Twente Spine Model: A thorough investigation of the spinal loads in a complete and coherent musculoskeletal model of the human spine

Differences in vertebral bone density between African apes

OBJECTIVES

Low-energy vertebral fractures are a common health concern, especially in elderly people. Interestingly, African apes do not seem to experience as many vertebral fractures and the low-energy ones are even rarer. One potential explanation for this difference is the lower bone density in humans. Yet, only limited research has been done on the vertebral bone density of the great apes and these have mainly included only single vertebrae. Hence the study aim is to expand our understanding of the vertebral microstructure of African apes in multiple spinal segments.

MATERIALS

Bone density in the vertebral body of C7, T12, and L3 was measured from 32 Pan troglodytes and 26 Gorilla gorilla using peripheral quantitative computed tomography (pQCT).

RESULTS

There was a clear difference between the three individual vertebrae and consequently the spinal segments in terms of trabecular density and cortical density and thickness. The variation of these bone parameters between the vertebrae differed between the apes but was also different from those reported for humans. The chimpanzees were observed to have overall higher trabecular density, but gorillas had higher cortical density and thickness. Cortical thickness had a relatively strong association with the vertebral size.

DISCUSSION

Despite the similarity in locomotion and posture, the results show slight differences in the bone parameters and their variation between spinal segments in African apes. This variation also differs from humans and appears to indicate a complex influence of locomotion, posture, and body size on the different spinal segments.

Ligamentous tethering and intradiscal pressure affecting the mechanical environment of scoliotic spines

Despite several theories have been proposed to explain the progression of Adolescent Idiopathic Scoliosis (AIS), there is no consensus on the mechanical factors that control the spinal deformities. Prominent biomechanical notions focus on the geometrical asymmetry and differential growth, however, the correlation between these phenomena remains unclear. We postulate that intradiscal pressure and its connection with the supporting ligamentous structures are the reasons behind the asymmetric growth in AIS. To investigate this hypothesis, a numerical 3D patient-specific model of a scoliotic spine is constructed to carry upper body weight. Four analyses are performed: control simulation with no ligaments followed by 3 simulations, in each, a different and stiffer set of ligaments is employed. The analyses showed that intradiscal pressure is relatively high in the spine's higher-deformity region. Moreover, the stiffness effect of the ligamentous tethering correlated directly to intradiscal pressure; the stiffer the ligaments, the higher the intradiscal pressure. Due to geometrical asymmetry, the pressure is eccentric toward the concave region of deformed vertebral units. As a result, the deformed annulus fibrosus generated uplifts in the convex side of deformed vertebral units. The eccentric pressure and the uplift are opposite in location and direction creating an imbalanced mechanical environment for the spine during growth.

Biomechanics of the tether breakage: tensile behaviour of a single-unit vertebral body tethering construct

PURPOSE

Tether breakage was reported as the most common complication of vertebral body tethering. However, as the literature suggests the physiological loads do not have the potential to cause the failure of the tether. Currently, the biomechanical reason behind the tether breakage is unknown. The current study aims to elucidate the effects of the tension forces on the failure mechanisms of the VBT and provide mechanical justification for how it can be identified radiographically.

METHODS

Tensile tests (20%/min strain rate) were performed on single-unit VBT samples. Failure modes and mechanical characteristics were reported.

RESULTS

The failure took place prematurely due to the slippage of the tether at the screw-tether junction where the tether is damaged significantly by the locking cap. Slippage was initiated at 10-13% tensile strain level where the tensile stress and tension force were 50.4 ± 1.5 MPa and 582.2 ± 30.8 N, respectively.

CONCLUSION

The failure occurs because of high-stress concentrations generated within the locking region which damages the tether surface and leads to the slippage of the tether. We observed that the loads leading to failure are within the physiological limits and may indicate the high likelihood of the tether breakage. The failure mode observed in our study is shown to be the dominant failure mode, and a design improvement on the gripping mechanism is suggested to avoid failure at the screw-tether junction. We observed that the tether elongates 10-13% prior to the breakage, which can be employed as a diagnostic criterion to screen for tether breakages radiographically.

Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment

STUDY DESIGN

A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers.

OBJECTIVE

This study aimed to determine the validity of a computational framework for predicting postoperative patient posture based on preoperative imaging and surgical data in a large clinical sample.

SUMMARY OF BACKGROUND DATA

Short-term and long-term studies on thoracolumbar fusion patients have discussed that a preoperative predictive model would benefit surgical planning and improve patient outcomes. Clinical studies have shown that postoperative alignment changes at the pelvis and intact spine levels may negatively affect postural balance and quality of life. However, it remains challenging to predict such changes preoperatively because of confounding surgical and patient factors.

MATERIALS AND METHODS

Patient-specific musculoskeletal models incorporated weight, height, body mass index, age, pathology-associated muscle strength, preoperative sagittal alignment, and surgical treatment details. The sagittal alignment parameters predicted by the simulations were compared with those observed radiographically at a minimum of three months after surgery.

RESULTS

Pearson correlation coefficients ranged from r=0.86 to 0.95, and mean errors ranged from 4.1° to 5.6°. The predictive accuracies for postoperative spinopelvic malalignment (pelvic incidence minus lumbar lordosis>10°) and sagittal imbalance parameters (TPA>14°, T9PA>7.4°, or LPA>7.2°) were between 81% and 94%. Patients treated with long fusion (greater than five segments) had relatively lower prediction errors for lumbar lordosis and spinopelvic mismatch than those in the local and short groups.

CONCLUSIONS

The overall model performance with long constructs was superior to those of the local (one to two segments) and short (three to four segments) fusion cases. The clinical framework is a promising tool in development to enhance clinical judgment and to help design treatment strategies for predictable surgical outcomes.

LEVEL OF EVIDENCE

3.

Recent Advances in Coupled MBS and FEM Models of the Spine—A Review

How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the overall kinematics and kinetics of the spine and the inner stress distribution of flexible components. We reviewed studies that included MBS and FEM co-simulations of the spine. Thereby, we classified the studies into unidirectional and bidirectional co-simulation, according to their data exchange methods. Several studies have demonstrated that using unidirectional co-simulation models provides useful insights into spinal biomechanics, although synchronizing the two distinct models remains a key challenge, often requiring extensive manual intervention. The use of a bidirectional co-simulation features an iterative, automated process with a constant data exchange between integrated subsystems. It reduces manual corrections of vertebra positions or reaction forces and enables detailed modeling of dynamic load cases. Bidirectional co-simulations are thus a promising new research approach for improved spine modeling, as a main challenge in spinal biomechanics is the nonlinear deformation of the intervertebral discs. Future studies will likely include the automated implementation of patient-specific bidirectional co-simulation models using hyper- or poroelastic intervertebral disc FEM models and muscle forces examined by an optimization algorithm in MBS. Applications range from clinical diagnosis to biomechanical analysis of overload situations in sports and injury prediction.

Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges

Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.

Relationship between Intervertebral Disc Compression Force and Sagittal Spinopelvic Lower Limb Alignment in Elderly Women in Standing Position with Patient-Specific Whole Body Musculoskeletal Model

The intervertebral disc loading based on compensated standing posture in patients with adult spinal deformity remains unclear. We analyzed the relationship between sagittal alignment and disc compression force (Fm). In 14 elderly women, the alignment of the sagittal spinopelvic and lower extremities was measured. Fm was calculated using the Anybody Modeling System. Patients were divided into low sagittal vertical axis (SVA) and high SVA groups. Comparisons between the two groups were performed and the relationship between the Fm and each parameter was examined using Spearman's correlation coefficient (r). The mean lumbar Fm in the high SVA group was 67.6%; significantly higher than that in the low SVA group (p = 0.046). There was a negative correlation between cervical Fm with T1 slope (r = -0.589, p = 0.034) and lumbar Fm with lumbar lordosis (r = -0.566, p = 0.035). Lumbar Fm was positively correlated with center of gravity-SVA (r = 0.615, p = 0.029), T1 slope (r = 0.613, p = 0.026), and SVA (r = 0.612, p = 0.020). The results suggested sagittal malalignment increased the load on the thoracolumbar and lower lumbar discs and was associated with cervical disc loading.

