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Zhou Z, Wang S, Zhang S, Pan X, Yang H, Zhuang Y, Lu Z. Deep learning-based spinal canal segmentation of computed tomography image for disease diagnosis: A proposed system for spinal stenosis diagnosis. Medicine (Baltimore) 2024; 103:e37943. [PMID: 38701305 PMCID: PMC11062721 DOI: 10.1097/md.0000000000037943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Lumbar disc herniation was regarded as an age-related degenerative disease. Nevertheless, emerging reports highlight a discernible shift, illustrating the prevalence of these conditions among younger individuals. METHODS This study introduces a novel deep learning methodology tailored for spinal canal segmentation and disease diagnosis, emphasizing image processing techniques that delve into essential image attributes such as gray levels, texture, and statistical structures to refine segmentation accuracy. RESULTS Analysis reveals a progressive increase in the size of vertebrae and intervertebral discs from the cervical to lumbar regions. Vertebrae, bearing weight and safeguarding the spinal cord and nerves, are interconnected by intervertebral discs, resilient structures that counteract spinal pressure. Experimental findings demonstrate a lack of pronounced anteroposterior bending during flexion and extension, maintaining displacement and rotation angles consistently approximating zero. This consistency maintains uniform anterior and posterior vertebrae heights, coupled with parallel intervertebral disc heights, aligning with theoretical expectations. CONCLUSIONS Accuracy assessment employs 2 methods: IoU and Dice, and the average accuracy of IoU is 88% and that of Dice is 96.4%. The proposed deep learning-based system showcases promising results in spinal canal segmentation, laying a foundation for precise stenosis diagnosis in computed tomography images. This contributes significantly to advancements in spinal pathology understanding and treatment.
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Affiliation(s)
- Zhiyi Zhou
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Shenjun Wang
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Shujun Zhang
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Xiang Pan
- School of Artificial Intelligence and Computer Science, Jiangnan University, Wuxi, China
| | - Haoxia Yang
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Yin Zhuang
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Zhengfeng Lu
- Department of Orthopaedics, Wuxi The Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China
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Jain P, Khan MR. Comparison of novel stabilisation device with various stabilisation approaches: A finite element based biomechanical analysis. Int J Artif Organs 2022; 45:514-522. [PMID: 35393885 DOI: 10.1177/03913988221088334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The treatment of spinal failure requires suitable instrumentation, which is based on numerous concepts such as rigid fixation, semi-rigid and dynamic stabilisation. In the present work, the biomechanical investigation of various fixation systems on the lumbar segment L2-L3 was performed employing finite element analysis. Different devices were considered: novel stabilisation device (NSD), rigid implant (RI) and existing dynamic stabilisation device (EDSD). All instrumented models were loaded with a condition of 400 N compressive force with a moment of 10Nm during flexion, extension, lateral bending and axial rotation. The results of range of motion change (RMC), von-Mises stress and strain were compared. The spinal biomechanics post instrumentation resulted significantly sensitive to the geometrical feature of the implant. The obtained results showed that NSD has intermediate motion characteristics in between dynamic stabilisation and rigid fixation. However, the optimum features of a novel stabilisation device for the treatment of spinal failure still need to be verified employing in-vivo, in-vitro studies.
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Affiliation(s)
- Pushpdant Jain
- School of Mechanical Engineering, VIT Bhopal University, Sehore, Madhya Pradesh, India
| | - Mohammed Rajik Khan
- Department of Industrial Design, National Institute of Technology Rourkela, Rourkela, Odisha, India
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Biswas JK, Malas A, Majumdar S, Rana M. A comparative finite element analysis of artificial intervertebral disc replacement and pedicle screw fixation of the lumbar spine. Comput Methods Biomech Biomed Engin 2022; 25:1812-1820. [PMID: 35152795 DOI: 10.1080/10255842.2022.2039130] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Titanium alloy-based Pedicle screw-rod fusion is a very common technique to provide higher fusion regularity than other methods. In recent times, Carbon-fibre-reinforced (CFR)-PEEK rod is used to better reduce the fusion rate. Alternatively, total disc replacement (TDR) is also very common for the non-fusion treatment method for degenerative disc disease (DDD). This study aims to investigate flexibility (ROM), stability, stress condition in implant, implant adjacent bone of the implanted lumbar spine during different physiological movements and loading environments. The finite element (FE) intact model of the lumbar spine (L2-L5) with two-level pedicle screw-rod fusion at L3-L4-L5 and two-level artificial disc replacement was developed. CFR-PEEK was taken for rod for semi-rigid fusion. UHMWPE was taken as core part of the artificial disc. The FE models were simulated under 6, 8 and 10 Nm moments in left right lateral bending, flexion and extension movements. The total ROM was reduced for two-level pedicle screw fixation and increased for the artificial disc replacement model during flexion extension compared to the intact spine. The total ROM was reduced by around 54% and 25% for two-level fixation and increased by 30% and 19.5% for artificial disc replacement spine, under flexion-extension and left-right lateral bending respectively. For screw fixation, the ROM increased by 15% and 18% reduced by 4.5% and 14% for disc replacement at the adjacent segments for flexion-extension and left-right lateral bending.
