeh
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Brett T. Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kelsey R. Velie
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Dennis E. Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Mary L. Bouxsein
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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40
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Kuai S, Liao Z, Zhou W, Guan X, Ji R, Zhang R, Guo D, Liu W. The Effect of Lumbar Disc Herniation on Musculoskeletal Loadings in the Spinal Region During Level Walking and Stair Climbing. Med Sci Monit 2017; 23:3869-3877. [PMID: 28796755 PMCID: PMC5562184 DOI: 10.12659/msm.903349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background People with low back pain (LBP) alter their motion patterns during level walking and stair climbing due to pain or fear. However, the alternations of load sharing during the two activities are largely unknown. The objective of this study was to investigate the effect of LBP caused by lumbar disc herniation (LDH) on the muscle activities of 17 main trunk muscle groups and the intradiscal forces acting on the five lumbar discs. Material/Methods Twenty-six healthy adults and seven LDH patients were recruited to perform level walking and stair climbing in the Gait Analysis Laboratory. Eight optical markers were placed on the bony landmarks of the spinous process and pelvis, and the coordinates of these markers were captured during the two activities using motion capture system. The coordinates of the captured markers were applied to developed musculoskeletal model to calculate the kinetic variables. Results LDH patients demonstrated higher muscle activities in most trunk muscle groups during both level walking and stair climbing. There were decreases in anteroposterior shear forces on the discs in the pathological region and increases in the compressive forces on all the lumbar discs during level walking. The symmetry of mediolateral shear forces was worse in LDH patients than healthy adults during stair climbing. Conclusions LDH patients exhibited different kinetic alternations during level walking and stair climbing. However, both adaptive strategies added extra burdens to the trunk system and further increased the risk for development of LDH.
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Affiliation(s)
- Shengzheng Kuai
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland).,Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen, Guangdong, China (mainland)
| | - Zhenhua Liao
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen, Guangdong, China (mainland)
| | - Wenyu Zhou
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Xinyu Guan
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland)
| | - Run Ji
- Institute of Biomechanics, National Research Center for Rehabilitation Technical Aids, Beijing, China (mainland)
| | - Rui Zhang
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Daiqi Guo
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland).,Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen, Guangdong, China (mainland)
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Arshad R, Zander T, Bashkuev M, Schmidt H. Influence of spinal disc translational stiffness on the lumbar spinal loads, ligament forces and trunk muscle forces during upper body inclination. Med Eng Phys 2017; 46:54-62. [DOI: 10.1016/j.medengphy.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/04/2017] [Accepted: 05/27/2017] [Indexed: 11/30/2022]
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Multimodal Medical Imaging Fusion for Patient Specific Musculoskeletal Modeling of the Lumbar Spine System in Functional Posture. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0243-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Effect of Lumbar Disc Herniation on Spine Loading Characteristics during Trunk Flexion and Two Types of Picking Up Activities. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:6294503. [PMID: 29065628 PMCID: PMC5485332 DOI: 10.1155/2017/6294503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
The main purpose of this study was to investigate the compensatory response of the muscle activities of seventeen major muscle groups in the spinal region, intradiscal forces of the five lumbar motion segment units (MSUs), and facet forces acting on the ten lumbar facet joints in patients with lumbar disc herniation (LDH). Twenty-six healthy adults and seven LDH patients performed trunk flexion, ipsilateral picking up, and contralateral picking up in sequence. Eight optical markers were placed on the landmarks of the pelvis and spinal process. The coordinates of these markers were captured to drive a musculoskeletal model to calculate the muscle activities, intradiscal forces, and facet forces. The muscle activities of the majority of the seventeen major muscle groups were found increases in LDH patients. In addition, the LDH patients displayed larger compressive forces and anteroposterior forces on all the five lumbar MSUs and more lumbar facet inventions on most facet joints. These findings suggest that the LDH patients demonstrate compensatory increases in the most trunk muscle activities and all spinal loads. These negative compensatory responses increase the risk of the aggravation of disc herniation. Therefore, treatment should intervene as earlier as possible for the severe LDH patients.
