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Smit T, Aage N, Haschtmann D, Ferguson SJ, Helgason B. Anatomically and mechanically conforming patient-specific spinal fusion cages designed by full-scale topology optimization. J Mech Behav Biomed Mater 2024; 159:106695. [PMID: 39186906 DOI: 10.1016/j.jmbbm.2024.106695] [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: 11/27/2023] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
Cage subsidence after instrumented lumbar spinal fusion surgery remains a significant cause of treatment failure, specifically for posterior or transforaminal lumbar interbody fusion. Recent advancements in computational techniques and additive manufacturing, have enabled the development of patient-specific implants and implant optimization to specific functional targets. This study aimed to introduce a novel full-scale topology optimization formulation that takes the structural response of the adjacent bone structures into account in the optimization process. The formulation includes maximum and minimum principal strain constraints that lower strain concentrations in the adjacent vertebrae. This optimization approach resulted in anatomically and mechanically conforming spinal fusion cages. Subsidence risk was quantified in a commercial finite element solver for off-the-shelf, anatomically conforming and the optimized cages, in two representative patients. We demonstrated that the anatomically and mechanically conforming cages reduced subsidence risk by 91% compared to an off-the-shelf implant with the same footprint for a patient with normal bone quality and 54% for a patient with osteopenia. Prototypes of the optimized cage were additively manufactured and mechanically tested to evaluate the manufacturability and integrity of the design and to validate the finite element model.
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Affiliation(s)
- Thijs Smit
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
| | - Niels Aage
- Solid Mechanics, Technical University of Denmark, Denmark
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
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Messina C, Fusco S, Gazzotti S, Albano D, Bonaccorsi G, Guglielmi G, Bazzocchi A. DXA beyond bone mineral density and the REMS technique: new insights for current radiologists practice. LA RADIOLOGIA MEDICA 2024; 129:1224-1240. [PMID: 39080226 PMCID: PMC11322484 DOI: 10.1007/s11547-024-01843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 07/01/2024] [Indexed: 08/15/2024]
Abstract
Osteoporosis is the most prevalent skeletal disorder, a condition that is associated with significant social and healthcare burden. In the elderly, osteoporosis is commonly associated with sarcopenia, further increasing the risk of fracture. Several imaging techniques are available for a non-invasive evaluation of osteoporosis and sarcopenia. This review focuses on dual-energy X-ray absorptiometry (DXA), as this technique offers the possibility to evaluate bone mineral density and body composition parameters with good precision and accuracy. DXA is also able to evaluate the amount of aortic calcification for cardiovascular risk estimation. Additionally, new DXA-based parameters have been developed in recent years to further refine fracture risk estimation, such as the Trabecular Bone Score and the Bone Strain Index. Finally, we describe the recent advances of a newly developed ultrasound-based technology known as Radiofrequency Echographic Multi-Spectrometry, which represent the latest non-ionizing approach for osteoporosis evaluation at central sites.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Stefano Fusco
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122, Milan, Italy
| | - Silvia Gazzotti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Domenico Albano
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
| | - Gloria Bonaccorsi
- Department of Translational Medicine, Menopause and Osteoporosis Center, University of Ferrara, Ferrara, Italy
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, 71122, Foggia, Italy.
- Radiology Unit "Mons. Dimiccoli" Teaching Hospital, Barletta (BT), Italy.
- Radiology Unit, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, 71013, San Giovanni Rotondo, Italy.
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
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Lerchl T, Nispel K, Bodden J, Sekuboyina A, El Husseini M, Fritzsche C, Senner V, Kirschke JS. Musculoskeletal spine modeling in large patient cohorts: how morphological individualization affects lumbar load estimation. Front Bioeng Biotechnol 2024; 12:1363081. [PMID: 38933541 PMCID: PMC11199547 DOI: 10.3389/fbioe.2024.1363081] [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: 12/29/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction: Achieving an adequate level of detail is a crucial part of any modeling process. Thus, oversimplification of complex systems can lead to overestimation, underestimation, and general bias of effects, while elaborate models run the risk of losing validity due to the uncontrolled interaction of multiple influencing factors and error propagation. Methods: We used a validated pipeline for the automated generation of multi-body models of the trunk to create 279 models based on CT data from 93 patients to investigate how different degrees of individualization affect the observed effects of different morphological characteristics on lumbar loads. Specifically, individual parameters related to spinal morphology (thoracic kyphosis (TK), lumbar lordosis (LL), and torso height (TH)), as well as torso weight (TW) and distribution, were fully or partly considered in the respective models according to their degree of individualization, and the effect strengths of these parameters on spinal loading were compared between semi- and highly individualized models. T-distributed stochastic neighbor embedding (T-SNE) analysis was performed for overarching pattern recognition and multiple regression analyses to evaluate changes in occurring effects and significance. Results: We were able to identify significant effects (p < 0.05) of various morphological parameters on lumbar loads in models with different degrees of individualization. Torso weight and lumbar lordosis showed the strongest effects on compression (β ≈ 0.9) and anterior-posterior shear forces (β ≈ 0.7), respectively. We could further show that the effect strength of individual parameters tended to decrease if more individual characteristics were included in the models. Discussion: The induced variability due to model individualization could only partly be explained by simple morphological parameters. Our study shows that model simplification can lead to an emphasis on individual effects, which needs to be critically assessed with regard to in vivo complexity. At the same time, we demonstrated that individualized models representing a population-based cohort are still able to identify relevant influences on spinal loading while considering a variety of influencing factors and their interactions.
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Affiliation(s)
- Tanja Lerchl
- Associate Professorship of Sports Equipment and Sports Materials, School of Engineering and Design, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kati Nispel
- Associate Professorship of Sports Equipment and Sports Materials, School of Engineering and Design, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, 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
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Fritzsche
- Associate Professorship of Sports Equipment and Sports Materials, School of Engineering and Design, Technical University of Munich, Garching, Germany
| | - Veit Senner
- Associate Professorship of Sports Equipment and Sports Materials, School of Engineering and Design, Technical University of Munich, Garching, 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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Eremina GM, Smolin AY. Effect of patient-specific factors on regeneration in lumbar spine at healthy disc and total disc replacement. Computer simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108172. [PMID: 38669718 DOI: 10.1016/j.cmpb.2024.108172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative diseases of the spine have a negative impact on the quality of life of patients. This study presents the results of numerical modelling of the mechanical behaviour of the lumbar spine with patient-specific conditions at physiological loads. This paper aims to numerically study the influence of degenerative changes in the spine and the presence of an endoprosthesis on the creation of conditions for tissue regeneration. METHODS A numerical model of the mechanical behaviour of lumbar spine at healthy and after total disc replacement under low-energy impacts equivalent to physiological loads is presented. The model is based on the movable cellular automaton method (discrete elements), where the mechanical behaviour of bone tissue is described using the Biot poroelasticity accounting for the presence and transfer of interstitial biological fluid. The nutritional pathways of the intervertebral disc in cases of healthy and osteoporotic bone tissues were predicted based on the analysis of the simulation results according to the mechanobiological principles. RESULTS Simulation of total disc replacement showed that osseointegration of the artificial disc plates occurs only in healthy bone tissue. With total disc replacement in a patient with osteoporosis, there is an area of increased risk of bone resorption in the near-contact area, approximately 1 mm wide, around the fixators. Dynamic loads may improve the osseointegration of the implant in pathological conditions of the bone tissue. CONCLUSIONS The results obtained in the case of healthy spine and osteoporotic bone tissues correspond to the experimental data on biomechanics and possible methods of IVD regeneration from the position of mechanobiological principles. The results obtained with an artificial disc (with keel-type fixation) showed that the use of this type of endoprosthesis in healthy bone tissues allows to reproduce the function of the natural intervertebral disc and does not contribute to the development of neoplastic processes. In the case of an artificial disc with osteoporosis of bone tissues, there is a zone with increased risk of tissue resorption and development of neoplastic processes in the area near the contact of the implant attachment. This circumstance can be compensated by increasing the loading level.
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Affiliation(s)
- Galina M Eremina
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia.
| | - Alexey Yu Smolin
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia
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Rieger F, Rothenfluh DA, Ferguson SJ, Ignasiak D. Comprehensive assessment of global spinal sagittal alignment and related normal spinal loads in a healthy population. J Biomech 2024; 170:112127. [PMID: 38781798 DOI: 10.1016/j.jbiomech.2024.112127] [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: 08/29/2023] [Revised: 02/12/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Abnormal postoperative global sagittal alignment (GSA) is associated with an increased risk of mechanical complications after spinal surgery. Typical assessment of sagittal alignment relies on a few selected measures, disregarding global complexity and variability of the sagittal curvature. The normative range of spinal loads associated with GSA has not yet been considered in clinical evaluation. The study objectives were to develop a new GSA assessment method that holistically describes the inherent relationships within GSA and to estimate the related spinal loads. Vertebral endplates were annotated on radiographs of 85 non-pathological subjects. A Principal Component Analysis (PCA) was performed to derive a Statistical Shape Model (SSM). Associations between identified GSA variability modes and conventional alignment measures were assessed. Simulations of respective Shape Modes (SMs) were performed using an established musculoskeletal AnyBody model to estimate normal variation in cervico-thoraco-lumbar loads. The first six principal components explained 97.96% of GSA variance. The SSM provides the normative range of GSA and a visual representation of the main variability modes. Normal variation relative to the population mean in identified alignment features was found to influence spinal loads, e.g. the lower bound of the second shape mode (SM2-2σ) corresponds to an increase in L4L5-compression by 378.64 N (67.86%). Six unique alignment features were sufficient to describe GSA almost entirely, demonstrating the value of the proposed method for an objective and comprehensive analysis of GSA. The influence of these features on spinal loads provides a normative biomechanical reference, eventually guiding surgical planning of deformity correction in the future.
