Application of the restoring force method for identification of lumbar spine flexion-extension motion under flexion-extension moment

Defining and measuring objective and subjective spinal stiffness: a scoping review

PURPOSE

Examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications.

METHODS

A scoping review was conducted to determine what is known about definitions and measures of the specific term of spinal stiffness. Following the framework by Arksey and O'Malley, eligible peer-reviewed studies identified using PubMed, Ebsco health, and Scopus were included if they reported definitions or measures of spinal stiffness. Using a data abstraction form, the studies were classified into four themes: biomechanical, surgical, pathophysiological, and segmental spinal assessment. To identify similarities and differences between studies, sixteen categories were generated.

RESULTS

In total, 2426 records were identified, and 410 met the eligibility criteria. There were 350 measures (132 subjective; 218 objective measures) and 93 indicators of spinal stiffness. The majority of studies (n = 69%) did not define stiffness.

CONCLUSION

This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There is no consensus regarding a standardised definition of stiffness in the reviewed literature.

An alternative measurement tool for the identification of hysteretic responses in biological joints

In structural engineering, sophisticated multi-dimensional analysis techniques, such as the Restoring Force Method (RFM), have been established for complex, nonlinear hysteretic systems. The purpose of the present study was to apply the RFM to quantify nonlinear spine hysteresis responses under applied moments. First, synthetic hysteretic spine responses (n=50) were generated based on representative results from pure moment flexion-extension loading of a human cadaveric lumbar spine segment. Then, the RFM was applied to each hysteresis response to describe the flexion-extension rotation as a function of applied moment and simulated axial displacement using a set of 16 unique coefficients. Range of motion, neutral zone, elastic zone, and stiffness were also measured. The RFM coefficient corresponding to the 1st-order linear dependence of rotation on applied moment was dominant, and paralleled changes in elastic zone. The remaining RFM coefficients were not captured from the traditional biomechanical analysis. Therefore, the RFM may potentially supplement the traditional analysis to develop a more comprehensive, quantitative description of spine hysteresis. The results suggest the potential for more thorough and specific characterization of spine kinematics, and may lead to future applications of such techniques in characterizing biological structures.