Computational lumbar spine models: A literature review

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.

Yeditepe spine mesh: Finite element modeling and validation of a parametric CAD model of lumbar spine

Finite element analysis is a powerful tool that is often used to study the biomechanical response of the spine. The primary objective of this study was to illustrate the mechanical behavior of a previously proposed parametric CAD spine model in comparison with a segmented FSU model and the literature. In this study, two finite element models of the L4-L5 spinal level were developed from the same patient's CT scan data. The first was developed using well-known segmentation methods, whereas the second was developed from the new by using a novel parametric CAD model. Both models were subjected to the same loading and boundary conditions to perform flexion, extension, lateral bending and axial rotation motions. The segmented finite element model was observed to be in good agreement with the literature. The parametric finite element model results were also observed to be in good agreement with the segmented finite element model and with the literature except under extension.

Design of personalized scoliosis braces based on differentiable biomechanics—Synthetic study

This work describes a computational methodology for the design of braces for adolescent idiopathic scoliosis. The proposed methodology relies on a personalized simulation model of the patient’s trunk, and automatically searches for the brace geometry that optimizes the trade-off between clinical improvement and patient comfort. To do this, we introduce a formulation of differentiable biomechanics of the patient’s trunk, the brace, and their interaction. We design a simulation model that is differentiable with respect to both the deformation state and the brace design parameters, and we show how this differentiable model is used for the efficient update of brace design parameters within a numerical optimization algorithm. To evaluate the proposed methodology, we have obtained trunk models with personalized geometry for five patients of adolescent idiopathic scoliosis, and we have designed Boston-type braces. In a simulation setting, the designed braces improve clinical metrics by 45% on average, under acceptable comfort conditions. In the future, the methodology can be extended beyond synthetic validation, and tested with physical braces on the actual patients.

Biomechanical Morphing for Personalized Fitting of Scoliotic Torso Skeleton Models

The use of patient-specific biomechanical models offers many opportunities in the treatment of adolescent idiopathic scoliosis, such as the design of personalized braces. The first step in the development of these patient-specific models is to fit the geometry of the torso skeleton to the patient’s anatomy. However, existing methods rely on high-quality imaging data. The exposure to radiation of these methods limits their applicability for regular monitoring of patients. We present a method to fit personalized models of the torso skeleton that takes as input biplanar low-dose radiographs. The method morphs a template to fit annotated points on visible portions of the spine, and it relies on a default biomechanical model of the torso for regularization and robust fitting of hardly visible parts of the torso skeleton, such as the rib cage. The proposed method provides an accurate and robust solution to obtain personalized models of the torso skeleton, which can be adopted as part of regular management of scoliosis patients. We have evaluated the method on ten young patients who participated in our study. We have analyzed and compared clinical metrics on the spine and the full torso skeleton, and we have found that the accuracy of the method is at least comparable to other methods that require more demanding imaging methods, while it offers superior robustness to artifacts such as interpenetration of ribs. Normal-dose X-rays were available for one of the patients, and for the other nine we acquired low-dose X-rays, allowing us to validate that the accuracy of the method persisted under less invasive imaging modalities.

Validation of a Patient-Specific Musculoskeletal Model for Lumbar Load Estimation Generated by an Automated Pipeline From Whole Body CT

Background: Chronic back pain is a major health problem worldwide. Although its causes can be diverse, biomechanical factors leading to spinal degeneration are considered a central issue. Numerical biomechanical models can identify critical factors and, thus, help predict impending spinal degeneration. However, spinal biomechanics are subject to significant interindividual variations. Therefore, in order to achieve meaningful findings on potential pathologies, predictive models have to take into account individual characteristics. To make these highly individualized models suitable for systematic studies on spinal biomechanics and clinical practice, the automation of data processing and modeling itself is inevitable. The purpose of this study was to validate an automatically generated patient-specific musculoskeletal model of the spine simulating static loading tasks.

