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Prado M, Oyama S, Giambini H. Marker-Based Versus IMU-Based Kinematics for Estimates of Lumbar Spine Loads Using a Full-Body Musculoskeletal Model. J Appl Biomech 2024; 40:306-315. [PMID: 38881179 DOI: 10.1123/jab.2023-0202] [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: 08/02/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 06/18/2024]
Abstract
Musculoskeletal modeling, typically implemented using marker-based systems in laboratory environments, is commonly used for noninvasive estimations of loads. Inertial measurement units (IMUs) have become an alternative for the evaluation of kinematics. However, estimates of spine joint contact forces using IMUs have yet to be thoroughly evaluated. Dynamics tasks and static postures from activities of daily living were captured on 11 healthy subjects using both systems simultaneously. Spine kinematics obtained from IMU- and marker-based systems and L4-L5 joint contact forces were compared. Lateral bending resulted in a weak agreement with significant differences between the 2 systems (P = .02, average root mean-squared error = 4.81), whereas flexion-extension and axial rotation exhibited the highest agreement with no significant differences (P < .05, average root mean-squared error = 5.51 and P < .31, average root mean-squared error = 5.08, respectively). All tasks showed excellent correlations (R2 = .76-.99) in estimated loads between systems. Differences in predicted loads at the L4-L5 were only observed during flexion-extension (1041 N vs 947 N, P = .0004) and walking with weights (814 N vs 727 N, P = .004). Different joint reaction force outcomes were obtained in 2 of the 8 tasks between systems, suggesting that IMUs can be robust tools allowing for convenient and less expensive evaluations and for longitudinal assessments inside and outside the laboratory setting.
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Affiliation(s)
- Maria Prado
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Sakiko Oyama
- Department of Kinesiology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
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Fan S, Luo H, Chen S, Xiang H, Mai Q, Zhu Z, Chen Y, Hou Z, Chen W, Zhu Q, Zhang Y. Effect of different lumbar-iliac fixation and sacral slope for Tile C1.3 pelvic fractures: a biomechanical study. J Orthop Traumatol 2024; 25:32. [PMID: 38926180 PMCID: PMC11208344 DOI: 10.1186/s10195-024-00776-0] [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: 01/10/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Lumbar-iliac fixation (LIF) is a common treatment for Tile C1.3 pelvic fractures, but different techniques, including L4-L5/L5 unilateral LIF (L4-L5/L5 ULIF), bilateral LIF (BLIF), and L4-L5/L5 triangular osteosynthesis (L4-L5/L5 TOS), still lack biomechanical evaluation. The sacral slope (SS) is key to the vertical shear of the sacrum but has not been investigated for its biomechanical role in lumbar-iliac fixation. The aim of this study is to evaluate the biomechanical effects of different LIF and SS on Tile C1.3 pelvic fracture under two-legged standing load in human cadavers. METHODS Eight male fresh-frozen human lumbar-pelvic specimens were used in this study. Compressive force of 500 N was applied to the L4 vertebrae in the two-legged standing position of the pelvis. The Tile C1.3 pelvic fracture was prepared, and the posterior pelvic ring was fixed with L5 ULIF, L4-L5 ULIF, L5 TOS, L4-L5 TOS, and L4-L5 BLIF, respectively. Displacement and rotation of the anterior S1 foramen at 30° and 40° sacral slope (SS) were analyzed. RESULTS The displacement of L4-L5/L5 TOS in the left-right and vertical direction, total displacement, and rotation in lateral bending decreased significantly, which is more pronounced at 40° SS. The difference in stability between L4-L5 and L5 ULIF was not significant. BLIF significantly limited left-right displacement. The ULIF vertical displacement at 40° SS was significantly higher than that at 30° SS. CONCLUSIONS This study developed an in vitro two-legged standing pelvic model and demonstrated that TOS enhanced pelvic stability in the coronal plane and cephalad-caudal direction, and BLIF enhanced stability in the left-right direction. L4-L5 ULIF did not further improve the immediate stability, whereas TOS is required to increase the vertical stability at greater SS.
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Affiliation(s)
- Shicai Fan
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongjie Luo
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Sheqiang Chen
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Haibo Xiang
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiguang Mai
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenhua Zhu
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuhui Chen
- Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyong Hou
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Chen
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qingan Zhu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Yingze Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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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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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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Cochrane D, Leyten C. Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study. J Bodyw Mov Ther 2024; 38:47-53. [PMID: 38763595 DOI: 10.1016/j.jbmt.2023.12.007] [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: 04/08/2022] [Revised: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. OBJECTIVE The current study investigated scapula positioning in those with non-specific LBP. METHODS Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. RESULTS No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. CONCLUSION The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.
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Affiliation(s)
- Darryl Cochrane
- School of Sport, Exercise & Nutrition, Massey University, New Zealand.
| | - Cara Leyten
- School of Sport, Exercise & Nutrition, Massey University, New Zealand
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Di Martino A, Geraci G, Brunello M, D'Agostino C, Davico G, Curreli C, Traina F, Faldini C. Hip-spine relationship: clinical evidence and biomechanical issues. Arch Orthop Trauma Surg 2024; 144:1821-1833. [PMID: 38472450 PMCID: PMC10965652 DOI: 10.1007/s00402-024-05227-3] [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: 11/18/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
The hip-spine relationship is a critical consideration in total hip arthroplasty (THA) procedures. While THA is generally successful in patient, complications such as instability and dislocation can arise. These issues are significantly influenced by the alignment of implant components and the overall balance of the spine and pelvis, known as spinopelvic balance. Patients with alteration of those parameters, in particular rigid spines, often due to fusion surgery, face a higher risk of THA complications, with an emphasis on complications in instability, impingement and dislocation. For these reasons, over the years, computer modelling and simulation techniques have been developed to support clinicians in the different steps of surgery. The aim of the current review is to present current knowledge on hip-spine relationship to serve as a common platform of discussion among clinicians and engineers. The offered overview aims to update the reader on the main critical aspects of the issue, from both a theoretical and practical perspective, and to be a valuable introductory tool for those approaching this problem for the first time.