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Affiliation(s)
- Florian Rieger
- Institute for Biomechanics, LOT, ETH Zurich, Zurich, Switzerland.
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Xiao Y, Zhu C, Xiu P, Wang L, Zhang Z, Deng Z, Song Y, Yang X. Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion: The Prevalence, Risk Factors, and Impact on Fusion. Spine (Phila Pa 1976) 2024; 49:E135-E141. [PMID: 38031447 DOI: 10.1097/brs.0000000000004890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aimed to assess postoperative sclerotic modic changes (MCs) following transforaminal lumbar interbody fusion for lumbar degenerative disc disease, investigating their prevalence, risk factors, and association with clinical outcomes. SUMMARY OF BACKGROUND DATA Sclerotic MCs may occur in patients with lumbar degenerative disc disease after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown. MATERIALS AND METHODS The study included 467 patients (510 levels) who underwent single or two-level transforaminal lumbar interbody fusion surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and a non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up visual analogue scale and Oswestry disability index scores were collected. Multivariable logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs. RESULTS The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had a higher body mass index (BMI). The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at six months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Postoperative visual analogue scale and Oswestry disability index scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs. CONCLUSION Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact postoperative outcomes. To prevent postoperative sclerotic MCs, the authors postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the perioperative time window.
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Affiliation(s)
- Yang Xiao
- Department of Orthopaedic, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Singh NK, Singh NK, Verma R, Diwan AD. Validation and Estimation of Obesity-Induced Intervertebral Disc Degeneration through Subject-Specific Finite Element Modelling of Functional Spinal Units. Bioengineering (Basel) 2024; 11:344. [PMID: 38671766 PMCID: PMC11048157 DOI: 10.3390/bioengineering11040344] [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: 02/07/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Intervertebral disc degeneration has been linked to obesity; its potential mechanical effects on the intervertebral disc remain unknown. This study aimed to develop and validate a patient-specific model of L3-L4 vertebrae and then use the model to estimate the impact of increasing body weight on disc degeneration. (2) Methods: A three-dimensional model of the functional spinal unit of L3-L4 vertebrae and its components were developed and validated. Validation was achieved by comparing the range of motions (RoM) and intradiscal pressures with the previous literature. Subsequently, the validated model was loaded according to the body mass index and estimated stress, deformation, and RoM to assess disc degeneration. (3) Results: During validation, L3-L4 RoM and intradiscal pressures: flexion 5.17° and 1.04 MPa, extension 1.54° and 0.22 MPa, lateral bending 3.36° and 0.54 MPa, axial rotation 1.14° and 0.52 MPa, respectively. When investigating the impact of weight on disc degeneration, escalating from normal weight to obesity reveals an increased RoM, by 3.44% during flexion, 22.7% during extension, 29.71% during lateral bending, and 33.2% during axial rotation, respectively. Also, stress and disc deformation elevated with increasing weight across all RoM. (4) Conclusions: The predicted mechanical responses of the developed model closely matched the validation dataset. The validated model predicts disc degeneration under increased weight and could lay the foundation for future recommendations aimed at identifying predictors of lower back pain due to disc degeneration.
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Affiliation(s)
- Nitesh Kumar Singh
- Computational Biomechanics Lab, Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India;
| | - Nishant K. Singh
- Computational Biomechanics Lab, Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India;
| | - Rati Verma
- Biomechanics Lab, School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi 221005, India;
| | - Ashish D. Diwan
- Spine Labs & Spine Service, St George & Sutherland Campus, Clinical School of Faculty of Health & Medicine, University of New South Wales, Sydney, NSW 2502, Australia;
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Bahramian M, Arjmand N, El-Rich M, Parnianpour M. Effect of obesity on spinal loads during load-reaching activities: A subject- and kinematics-specific musculoskeletal modeling approach. J Biomech 2023; 161:111770. [PMID: 37633816 DOI: 10.1016/j.jbiomech.2023.111770] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
Obesity has been associated to increase the risk of low back disorders. Previous musculoskeletal models simulating the effect of body weight on intervertebral joint loads have assumed identical body postures for obese and normal-weight individuals during a given physical activity. Our recent kinematic-measurement studies, however, indicate that obese individuals adapt different body postures (segmental orientations) than normal-weight ones when performing load-reaching activities. The present study, therefore, used a subject- and kinematics-specific musculoskeletal modeling approach to compare spinal loads of nine normal-weight and nine obese individuals each performing twelve static two-handed load-reaching activities at different hand heights, anterior distances, and asymmetry angles (total of 12 tasks × 18 subjects = 216 model simulations). Each model incorporated personalized muscle architectures, body mass distributions, and full-body kinematics for each subject and task. Results indicated that even when accounting for subject-specific body kinematics obese individuals experienced significantly larger (by ∼38% in average) L5-S1 compression (2305 ± 468 N versus 1674 ± 337 N) and shear (508 ± 111 N versus 705 ± 150 N) loads during all reaching activities (p < 0.05 for all hand positions). This average difference of ∼38% was similar to the results obtained from previous modeling investigations that neglected kinematics differences between the two weight groups. Moreover, there was no significant interaction effect between body weight and hand position on the spinal loads; indicating that the effect of body weight on L5-S1 loads was not dependent on the position of hands. Postural differences alone appear, hence, ineffective in compensating the greater spinal loads that obese people experience during reaching activities.
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Affiliation(s)
- M Bahramian
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - M El-Rich
- Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - M Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Xiang Y, Zaman R, Arefeen A, Quarnstrom J, Rakshit R, Yang J. Hybrid musculoskeletal model-based 3D asymmetric lifting prediction and comparison with symmetric lifting. Proc Inst Mech Eng H 2023:9544119231172862. [PMID: 37139889 DOI: 10.1177/09544119231172862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In this study, a 3D asymmetric lifting motion is predicted by using a hybrid predictive model to prevent potential musculoskeletal lower back injuries for asymmetric lifting tasks. The hybrid model has two modules: a skeletal module and an OpenSim musculoskeletal module. The skeletal module consists of a dynamic joint strength based 40 degrees of freedom spatial skeletal model. The skeletal module can predict the lifting motion, ground reaction forces (GRFs), and center of pressure (COP) trajectory using an inverse dynamics-based motion optimization method. The musculoskeletal module consists of a 324-muscle-actuated full-body lumbar spine model. Based on the predicted kinematics, GRFs and COP data from the skeletal module, the musculoskeletal module estimates muscle activations using static optimization and joint reaction forces through the joint reaction analysis tool in OpenSim. The predicted asymmetric motion and GRFs are validated with experimental data. Muscle activation results between the simulated and experimental EMG are also compared to validate the model. Finally, the shear and compression spine loads are compared to NIOSH recommended limits. The differences between asymmetric and symmetric liftings are also compared.
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Affiliation(s)
- Yujiang Xiang
- School of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Rahid Zaman
- School of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Asif Arefeen
- School of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Joel Quarnstrom
- School of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Ritwik Rakshit
- Human-Centric Design Research Lab, Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - James Yang
- Human-Centric Design Research Lab, Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
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Mo F, Meng Q, Wu K, Zhang Q, Li K, Liao Z, Zhao H. A neuromuscular human body model for lumbar injury risk analysis in a vibration loading environment. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107442. [PMID: 36905749 DOI: 10.1016/j.cmpb.2023.107442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-term intensive exposure to whole-body vibration substantially increases the risk of low back pain and degenerative diseases in special occupational groups, like motor vehicle drivers, military vehicle occupants, aircraft pilots, etc. This study aims to establish and validate a neuromuscular human body model focusing on improvement of the detailed description of anatomic structures and neural reflex control, for lumbar injury analysis in vibration loading environments. METHODS A whole-body musculoskeletal in Opensim codes was first improved by including a detailed anatomic description of spinal ligaments, non-linear intervertebral disc, and lumbar facet joints, and coupling a proprioceptive feedback closed-loop control strategy with GTOs and muscle spindles modeling in Python codes. Then, the established neuromuscular model was multi-levelly validated from sub-segments to the whole model, from regular movements to dynamic responses to vibration loadings. Finally, the neuromuscular model was combined with a dynamic model of an armored vehicle to analyze occupant lumbar injury risk in vibration loadings due to different road conditions and traveling velocities. RESULT Based on a series of biomechanical indexes, including lumbar joint rotation angles, the lumbar intervertebral pressures, the displacement of the lumbar segments, and the lumbar muscle activities, the validation results show that the present neuromuscular model is available and feasible in predicting lumbar biomechanical responses in normal daily movement and vibration loading environments. Furthermore, the combined analysis with the armored vehicle model predicted similar lumbar injury risk to the experimental or epidemiologic studies. The preliminary analysis results also showed that road types and travelling velocities have substantial combined effects on lumbar muscle activities, and indicated that intervertebral joint pressure and muscle activity indexes can need to be jointly considered for lumbar injury risk evaluation. CONCLUSION In conclusion, the established neuromuscular model is an effective tool to evaluate vibration loading effects on injury risk of the human body and assist vehicle design vibration comfort by directly concerning the human body injury itself.