Methods: CT imaging data from two patients with non-degenerative spines were processed using an automated deep learning-based segmentation pipeline. In a semi-automated process with minimal user interaction, we generated patient-specific musculoskeletal models and simulated various static loading tasks. To validate the model, calculated vertebral loadings of the lumbar spine and muscle forces were compared with in vivo data from the literature. Finally, results from both models were compared to assess the potential of our process for interindividual analysis.

Results: Calculated vertebral loads and muscle activation overall stood in close correlation with data from the literature. Compression forces normalized to upright standing deviated by a maximum of 16% for flexion and 33% for lifting tasks. Interindividual comparison of compression, as well as lateral and anterior–posterior shear forces, could be linked plausibly to individual spinal alignment and bodyweight.

Conclusion: We developed a method to generate patient-specific musculoskeletal models of the lumbar spine. The models were able to calculate loads of the lumbar spine for static activities with respect to individual biomechanical properties, such as spinal alignment, bodyweight distribution, and ligament and muscle insertion points. The process is automated to a large extent, which makes it suitable for systematic investigation of spinal biomechanics in large datasets.

Biomechanical Properties of Paraspinal Muscles Influence Spinal Loading—A Musculoskeletal Simulation Study

Paraspinal muscles are vital to the functioning of the spine. Changes in muscle physiological cross-sectional area significantly affect spinal loading, but the importance of other muscle biomechanical properties remains unclear. This study explored the changes in spinal loading due to variation in five muscle biomechanical properties: passive stiffness, slack sarcomere length (SSL), in situ sarcomere length, specific tension, and pennation angle. An enhanced version of a musculoskeletal simulation model of the thoracolumbar spine with 210 muscle fascicles was used for this study and its predictions were validated for several tasks and multiple postures. Ranges of physiologically realistic values were selected for all five muscle parameters and their influence on L4-L5 intradiscal pressure (IDP) was investigated in standing and 36° flexion. We observed large changes in IDP due to changes in passive stiffness, SSL, in situ sarcomere length, and specific tension, often with interesting interplays between the parameters. For example, for upright standing, a change in stiffness value from one tenth to 10 times the baseline value increased the IDP only by 91% for the baseline model but by 945% when SSL was 0.4 μm shorter. Shorter SSL values and higher stiffnesses led to the largest increases in IDP. More changes were evident in flexion, as sarcomere lengths were longer in that posture and thus the passive curve is more influential. Our results highlight the importance of the muscle force-length curve and the parameters associated with it and motivate further experimental studies on in vivo measurement of those properties.

Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position

BACKGROUND

As a leading cause of disability with a high societal and economic cost, it is crucial to better understand risk factors of neck pain and surgical complications. Getting subject-specific external loading is essential for quantifying muscle forces and joint loads but it requires exertion trials and load cells which are uncommon in clinical settings.

METHODS

This paper presents a method to compute the gravitational loading at four levels of the cervical spine (C3C4, C4C5, C5C6, C6C7) in neutral standing position from biplanar radiographs exclusively. The resulting load was decomposed in local disc frames and its components were used to compare different populations: 118 asymptomatic subjects and 46 patients before and after surgery (anterior cervical discectomy and fusion or total disc replacement). Comparisons were performed at C6C7 and the upper level adjacent to surgery.

FINDINGS

Significant changes in gravitational loading were observed with age in healthy subjects as well as in patients after surgery and have been associated with changes in posture.

INTERPRETATION

This approach quantifies the influence of postural changes on gravitational loading on the cervical spine. It represents a simple way to obtain necessary input for muscle force quantification models in clinical routine and to use them for patient evaluation. The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms and complications following surgery.