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Affiliation(s)
- Alberto Di Martino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Giuseppe Geraci
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Matteo Brunello
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Claudio D'Agostino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Giorgio Davico
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cristina Curreli
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Xu W, Liu X, Wu L, Liang S, Zhang Y, Huang J, Zeng X, Li S, Xu F, Xiong Y. Fatty Infiltration of Multifidus Muscles: An Easily Overlooked Risk Factor for the Severity of Osteoporotic Vertebral Fractures. Orthop Surg 2024; 16:585-593. [PMID: 38238249 PMCID: PMC10925513 DOI: 10.1111/os.13990] [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: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES Osteoporotic vertebral fractures (OVFs) are a critical public health concern requiring urgent attention, and severe OVFs impose substantial health and economic burdens on patients and society. Analysis of the risk factors for severe OVF is imperative to actively prevent the occurrence of this degenerative disorder. This study aimed to investigate the risk factors associated with the severity of OVF, with a specific focus on changes in the paraspinal muscles. METHODS A total of 281 patients with a first-time single-level acute OVF between January 2016 and January 2023 were enrolled in the study. Clinical and radiological data were collected and analyzed. The cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles, including the multifidus muscles (MFMs), erector spinae muscles (ESMs), and psoas major muscles (PSMs), were measured by magnetic resonance imaging (MRI) of the L4/5 intervertebral discs. According to the classification system of osteoporotic fractures (OF classification) and recommended treatment plan, OVFs were divided into a low-grade OF group and a high-grade OF group. Univariate and multivariate logistic regression analyse s were performed to identify risk factors associated with the severity of OVF. RESULTS Ninety-eight patients were included in the low-grade OF group, and 183 patients were included in the high-grade OF group. Univariate analysis revealed a significantly higher incidence of a high degree of FI of MFMs (OR = 1.71, p = 0.002) and ESMs (OR = 1.56, p = 0.021) in the high-grade OF group. Further multivariate logistic regression analysis demonstrated that a high degree of FI of the MFMs (OR = 1.71, p = 0.002) is an independent risk factor for the severity of OVF. CONCLUSION A high degree of FI of the MFMs was identified as an independent risk factor for the severity of OVF. Decreasing the degree of FI in the MFMs might lower the incidence of the severity of OVF, potentially reducing the necessity for surgical intervention in OVF patients.
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Affiliation(s)
- Wuyan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xiaowen Liu
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
| | - Li Wu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Shaohua Liang
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Ye Zhang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Junbing Huang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xuwen Zeng
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Siming Li
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Fan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Yuchao Xiong
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
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Larivière C, Eskandari AH, Mecheri H, Ghezelbash F, Gagnon D, Shirazi-Adl A. Effect of personalized spinal profile on its biomechanical response in an EMG-assisted optimization musculoskeletal model of the trunk. J Biomech 2024; 162:111867. [PMID: 37992597 DOI: 10.1016/j.jbiomech.2023.111867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Recent developments in musculoskeletal (MS) modeling have been geared towards model customization. Personalization of the spine profile could affect estimates of spinal loading and stability, particularly in the upright standing posture where large inter-subject variations in the lumbar lordosis have been reported. This study investigates the biomechanical consequences of changes in the spinal profile. In 31 participants (healthy and with back pain), (1) the spine external profile was measured, (2) submaximal contractions were recorded in a dynamometer to calibrate the EMG-driven MS model and finally (3) static lifting in the upright standing challenging spine stability while altering load position and magnitude were considered. EMG signals of 12 trunk muscles and angular kinematics of 17 segments were recorded. For each participant, the MS model was constructed using either a generic or a personalized spinal profile and 17 biomechanical outcomes were computed, including individual muscle forces, ratios of muscle group forces, spinal loading and stability parameters. According to the ANOVA results and corresponding effect sizes, personalizing the spine profile induced medium and large effects on about half MS model outcomes related to the trunk muscle forces and negligible to small effects on spinal loading and stability as more aggregate outcomes. These effects are explained by personalized spine profiles that were a little more in extension as well as more pronounced spine curvatures (lordosis and kyphosis). These findings suggest that spine profile personalization should be considered in MS spine modeling as it may impact muscle force prediction and spinal loading.
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Affiliation(s)
- C Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.
| | - A H Eskandari
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada; Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - H Mecheri
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - F Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - D Gagnon
- Faculty of Physical Activity Sciences, University of Sherbrooke, Canada
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
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Recent Advances in Coupled MBS and FEM Models of the Spine—A Review. Bioengineering (Basel) 2023; 10:bioengineering10030315. [PMID: 36978705 PMCID: PMC10045105 DOI: 10.3390/bioengineering10030315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the overall kinematics and kinetics of the spine and the inner stress distribution of flexible components. We reviewed studies that included MBS and FEM co-simulations of the spine. Thereby, we classified the studies into unidirectional and bidirectional co-simulation, according to their data exchange methods. Several studies have demonstrated that using unidirectional co-simulation models provides useful insights into spinal biomechanics, although synchronizing the two distinct models remains a key challenge, often requiring extensive manual intervention. The use of a bidirectional co-simulation features an iterative, automated process with a constant data exchange between integrated subsystems. It reduces manual corrections of vertebra positions or reaction forces and enables detailed modeling of dynamic load cases. Bidirectional co-simulations are thus a promising new research approach for improved spine modeling, as a main challenge in spinal biomechanics is the nonlinear deformation of the intervertebral discs. Future studies will likely include the automated implementation of patient-specific bidirectional co-simulation models using hyper- or poroelastic intervertebral disc FEM models and muscle forces examined by an optimization algorithm in MBS. Applications range from clinical diagnosis to biomechanical analysis of overload situations in sports and injury prediction.