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Affiliation(s)
- Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Anindya Malas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Sourav Majumdar
- Department of Applied Science & Humanities, Guru Nanak Institute of Technology, Kolkata, West Bengal, India
| | - Masud Rana
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, West Bengal, India
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Biomechanical feasibility of semi-rigid stabilization and semi-rigid lumbar interbody fusion: a finite element study. BMC Musculoskelet Disord 2022; 23:10. [PMID: 34980068 PMCID: PMC8725514 DOI: 10.1186/s12891-021-04958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 12/12/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Semi-rigid lumbar fusion offers a compromise between pedicle screw-based rigid fixation and non-instrumented lumbar fusion. However, the use of semi-rigid interspinous stabilization (SIS) with interspinous spacer and ligamentoplasty and semi-rigid posterior instrumentation (SPI) to assist interbody cage as fusion constructs remained controversial. The purpose of this study is to investigate the biomechanical properties of semi-rigidly stabilized lumbar fusion using SIS or SPI and their effect on adjacent levels using finite element (FE) method. METHOD Eight FE models were constructed to simulate the lumbosacral spine. In the non-fusion constructs, semi-rigid stabilization with (i) semi-rigid interspinous spacer and artificial ligaments (PD-SIS), and (ii) PI with semi-rigid rods were simulated (PD + SPI). For fusion constructs, the spinal models were implanted with (iii) PEEK cage only (Cage), (iv) PEEK cage and SIS (Cage+SIS), (v) PEEK cage and SPI (Cage+SPI), (vi) PEEK cage and rigid PI (Cage+PI). RESULT The comparison of flexion-extension range of motion (ROM) in the operated level showed the difference between Cage+SIS, Cage+SPI, and Cage+PI was less than 0.05 degree. In axial rotation, ROM of Cage+SIS were greater than Cage+PI by 0.81 degree. In the infrajacent level, while Cage+PI increased the ROM by 24.1, 27,7, 25.9, and 10.3% and Cage+SPI increased the ROM by 26.1, 30.0, 27.1, and 10.8% in flexion, extension, lateral bending and axial rotation respectively, Cage+SIS only increased the ROM by 3.6, 2.8, and 11.2% in flexion, extension, and lateral bending and reduced the ROM by 1.5% in axial rotation. The comparison of the von Mises stress showed that SIS reduced the adjacent IVD stress by 9.0%. The simulation of the strain energy showed a difference between constructs less than 7.9%, but all constructs increased the strain energy in the infradjacent level. CONCLUSION FE simulation showed semi-rigid fusion constructs including Cage+SIS and Cage+SPI can provide sufficient stabilization and flexion-extension ROM reduction at the fusion level. In addition, SIS-assisted fusion resulted in less hypermobility and less von Mises stress in the adjacent levels. However, SIS-assisted fusion had a disadvantage of less ROM reduction in lateral bending and axial rotation. Further clinical studies are warranted to investigate the clinical efficacy and safety of semi-rigid fusions.
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Ou Y, Xiao Z, Wei J, Jiang H, Li Z. Upper and lower adjacent segment range of motion after fixation of different lumbar spine segments in the goat: an in vitro experiment. J Int Med Res 2021; 49:3000605211020219. [PMID: 34176345 PMCID: PMC8236786 DOI: 10.1177/03000605211020219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives The purpose of this study was to examine the biomechanical effects of fixation on range of motion (ROM) in the upper and lower adjacent segments of different lumbar spine segments in a goat spine model. Methods Fifteen goat spine specimens (vertebrae T12–S1) were randomly divided into three groups: A (single-segment fixation), B (double-segment fixation), and C (triple-segment fixation). Motion in different directions was tested using a spinal motion simulation test system with five external loading forces. Transverse, forward–backward, and vertical displacement of the upper and lower adjacent segments were measured. Results As the external load increased, the upper and lower adjacent segment ROM increased. A significantly greater ROM in group C compared with group A was found when the applied external force was greater than 75 N. The upper adjacent segment showed a significantly greater ROM than the lower adjacent segment ROM within each group. Conclusions Adjacent segment ROM increased with an increasing number of fixed lumbar segments. The upper adjacent segment ROM was greater than that of the lower adjacent segments. Adjacent segment stability after lumbar internal fixation worsened with an increasing number of fixed segments.