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Affiliation(s)
- Fuhao Mo
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Qingnan Meng
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Ke Wu
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Qiang Zhang
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Kui Li
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Zhikang Liao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
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Distefano F, Epasto G, Guglielmino E, Amata A, Mineo R. Subsidence of a partially porous titanium lumbar cage produced by electron beam melting technology. J Biomed Mater Res B Appl Biomater 2023; 111:590-598. [PMID: 36208414 PMCID: PMC10092161 DOI: 10.1002/jbm.b.35176] [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: 09/25/2021] [Revised: 07/30/2022] [Accepted: 09/25/2022] [Indexed: 01/21/2023]
Abstract
The lumbar intervertebral devices are widely used in the surgical treatment of lumbar diseases. The subsidence represents a serious clinical issue during the healing process, mainly when the interfaces between the implant and the vertebral bodies are not well designed. The aim of this study is the evaluation of subsidence risk for two different devices. The devices have the same shape, but one of them includes a filling micro lattice structure. The effect of the micro lattice structure on the subsidence behavior of the implant was evaluated by means of both experimental tests and finite element analyses. Compressive tests were carried out by using blocks made of grade 15 polyurethane, which simulate the vertebral bone. Non-linear, quasi-static finite element analyses were performed to simulate experimental and physiologic conditions. The experimental tests and the FE analyses showed that the subsidence risk is higher for the device without micro lattice structure, due to the smaller contact surface. Moreover, an overload in the central zone of the contact surface was detected in the same device and it could cause the implant failure. Thus, the micro lattice structure allows a homogenous pressure distribution at the implant-bone interface.
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Affiliation(s)
- Fabio Distefano
- Department of Engineering, University of Messina, Messina, Italy
| | - Gabriella Epasto
- Department of Engineering, University of Messina, Messina, Italy
| | | | - Aurora Amata
- ABR Srl, Zona Industriale Dittaino, Assoro, Italy
| | - Rosalia Mineo
- Mt Ortho srl, via fossa lupo sn Aci Sant'Antonio, Catania, Italy
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Pedersini R, Cosentini D, Rinaudo L, Zamparini M, Ulivieri FM, di Mauro P, Maffezzoni F, Monteverdi S, Vena W, Laini L, Amoroso V, Simoncini EL, Farina D, Mazziotti G, Berruti A. Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study. Bone Rep 2023; 18:101654. [PMID: 36700242 PMCID: PMC9868326 DOI: 10.1016/j.bonr.2023.101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed. Methods Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab. Results A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups. Conclusions Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.
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Key Words
- AI, aromatase inhibitor
- AIDen+, aromatase inhibitor with denosumab
- AIDen-, aromatase inhibitor without denosumab
- Aromatase inhibitors
- BMD, bone mineral density
- BMI, body-mass index
- BR, buckling ratio
- BSI, bone strain index
- Bone strain index
- CSA, cross-sectional area
- CSMI, cross-sectional moment of inertia
- DXA, dual-energy X-ray absorptiometry
- Dual-energy X-ray absorptiometry
- EBC, early breast cancer
- FS, femoral shaft
- HAL, hip axis length
- HR, hormone receptor
- HSA, Hip Structure Analysis
- IT, intertrochanteric
- NN, narrow neck
- NSA, neck shaft angle
- PS, propensity score
- ROC, receiver operator characteristic
- TBS, trabecular bone score
- VF, vertebral fracture
- Vertebral fractures
- Z, modulus
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Affiliation(s)
- Rebecca Pedersini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
- Corresponding author at: Oncologia Medica, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - Deborah Cosentini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
| | | | | | | | | | | | | | - Walter Vena
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Lara Laini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
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Coppock JA, Zimmer NE, Englander ZA, Danyluk ST, Kosinski AS, Spritzer CE, Goode AP, DeFrate LE. In vivo intervertebral disc mechanical deformation following a treadmill walking "stress test" is inversely related to T1rho relaxation time. Osteoarthritis Cartilage 2023; 31:126-133. [PMID: 36191831 PMCID: PMC10127291 DOI: 10.1016/j.joca.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/12/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the in vivo relationship between the mechanical response of intervertebral discs (IVDs) to dynamic activity and IVD biochemical composition assessed via T1rho relaxation imaging. DESIGN Eighteen asymptomatic participants with no history of low back pain (LBP), injury, or surgery underwent magnetic resonance (MR) imaging of their lumbar spine prior to and immediately following a treadmill walking "stress test." Anatomic (SPACE, FLASH) MR images were obtained pre- and post-exercise and utilized to measure IVD mechanical deformation. Quantitative (T1rho) imaging was performed pre-exercise to reflect IVD composition. Pre-exercise anatomic images were also utilized to assess IVD degenerative status based on the modified Pfirrmann scale. To quantify mechanical response, 3D surface models of the L1-L2-L5-S1 IVDs were created from manual segmentations of pre- and post-exercise anatomic images and utilized to assess changes in IVD height. IVD strain (%) was defined as change in IVD height normalized to pre-activity height. Linear mixed models were used to assess the relationships between IVD mechanical deformation (strain), composition (T1rho relaxation time), and degenerative status (Pfirrmann grade). RESULTS Increased compressive IVD strain was associated with lower T1rho relaxation times in the nucleus pulposus (NP) of the disc (βT1rho=5.07,CI:[1.52,7.77],Rmarg2=0.52,p=0.005). Thus, an inverse relationship between IVD strain and NP T1rho relaxation time was observed. CONCLUSION The in vivo mechanical response of the IVD to the "stress test" was sensitive to differences in NP composition. The results of this study suggest that quantification of in vivo IVD mechanical function and composition may provide insight into IVD health.
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Affiliation(s)
- J A Coppock
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - N E Zimmer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Z A Englander
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - S T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - A S Kosinski
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - C E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - A P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - L E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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14
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Hinnekens S, Bara J, Scheen P, Hidalgo B. Sex-related differences in motor control strategies during isometric contractions in the Sorensen test posture with different external loading. J Back Musculoskelet Rehabil 2022; 36:651-660. [PMID: 36530075 DOI: 10.3233/bmr-220058] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a sex-related difference in strength and endurance in trunk muscles: males have more strength while females have more endurance. OBJECTIVE Investigate sex-related differences in motor control strategies in back muscles during isometric contractions (IC) in the Sorensen test posture. METHODS Thirty-six healthy and young volunteers performed different tasks: three maximal voluntary contraction (MVC) tests recorded with a bio-feedback force sensor, and followed by five loaded IC (LIC) tests using bodyweight and loads of 0 to 8 kg with a 2-kg step. Surface electromyography was used to measure the activity of bilateral lumbar paravertebral (LP) and quadratus lumborum (QL) muscles. RESULTS Sex-related and load-related differences in EMG amplitudes were highlighted during LIC tests. Females showed significantly (p-value = 0.02) greater EMG amplitude for the highest load (8 kg) than males. Besides, significant differences between low (2 and 4 kg) and high (6 and 8 kg) loads for both LP and QL muscles and for both sexes were observed. Finally, for MVC tests, males produced significantly (p-value = 1.02e-4) greater strength during MVC tests (4.25 ± 1.37 N/kg vs 2.60 ± 0.78 N/kg). CONCLUSION The results were clinically relevant to bring attention to load strategy during rehabilitation, particularly in females who seemed to recruit the QL muscle more.
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Affiliation(s)
- Simon Hinnekens
- Mechatronic, Electrical Energy & Dynamic Systems (MEED), Institute of Mechanics, Materials & Civil Engineering (iMMC), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Julie Bara
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Pauline Scheen
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Benjamin Hidalgo
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium.,Neuromusculoskeletal Lab (NMSK), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, Département de Kinésithérapie, Brussels, Belgium
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15
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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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16
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Eremina G, Smolin A, Xie J, Syrkashev V. Development of a Computational Model of the Mechanical Behavior of the L4-L5 Lumbar Spine: Application to Disc Degeneration. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6684. [PMID: 36234026 PMCID: PMC9572952 DOI: 10.3390/ma15196684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Degenerative changes in the lumbar spine significantly reduce the quality of life of people. In order to fully understand the biomechanics of the affected spine, it is crucial to consider the biomechanical alterations caused by degeneration of the intervertebral disc (IVD). Therefore, this study is aimed at the development of a discrete element model of the mechanical behavior of the L4-L5 spinal motion segment, which covers all the degeneration grades from healthy IVD to its severe degeneration, and numerical study of the influence of the IVD degeneration on stress state and biomechanics of the spine. In order to analyze the effects of IVD degeneration on spine biomechanics, we simulated physiological loading conditions using compressive forces. The results of modeling showed that at the initial stages of degenerative changes, an increase in the amplitude and area of maximum compressive stresses in the disc is observed. At the late stages of disc degradation, a decrease in the value of intradiscal pressure and a shift in the maximum compressive stresses in the dorsal direction is observed. Such an influence of the degradation of the geometric and mechanical parameters of the tissues of the disc leads to the effect of bulging, which in turn leads to the formation of an intervertebral hernia.