Influence of Axial Load and a 45-Degree Flexion Head Position on Cervical Spinal Stiffness in Healthy Young Adults

Background: Neck pain is a major cause of disability worldwide. Poor neck posture such as using a smartphone or work-related additional cervical axial load, such headgear of aviators, can cause neck pain. This study aimed at investigating the role of head posture or additional axial load on spinal stiffness, a proxy measure to assess cervical motor control. Methods: The posterior-to-anterior cervical spinal stiffness of 49 young healthy male military employees [mean (SD) age 20 ± 1 years] was measured in two head positions: neutral and 45-degree flexed head position and two loading conditions: with and without additional 3 kg axial load. Each test condition comprised three trials. Measurements were taken at three cervical locations, i.e., spinous processes C2 and C7 and mid-cervical (MC). Results: Cervical spinal stiffness measurements showed good reliability in all test conditions. There was a significant three-way interaction between location × head position × load [F(2, 576) = 9.305, p < 0.001]. Significant two-way interactions were found between measurement locations × loading [F(2, 576) = 15.688, p < 0.001] and measurement locations × head position [F(2, 576) = 9.263, p < 0.001]. There was no significant interaction between loading × head position [F(1, 576) = 0.692, p = 0.406]. Post hoc analysis showed reduction of stiffness in all three measurement locations in flexion position. There was a decrease in stiffness in C2 with loading, increase in stiffness in C7 and no change in MC. Discussion: A flexed head posture leading to decreased stiffness of the cervical spine might contribute to neck pain, especially if the posture is prolonged and static, such as is the case with smartphone users. Regarding the additional load, stiffness decreased high cervical and increased low cervical. There was no change mid cervical. The lower spinal stiffness at the high cervical spine might be caused by capsular ligament laxity due to the buckling effect. At the lower cervical spine, the buckling effect seems to be less dominant, because the proximity to the ribs and sternum provide additional stiffness.

Analytical and Numerical Investigations of Mechanical Vibration in the Vertical Direction of a Human Body in a Driving Vehicle using Biomechanical Vibration Model

The main reason that affects the discomfort in a driving vehicle is the vibration response. The human body vibration leads to many malfunctions in both comfort and performance in human health. As a result, the human body’s simulation in sitting posture in the driving vehicle has a strategic relationship for all Tires and vehicles manufacturers. The digital process simulation of the human body seat vehicle vibration shows two significant advantages. The first advantage is the prevention of the high-cost modifications in the construction stage of the vehicle, while the second one describes the stability test during the undesirable vibrations. This study modelled the human body’s dynamic characterisations, natural frequency, and mechanical response when seated in the driving vehicle with vibration transmissibility in the vertical direction have been using the biomechanical vibration model. The vertical vibrations and the transmissibility of the human body dynamic response are presented in detail. Exciting results have been obtained, and they are significant for human health, which relates to sitting posture in the driving vehicle. It can assist in understanding the influences of low-frequency vibration on human health, comfort, and performance, and therefore it could be applied for ride comfort evaluation. An analytical solution to derive the general equations of motion for the human system was developed. Then, using the vibration analysis technique and the corresponding equations, the accurate dynamic response of the selected mode is identified. Furthermore, the mathematical modelling for free vibration using the finite element analysis has been performed to determine the appropriate values and set its description. Then, the comparison results of the two techniques have been carried out.

An Electromyographically Driven Cervical Spine Model in OpenSim

Relatively few biomechanical models exist aimed at quantifying the mechanical risk factors associated with neck pain. In addition, there is a need to validate spinal-rhythm techniques for inverse dynamics spine models. Therefore, the present investigation was 3-fold: (1) the development of a cervical spine model in OpenSim, (2) a test of a novel spinal-rhythm technique based on minimizing the potential energy in the passive tissues, and (3) comparison of an electromyographically driven approach to estimating compression and shear to other cervical spine models. The authors developed ligament force-deflection and intervertebral joint moment-angle curves from published data. The 218 Hill-type muscle elements, representing 58 muscles, were included and their passive forces validated against in vivo data. Our novel spinal-rhythm technique, based on minimizing the potential energy in the passive tissues, disproportionately assigned motion to the upper cervical spine that was not physiological. Finally, using kinematics and electromyography collected from 8 healthy male volunteers, the authors calculated the compression at C7-T1 as a function of the head-trunk Euler angles. Differences from other models varied from 25.5 to 368.1 N. These differences in forces may result in differences in model geometry, passive components, number of degrees of freedom, or objective functions.