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Bruno AG, Burkhart K, Allaire B, Anderson DE, Bouxsein ML. Spinal Loading Patterns From Biomechanical Modeling Explain the High Incidence of Vertebral Fractures in the Thoracolumbar Region. J Bone Miner Res 2017; 32:1282-1290. [PMID: 28244135 PMCID: PMC5466490 DOI: 10.1002/jbmr.3113] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/18/2017] [Accepted: 02/21/2017] [Indexed: 11/09/2022]
Abstract
Vertebral fractures occur most frequently in the mid-thoracic and thoracolumbar regions of the spine, yet the reasons for this site-specific occurrence are not known. Our working hypothesis is that the locations of vertebral fracture may be explained by the pattern of spine loading, such that during daily activities the mid-thoracic and thoracolumbar regions experience preferentially higher mechanical loading compared to other spine regions. To test this hypothesis, we used a female musculoskeletal model of the full thoracolumbar spine and rib cage to estimate the variation in vertebral compressive loads and associated factor-of-risk (load-to-strength ratio) throughout the spine for 119 activities of daily living, while also parametrically varying spine curvature (high, average, low, and zero thoracic kyphosis models). We found that nearly all activities produced loading peaks in the thoracolumbar and lower lumbar regions of the spine, but that the highest factor-of-risk values generally occurred in the thoracolumbar region of the spine because these vertebrae had lower compressive strength than vertebrae in the lumbar spine. The peaks in compressive loading and factor-of-risk in the thoracolumbar region were accentuated by increasing thoracic kyphosis. Activation of the multifidus muscle fascicles selectively in the thoracolumbar region appeared to be the main contributor to the relatively high vertebral compressive loading in the thoracolumbar spine. In summary, by using advanced musculoskeletal modeling to estimate vertebral loading throughout the spine, this study provides a biomechanical mechanism for the higher incidence of fractures in thoracolumbar vertebrae compared to other spinal regions. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alexander G Bruno
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katelyn Burkhart
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brett Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Validation of the AnyBody full body musculoskeletal model in computing lumbar spine loads at L4L5 level. J Biomech 2017; 58:89-96. [PMID: 28521951 DOI: 10.1016/j.jbiomech.2017.04.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/10/2017] [Accepted: 04/24/2017] [Indexed: 11/20/2022]
Abstract
In the panorama of available musculoskeletal modeling software, AnyBody software is a commercial tool that provides a full body musculoskeletal model which is increasingly exploited by numerous researchers worldwide. In this regard, model validation becomes essential to guarantee the suitability of the model in representing the simulated system. When focusing on lumbar spine, the previous works aimed at validating the AnyBody model in computing the intervertebral loads held several limitations, and a comprehensive validation is to be considered as lacking. The present study was aimed at extensively validating the suitability of the AnyBody model in computing lumbar spine loads at L4L5 level. The intersegmental loads were calculated during twelve specific exercise tasks designed to accurately replicate the conditions during which Wilke et al. (2001) measured in vivo the L4L5 intradiscal pressure. Motion capture data of one volunteer subject were acquired during the execution of the tasks and then imported into AnyBody to set model kinematics. Two different approaches in computing intradiscal pressure from the intersegmental load were evaluated. Lumbopelvic rhythm was compared with reference in vivo measurements to assess the accuracy of the lumbopelvic kinematics. Positive agreement was confirmed between the calculated pressures and the in vivo measurements, thus demonstrating the suitability of the AnyBody model. Specific caution needs to be taken only when considering postures characterized by large lateral displacements. Minor discrepancy was found assessing lumbopelvic rhythm. The present findings promote the AnyBody model as an appropriate tool to non-invasively evaluate the lumbar loads at L4L5 in physiological activities.
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Hwang J, Knapik GG, Dufour JS, Marras WS. Curved muscles in biomechanical models of the spine: a systematic literature review. ERGONOMICS 2017; 60:577-588. [PMID: 27189654 DOI: 10.1080/00140139.2016.1190410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Early biomechanical spine models represented the trunk muscles as straight-line approximations. Later models have endeavoured to accurately represent muscle curvature around the torso. However, only a few studies have systematically examined various techniques and the logic underlying curved muscle models. The objective of this review was to systematically categorise curved muscle representation techniques and compare the underlying logic in biomechanical models of the spine. Thirty-five studies met our selection criteria. The most common technique of curved muscle path was the 'via-point' method. Curved muscle geometry was commonly developed from MRI/CT database and cadaveric dissections, and optimisation/inverse dynamics models were typically used to estimate muscle forces. Several models have attempted to validate their results by comparing their approach with previous studies, but it could not validate of specific tasks. For future needs, personalised muscle geometry, and person- or task-specific validation of curved muscle models would be necessary to improve model fidelity. Practitioner Summary: The logic underlying the curved muscle representations in spine models is still poorly understood. This literature review systematically categorised different approaches and evaluated their underlying logic. The findings could direct future development of curved muscle models to have a better understanding of the biomechanical causal pathways of spine disorders.
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Affiliation(s)
- Jaejin Hwang
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - Gregory G Knapik
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - Jonathan S Dufour
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - William S Marras
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
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Validation of a personalized curved muscle model of the lumbar spine during complex dynamic exertions. J Electromyogr Kinesiol 2017; 33:1-9. [DOI: 10.1016/j.jelekin.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/21/2022] Open
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Abstract
Advancing the knowledge of the biomechanics of the human body is essential to improve the clinical decision-makings of musculoskeletal disorders in the framework of in silico medicine. An impressive number of research projects focused on the development of rigid-body musculoskeletal models have been conducted over the world thanks to the new research directives. However, the application of these models in clinical practices remains a challenging issue. The objective of this review paper was to present the most current rigid-body musculoskeletal models of the human body systems and to analyze their trends and weaknesses for clinical applications. Then, recommendations were proposed for future researches toward fully clinical decision support. A systematic review process was performed. Well-selected studies related to the most current rigid-body 3D musculoskeletal models for each body system component (jaw, cervical spine, upper limbs, lumbar spine, and lower limbs) were summarized and explored. Trends in rigid musculoskeletal modeling are highlighted as personalization, new imaging techniques for specific joint kinematics, and computational efficiency. Weaknesses are highlighted as modeling assumptions, use of generic model, lack of modeling consensus, model validation, and parameter and model uncertainties. Future directions related to joint and muscle modeling, neuro-musculoskeletal modeling, model validation, data and model uncertainty quantification are recommended.