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Affiliation(s)
- Yufu Ou
- Department of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zengming Xiao
- Department of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianxun Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hua Jiang
- Department of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhuhai Li
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Biswas JK, Rana M, Malas A, Roy S, Chatterjee S, Choudhury S. Effect of single and multilevel artificial inter-vertebral disc replacement in lumbar spine: A finite element study. Int J Artif Organs 2021; 45:193-199. [PMID: 33706581 DOI: 10.1177/03913988211001875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Degenerative disc disease (DDD) in lumbar spine is one of the major musculoskeletal disorders that cause low back pain (LBP). The intervertebral disc structure and dynamics of the lumbar spine are significantly affected by lumbar DDD, leading to a reduced range of motion (ROM), muscle weakness and gradual degradation. Spinal fusion and inter-vertebral disc replacement prostheses are two major surgical methods used for treating lumbar DDD. The aim of this present study is to examine biomechanical impacts of single level (L3-L4 and L4-L5) and multi level (L3-L4-L5) inter-vertebral disc replacement in lumbar spine (L2-L5) and to compare the performance with intact spine. Finite element (FE) analysis has been used to compare the mobility and stress distribution of all the models for four physiological movements, namely flexion, extension, left and right lateral bending under 6, 8 and 10 Nm moments. Spinal fusion implants completely restrict the motion of the implanted segment and increase disc stress at the adjacent levels. In contrast to that, the results single level ADR models showed closer ROM and disc stress to natural model. At the spinal segments adjacent to the implantation, single level ADR shows lower chance of disc degeneration. However, significantly increased ROM was observed in case of double level ADR.
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Affiliation(s)
- Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, India
| | - Masud Rana
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, India
| | - Anindya Malas
- Department of Mechanical Engineering, National Institute of Technology, Patna, India
| | - Sandipan Roy
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Subhomoy Chatterjee
- Department of Sports Biomechanics, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Sandeep Choudhury
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Chennai, India
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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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Jain P, Rana M, Biswas JK, Khan MR. Biomechanics of spinal implants-a review. Biomed Phys Eng Express 2020; 6:042002. [PMID: 33444261 DOI: 10.1088/2057-1976/ab9dd2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Spinal instrumentations have been classified as rigid fixation, total disc replacement and dynamic stabilization system for treatment of various spinal disorders. The efficacy and biomechanical suitability of any spinal implant can be measured through in vitro, in vivo experiments and numerical techniques. With the advancement in technology finite element models are making an important contribution to understand the complex structure of spinal components along with allied functionality, designing and application of spinal instrumentations at preliminary design stage. This paper aimed to review the past and recent studies to describe the biomechanical aspects of various spinal implants. The literatures were grouped and reviewed in accordance to instrumentation category and their functionality in the spinal column at respective locations.
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Affiliation(s)
- Pushpdant Jain
- School of Mechanical Engineering, VIT Bhopal University, Bhopal-Indore Highway Kothrikalan, Sehore Madhya Pradesh - 466114, India
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Design and development of a novel expanding flexible rod device (FRD) for stability in the lumbar spine: A finite-element study. Int J Artif Organs 2020; 43:803-810. [DOI: 10.1177/0391398820917390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study is to design a novel expanding flexible rod device, for pedicle screw fixation to provide dynamic stability, based on strength and flexibility. Three-dimensional finite-element models of lumbar spine (L1-S) with flexible rod device on L3-L4-L5 levels are developed. The implant material is taken to be Ti-6Al-4V. The models are simulated under different boundary conditions, and the results are compared with intact model. In natural model, total range of motion under 10 Nm moment were found 66.7°, 24.3° and 13.59°, respectively during flexion–extension, lateral bending and axial rotation. The von Mises stress at intact bone was 4 ± 2 MPa and at bone, adjacent to the screw in the implanted bone, was 6 ± 3 MPa. The von Mises stress of disc of intact bone varied from 0.36 to 2.13 MPa while that of the disc between the fixed vertebra of the fixation model reduced by approximately 10% for flexion and 25% for extension compared to intact model. The von Mises stresses of pedicle screw were 120, 135, 110 and 90 MPa during flexion, extension, lateral bending, and axial rotation, respectively. All the stress values were within the safe limit of the material. Using the flexible rod device, flexibility was significantly increased in flexion/extension but not in axial rotation and lateral bending. The results suggest that dynamic stabilization system with respect to fusion is more effective for homogenizing the range of motion of the spine.
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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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