1
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Banks JJ, Quirk DA, Chung J, Cherin JM, Walsh CJ, Anderson DE. The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts. ERGONOMICS 2024:1-14. [PMID: 38389220 DOI: 10.1080/00140139.2024.2320355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Back support exosuits aim to reduce tissue demands and thereby risk of injury and pain. However, biomechanical analyses of soft active exosuit designs have been limited. The objective of this study was to evaluate the effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading in participants performing stoop and squat lifts of 6 and 10 kg crates, using participant-specific musculoskeletal models. The exosuit did not change overall trunk motion but affected lumbo-pelvic motion slightly, and reduced peak compressive and shear vertebral loads at some levels, although shear increased slightly at others. This study indicates that soft active exosuits have limited kinematic effects during lifting, and can reduce spinal loading depending on the vertebral level. These results support the hypothesis that a soft exosuit can assist without limiting trunk movement or negatively impacting skeletal loading and have implications for future design and ergonomic intervention efforts.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David A Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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2
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Akhavanfar M, Mir-Orefice A, Uchida TK, Graham RB. An Enhanced Spine Model Validated for Simulating Dynamic Lifting Tasks in OpenSim. Ann Biomed Eng 2024; 52:259-269. [PMID: 37741902 DOI: 10.1007/s10439-023-03368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
A fully articulated thoracolumbar spine model had been previously developed in OpenSim and had been extensively validated against experimental data during various static tasks. In the present study, we enhanced this detailed musculoskeletal model by adding the role of passive structures and adding kinematic constraints to make it suitable for dynamic tasks. We validated the spinal forces estimated by this enhanced model during nine dynamic lifting/lowering tasks. Moreover, we recently developed and evaluated five approaches in OpenSim to model the external loads applied to the hands during lifting/lowering tasks, and in the present study, we assessed which approach results in more accurate spinal forces. Regardless of the external load modeling approach, the maximum forces predicted by our enhanced spine model across all tasks, as well as the pattern of estimated spinal forces within each task, showed strong correlations (r-values and cross-correlation coefficients > 0.9) with experimental data. Given the biofidelity of our enhanced model, its accessibility via the open-source OpenSim software, and the extent to which this model has been validated, we recommend it for applications requiring estimation of spinal forces during lifting/lowering tasks using multibody-based models and inverse dynamic analyses.
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Affiliation(s)
| | - Alexandre Mir-Orefice
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Thomas K Uchida
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Canada.
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3
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Sibson BE, Banks JJ, Yawar A, Yegian AK, Anderson DE, Lieberman DE. Using inertial measurement units to estimate spine joint kinematics and kinetics during walking and running. Sci Rep 2024; 14:234. [PMID: 38168540 PMCID: PMC10762015 DOI: 10.1038/s41598-023-50652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
Optical motion capture (OMC) is considered the best available method for measuring spine kinematics, yet inertial measurement units (IMU) have the potential to collect data outside the laboratory. When combined with musculoskeletal modeling, IMU technology may be used to estimate spinal loads in real-world settings. To date, IMUs have not been validated for estimates of spinal movement and loading during both walking and running. Using OpenSim Thoracolumbar Spine and Ribcage models, we compare IMU and OMC estimates of lumbosacral (L5/S1) and thoracolumbar (T12/L1) joint angles, moments, and reaction forces during gait across six speeds for five participants. For comparisons, time series are ensemble averaged over strides. Comparisons between IMU and OMC ensemble averages have low normalized root mean squared errors (< 0.3 for 81% of comparisons) and high, positive cross-correlations (> 0.5 for 91% of comparisons), suggesting signals are similar in magnitude and trend. As expected, joint moments and reaction forces are higher during running than walking for IMU and OMC. Relative to OMC, IMU overestimates joint moments and underestimates joint reaction forces by 20.9% and 15.7%, respectively. The results suggest using a combination of IMU technology and musculoskeletal modeling is a valid means for estimating spinal movement and loading.
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Affiliation(s)
- Benjamin E Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA.
| | - Jacob J Banks
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Ali Yawar
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Andrew K Yegian
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
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Rauber C, Lüscher D, Poux L, Schori M, Deml MC, Hasler CC, Bassani T, Galbusera F, Büchler P, Schmid S. Predicted vs. measured paraspinal muscle activity in adolescent idiopathic scoliosis patients: EMG validation of optimization-based musculoskeletal simulations. J Biomech 2024; 163:111922. [PMID: 38220500 DOI: 10.1016/j.jbiomech.2023.111922] [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: 08/09/2023] [Revised: 11/16/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
Musculoskeletal (MSK) models offer great potential for predicting the muscle forces required to inform more detailed simulations of vertebral endplate loading in adolescent idiopathic scoliosis (AIS). In this work, simulations based on static optimization were compared with in vivo measurements in two AIS patients to determine whether computational approaches alone are sufficient for accurate prediction of paraspinal muscle activity during functional activities. We used biplanar radiographs and marker-based motion capture, ground reaction force, and electromyography (EMG) data from two patients with mild and moderate thoracolumbar AIS (Cobb angles: 21° and 45°, respectively) during standing while holding two weights in front (reference position), walking, running, and object lifting. Using a fully automated approach, 3D spinal shape was extracted from the radiographs. Geometrically personalized OpenSim-based MSK models were created by deforming the spine of pre-scaled full-body models of children/adolescents. Simulations were performed using an experimentally controlled backward approach. Differences between model predictions and EMG measurements of paraspinal muscle activity (both expressed as a percentage of the reference position values) at three different locations around the scoliotic main curve were quantified by root mean square error (RMSE) and cross-correlation (XCorr). Predicted and measured muscle activity correlated best for mild AIS during object lifting (XCorr's ≥ 0.97), with relatively low RMSE values. For moderate AIS as well as the walking and running activities, agreement was lower, with XCorr reaching values of 0.51 and comparably high RMSE values. This study demonstrates that static optimization alone seems not appropriate for predicting muscle activity in AIS patients, particularly in those with more than mild deformations as well as when performing upright activities such as walking and running.