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Lerchl T, Nispel K, Baum T, Bodden J, Senner V, Kirschke JS. Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges. Bioengineering (Basel) 2023; 10:bioengineering10020202. [PMID: 36829696 PMCID: PMC9952620 DOI: 10.3390/bioengineering10020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.
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Affiliation(s)
- Tanja Lerchl
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-15365
| | - Kati Nispel
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Veit Senner
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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Ignasiak D, Behm P, Mannion AF, Galbusera F, Kleinstück F, Fekete TF, Haschtmann D, Jeszenszky D, Zimmermann L, Richner-Wunderlin S, Vila-Casademunt A, Pellisé F, Obeid I, Pizones J, Sánchez Pérez-Grueso FJ, Karaman MI, Alanay A, Yilgor Ç, Ferguson SJ, Loibl M. Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. 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 2023; 32:571-583. [PMID: 36526952 DOI: 10.1007/s00586-022-07477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS Spinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.
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Affiliation(s)
- Dominika Ignasiak
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland.
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laura Zimmermann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
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12
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Wu J, Chen Z, Wang H, Tian Y, Ma X, Lyu F, Jiang J, Wang H. The Influence of Roussouly Type on the Prevalence, Subtype, and Distribution Characteristics of Modic Changes in Patients with Lumbar Degenerative Disc Disease. World Neurosurg 2023; 169:e102-e109. [PMID: 36309336 DOI: 10.1016/j.wneu.2022.10.070] [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: 09/30/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The relationship between Roussouly type and Modic changes (MC) is unknown. The aim of our study was to investigate the influence of Roussouly type on the characteristics of MC in patients with lumbar degenerative disc disease. METHODS This cross-sectional observational study from Huashan Hospital included 270 patients with lumbar degenerative disc disease. Subjects were divided into 4 groups according to the Roussouly classification. Prevalence, subtype, and distribution characteristics of MC from L1-L2 upper end plate to L5-S1 lower end plate were compared between 4 Roussouly types. RESULTS Of 270 patients, 65 (24.1%) were Roussouly type I, 115 (42.6%) were Roussouly type II, 55 (20.4%) were Roussouly type III, and 35 (13.0%) were Roussouly type IV. MC were present in 45.9% (n = 270) of patients, 12.7% (n = 2700) of end plates, and 11.8% (n = 1350) of intervertebral discs. The prevalence rate of MC by subtype and intervertebral disc among the 4 Roussouly types was statistically different (P < 0.05), and the prevalence rate of MC by intervertebral disc in Roussouly type I was statistically higher than the other 3 Roussouly types. In Roussouly types I and IV, the prevalence rate of MC at L4-L5 level showed no significant differences compared with those at upper lumbar levels, while in Roussouly types II and III, the prevalence rate of MC at L4-L5 level was significantly higher than those at upper lumbar levels. CONCLUSIONS Roussouly types can influence prevalence, subtype, and distribution characteristics of MC in patients with lumbar degenerative disc disease.
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Affiliation(s)
- Jianwei Wu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenhao Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongwei Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Tian
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China; Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
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13
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Miura T, Hongo M, Kasukawa Y, Kijima H, Kudo D, Saito K, Kimura R, Iwami T, Miyakoshi N. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16452. [PMID: 36554333 PMCID: PMC9779485 DOI: 10.3390/ijerph192416452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Tazawako Hospital, Akita 014-1201, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Yuji Kasukawa
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Daisuke Kudo
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Takehiro Iwami
- Department of Mechanical Engineering, Faculty of Engineering Science, Akita University, Akita 010-8502, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
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Muacevic A, Adler JR, Chhabra HS, Jain A. Impact of Lumbar Postures on the Functioning of Pelvic Floor Muscles Among Osteoporotic Post-Menopausal Women. Cureus 2022; 14:e32869. [PMID: 36578851 PMCID: PMC9785378 DOI: 10.7759/cureus.32869] [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] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Maintaining continence and providing support to the abdominal contents and sexual functioning are among the primary roles of pelvic floor muscles. The pelvic floor muscles work in synergy with the abdominal muscle to perform these functions. Abdominal muscle activation in the sagittal plane is influenced by the lumbar spine posture. As pelvic floor dysfunction is common among post-menopausal women, this study aims to find out the relationship between lumbar posture and electromyographic (EMG) activity of the rectus abdominis (RA) muscle and vaginal pressure (VP) as a functioning of the pelvic floor muscles among osteoporotic post-menopausal females. Methods A total of 78 osteoporotic post-menopausal women were recruited and allocated into three groups depending on lumbar lordotic angle, namely normal lordosis (n=26) hyperlordosis (n=26), and hypolordosis (n=26). All the subjects were recorded for RA EMG activity and VP for pelvic floor function in the quiet standing (QS) position, and voluntary dynamic tasks such as maximal coughing (MC) and Valsalva maneuver (VM). Data were analyzed using one-way analysis of variance (ANOVA) and post hoc analysis. A 5% probability level was considered statistically significant, i.e., p<0.05. Results The results showed a significant reduction in the RA activity and VP during the dynamic tasks (MC and VM) among subjects with the altered lumbar lordotic angle (p<0.05). The reduction in RA activity and VP was found to be significantly higher (p<0.05) in subjects with hyperlordotic lumbar spine than in those with hypolordotic lumbar spine as compared to normal lordosis during QS, MC, and VM. Conclusion We conclude that osteoporotic post-menopausal women with different lumbar lordotic angle show variations in RA activity and pressure generated by the vagina as a function of the pelvic floor during voluntary dynamic tasks.