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Affiliation(s)
- Galina Eremina
- Institute of Strength Physics and Materials Science, Siberian Branch of the Russian Academy of Sciences, Pr. Akademicheskii, 2/4, 634055 Tomsk, Russia
| | - Alexey Smolin
- Institute of Strength Physics and Materials Science, Siberian Branch of the Russian Academy of Sciences, Pr. Akademicheskii, 2/4, 634055 Tomsk, Russia
| | - Jing Xie
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Vladimir Syrkashev
- Department of General Medicine, Siberian State Medical University, Moskovsky Trakt, 2, 634050 Tomsk, Russia
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17
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Ulivieri FM, Rinaudo L, Messina C, Aliprandi A, Sconfienza LM, Sardanelli F, Cesana BM. Bone Strain Index: preliminary distributional characteristics in a population of women with normal bone mass, osteopenia and osteoporosis. Radiol Med 2022; 127:1151-1158. [DOI: 10.1007/s11547-022-01543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
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18
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Analysis of Healthcare Push and Pull Task via JACK: Predicted Joint Accuracy during Full-Body Simulation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The posture accuracy of full-body dynamic simulation has been successfully evaluated in JACK Siemens software via analyzing two common push and pull tasks. The difference in joint angles between the actual and predicted human movement directly results in the strength of force exposed on the lumbar spine. In this study, the individual factors, such as body height, body weight, trunk and hip flexion, shoulder movement, and muscle strength between genders, have shown a strong association with the adopted postures and exposed spinal forces during task performance. To provide robust ergonomics analysis, these individual variables should be adequately considered in software design for the long-term goal of injury prevention in diverse occupational workplaces.
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19
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Ulivieri FM, Rinaudo L. The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine. J Clin Med 2022; 11:jcm11092284. [PMID: 35566410 PMCID: PMC9102586 DOI: 10.3390/jcm11092284] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022] Open
Abstract
Bone strain Index (BSI) is an innovative index of bone strength that provides information about skeletal resistance to loads not considered by existing indexes (Bone Mineral Density, BMD. Trabecular Bone Score, TBS. Hip Structural Analysis, HSA. Hip Axis Length, HAL), and, thus, improves the predictability of fragility fractures in osteoporotic patients. This improved predictability of fracture facilitates the possibility of timely intervention with appropriate therapies to reduce the risk of fracture. The development of the index was the result of combining clinical, radiographical and construction-engineering skills. In fact, from a physical point of view, primary and secondary osteoporosis, leading to bone fracture, are determined by an impairment of the physical properties of bone strength: density, internal structure, deformation and fatigue. Dual X-ray absorptiometry (DXA) is the gold standard for assessing bone properties, and it allows measurement of the BMD, which is reduced mainly in primary osteoporosis, the structural texture TBS, which can be particularly degraded in secondary osteoporosis, and the bone geometry (HSA, HAL). The authors recently conceived and developed a new bone deformation index named Bone Strain Index (BSI) that assesses the resistance of bone to loads. If the skeletal structure is equated to engineering construction, these three indexes are all considered to determine the load resistance of the construct. In particular, BSI allows clinicians to detect critical information that BMD and TBS cannot explain, and this information is essential for an accurate definition of a patient’s fracture risk. The literature demonstrates that both lumbar and femoral BSI discriminate fractured osteoporotic people, that they predict the first fragility fracture, and further fragility fractures, monitor anabolic treatment efficacy and detect patients affected by secondary osteoporosis. BSI is a new diagnostic tool that offers a unique perspective to clinical medicine to identify patients affected by primary and, specially, secondary osteoporosis. This literature review illustrates BSI’s state of the art and its ratio in clinical medicine.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Centro per la Diagnosi e la Terapia dell’Osteoporosi, Casa di Cura La Madonnina, Via Quadronno 29, 20122 Milan, Italy
- Correspondence:
| | - Luca Rinaudo
- Tecnologie Avanzate T.A. Srl, Lungo Dora Voghera 36, 10153 Torino, Italy;
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20
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Yang M, Xiang D, Wang S, Liu W. In Vitro Studies for Investigating Creep of Intervertebral Discs under Axial Compression: A Review of Testing Environment and Results. MATERIALS 2022; 15:ma15072500. [PMID: 35407833 PMCID: PMC9000064 DOI: 10.3390/ma15072500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/06/2023]
Abstract
Creep responses of intervertebral discs (IVDs) are essential for spinal biomechanics clarification. Yet, there still lacks a well-recognized investigation protocol for this phenomenon. Current work aims at providing researchers with an overview of the in vitro creep tests reported by previous studies, specifically specimen species, testing environment, loading regimes and major results, based on which a preliminary consensus that may guide future creep studies is proposed. Specimens used in creep studies can be simplified as a “bone–disc–bone” structure where three mathematical models can be adopted for describing IVDs’ responses. The preload of 10–50 N for 30 min or three cycles followed by 4 h-creep under constant compression is recommended for ex vivo simulation of physiological condition of long-time sitting or lying. It is worth noticing that species of specimens, environment temperature and humidity all have influences on biomechanical behaviors, and thus are summarized and compared through the literature review. All factors should be carefully set according to a guideline before tests are conducted to urge comparable results across studies. To this end, this review also provides a guideline, as mentioned before, and specific steps that might facilitate the community of biomechanics to obtain more repeatable and comparable results from both natural specimens and novel biomaterials.
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Affiliation(s)
- Mengying Yang
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China;
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China;
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Dingding Xiang
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China;
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Song Wang
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (S.W.); (W.L.)
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China;
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (S.W.); (W.L.)
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21
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Loenen ACY, Noailly J, Ito K, Willems PC, Arts JJ, van Rietbergen B. Patient-Specific Variations in Local Strain Patterns on the Surface of a Trussed Titanium Interbody Cage. Front Bioeng Biotechnol 2022; 9:750246. [PMID: 35087797 PMCID: PMC8786731 DOI: 10.3389/fbioe.2021.750246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: 3D printed trussed titanium interbody cages may deliver bone stimulating mechanobiological strains to cells attached at their surface. The exact size and distribution of these strains may depend on patient-specific factors, but the influence of these factors remains unknown. Therefore, this study aimed to determine patient-specific variations in local strain patterns on the surface of a trussed titanium interbody fusion cage.Materials and Methods: Four patients eligible for spinal fusion surgery with the same cage size were selected from a larger database. For these cases, patient-specific finite element models of the lumbar spine including the same trussed titanium cage were made. Functional dynamics of the non-operated lumbar spinal segments, as well as local cage strains and caudal endplate stresses at the operated segment, were evaluated under physiological extension/flexion movement of the lumbar spine.Results: All patient-specific models revealed physiologically realistic functional dynamics of the operated spine. In all patients, approximately 30% of the total cage surface experienced strain values relevant for preserving bone homeostasis and stimulating bone formation. Mean caudal endplate contact pressures varied up to 10 MPa. Both surface strains and endplate contact pressures varied more between loading conditions than between patients.Conclusions: This study demonstrates the applicability of patient-specific finite element models to quantify the impact of patient-specific factors such as bone density, degenerative state of the spine, and spinal curvature on interbody cage loading. In the future, the same framework might be further developed in order to establish a pipeline for interbody cage design optimizations.
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Affiliation(s)
- Arjan C. Y. Loenen
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jérôme Noailly
- Department of Information and Communication Technologies, BCN MedTech, Universitat Pompeu Fabra, Barcelona, Spain
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Paul C. Willems
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jacobus J. Arts
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Bert van Rietbergen
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- *Correspondence: Bert van Rietbergen,
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Ulivieri FM, Rinaudo L, Messina C, Piodi LP, Capra D, Lupi B, Meneguzzo C, Sconfienza LM, Sardanelli F, Giustina A, Grossi E. Bone Strain Index predicts fragility fracture in osteoporotic women: an artificial intelligence-based study. Eur Radiol Exp 2021; 5:47. [PMID: 34664136 PMCID: PMC8523735 DOI: 10.1186/s41747-021-00242-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We applied an artificial intelligence-based model to predict fragility fractures in postmenopausal women, using different dual-energy x-ray absorptiometry (DXA) parameters. METHODS One hundred seventy-four postmenopausal women without vertebral fractures (VFs) at baseline (mean age 66.3 ± 9.8) were retrospectively evaluated. Data has been collected from September 2010 to August 2018. All subjects performed a spine x-ray to assess VFs, together with lumbar and femoral DXA for bone mineral density (BMD) and the bone strain index (BSI) evaluation. Follow-up exams were performed after 3.34 ± 1.91 years. Considering the occurrence of new VFs at follow-up, two groups were created: fractured versus not-fractured. We applied an artificial neural network (ANN) analysis with a predictive tool (TWIST system) to select relevant input data from a list of 13 variables including BMD and BSI. A semantic connectivity map was built to analyse the connections among variables within the groups. For group comparisons, an independent-samples t-test was used; variables were expressed as mean ± standard deviation. RESULTS For each patient, we evaluated a total of n = 6 exams. At follow-up, n = 69 (39.6%) women developed a VF. ANNs reached a predictive accuracy of 79.56% within the training testing procedure, with a sensitivity of 80.93% and a specificity of 78.18%. The semantic connectivity map showed that a low BSI at the total femur is connected to the absence of VFs. CONCLUSION We found a high performance of ANN analysis in predicting the occurrence of VFs. Femoral BSI appears as a useful DXA index to identify patients at lower risk for lumbar VFs.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
- Current address: Università Vita-Salute San Raffaele, Via Olgettina, 58 20132, Milan, Italy
| | - Luca Rinaudo
- BSE TECHNOLOGIC S.r.l., Lungo Dora Voghera, 34/36A, 10153, Turin, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy
| | - Luca Petruccio Piodi
- Former: Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Davide Capra
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20133, Milan, Italy
| | - Barbara Lupi
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Camilla Meneguzzo
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20133, Milan, Italy.