A study of the sensitivity of biomechanical models of the spine for scoliosis brace design

BACKGROUND AND OBJECTIVE

The development of biomechanical models of the torso and the spine opens the door to computational solutions for the design of braces for adolescent idiopathic scoliosis. However, the design of such biomechanical models faces several unknowns, such as the correct identification of relevant mechanical elements, or the required accuracy of model parameters. The objective of this study was to design a methodology for the identification of the aforementioned elements, with the purpose of creating personalized models suited for patient-specific brace design and the definition of parameter estimation criteria.

METHODS

We have developed a comprehensive model of the torso, including spine, ribcage and soft tissue, and we have developed computational tools for the analysis of the model parameters. With these tools, we perform an analysis of the model under typical loading conditions of scoliosis braces.

RESULTS

We present a complete sensitivity analysis of the models mechanical parameters and a comparison between a reference healthy subject and a subject suffering from scoliosis. Furthermore, we make a direct connection between error bounds on the deformation and tolerances for parameter estimation, which can guide the personalization of the model.

CONCLUSIONS

Not surprisingly, the stiffness parameters that govern the lateral deformation of the spine in the frontal plane are some of the most relevant parameters, and require careful modeling. More surprisingly, their relevance is on par with the correct parameterization of the soft tissue of the torso. For scoliosis patients, but not for healthy subjects, we observe that the axial rotation of the spine also requires careful modeling.

The Influence of Kinematic Constraints on Model Performance During Inverse Kinematics Analysis of the Thoracolumbar Spine

Motion analysis is increasingly applied to spine musculoskeletal models using kinematic constraints to estimate individual intervertebral joint movements, which cannot be directly measured from the skin surface markers. Traditionally, kinematic constraints have allowed a single spinal degree of freedom (DOF) in each direction, and there has been little examination of how different kinematic constraints affect evaluations of spine motion. Thus, the objective of this study was to evaluate the performance of different kinematic constraints for inverse kinematics analysis. We collected motion analysis marker data in seven healthy participants (4F, 3M, aged 27–67) during flexion–extension, lateral bending, and axial rotation tasks. Inverse kinematics analyses were performed on subject-specific models with 17 thoracolumbar joints allowing 51 rotational DOF (51DOF) and corresponding models including seven sets of kinematic constraints that limited spine motion from 3 to 9DOF. Outcomes included: (1) root mean square (RMS) error of spine markers (measured vs. model); (2) lag-one autocorrelation coefficients to assess smoothness of angular motions; (3) maximum range of motion (ROM) of intervertebral joints in three directions of motion (FE, LB, AR) to assess whether they are physiologically reasonable; and (4) segmental spine angles in static ROM trials. We found that RMS error of spine markers was higher with constraints than without (p < 0.0001) but did not notably improve kinematic constraints above 6DOF. Compared to segmental angles calculated directly from spine markers, models with kinematic constraints had moderate to good intraclass correlation coefficients (ICCs) for flexion–extension and lateral bending, though weak to moderate ICCs for axial rotation. Adding more DOF to kinematic constraints did not improve performance in matching segmental angles. Kinematic constraints with 4–6DOF produced similar levels of smoothness across all tasks and generally improved smoothness compared to 9DOF or unconstrained (51DOF) models. Our results also revealed that the maximum joint ROMs predicted using 4–6DOF constraints were largely within physiologically acceptable ranges throughout the spine and in all directions of motions. We conclude that a kinematic constraint with 5DOF can produce smooth spine motions with physiologically reasonable joint ROMs and relatively low marker error.