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Zhang SB, Chen H, Xu HW, Yi YY, Fang XY, Wang SJ. Computed tomography-based paravertebral muscle density predicts subsequent vertebral fracture risks independently of bone mineral density in postmenopausal women following percutaneous vertebral augmentation. Aging Clin Exp Res 2022; 34:2797-2805. [PMID: 36001272 DOI: 10.1007/s40520-022-02218-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/29/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The risk of subsequent vertebral fractures (SVF) after the primary vertebral fracture cannot be explained by lower bone mineral density (BMD) alone. Computed tomography (CT) measurements of paravertebral muscle density (PMD) are recognized radiographic markers used to predict physical function, fragile fractures. AIMS This study aims to investigate the relationship between PMD and the risk of SVF in cohorts of postmenopausal women, and to determine if combining both PMD and BMD measures derived from CT can improve the accuracy of predicting SVF. METHODS This study enrolled 305 postmenopausal women between the ages of 50 and 88 for 3 years of follow-up studies. Trabecular attenuation (Hounsfield units, HU) was measured at L1 level and muscle attenuation of paravertebral muscle at L3 level on preoperative lumbar CT scans to determine the L1 BMD and L3 PMD. Kaplan-Meier analysis was applied to evaluate SVF-free survival. The hazard ratios (HRs) of PMD for SVF events were estimated with the Cox proportional hazards model. The predictive values of L1 BMD and L3 PMD for SVF were quantified using the Receiver-Operating Characteristic (ROC) curve. RESULT During the 3 years of follow-up studies, 88 patients (28.9%) suffered an SVF. ROC curve analysis demonstrated that an L3 PMD threshold of 32 HU had a sensitivity of 89.8% and a specificity of 62% for the prediction of SVF. Kaplan-Meier analysis showed that L3 PMD ≤ 32 HU was significantly associated with lower SVF-free survival (p < 0.001; log-rank test). After adjusting for age, BMI, diabetes, postoperative osteoporosis treatment, handgrip strength, L1 BMD, multivariate analyses also indicated a persistent modest effect of L3 PMD on SVF-free survival. The area under the ROC curve of L3 PMD and L1 BMD, combined to predict the risk of SVF, was 0.790, which was significantly higher than the value for L1 BMD alone (0.735). L3 PMD and L1 BMD significantly improved the accuracy of SVF risk prediction compared with L1 BMD alone, which was confirmed by reclassification improvement measures. The inclusion of handgrip strength and postoperative osteoporosis treatment in the model further improved SVF prediction accuracy, and PMD remained significant in the model. CONCLUSION Decreased L3 PMD is an independent risk predictor of SVF. Combined CT-based L1 BMD and L3 PMD can significantly improve the accuracy of predicting the risk of SVF in postmenopausal women who have suffered prior osteoporotic vertebral fractures.
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Affiliation(s)
- Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Hao Chen
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Xin-Yue Fang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China. .,Department of Orthopedic, East Hospital, Ji'an Hospital, Jiangxi, 343000, China.
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16
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Effect of Unilateral Knee Extension Restriction on the Lumbar Region during Gait. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1151753. [PMID: 36046010 PMCID: PMC9424019 DOI: 10.1155/2022/1151753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
Unilateral knee extension restriction might change trunk alignment and increase mechanical load on the lumbar region during walking. We aimed to clarify lumbar region mechanical load during walking with restricted knee extension using a musculoskeletal model simulation. Seventeen healthy adult males were enrolled in this study. Participants walked 10 m at a comfortable velocity with and without restricted right knee extension of 15° and 30° using a knee brace. L4-5 joint moment, joint reaction force, and muscle forces around the lumbar region during walking were calculated for each condition. Peaks of kinetic data were compared among three gait conditions during 0%-30% and 50%-80% of the right gait cycle. Lumbar extension moment at early stance of the bilateral lower limbs was significantly increased in the 30° restricted condition (p ≤ 0.021). Muscle force of the multifidus showed peaks at stance phase of the contralateral side during walking, and the erector spinae showed force peaks at early stance of the bilateral lower limb. Muscle force of the multifidus and erector spinae increased with increasing degree of knee flexion (p ≤ 0.010), with a large effect size (η 2 = 0.273-0.486). The joint force acting on L4-5 showed two peaks at early stance of the bilateral lower limbs during the walking cycle. The anterior and vertical joint force on L4-5 increased by 14.2%-36.5% and 10.0%-23.0% in walking with restricted knee extension, respectively (p ≤ 0.010), with a large effect size (η 2 = 0.149-0.425). Restricted knee joint extension changed trunk alignment and increased the muscle force and the vertical and anterior joint force on the L4-5 joint during walking; this tendency became more obvious with increased restriction angle. Our results provide important information for therapists engaged in the rehabilitation of patients with knee contracture.
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17
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Johansson F, Sirat Z, Hebelka H, Brisby H, Nordström F, Lagerstrand K. Non-Invasive Evaluation of Intradiscal Deformation during Axial Loading of the Spine Using Deformation-Field Magnetic Resonance Imaging: A Potential Tool for Micro-Instability Measurements. J Clin Med 2022; 11:jcm11164665. [PMID: 36012904 PMCID: PMC9410209 DOI: 10.3390/jcm11164665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Degeneration alters the structural components of the disc and its mechanical behavior. Understanding this pathophysiological process is of great importance, as it may lead to back pain. However, non-invasive methods to characterize the disc mechanics in vivo are lacking. Here, a potential method for measurements of the intradiscal deformation under stress is presented. The method utilizes a standard MRI protocol, commercial loading equipment, and registration software. The lumbar spine (L1/L2–L5/S1) of 36 human subjects was imaged with and without axial loading of the spine. The resulting images were registered, and changes in the images during the registration were displayed pixel-by-pixel to visualize the internal deformation of the disc. The degeneration grade, disc height, disc angle and tilt angle were determined and correlated with the deformation using multivariate regression analysis. The largest deformation was found at the lower lumbar spine, and differences in regional behaviors between individual discs were found. Weak to moderate correlations between the deformation and different disc characteristics were found, where the degeneration grade and tilt angle were the main contributing factors. To conclude, the image-based method offers a potential tool to study the pathophysiological process of the disc.