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20133, Milan, Italy
- IRCCS Policlinico San Donato, Via Rodolfo Morandi, 30, 20097, San Donato Milanese, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences (IEMS) San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Via Olgettina Milano, 20, 20132, Milan, MI, Italy
| | - Enzo Grossi
- Villa Santa Maria Foundation, Via IV Novembre, 15, 22038, Tavernerio, Como, Italy
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23
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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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24
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Coppock JA, Danyluk ST, Englander ZA, Spritzer CE, Goode AP, DeFrate LE. Increasing BMI increases lumbar intervertebral disc deformation following a treadmill walking stress test. J Biomech 2021; 121:110392. [PMID: 33819699 DOI: 10.1016/j.jbiomech.2021.110392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
High body mass index (BMI) and obesity have been implicated as risk factors for lumbar degenerative disc disease and low back pain. Despite this, there is limited in vivo data to quantify how obesity influences the mechanical function of intervertebral discs (IVD) in response to activities of daily living. Recently, our lab has developed methodologies to non-invasively measure in vivo IVD deformation resulting from activities of daily living using magnetic resonance (MR) imaging and solid modeling techniques. This pilot study expands on these methodologies to assess how BMI influences IVD deformation following treadmill walking in eight asymptomatic individuals. Ordinary least squares regression analyses revealed a statistically significant relationship between BMI and compressive deformation (strain (%)) in the L5-S1 IVD (R2 = 0.61, p < 0.05). This relationship was weaker in the L3-L4 (R2 = 0.28, p > 0.05) and L4-L5 IVDs (R2 = 0.28, p > 0.05). Importantly, no relationship between pre-exercise disc height and BMI was identified (p > 0.05). Therefore, the results of this study suggest that BMI may alter the mechanical response of lumbar spine IVDs, particularly at the L5-S1 level. Furthermore, the observed relationship between increased BMI and IVD compressive deformation, in the absence of a detected relationship between pre-exercise disc height and BMI, suggests that changes in IVD mechanical function may be more sensitive to alterations in disc health than static clinical imaging alone. This finding highlights the importance of quantifying disc mechanical function when examining the relationship between BMI and IVD degeneration.
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Affiliation(s)
- James A Coppock
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Stephanie T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, United States
| | - Zoë A Englander
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, United States
| | - Adam P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Duke Clinical Research Institute, Duke University School of Medicine, United States; Department of Population Health Sciences, United States
| | - Louis E DeFrate
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States; Department of Mechanical Engineering and Materials Science, Duke University, United States.
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25
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Ulivieri FM, Rinaudo L. Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index. Front Med (Lausanne) 2021; 7:590139. [PMID: 33521014 PMCID: PMC7843921 DOI: 10.3389/fmed.2020.590139] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
For a proper assessment of osteoporotic fragility fracture prediction, all aspects regarding bone mineral density, bone texture, geometry and information about strength are necessary, particularly in endocrinological and rheumatological diseases, where bone quality impairment is relevant. Data regarding bone quantity (density) and, partially, bone quality (structure and geometry) are obtained by the gold standard method of dual X-ray absorptiometry (DXA). Data about bone strength are not yet readily available. To evaluate bone resistance to strain, a new DXA-derived index based on the Finite Element Analysis (FEA) of a greyscale of density distribution measured on spine and femoral scan, namely Bone Strain Index (BSI), has recently been developed. Bone Strain Index includes local information on density distribution, bone geometry and loadings and it differs from bone mineral density (BMD) and other variables of bone quality like trabecular bone score (TBS), which are all based on the quantification of bone mass and distribution averaged over the scanned region. This state of the art review illustrates the methodology of BSI calculation, the findings of its in reproducibility and the preliminary data about its capability to predict fragility fracture and to monitor the follow up of the pharmacological treatment for osteoporosis.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Unità Operativa (UO) Medicina Nucleare, Milan, Italy
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26
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Ulivieri FM, Rinaudo L, Piodi LP, Messina C, Sconfienza LM, Sardanelli F, Guglielmi G, Grossi E. Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis. PLoS One 2021; 16:e0245967. [PMID: 33556061 PMCID: PMC7870050 DOI: 10.1371/journal.pone.0245967] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteoporosis is an asymptomatic disease of high prevalence and incidence, leading to bone fractures burdened by high mortality and disability, mainly when several subsequent fractures occur. A fragility fracture predictive model, Artificial Intelligence-based, to identify dual X-ray absorptiometry (DXA) variables able to characterise those patients who are prone to further fractures called Bone Strain Index, was evaluated in this study. METHODS In a prospective, longitudinal, multicentric study 172 female outpatients with at least one vertebral fracture at the first observation were enrolled. They performed a spine X-ray to calculate spine deformity index (SDI) and a lumbar and femoral DXA scan to assess bone mineral density (BMD) and bone strain index (BSI) at baseline and after a follow-up period of 3 years in average. At the end of the follow-up, 93 women developed a further vertebral fracture. The further vertebral fracture was considered as one unit increase of SDI. We assessed the predictive capacity of supervised Artificial Neural Networks (ANNs) to distinguish women who developed a further fracture from those without it, and to detect those variables providing the maximal amount of relevant information to discriminate the two groups. ANNs choose appropriate input data automatically (TWIST-system, Training With Input Selection and Testing). Moreover, we built a semantic connectivity map usingthe Auto Contractive Map to provide further insights about the convoluted connections between the osteoporotic variables under consideration and the two scenarios (further fracture vs no further fracture). RESULTS TWIST system selected 5 out of 13 available variables: age, menopause age, BMI, FTot BMC, FTot BSI. With training testing procedure, ANNs reached predictive accuracy of 79.36%, with a sensitivity of 75% and a specificity of 83.72%. The semantic connectivity map highlighted the role of BSI in predicting the risk of a further fracture. CONCLUSIONS Artificial Intelligence is a useful method to analyse a complex system like that regarding osteoporosis, able to identify patients prone to a further fragility fracture. BSI appears to be a useful DXA index in identifying those patients who are at risk of further vertebral fractures.
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Affiliation(s)
- Fabio Massimo Ulivieri
- UO Medicina Nucleare, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera, Torino, Italy
| | | | - Carmelo Messina
- UO Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Diagnostica per Immagini e Radioterapia, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- * E-mail:
| | - Luca Maria Sconfienza
- UO Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Diagnostica per Immagini e Radioterapia, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Francesco Sardanelli
- Diagnostica per Immagini e Radioterapia, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- Radiologia e Diagnostica per Immagini, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese (MI), Italy
| | - Giuseppe Guglielmi
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia, Viale Luigi Pinto, Foggia, Italy
| | - Enzo Grossi
- Villa Santa Maria Foundation, Tavernerio (CO), Italy
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Comparison of different lifting analysis tools in estimating lower spinal loads - Evaluation of NIOSH criterion. J Biomech 2020; 112:110024. [PMID: 32961423 DOI: 10.1016/j.jbiomech.2020.110024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
Excessive loads on the human spine is recognized as a risk factor for back injuries/pain. Various lifting analysis tools such as musculoskeletal models, regression equations and NIOSH (National Institute for Occupational Safety and Health) lifting equation (NLE) have been proposed to evaluate and mitigate associated risks during manual material handling activities. Present study aims to compare predicted spinal loads from 5 different lifting analysis tools as well as to critically evaluate the NIOSH recommended weight limit (RWL). Spinal loads were estimated under different symmetric/asymmetric lifting tasks in which hand-load mass at each task was set based on RWL from NLE. Estimated intradiscal pressures (IDPs) of various tools were also compared with in vivo measurements. We compared RWL by NLE versus our estimations of RWL calculated from our regression equations using biomechanical criteria (compression <3400 N with/without shear <1000, 1250 or 1500 N). Our regression equations followed by OpenSim, AnyBody, simple polynomial and 3DSSPP satisfactorily predicted L4-L5 IDPs. Lifting analysis tools estimated comparable spinal compression forces (mean Pearson's r = 0.80; standard deviation of relative difference = 26%) while in shear, differences were greater (mean Pearson's r = 0.68; standard deviation of relative difference = 56%). NLE estimations of RWL were conservative in comparison with our estimations for lean individuals (BMI < 25 kg/m2) when compression <3400 N and shear <1250 N were considered as the biomechanical criteria. For heavier individuals, however, NLE estimations of RWL generated spinal compression >3400 N (NIOSH biomechanical safety threshold) as well as shear >1000 N. Although RWLs estimated by NLE was body weight independent, body weight substantially altered RWLs estimated from our regression equations. For improved estimation of the risk of injury, more accurate failure criteria for spinal segments are essential.