Calibration and validation of a novel hybrid model of the lumbosacral spine in ArtiSynth-The passive structures

In computational biomechanics, two separate types of models have been used predominantly to enhance the understanding of the mechanisms of action of the lumbosacral spine (LSS): Finite element (FE) and musculoskeletal multibody (MB) models. To combine advantages of both models, hybrid FE-MB models are an increasingly used alternative. The aim of this paper is to develop, calibrate, and validate a novel passive hybrid FE-MB open-access simulation model of a ligamentous LSS using ArtiSynth. Based on anatomical data from the Male Visible Human Project, the LSS model is constructed from the L1-S1 rigid vertebrae interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, and facet joints. A mesh convergence study, sensitivity analyses, and systematic calibration were conducted with the hybrid functional spinal unit (FSU) L4/5. The predicted mechanical responses of the FSU L4/5, the lumbar spine (L1-L5), and the LSS were validated against literature data from in vivo and in vitro measurements and in silico models. Spinal mechanical responses considered when loaded with pure moments and combined loading modes were total and intervertebral range of motions, instantaneous axes and centers of rotation, facet joint contact forces, intradiscal pressures, disc bulges, and stiffnesses. Undesirable correlations with the FE mesh were minimized, the number of crisscrossed collagen fiber rings was reduced to five, and the individual influences of specific anatomical structures were adjusted to in vitro range of motions. Including intervertebral motion couplings for axial rotation and nonlinear stiffening under increasing axial compression, the predicted kinematic and structural mechanics responses were consistent with the comparative data. The results demonstrate that the hybrid simulation model is robust and efficient in reproducing valid mechanical responses to provide a starting point for upcoming optimizations and extensions, such as with active skeletal muscles.

Trunk Flexion Monitoring among Warehouse Workers Using a Single Inertial Sensor and the Influence of Different Sampling Durations

Trunk flexion represents a risk factor for the onset of low-back disorders, yet limited quantitative data exist regarding flexion exposures in actual working conditions. In this study, we evaluated the potential of using a single inertial measurement unit (IMU) to classify trunk flexion, in terms of amplitude, frequency, and duration, and assessed the influence of alternative time durations on exposure results. Twelve warehouse workers were monitored during two hours of an actual shift while wearing a single IMU on their low back. Trunk flexion data were reduced using exposure variation analysis integrated with recommended exposure thresholds. Workers spent 5.1% of their working time with trunk flexion of 30-60° and 2.3% with flexion of 60-90°. Depending on the level of acceptable error, relatively shorter monitoring periods (up to 50 min) might be sufficient to characterize trunk flexion exposures. Future work is needed, however, to determine if these results generalize to other postural exposures and tasks.

Investigation of Alterations in the Lumbar Disc Biomechanics at the Adjacent Segments After Spinal Fusion Using a Combined In Vivo and In Silico Approach

The development of adjacent segment degeneration (ASD) is a major concern after lumbar spinal fusion surgery, but the causative mechanisms remain unclear. This study used a combined in vivo and in silico method to investigate the changes of anatomical dimensions and biomechanical responses of the adjacent segment (L3-4) after spinal fusion (L4-S1) in five patients under weight-bearing upright standing conditions. The in vivo adjacent disc height changes before and after fusion were measured using a dual fluoroscopic imaging system (DFIS), and the measured in vivo intervertebral positions and orientations were used as displacement boundary conditions of the patient-specific three-dimensional (3D) finite element (FE) disc models to simulate the biomechanical responses of adjacent discs to fusion of the diseased segments. Our data (represented by medians and 95% confidence intervals) showed that a significant decrease by - 0.8 (- 1.2, - 0.4) mm (p < 0.05) in the adjacent disc heights occurred at the posterior region after fusion. The significant increases in disc tissue strains and stresses, 0.32 (0.21, 0.43) mm/mm (p < 0.05) and 1.70 (1.07, 3.60) MPa (p < 0.05), respectively, after fusion were found in the posterolateral portions of the outermost annular lamella. The intradiscal pressure of the adjacent disc was significantly increased by 0.29 (0.13, 0.47) MPa after fusion (p < 0.05). This study demonstrated that fusion could cause alterations in adjacent disc biomechanics, and the combined in vivo and in silico method could be a valuable tool for the quantitative assessment of ASD after fusion.