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Affiliation(s)
- Frida Johansson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Correspondence:
| | - Zainab Sirat
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Fredrik Nordström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Lerchl T, El Husseini M, Bayat A, Sekuboyina A, Hermann L, Nispel K, Baum T, Löffler MT, Senner V, Kirschke JS. Validation of a Patient-Specific Musculoskeletal Model for Lumbar Load Estimation Generated by an Automated Pipeline From Whole Body CT. Front Bioeng Biotechnol 2022; 10:862804. [PMID: 35898642 PMCID: PMC9309792 DOI: 10.3389/fbioe.2022.862804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Chronic back pain is a major health problem worldwide. Although its causes can be diverse, biomechanical factors leading to spinal degeneration are considered a central issue. Numerical biomechanical models can identify critical factors and, thus, help predict impending spinal degeneration. However, spinal biomechanics are subject to significant interindividual variations. Therefore, in order to achieve meaningful findings on potential pathologies, predictive models have to take into account individual characteristics. To make these highly individualized models suitable for systematic studies on spinal biomechanics and clinical practice, the automation of data processing and modeling itself is inevitable. The purpose of this study was to validate an automatically generated patient-specific musculoskeletal model of the spine simulating static loading tasks. Methods: CT imaging data from two patients with non-degenerative spines were processed using an automated deep learning-based segmentation pipeline. In a semi-automated process with minimal user interaction, we generated patient-specific musculoskeletal models and simulated various static loading tasks. To validate the model, calculated vertebral loadings of the lumbar spine and muscle forces were compared with in vivo data from the literature. Finally, results from both models were compared to assess the potential of our process for interindividual analysis. Results: Calculated vertebral loads and muscle activation overall stood in close correlation with data from the literature. Compression forces normalized to upright standing deviated by a maximum of 16% for flexion and 33% for lifting tasks. Interindividual comparison of compression, as well as lateral and anterior–posterior shear forces, could be linked plausibly to individual spinal alignment and bodyweight. Conclusion: We developed a method to generate patient-specific musculoskeletal models of the lumbar spine. The models were able to calculate loads of the lumbar spine for static activities with respect to individual biomechanical properties, such as spinal alignment, bodyweight distribution, and ligament and muscle insertion points. The process is automated to a large extent, which makes it suitable for systematic investigation of spinal biomechanics in large datasets.
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Affiliation(s)
- Tanja Lerchl
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Tanja Lerchl,
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Amirhossein Bayat
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luis Hermann
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Kati Nispel
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Veit Senner
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schmalz T, Colienne A, Bywater E, Fritzsche L, Gärtner C, Bellmann M, Reimer S, Ernst M. A Passive Back-Support Exoskeleton for Manual Materials Handling: Reduction of Low Back Loading and Metabolic Effort during Repetitive Lifting. IISE Trans Occup Ergon Hum Factors 2022. [PMID: 34763618 DOI: 10.1080/24725838.2021.2005720] [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: 10/18/2022]
Abstract
OCCUPATIONAL APPLICATIONSGlobalization and eCommerce continue to fuel unprecedented growth in the logistics and warehousing markets. Simultaneously, the biggest bottleneck for these industries is their human capital. Where automation and robotic solutions fail to deliver a return on investment, humans frequently take over handling tasks that place harmful loads and strains on the body. Occupational exoskeletons can reduce fatigue and strain by supporting the lower spine and are designed to prevent work-related musculoskeletal disorders and other injuries. They are a mid- to long-term investment for industries to improve ergonomic conditions in workplaces, with the potential for reducing absences from work, sick days logged, and workers compensation claims. To examine the effectiveness of the newly introduced Paexo Back exoskeleton, a study was completed with 10 participants who completed manual load handling tasks with and without the exoskeleton. Key findings include significant reductions in metabolic effort and low back loading when the exoskeleton is worn.
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Affiliation(s)
- Thomas Schmalz
- Ottobock SE & Co. KGaA/Clinical Research & Services - Biomechanics, Göttingen, Germany
| | - Anja Colienne
- Private University of Applied Science, Göttingen, Germany
| | | | | | | | - Malte Bellmann
- Ottobock SE & Co. KGaA/Clinical Research & Services - Biomechanics, Göttingen, Germany
| | - Samuel Reimer
- Ottobock SE & Co. KGaA/Business Development Industrials, Duderstadt, Germany
| | - Michael Ernst
- Ottobock SE & Co. KGaA/Clinical Research & Services - Biomechanics, Göttingen, Germany
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20
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Panico M, Bassani T, Villa TMT, Galbusera F. The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading. Front Bioeng Biotechnol 2021; 9:745703. [PMID: 34881230 PMCID: PMC8645959 DOI: 10.3389/fbioe.2021.745703] [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] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Simplified loading conditions such as pure moments are frequently used to compare different instrumentation techniques to treat spine disorders. The purpose of this study was to determine if the use of realistic loading conditions such as muscle forces can alter the stresses in the implants with respect to pure moment loading. A musculoskeletal model and a finite element model sharing the same anatomy were built and validated against in vitro data, and coupled in order to drive the finite element model with muscle forces calculated by the musculoskeletal one for a prescribed motion. Intact conditions as well as a L1-L5 posterior fixation with pedicle screws and rods were simulated in flexion-extension and lateral bending. The hardware stresses calculated with the finite element model with instrumentation under simplified and realistic loading conditions were compared. The ROM under simplified loading conditions showed good agreement with in vitro data. As expected, the ROMs between the two types of loading conditions showed relatively small differences. Realistic loading conditions increased the stresses in the pedicle screws and in the posterior rods with respect to simplified loading conditions; an increase of hardware stresses up to 40 MPa in extension for the posterior rods and 57 MPa in flexion for the pedicle screws were observed with respect to simplified loading conditions. This conclusion can be critical for the literature since it means that previous models which used pure moments may have underestimated the stresses in the implants in flexion-extension and in lateral bending.