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28
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Marker-less versus marker-based driven musculoskeletal models of the spine during static load-handling activities. J Biomech 2020; 112:110043. [DOI: 10.1016/j.jbiomech.2020.110043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
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Jain P, Khan MR. Selection of suitable pedicle screw for degenerated cortical and cancellous bone of human lumbar spine: A finite element study. Int J Artif Organs 2020; 44:361-366. [PMID: 33045876 DOI: 10.1177/0391398820964483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pedicular arthrodesis is the traditional procedure in terms of increase in the biomechanical stability with higher fixation rate. The current work aims to identify the effect of three spinal pedicle screws considering cortical and cancellous degeneracy condition. Lumbar section L2-L3 is utilized and various load and moment conditions were applied to depict the various biomechanical parameters for selection of suitable screw. Three dimensional model is considered in finite element analysis to identify the various responses of pedicle screw at bone screw juncture. Computed tomography (CT) images of a healthy male were considered to generate the finite element vertebral model. Generated intact model was further utilized to develop the other implanted models of degenerated cortical and cancellous bone models. The three fused instrumented models with different cortical and cancellous degeneracy conditions were analyzed in finite element analysis. The results were obtained as stress pattern at bone screw boundary and intervertebral disc stress. FE simulated results represents significant changes in the von Mises stress due to various load and moment conditions on degenerated bones during different body movement conditions. Results have shown that among all pedicle screws, the 6.0 mm diameter screw reflects very less stress values at the juncture. Multiple results on biomechanical aspects obtained during the FE study can be considered to design a new stabilization device and may be helpful to plan surgery of critical sections.
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Affiliation(s)
- Pushpdant Jain
- School of Mechanical Engineering, VIT Bhopal University, Madhya Pradesh, India
| | - Mohammed Rajik Khan
- Department of Industrial Design, National Institute of Technology Rourkela, Odisha, India
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30
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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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31
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Nonlinear stress-dependent recovery behavior of the intervertebral disc. J Mech Behav Biomed Mater 2020; 110:103881. [PMID: 32957189 DOI: 10.1016/j.jmbbm.2020.103881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/22/2020] [Accepted: 05/23/2020] [Indexed: 12/17/2022]
Abstract
The intervertebral disc exhibits complex mechanics due to its heterogeneous structure, inherent viscoelasticity, and interstitial fluid-matrix interactions. Sufficient fluid flow into the disc during low loading periods is important for maintaining mechanics and nutrient transport. However, there is a lack of knowledge on the effect of loading magnitude on time-dependent recovery behavior and the relative contribution of multiple recovery mechanisms during recovery. In most studies that have evaluated disc recovery behavior, a single load condition has been considered, making it difficult to compare findings across studies. Hence, the objective of this study was to quantify unloaded disc recovery behavior after compressive creep loading under a wide range of physiologically relevant stresses (0.2-2 MPa). First, the repeatability of disc recovery behavior was assessed. Once repeatable recovery behavior was confirmed, each motion segment was subject to three cycles of creep-recovery loading, where each cycle consisted of a 24-h creep at a pre-assigned load (100, 200, 300, 600, 900, or 1200 N), followed by an 18-h recovery period at a nominal load (10 N). Results showed that disc recovery behavior was strongly influenced by the magnitude of loading. The magnitude of instantaneous and time-dependent recovery deformations increased nonlinearly with an increase in compressive stress during creep. In conclusion, this study highlights that elastic deformation, intrinsic viscoelasticity, and poroelasticity all have substantial contributions to disc height recovery during low loading periods. However, their relative contributions to disc height recovery largely depend on the magnitude of loading. While loading history does not influence the contribution of the short-term recovery, the contribution of long-term recovery is highly sensitive to loading magnitude.
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Ulivieri FM, Piodi LP, Rinaudo L, Scanagatta P, Cesana BM. Bone strain index in the prediction of vertebral fragility refracture. Eur Radiol Exp 2020; 4:23. [PMID: 32274595 PMCID: PMC7145882 DOI: 10.1186/s41747-020-00151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
Dual-energy x-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. We present the preliminary results about the BSI ability to predict a refracture in patients with fragility fractures. A total of 143 consecutive fractured patients with primary osteoporosis (121 females) performed a spine x-ray examination for the calculation of spine deformity index (SDI) and a DXA densitometry for BMD, TBS, and BSI at basal time and in the follow-up. A refracture was considered as a one-unit increase in SDI. For each unit increase of the investigated indexes, the hazard ratio of refracture, 95% confidence interval, p value, and proportionality test p value were for BSI 1.201, 0.982−1.468, 0.074, and 0.218; for lumbar BMD 0.231, 0.028−1.877, 0.170, and 0.305; and for TBS 0.034, 0.001−2.579, 0.126, and 0.518, respectively. BSI was the index predictive of refracture nearest to statistical significance. If confirmed, it may be used for a better risk assessment of osteoporotic patients.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UO Medicina Nucleare, Via Francesco Sforza, 35, 20122, Milano, Italy.
| | - Luca Petruccio Piodi
- Formerly: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UO Gastroenterologia ed Endoscopia Digestiva, Via Francesco Sforza, 35, 20122, Milano, Italy
| | - Luca Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera, 34/36A, 10153, Torino, Italy
| | - Paolo Scanagatta
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milano, Italy
| | - Bruno Mario Cesana
- Unità di Statistica Medica, Biometria e, Bioinformatica "Giulio A. Maccacaro", Dipartimento di Scienze Cliniche e Salute della Comunità, Università degli Studi di Milano, Via Vanzetti 5, 20100, Milano, Italy
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33
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Messina C, Piodi LP, Grossi E, Eller-Vainicher C, Bianchi ML, Ortolani S, Di Stefano M, Rinaudo L, Sconfienza LM, Ulivieri FM. Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients. PLoS One 2020; 15:e0229820. [PMID: 32160208 PMCID: PMC7065795 DOI: 10.1371/journal.pone.0229820] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/16/2020] [Indexed: 02/05/2023] Open
Abstract
Teriparatide is a bone-forming therapy for osteoporosis that increases bone quantity and texture, with uncertain action on bone geometry. No data are available regarding its influence on bone strain. To investigate teriparatide action on parameters of bone quantity and quality and on Bone Strain Index (BSI), also derived from DXA lumbar scan, based on the mathematical model finite element method. Forty osteoporotic patients with fractures were studied before and after two years of daily subcutaneous 20 mcg of teriparatide with dual X-ray photon absorptiometry to assess bone mineral density (BMD), hip structural analysis (HSA), trabecular bone score (TBS), BSI. Spine deformity index (SDI) was calculated from spine X-ray. Shapiro-Wilks, Wilcoxon and Student's t test were used for classical statistical analysis. Auto Contractive Map was used for Artificial Neural Network Analysis (ANNs). In the entire population, the ameliorations after therapy regarded BSI (-13.9%), TBS (5.08%), BMD (8.36%). HSA parameters of femoral shaft showed a worsening. Dividing patients into responders (BMD increase >10%) and non-responders, the first presented TBS and BSI ameliorations (11.87% and -25.46%, respectively). Non-responders presented an amelioration of BSI only, but less than in the other subgroup (-6.57%). ANNs maps reflect the mentioned bone quality improvements. Teriparatide appears to ameliorate not only BMD and TBS, but also BSI, suggesting an increase of bone strength that may explain the known reduction in fracture risk, not simply justified by BMD increase. BSI appears to be a sensitive index of TPD effect. ANNs appears to be a valid tool to investigate complex clinical systems.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Luca Petruccio Piodi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, UO Gastroenterologia ed Endoscopia Digestiva, Milano, Italy
| | - Enzo Grossi
- Villa Santa Maria Foundation, Centro di Riabilitazioni Neuropsichiatrica, UO Autismo, Tavernerio (CO), Italy
| | | | - Maria Luisa Bianchi
- IRCCS Istituto Auxologico, UO Endocrinologia e Malattie del Metabolismo, Milano, Italy
| | - Sergio Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia e Malattie del Metabolismo, Milano, Italy
| | - Marco Di Stefano
- A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Corso Bramante, Torino, Italy
| | - Luca Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera, Torino, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Fabio Massimo Ulivieri
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, UO Medicina Nucleare, Milano, Italy
- * E-mail:
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Colombo C, Libonati F, Rinaudo L, Bellazzi M, Ulivieri FM, Vergani L. A new finite element based parameter to predict bone fracture. PLoS One 2019; 14:e0225905. [PMID: 31805121 PMCID: PMC6894848 DOI: 10.1371/journal.pone.0225905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022] Open
Abstract
Dual Energy X-Ray Absorptiometry (DXA) is currently the most widely adopted non-invasive clinical technique to assess bone mineral density and bone mineral content in human research and represents the primary tool for the diagnosis of osteoporosis. DXA measures areal bone mineral density, BMD, which does not account for the three-dimensional structure of the vertebrae and for the distribution of bone mass. The result is that longitudinal DXA can only predict about 70% of vertebral fractures. This study proposes a complementary tool, based on Finite Element (FE) models, to improve the DXA accuracy. Bone is simulated as elastic and inhomogeneous material, with stiffness distribution derived from DXA greyscale images of density. The numerical procedure simulates a compressive load on each vertebra to evaluate the local minimum principal strain values. From these values, both the local average and the maximum strains are computed over the cross sections and along the height of the analysed bone region, to provide a parameter, named Strain Index of Bone (SIB), which could be considered as a bone fragility index. The procedure is initially validated on 33 cylindrical trabecular bone samples obtained from porcine lumbar vertebrae, experimentally tested under static compressive loading. Comparing the experimental mechanical parameters with the SIB, we could find a higher correlation of the ultimate stress, σULT, with the SIB values (R2adj = 0.63) than that observed with the conventional DXA-based clinical parameters, i.e. Bone Mineral Density, BMD (R2adj = 0.34) and Trabecular Bone Score, TBS (R2adj = -0.03). The paper finally presents a few case studies of numerical simulations carried out on human lumbar vertebrae. If our results are confirmed in prospective studies, SIB could be used-together with BMD and TBS-to improve the fracture risk assessment and support the clinical decision to assume specific drugs for metabolic bone diseases.