Surface-based modeling of muscles: Functional simulation of the shoulder

Musculoskeletal simulations are an essential tool for studying functional implications of pathologies and of potential surgical outcomes, e.g., for the complex shoulder anatomy. Most shoulder models rely on line-segment approximation of muscles with potential limitations. Comprehensive shoulder models based on continuum-mechanics are scarce due to their complexity in both modeling and computation. In this paper, we present a surface-based modeling approach for muscles, which simplifies the modeling process and is efficient for computation. We propose to use surface geometries for modeling muscles, and devise an automatic approach to generate such models, given the locations of the origin and insertion of tendons. The surfaces are expressed as higher-order tensor B-splines, which ensure smoothness of the geometrical representation. They are simulated as membrane elements within a finite element simulation. This is demonstrated on a comprehensive model of the upper limb, where muscle activations needed to perform desired motions are obtained by using inverse dynamics. In synthetic examples, we demonstrate our proposed surface elements both to be easy to customize (e.g., with spatially varying material properties) and to be substantially (up to 12 times) faster in simulation compared to their volumetric counterpart. With our presented automatic approach of muscle wrapping around bones, the humeral head is exemplified to be wrapped physiologically consistently with surface elements. Our functional simulation is shown to successfully replicate a tracked shoulder motion during activities of daily living. We demonstrate surface-based models to be a numerically stable and computationally efficient compromise between line-segment and volumetric models, enabling anatomical correctness, subject-specific customization, and fast simulations, for a comprehensive simulation of musculoskeletal motion.

Coupled artificial neural networks to estimate 3D whole-body posture, lumbosacral moments, and spinal loads during load-handling activities

Biomechanical modeling approaches require body posture to evaluate the risk of spine injury during manual material handling. The procedure to measure body posture via motion-analysis techniques as well as the subsequent calculations of lumbosacral moments and spine loads by, respectively, inverse-dynamic and musculoskeletal models are complex and time-consuming. We aim to develop easy-to-use yet accurate artificial neural networks (ANNs) that predict 3D whole-body posture (ANN_posture), segmental orientations (ANN_angle), and lumbosacral moments (ANN_moment) based on our measurements during load-handling activities. Fifteen individuals each performed 135 load-handling activities by reaching (0 kg) or handling (5 and 10 kg) weights located at nine different horizontal and five vertical (0, 30, 60, 90, and 120 cm from the floor) locations. Whole-body posture was measured via a motion capture system and lumbosacral moments were calculated via a 3D top-down eight link-segment inverse-dynamic model. ANN_posture, ANN_angle, and ANN_moment were trained (RMSEs = 6.7 cm, 29.8°, and 16.2 Nm, respectively) and their generalization capability was tested (RMSE = 7.0 cm and R² = 0.97, RMSE = 29.9° and R² = 0.85, and RMSE = 16.5 Nm and R² = 0.97, respectively). These ANNs were subsequently coupled to our previously-developed/validated ANN_load, which predicts spinal loads during 3D load-handling activities. The results showed outputs of the coupled ANNs for L4-L5 intradiscal pressure (IDPs) during a number of activities were in agreement with measured IDPs (RMSE = 0.37 MPa and R² = 0.89). Hence, coupled ANNs were found to be robust tools to evaluate posture, lumbosacral moments, spinal loads, and thus risk of injury during load-handling activities.

Experimental platform to facilitate novel back brace development for the improvement of spine stability

The spine or 'back' has many functions including supporting our body frame whilst facilitating movement, protecting the spinal cord and nerves and acting as a shock absorber. In certain instances, individuals may develop conditions that not only cause back pain but also may require additional support for the spine. Common movements such as twisting, standing and bending motions could exacerbate these conditions and intensify this pain. Back braces can be used in certain instances to constrain such motion as part of an individual's therapy and have existed as both medical and retail products for a number of decades. Arguably, back brace designs have lacked the innovation expected in this time. Existing designs are often found to be heavy, overly rigid, indiscrete and largely uncomfortable. In order to facilitate the development of new designs of back braces capable of being optimised to constrain particular motions for specific therapies, a numerical and experimental design strategy has been devised, tested and proven for the first time. The strategy makes use of an experimental test rig in conjunction with finite element analysis simulations to investigate and quantify the effects of back braces on flexion, extension, lateral bending and torsional motions as experienced by the human trunk. This paper describes this strategy and demonstrates its effectiveness through the proposal and comparison of two novel back brace designs.