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Affiliation(s)
- Matteo Panico
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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21
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Miura T, Miyakoshi N, Saito K, Kijima H, Iida J, Hatakeyama K, Suzuki K, Komatsu A, Iwami T, Matsunaga T, Shimada Y. Association between global sagittal malalignment and increasing hip joint contact force, analyzed by a novel musculoskeletal modeling system. PLoS One 2021; 16:e0259049. [PMID: 34710144 PMCID: PMC8553155 DOI: 10.1371/journal.pone.0259049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/11/2021] [Indexed: 01/02/2023] Open
Abstract
Patients with adult spinal deformity have various standing postures. Although several studies have reported a relationship between sagittal alignment and exacerbation of hip osteoarthritis, information is limited regarding how spinopelvic sagittal alignment changes affect hip joint loading. This study aimed to investigate the relationship between sagittal spinopelvic-lower limb alignment and the hip joint contact force (HCF) using a novel musculoskeletal model. We enrolled 20 women (78.3±6.7 years) from a single institution. Standing lateral radiographs were acquired to measure thoracic kyphosis, lumbar lordosis, the pelvic tilt, sacral slope, sagittal vertical axis (SVA), femur obliquity angle, and knee flexion angle. In the model simulation, the Anybody Modeling System was used, which alters muscle pathways using magnetic resonance imaging data. Each patient’s alignment was entered into the model; the HCF and hip moment in the standing posture were calculated using inverse dynamics analysis. The relationship between the HCF and each parameter was examined using Spearman’s correlation coefficient (r). The patients were divided into low SVA and high SVA groups, with a cutoff value of 50 mm for the SVA. The HCF was 168.2±60.1 N (%BW) and positively correlated with the SVA (r = 0.6343, p<0.01) and femur obliquity angle (r = 0.4670, p = 0.03). The HCF were 122.2 and 214.1 N (75.2% difference) in the low SVA and high SVA groups, respectively (p<0.01). The flexion moment was also increased in the high SVA group compared with that in the low SVA group (p = 0.03). The SVA and femur obliquity angle are factors related to the HCF, suggesting an association between adult spinal deformity and the exacerbation of hip osteoarthritis. Future studies will need to assess the relationship between the hip joint load and sagittal spinopelvic parameters in dynamic conditions.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Kakunodate General Hospital, Akita, Japan
- * E-mail:
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Jumpei Iida
- Department of Orthopedic Surgery, Omagari Kousei Medical Center, Akita, Japan
| | | | - Kotaro Suzuki
- Department of Mechanical Engineering, Akita University Faculty of Engineering Science, Akita, Japan
| | - Akira Komatsu
- National Institute of Technology (KOSEN), Sendai College, Sendai-shi, Miyagi, Japan
| | - Takehiro Iwami
- Department of Mechanical Engineering, Akita University Faculty of Engineering Science, Akita, Japan
| | - Tosiki Matsunaga
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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22
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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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23
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Yanagisawa O, Oshikawa T, Matsunaga N, Adachi G, Kaneoka K. Acute Physiological Response of Lumbar Intervertebral Discs to High-load Deadlift Exercise. Magn Reson Med Sci 2021; 20:290-294. [PMID: 32879259 PMCID: PMC8424024 DOI: 10.2463/mrms.mp.2020-0052] [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] [Indexed: 01/08/2023] Open
Abstract
Purpose: We aimed to evaluate the acute physiological effects of high-load deadlift exercise on the lumbar intervertebral discs using MR diffusion-weighted imaging (DWI). Methods: Fifteen volunteers (11 men and 4 women; 23.2 ± 3.3 years) without lumbar intervertebral disc degeneration performed deadlift exercise (70% of 1 repetition maximum, 6 repetitions, 5 sets, 90 s rest between sets) using a Smith machine. Sagittal MR diffusion-weighted images of the lumbar intervertebral discs were obtained using a 1.5-Tesla MR system with a spine coil before and immediately after the exercise. We calculated apparent diffusion coefficient (ADC; an index of water movement) of the nucleus pulposus from diffusion weighted images at all lumbar intervertebral discs (L1/2 through L5/S1). Results: All lumbar intervertebral discs showed significantly decreased ADC values immediately after deadlift exercise (L1/2, −2.8%; L2/3, −2.1%; L3/4, −2.8%; L4/5, −4.9%; L5/S1, −6.2%; P < 0.01). In addition, the rate of ADC decrease of the L5/S1 disc was significantly greater than those of the L1/2 (P = 0.017), L2/3 (P < 0.01), and L3/4 (P = 0.02) discs. Conclusion: The movement of water molecules within the lumbar intervertebral discs is suppressed by high-load deadlift exercise, which would be attributed to mechanical stress on the lumbar intervertebral discs during deadlift exercise. In particular, the L5/S1 disc is subjected to greater mechanical stress than the other lumbar intervertebral discs.
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Affiliation(s)
| | | | - Naoto Matsunaga
- General Education Core Curriculum Division, Seigakuin University
| | - Gen Adachi
- Graduate School of Sport Sciences, Waseda University
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24
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Liang CL, Wang SW, Chen HJ, Tsai YD, Chen JS, Wang HK, Wang KW. Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study. J Pain Res 2021; 14:1949-1957. [PMID: 34234541 PMCID: PMC8253931 DOI: 10.2147/jpr.s303979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background After proper patient selection, anatomically correct pulsed radiofrequency of the lumbar facet joints provide long-term pain relief in a routine clinical setting. In the study, we performed an analysis of clinical and radiological predictive factors and provide the scientific basis for this promising modality. Methods The study included 198 patients with lower back pain due to lumbar facet joint disease who underwent medial branch block and pulsed radiofrequency during the period 2015–2019. According to the improvement in pain score, the patients were divided into good and poor outcome groups. Clinical and radiological data were collected and analyzed. Results The multivariable analysis revealed the predictive factors, including lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and post lumbar fusion procedures. Conclusion With the results of this study, we demonstrated that the improved outcome after the surgery was related to lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and the lumbar fusion procedures. Old compression fractures and lumbar fusion would change the radiological factors and cause refractory lumbar facet joint pain.