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Affiliation(s)
- Chiara Colombo
- Department of Mechanical Engineering, Politecnico di Milano, Milano, Italy
| | - Flavia Libonati
- Department of Mechanical Engineering, Politecnico di Milano, Milano, Italy
| | - Luca Rinaudo
- TECHNOLOGIC S.r.l. Hologic Italia, Lungo Dora Voghera, Torino, Italy
| | - Martina Bellazzi
- Department of Mechanical Engineering, Politecnico di Milano, Milano, Italy
| | - Fabio Massimo Ulivieri
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Nuclear Medicine-Bone Metabolic Unit, Milano, Italy
- * E-mail:
| | - Laura Vergani
- Department of Mechanical Engineering, Politecnico di Milano, Milano, Italy
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Epasto G, Distefano F, Mineo R, Guglielmino E. Subject-specific finite element analysis of a lumbar cage produced by electron beam melting. Med Biol Eng Comput 2019; 57:2771-2781. [PMID: 31741290 DOI: 10.1007/s11517-019-02078-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/07/2019] [Indexed: 01/04/2023]
Abstract
The aim of this study was the analysis of the mechanical behaviour of a partially porous lumbar custom-made cage by means of a subject-specific finite element analysis (FEA). The cage, made of Ti6Al4V ELI alloy, was produced via electron beam melting (EBM) process and surgically implanted in a female subject, 50 years old. The novelty of this study was the customized design of the cage and of its internal structure, which is impossible to obtain with the traditional production techniques. The 3D model of the spine was obtained from the computed tomography (CT) of the patient. Moreover, high-resolution industrial CT was also used to reconstruct a 3D model of the cage, with its real (as-produced) features, such as superficial roughness, morphology of the bulk and of the porous structure. The workflow was divided in several steps: the main finite element analyses were non-linear and quasi-static regarding: the rhombic dodecahedron (RD) unit cell of the porous structure; the device; the whole L4-L5 motion segment with the implanted cage. Stress distribution was calculated under compression load for all models. For the RD unit cell, the maximum stress appeared at the connected cross nodes, where notch effect was present. For the cage subjected to a load of 1 kN, the porous structure did not present any functional failure. For the whole biomechanical system subjected to a physiological load of 360 N, the calculated stress in the bone was smaller than its yield strength value. On the axial view, a zone with higher compressive stresses was present on the L5 vertebral body. This was due to the contact stress between the cage and the vertebra. From the comparison between FE results and the CT images of the spine, bone remodelling was supposed, with the formation of new bone. Graphical abstract Workflow showing the phases of the research.
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Affiliation(s)
- Gabriella Epasto
- Department of Engineering, University of Messina, Contrada di Dio, Vill. Sant'Agata, 98166, Messina, Italy.
| | - Fabio Distefano
- Department of Engineering, University of Messina, Contrada di Dio, Vill. Sant'Agata, 98166, Messina, Italy
| | - Rosalia Mineo
- Mt Ortho srl, via fossa lupo sn Aci Sant'Antonio, 95025, Catania, Italy
| | - Eugenio Guglielmino
- Department of Engineering, University of Messina, Contrada di Dio, Vill. Sant'Agata, 98166, Messina, Italy
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Behjati M, Arjmand N. Biomechanical Assessment of the NIOSH Lifting Equation in Asymmetric Load-Handling Activities Using a Detailed Musculoskeletal Model. HUMAN FACTORS 2019; 61:191-202. [PMID: 30222936 DOI: 10.1177/0018720818795038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess adequacy of the National Institute for Occupational Safety and Health (NIOSH) Lifting Equation (NLE) in controlling lumbar spine loads below their recommended action limits during asymmetric load-handling activities using a detailed musculoskeletal model, that is, the AnyBody Modeling System. BACKGROUND The NIOSH committee employed simplistic biomechanical models for the calculation of the spine compressive loads with no estimates of the shear loads. It is therefore unknown whether the NLE would adequately control lumbar compression and shear loads below their recommended action limits during asymmetric load-handling activities. METHOD Twenty-four static stoop lifting tasks at different load asymmetry angles, heights, and horizontal distances were performed by one normal-weight (70 kg) and one obese (93 kg) individual. For each task, the recommended weight limit computed by the NLE and body segment angles measured by a video-camera system (VICON) were prescribed in the participant-specific models developed in the AnyBody Modeling System that estimated spinal loads. RESULTS For both individuals, the NLE adequately controlled L5-S1 loads below their recommended action limits for all activities performed in upright postures. Both individuals, however, experienced compressive and/or shear L5-S1 loads beyond the recommended action limits when lifting was performed near the floor with large load asymmetry. CONCLUSION The NLE failed to control spinal loads below the recommended limits during asymmetric lifting tasks performed near the floor. APPLICATION The NLE should be used with caution for extreme tasks involving load handling near the floor with large load asymmetry.
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Piovesan A, Berti F, Villa T, Pennati G, La Barbera L. Computational and Experimental Fatigue Analysis of Contoured Spinal Rods. J Biomech Eng 2019; 141:2724665. [DOI: 10.1115/1.4042767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Indexed: 02/06/2023]
Abstract
Posterior fixation with contoured rods is an established methodology for the treatment of spinal deformities. Both uniform industrial preforming and intraoperative contouring introduce tensile and compressive plastic deformations, respectively, at the concave and at the convex sides of the rod. The purpose of this study is to develop a validated numerical framework capable of predicting how the fatigue behavior of contoured spinal rods is affected by residual stresses when loaded in lordotic and kyphotic configurations. Established finite element models (FEM) describing static contouring were implemented as a preliminary simulation step and were followed by subsequent cyclical loading steps. The equivalent Sines stress distribution predicted in each configuration was compared to that in straight rods (SR) and related to the corresponding experimental number of cycles to failure. In the straight configuration, the maximum equivalent stress (441 MPa) exceeds the limit curve, as confirmed by experimental rod breakage after around 1.9 × 105 loading cycles. The stresses further increased in the lordotic configuration, where failure was reached within 2.4 × 104 cycles. The maximum equivalent stress was below the limit curve for the kyphotic configuration (640 MPa), for which a run-out of 106 cycles was reached. Microscopy inspection confirmed agreement between numerical predictions and experimental fatigue crack location. The contouring technique (uniform contouring (UC) or French bender (FB)) was not related to any statistically significant difference. Our study demonstrates the key role of residual stresses in altering the mean stress component, superposing to the tensile cyclic load, potentially explaining the higher failure rate of lordotic rods compared to kyphotic ones.
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Affiliation(s)
- Agnese Piovesan
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy e-mail:
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Corbeil P, Plamondon A, Handrigan G, Vallée-Marcotte J, Laurendeau S, Ten Have J, Manzerolle N. Biomechanical analysis of manual material handling movement in healthy weight and obese workers. APPLIED ERGONOMICS 2019; 74:124-133. [PMID: 30487091 DOI: 10.1016/j.apergo.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/29/2018] [Accepted: 08/18/2018] [Indexed: 06/09/2023]
Abstract
The risk of back injury during work remains high today for manual materials handler. The purpose of this study is to identify the potential presence of compensatory strategies in obese and non-obese handlers and evaluate the impact these strategies have on trunk kinematics and kinetics. The biomechanical and ergonomic impacts in 17 obese and 20 healthy-weight handlers were evaluated. The task studied consisted in moving boxes from a conveyor to a hand trolley and back. The results show that the anthropometric characteristics of obese handlers are linked to a significant increase in peak lumbar loading during lifting and lowering of boxes. Few postural differences between the two groups were observed. These results suggest that the excess weight of an obese worker has a significant added effect on the musculoskeletal structures of the back, which exposes obese handlers to a higher risk of developing a musculoskeletal disorder during load handling.