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Affiliation(s)
- Tien Tuan Dao
- Sorbonne University, Université de technologie de Compiègne, CNRS, UMR 7338 Biomechanics and Bioengineering, BP 20529, 60205 Compiègne cedex, France
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Bassani T, Ottardi C, Costa F, Brayda-Bruno M, Wilke HJ, Galbusera F. Semiautomated 3D Spine Reconstruction from Biplanar Radiographic Images: Prediction of Intervertebral Loading in Scoliotic Subjects. Front Bioeng Biotechnol 2017; 5:1. [PMID: 28164082 PMCID: PMC5247473 DOI: 10.3389/fbioe.2017.00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/04/2017] [Indexed: 11/13/2022] Open
Abstract
The present study proposes a semiautomatic software approach to reconstruct 3D subject-specific musculoskeletal model of thoracolumbar spine from radiographic digitized images acquired with EOS system. The approach is applied to evaluate the intervertebral loads in 38 standing adolescents with mild idiopathic scoliosis. For each vertebra, a set of landmarks was manually identified on radiographic images. The landmark coordinates were processed to calculate the following vertebral geometrical properties in the 3D space (i) location (ii) dimensions; and (iii) rotations. Spherical joints simulated disks, ligaments, and facet joints. Body weight distribution, muscles forces, and insertion points were placed according to physiological-anatomical values. Inverse static analysis, calculating joints' reactions in maintaining assigned spine configuration, was performed with AnyBody software. Reaction forces were computed to quantify intervertebral loads, and correlation with the patient anatomical parameters was then checked. Preliminary validation was performed comparing the model outcomes with that obtained from other authors in previous modeling works and from in vivo measurements. The comparison with previous modeling works and in vivo studies partially fulfilled the preliminary validation purpose. However, minor incongruities were pointed out that need further investigations. The subjects' intervertebral loads were found significantly correlated with the anatomical parameters in the sagittal and axial planes. Despite preliminary encouraging results that support model suitability, future investigations to consolidate the proposed approach are necessary. Nonetheless, the present method appears to be a promising tool that once fully validated could allow the subject-specific non-invasive evaluation of a deformed spine, providing supplementary information to the routine clinical examination and surgical intervention planning.
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Affiliation(s)
- Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
| | - Claudia Ottardi
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano , Milan , Italy
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Clinical and Research Center , Rozzano , Italy
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm (ZTF), Ulm University , Ulm , Germany
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Alkalay RN, Harrigan TP. Mechanical assessment of the effects of metastatic lytic defect on the structural response of human thoracolumbar spine. J Orthop Res 2016; 34:1808-1819. [PMID: 26748564 DOI: 10.1002/jor.23154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/29/2015] [Indexed: 02/04/2023]
Abstract
To investigate the effects of a clinical lytic defect on the structural response of human thoracolumbar functional spinal unit. A novel CT-compatible mechanical test system was used to image the deformation of a T12-L1 motion segment and measure the change in strain response under compressive loads ranging from 50 to 750 N. A lytic lesion (LM) with cortex involvement (33% by volume) was introduced to the upper vertebral body and the CT experiments were repeated. Finite element models, established from the CT volumes, were used to investigate the defect's effects on the structural response and the state of principal and shear stresses within the affected and adjacent vertebrae. The lytic lesion resulted in severe loss of the vertebral structural competence, resulting in significant, non-linear, and asymmetric increase in the experimentally measured strains and computed stresses within both vertebrae (p < 0.01). At the cortex, the tensile strains were significantly increased, while compressive strains significantly decreased, (p < 0.05). Both the vertebral bone and cortex regions adjacent to the defect showed significant increase in computed compressive, tensile, and shear stresses (p < 0.01). Changes in stress and strain distribution within the affected and adjacent vertebral bone and the experimentally observed bulging and buckling of the vertebral cortices suggested that initiation of catastrophic vertebral failure may occur under load magnitudes encountered in daily living. Although the effect of LM on the global deformation of the spine was well-predicted, our results show that FE predictions of local strain changes must be carefully assessed for clinical relevance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1808-1819, 2016.
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Affiliation(s)
- Ron N Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215.
| | - Timothy P Harrigan
- Applied Physics Laboratory, Johns Hopkins University, 11100 Johns Hopkins Road Laurel, Maryland, 20723
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