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Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Wei Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,Department of Rheumatology, E-DA Hospital, Kaohsiung, Taiwan
| | - Han-Jung Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Wei Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
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25
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Müller A, Rockenfeller R, Damm N, Kosterhon M, Kantelhardt SR, Aiyangar AK, Gruber K. Load Distribution in the Lumbar Spine During Modeled Compression Depends on Lordosis. Front Bioeng Biotechnol 2021; 9:661258. [PMID: 34178959 PMCID: PMC8222614 DOI: 10.3389/fbioe.2021.661258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Excessive or incorrect loading of lumbar spinal structures is commonly assumed as one of the factors to accelerate degenerative processes, which may lead to lower back pain. Accordingly, the mechanics of the spine under medical conditions, such as scoliosis or spondylolisthesis, is well-investigated. Treatments via both conventional therapy and surgical methods alike aim at restoring a "healthy" (or at least pain-free) load distribution. Yet, surprisingly little is known about the inter-subject variability of load bearings within a "healthy" lumbar spine. Hence, we utilized computer tomography data from 28 trauma-room patients, whose lumbar spines showed no visible sign of degeneration, to construct simplified multi-body simulation models. The subject-specific geometries, measured by the corresponding lumbar lordosis (LL) between the endplates of vertebra L1 and the sacrum, served as ceteris paribus condition in a standardized forward dynamic compression procedure. Further, the influence of stimulating muscles from the M. multifidus group was assessed. For the range of available LL from 28 to 66°, changes in compressive and shear forces, bending moments, as well as facet joint forces between adjacent vertebrae were calculated. While compressive forces tended to decrease with increasing LL, facet forces were tendentiously increasing. Shear forces decreased between more cranial vertebrae and increased between more caudal ones, while bending moments remained constant. Our results suggest that there exist significant, LL-dependent variations in the loading of "healthy" spinal structures, which should be considered when striving for individually appropriate therapeutic measures.
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Affiliation(s)
- Andreas Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Duebendorf, Switzerland
- Department of Mathematics and Natural Sciences, Institute of Sports Science, University Koblenz-Landau, Koblenz, Germany
| | - Robert Rockenfeller
- Department of Mathematics and Natural Sciences, Mathematical Institute, UniversityKoblenz-Landau, Koblenz, Germany
| | - Nicolas Damm
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
| | - Michael Kosterhon
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sven R. Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ameet K. Aiyangar
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Duebendorf, Switzerland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karin Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
- Department of Mathematics and Natural Sciences, Institute of Sports Science, University Koblenz-Landau, Koblenz, Germany
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26
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Pan F, Zhu R, Kong C, Zhu W, Lu S, Cheng L, Schmidt H. Characteristics of Lumbar Flexion Rhythm at Different Arm Positions. World Neurosurg 2021; 152:e81-e85. [PMID: 33991728 DOI: 10.1016/j.wneu.2021.05.014] [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: 03/20/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The lumbar spine displays its greatest mobility in ventral flexion, which is a potential risk factor for low back pain. The relative contribution of each segment to the complete flexion is denoted the spine rhythm, which is required to distinguish between normal and abnormal spinal profiles, and as well to calculate the spinal forces in musculoskeletal models. Nevertheless, different spine rhythms have been reported in literature and the effect of arm position has not been demonstrated. We therefore aimed to investigate the effects of different arm positions on spine rhythm during ventral flexion. METHODS A nonradiologic back measurement device was used to determine the real-time back lordosis during ventral flexion while participants (10 male and 10 female without low back pain) held their arms at 6 different positions. RESULTS During flexion with the arms naturally hanging down at both sides, the lumbar range of flexion was 52.6° ± 13.1°. Different arm positions displayed nonsignificant effect on lumbar range of flexion (P > 0.05). The middle and lower levels contributed more to the whole lumbar range of flexion than the upper level (P < 0.05), which is independent of arm position. CONCLUSIONS The lumbar spine displayed greater flexion in the middle and lower levels and its flexion rhythm remained unchanged at different arm positions. These results strike importance to explore for more reasons explaining the different lumbar flexion rhythms reported in literature.
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Affiliation(s)
- Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, P. R. China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, P. R. China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Liming Cheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, P. R. China
| | - Hendrik Schmidt
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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27
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Manual Pressure Release and Low-Grade Electrical Peripheral Receptor Stimulation in Nonspecific Low Back Pain: A Randomized Controlled Trial. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33474700 DOI: 10.1007/5584_2020_605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Chronic nonspecific low back pain is a frequent clinical condition affecting the general population and influencing disability level and quality of life. We performed a single-blinded, randomized, and controlled study to compare the effectiveness of manual pressure release (MPR) and electrical neuromodulation (ENM) treatments in the management of chronic low back pain. There were 20 patients with chronic low back pain randomly assigned to 6 treatment sessions with either technique. Both groups were treated for 2 days a week for 3 weeks. Myofascial trigger points (MTrPs) were identified and skin conductance, pressure-pain threshold, postural changes, and the Oswestry Disability Index were assessed before and after each treatment session, along with the protocol-end data compared against the baseline data in each group. We found an outstanding and about equal deactivation of MTrPs from pre- to post-treatment in both groups, reducing disability in patients with chronic low back pain. The study highlights the ENM as a reliable tool for the evaluation of MTrPs, given a high agreement with the MPR. The effect on the neuromuscular condition of treating the "key trigger points" found in this study advances the knowledge of medical rehabilitation.