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Affiliation(s)
- Philippe Corbeil
- Department of Kinesiology, Laval University, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
| | - André Plamondon
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail (IRSST), Montreal, Canada
| | - Grant Handrigan
- School of Kinesiology and Leisure Studies, Université de Moncton, Moncton, NB, Canada
| | | | - Simon Laurendeau
- Department of Kinesiology, Laval University, Quebec City, QC, Canada
| | - Jasmin Ten Have
- Department of Kinesiology, Laval University, Quebec City, QC, Canada
| | - Nancy Manzerolle
- Department of Kinesiology, Laval University, Quebec City, QC, Canada
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Comparison of patient-specific computational models vs. clinical follow-up, for adjacent segment disc degeneration and bone remodelling after spinal fusion. PLoS One 2018; 13:e0200899. [PMID: 30161138 PMCID: PMC6116979 DOI: 10.1371/journal.pone.0200899] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/04/2018] [Indexed: 11/21/2022] Open
Abstract
Spinal fusion is a standard surgical treatment for patients suffering from low back pain attributed to disc degeneration. However, results are somewhat variable and unpredictable. With fusion the kinematic behaviour of the spine is altered. Fusion and/or stabilizing implants carrying considerable load and prevent rotation of the fused segments. Associated with these changes, a risk for accelerated disc degeneration at the adjacent levels to fusion has been demonstrated. However, there is yet no method to predict the effect of fusion surgery on the adjacent tissue levels, i.e. bone and disc. The aim of this study was to develop a coupled and patient-specific mechanoregulated model to predict disc generation and changes in bone density after spinal fusion and to validate the results relative to patient follow-up data. To do so, a multiscale disc mechanoregulation adaptation framework was developed and coupled with a previously developed bone remodelling algorithm. This made it possible to determine extra cellular matrix changes in the intervertebral disc and bone density changes simultaneously based on changes in loading due to fusion surgery. It was shown that for 10 cases the predicted change in bone density and degeneration grade conforms reasonable well to clinical follow-up data. This approach helps us to understand the effect of surgical intervention on the adjacent tissue remodelling. Thereby, providing the first insight for a spine surgeon as to which patient could potentially be treated successfully by spinal fusion and in which patient has a high risk for adjacent tissue changes.
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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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Zanjani-Pour S, Meakin JR, Breen A, Breen A. Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models. J Biomech 2018; 70:134-139. [DOI: 10.1016/j.jbiomech.2017.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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Akhavanfar M, Kazemi H, Eskandari A, Arjmand N. Obesity and spinal loads; a combined MR imaging and subject-specific modeling investigation. J Biomech 2018; 70:102-112. [DOI: 10.1016/j.jbiomech.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
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Senteler M, Aiyangar A, Weisse B, Farshad M, Snedeker JG. Sensitivity of intervertebral joint forces to center of rotation location and trends along its migration path. J Biomech 2018; 70:140-148. [DOI: 10.1016/j.jbiomech.2017.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/04/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022]
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Ameer MAM, Abdel-Aziem AA. Relationship between anthropometric measures and sagittal spinal curvatures in adult male handball players. HUMAN MOVEMENT 2017. [DOI: 10.1515/humo-2017-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPurpose. Increasing anthropometric measures bring considerable spinal loads during sports practice, which inversely affects the adaptation abilities of the spinal structures; this in turn influences the spinal curvatures. The study was conducted to explore the relationship between anthropometric measures and sagittal spinal curvatures in handball players. Method. The total of 83 male handball players were divided into 2 groups, depending on their body height: group 1 (age, 23.62 ± 2.07 years) consisted of 40 handball players with height above average, group 2 (age, 24.63 ± 2.58 years) consisted of 43 handball players with height below average. The thoracic and lumbar curvatures and trunk height were measured with the Formetric III 4D spine and posture analysis system. Results. The thoracic kyphosis of group 1 was significantly higher than that of group 2 (p = 0.038), without a significant difference in lumbar lordosis (p = 0.312), and significant difference in the coefficient of compensation between thoracic kyphosis and lumbar lordosis (p = 0.026). Group 1 showed strong positive correlation between body height and kyphotic angle (r = 0.897), and moderate positive correlation with lordosis angle (r = 0.496). In group 2, there was weak positive correlation with kyphotic angle (r = 0.381), and weak negative correlation with lumbar lordosis angle (r = -0.355). Conclusions. Increasing body height of handball players is associated with bigger kyphotic and lordotic angles. Owing to frequent sagittal asymmetric overloading of the spine during handball training, exercises that help maintain good posture and correct the thoracic kyphosis are required, especially for taller players.
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Ignasiak D, Rüeger A, Sperr R, Ferguson SJ. Thoracolumbar spine loading associated with kinematics of the young and the elderly during activities of daily living. J Biomech 2017; 70:175-184. [PMID: 29248192 DOI: 10.1016/j.jbiomech.2017.11.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/03/2017] [Accepted: 11/26/2017] [Indexed: 01/27/2023]
Abstract
Excessive mechanical loading of the spine is a critical factor in vertebral fracture initiation. Most vertebral fractures develop spontaneously or due to mild trauma, as physiological loads during activities of daily living might exceed the failure load of osteoporotic vertebra. Spinal loading patterns are affected by vertebral kinematics, which differ between elderly and young individuals. In this study, the effects of age-related changes in spine kinematics on thoracolumbar spinal segmental loading during dynamic activities of daily living were investigated using combined experimental and modeling approach. Forty-four healthy volunteers were recruited into two age groups: young (N = 23, age = 27.1 ± 3.8) and elderly (N = 21, age = 70.1 ± 3.9). The spinal curvature was assessed with a skin-surface device and the kinematics of the spine and lower extremities were recorded during daily living tasks (flexion-extension and stand-sit-stand) with a motion capture system. The obtained data were used as input for a musculoskeletal model with a detailed thoracolumbar spine representation. To isolate the effect of kinematics on predicted loads, other model properties were kept constant. Inverse dynamics simulations were performed in the AnyBody Modeling System to estimate corresponding spinal loads. The maximum compressive loads predicted for the elderly motion patterns were lower than those of the young for L2/L3 and L3/L4 lumbar levels during flexion and for upper thoracic levels during stand-to-sit (T1/T2-T8/T9) and sit-to-stand (T3/T4-T6/T7). However, the maximum loads predicted for the lower thoracic levels (T9/T10-L1/L2), a common site of vertebral fractures, were similar compared to the young. Nevertheless, these loads acting on the vertebrae of reduced bone quality might contribute to a higher fracture risk for the elderly.
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Affiliation(s)
| | | | - Ramona Sperr
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Biomechanical Study of Fused Lumbar Spine Considering Bone Degeneracy Using FEA. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2017. [DOI: 10.1007/s13369-017-2848-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Trzciński D, Myszka A, Piontek J. High stature and body mass might affect the occurrence of Schmorl’s nodes. ANTHROPOLOGICAL REVIEW 2017. [DOI: 10.1515/anre-2017-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Schmorl’s nodes are vertical herniation of intervertebral discs into the body of neighbouring vertebral endplate. Notwithstanding extensive studies, no consensus has been reached in the subject of their possible etiology. It is hypothesized that physical stress, trauma and high axial loading are the key factors in the occurrence of this pathology. The main objective of the current work is to reevaluate the relationship between stature and body mass and Schmorl’s nodes. For this purpose, skeletal samples from Lithuania (44 males and 19 females) and Poland (97 males and 60 females) were used. The study confirmed that Schmorl’s nodes are age-independent, and more frequent in males (12.63% on the superior and 19.32% on the inferior surface of vertebrae) than in females (6.23% and 12.29% respectively). Obtained results also suggest that high stature (e.g. Spearmann correlation for superior: R=0.20 p=0.017, and inferior: R=0.31 p=0.000 surface of vertebrae) and body mass (R=0.25, p=0.002 and R=0.32, p<0.001, respectively) are factors that increase the risk of Schmorl’s nodes. Authors hypothesize that the afore-mentioned body size traits alter loadings acting on intervertebral discs, and rigidity of the spine.
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Affiliation(s)
- Dawid Trzciński
- Department of Human Evolutionary Biology, Institute of Anthropology , Adam Mickiewicz University in Poznań , Poland
| | - Anna Myszka
- Department of Human Evolutionary Biology, Institute of Anthropology , Adam Mickiewicz University in Poznań , Poland
| | - Janusz Piontek
- Department of Human Evolutionary Biology, Institute of Anthropology , Adam Mickiewicz University in Poznań , Poland
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Ngo BPT, Yazdani A, Carlan N, Wells R. Lifting Height as the Dominant Risk Factor for Low-Back Pain and Loading During Manual Materials Handling: A Scoping Review. IISE Trans Occup Ergon Hum Factors 2017. [DOI: 10.1080/24725838.2017.1338633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Amin Yazdani
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Nicolette Carlan
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Richard Wells
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
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Obesity and Obesity Shape Markedly Influence Spine Biomechanics: A Subject-Specific Risk Assessment Model. Ann Biomed Eng 2017; 45:2373-2382. [DOI: 10.1007/s10439-017-1868-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/03/2017] [Indexed: 12/15/2022]
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50
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Bayoglu R, Geeraedts L, Groenen KH, Verdonschot N, Koopman B, Homminga J. Twente spine model: A complete and coherent dataset for musculo-skeletal modeling of the thoracic and cervical regions of the human spine. J Biomech 2017; 58:52-63. [DOI: 10.1016/j.jbiomech.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/06/2017] [Accepted: 04/09/2017] [Indexed: 02/07/2023]
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