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28
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Rossi MK, Pasanen K, Heinonen A, Äyrämö S, Leppänen M, Myklebust G, Vasankari T, Kannus P, Parkkari J. The standing knee lift test is not a useful screening tool for time loss from low back pain in youth basketball and floorball players. Phys Ther Sport 2021; 49:141-148. [PMID: 33689988 DOI: 10.1016/j.ptsp.2021.01.017] [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: 12/30/2019] [Revised: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players. DESIGN A prospective cohort study. SETTING Finnish elite youth floorball and basketball players. PARTICIPANTS Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8). MAIN OUTCOME MEASURES LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox's proportional hazard models with mixed effects were used for the analysis. RESULTS Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively. CONCLUSIONS Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players.
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Affiliation(s)
- Marleena Katariina Rossi
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland.
| | - Kati Pasanen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2n 4N1, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Drvie NW, Calgary, AB, T2N 4Z6, Canada
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Sami Äyrämö
- Faculty of Information Technology, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Mari Leppänen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Sciences, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Tommi Vasankari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Pekka Kannus
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Department of Orthopedics & Traumatology, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Tampere University Hospital, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
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Zuo XH, Chen YB, Xie P, Zhang WD, Xue XY, Zhang QX, Shan B, Zhang XB, Bao HG, Si YN. Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:138. [PMID: 33588890 PMCID: PMC7885256 DOI: 10.1186/s13018-021-02225-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.,Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Yin-Bing Chen
- Department of Orthopedic Surgery, The Affiliated Haian Hospital of Nantong University, Haian, 226600, China
| | - Peng Xie
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Wen-Dong Zhang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xiang-Yun Xue
- Department of Pain Management, Yancheng No.1 People's Hospital, Yancheng, 224000, China
| | - Qian-Xi Zhang
- Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Ben Shan
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Xiao-Bing Zhang
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China.
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Lee BJ, Koo HW, Yoon SW, Sohn MJ. Usefulness of Trabecular CT Attenuation Measurement of Lumbar Spine in Predicting Osteoporotic Compression Fracture: Is the L4 Trabecular Region of Interest Most Relevant? Spine (Phila Pa 1976) 2021; 46:175-183. [PMID: 33065695 DOI: 10.1097/brs.0000000000003756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to evaluate the usefulness of computed tomography (CT) attenuation in defining trabecular region-of-interest (t-ROI) at lumbar vertebral body in the assessment of osteoporotic compression fracture (OCF) compared to spinal dual x-ray absorptiometry (DXA). SUMMARY OF BACKGROUND DATA Even though osteoporosis was not diagnosed in the bone mineral density measurement using DXA, we often experienced cases where the screw was weakly inserted due to low bone quality during screw insertion. METHODS A total of 188 patients who met the inclusion criteria were enrolled. We determined best cutoff value of the simple t-ROI attenuation at the most relevant level for predicting OCF. We assessed correlations between the simple t-ROI attenuation at the most relevant level and OCF rate, and investigate the association between the number of compression fracture and simple t-ROI attenuation at the most relevant level. RESULTS L4 ROI attenuation is the most accurate measurement for predicting osteoporotic compression fracture with an area under the curve of 0.798. The optimal cutoff point of L4 ROI attenuation was measured at 90.5 HU with 88.8% and 60.6% sensitivity and specificity, respectively. L4 ROI attenuation was significantly correlated with the osteoporotic compression fracture rate (r = -0.545, P < 0.001). The number of compression fracture (coefficient of determination R2 = 0.286; P < 0.001) was independently correlated with L4 ROI attenuation. CONCLUSION Simple t-ROI computed tomography attenuation is an accurate measurement tool in predicting OCF compared to DXA T-score. The value of L4 t-ROI attenuation is the most relevant measurement for predicting osteoporotic compression fracture, is an alternative to DXA, and can predict the number and rate of compression fractures. Spine surgeons should be aware of L4 t-ROI attenuation to make successful fusion in spine surgery for elderly patients group.Level of Evidence: 3.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea
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Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity. J Biomech 2020; 110:109946. [DOI: 10.1016/j.jbiomech.2020.109946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
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Lordosis Recreation With PLIF Surgery-What Is the Influence on Adjacent Segment Lordosis?: An Observational Study of Radiological Alignment Change. Spine (Phila Pa 1976) 2020; 45:1178-1184. [PMID: 32205687 DOI: 10.1097/brs.0000000000003492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE We aimed to assess the changes in adjacent segmental lordosis (SL) across the intervertebral disc space following single level posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND DATA Adjacent segment degeneration is well documented following fusion surgery as are the spinopelvic parameters. What isn't known is the effect of fusion surgery on the adjacent SL of the lumbar spine following PLIF. METHODS Preoperative and 1-year postoperative erect lateral radiographs were analyzed for lordotic angulation of all lumbar segments and pelvic incidence (PI) in patients undergoing L4/5 or L5/S1 PLIF. RESULTS Fourty seven PLIFs achieved a mean of 7° increase in SL at L4/5 (P < 0.05) and 11° at L5/S1 (P < 0.05). In L5/S1 PLIF the lordosis gain was associated with lordosis reduction at adjacent segments 3° at L4/5 (P < 0.05); 1° at L3/4 (P < 0.05), 0° at L2/3(NS); 0° at L1/2(NS), and modest gain in overall lordosis (3°). At L4/5 PLIF the global lordosis increased by 5°, but less so at the adjacent discs (L5/S1 = 1°; L3/4 ≤ 1°; L2/3 ≤ -1°, and; L1/2 = <-1°). 19% of cases had a PI-LL > 10° preoperatively, reducing to 4° postoperatively. CONCLUSION SL increased significantly at the PLIF level. At L5/S1 minimal overall lordosis change occurred however there was reduction in lordosis at adjacent levels representing reduced adjacent segment "compensation." Conversely L4/5 PLIF showed minimal change at adjacent levels but greater overall lordosis increase. Lumbar lordosis (LL) assessment requires monosegmental assessment as well as overall measure of the LL. PLIF surgery changes both LL and SL at adjacent levels. LEVEL OF EVIDENCE 3.
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