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Affiliation(s)
- Cedric Rauber
- Spinal Movement Biomechanics Group, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Computational Bioengineering Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dominique Lüscher
- Spinal Movement Biomechanics Group, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Computational Bioengineering Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Lucile Poux
- Spinal Movement Biomechanics Group, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Maria Schori
- Physiotherapie Maria Schori Bern, Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Carol-Claudius Hasler
- Orthopaedic Department and Spine Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- Spine Research Group, Schulthess Klinik, Zürich, Switzerland
| | - Philippe Büchler
- Computational Bioengineering Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
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5
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Yan C, Lynch AC, Alemi MM, Banks JJ, Bouxsein ML, Anderson DE. Validity of evaluating spinal kinetics without participant-specific kinematics. J Biomech 2023; 161:111821. [PMID: 37805384 DOI: 10.1016/j.jbiomech.2023.111821] [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: 01/18/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Musculoskeletal models are commonly used to estimate in vivo spinal loads under various loading conditions. Typically, participant-specific measured kinematics (PSMK) are coupled with participant-specific models, but obtaining PSMK data can be costly and infeasible in large studies or clinical practice. Thus, we evaluated two alternative methods to estimate spinal loads without PSMK: 1) ensemble average kinematics (EAK) based on kinematics from all participants; and 2) using separately measured individual kinematics (SMIK) from multiple other participants as inputs, then averaging the resulting loads. This study compares the dynamic spine loading patterns and peak loads in older adults performing five lifting tasks using PSMK, EAK and SMIK. Median root mean square errors of EAK and SMIK methods versus PSMK ranged from 18 to 72% body weight for compressive loads and from 2 to 25% body weight for shear loads, with median cross-correlations ranging from 0.931 to 0.991. The root mean square errors and cross-correlations between repeated PSMK trials fell within similar ranges. Compressive peak loads evaluated by EAK and SMIK were not different than PSMK in 12 of 15 cases, while by comparison repeated PSMK trials were not different in 13 of 15 cases. Overall, the resulting spine loading magnitudes and profiles using EAK or SMIK were not notably different than using a PSMK approach, and differences were not greater than between two PSMK trials. Thus, these findings indicate that these approaches may be used to make reasonable estimates of dynamic spinal loading without direct measurement of participant kinematics.
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Affiliation(s)
- Chenxi Yan
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States.
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6
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Alemi MM, Banks JJ, Lynch AC, Allaire BT, Bouxsein ML, Anderson DE. EMG Validation of a Subject-Specific Thoracolumbar Spine Musculoskeletal Model During Dynamic Activities in Older Adults. Ann Biomed Eng 2023; 51:2313-2322. [PMID: 37353715 DOI: 10.1007/s10439-023-03273-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
Musculoskeletal models can uniquely estimate in vivo demands and injury risk. In this study, we aimed to compare muscle activations from subject-specific thoracolumbar spine OpenSim models with recorded muscle activity from electromyography (EMG) during five dynamic tasks. Specifically, 11 older adults (mean = 65 years, SD = 9) lifted a crate weighted to 10% of their body mass in axial rotation, 2-handed sagittal lift, 1-handed sagittal lift, and lateral bending, and simulated a window opening task. EMG measurements of back and abdominal muscles were directly compared to equivalent model-predicted activity for temporal similarity via maximum absolute normalized cross-correlation (MANCC) coefficients and for magnitude differences via root-mean-square errors (RMSE), across all combinations of participants, dynamic tasks, and muscle groups. We found that across most of the tasks the model reasonably predicted temporal behavior of back extensor muscles (median MANCC = 0.92 ± 0.07) but moderate temporal similarity was observed for abdominal muscles (median MANCC = 0.60 ± 0.20). Activation magnitude was comparable to previous modeling studies, and median RMSE was 0.18 ± 0.08 for back extensor muscles. Overall, these results indicate that our thoracolumbar spine model can be used to estimate subject-specific in vivo muscular activations for these dynamic lifting tasks.
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Affiliation(s)
- Mohammad Mehdi Alemi
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RN119, Boston, MA, 02215, USA.
| | - Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
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7
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Meszaros-Beller L, Hammer M, Schmitt S, Pivonka P. Effect of neglecting passive spinal structures: a quantitative investigation using the forward-dynamics and inverse-dynamics musculoskeletal approach. Front Physiol 2023; 14:1135531. [PMID: 37324394 PMCID: PMC10264677 DOI: 10.3389/fphys.2023.1135531] [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: 01/01/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose: Inverse-dynamics (ID) analysis is an approach widely used for studying spine biomechanics and the estimation of muscle forces. Despite the increasing structural complexity of spine models, ID analysis results substantially rely on accurate kinematic data that most of the current technologies are not capable to provide. For this reason, the model complexity is drastically reduced by assuming three degrees of freedom spherical joints and generic kinematic coupling constraints. Moreover, the majority of current ID spine models neglect the contribution of passive structures. The aim of this ID analysis study was to determine the impact of modelled passive structures (i.e., ligaments and intervertebral discs) on remaining joint forces and torques that muscles must balance in the functional spinal unit. Methods: For this purpose, an existing generic spine model developed for the use in the demoa software environment was transferred into the musculoskeletal modelling platform OpenSim. The thoracolumbar spine model previously used in forward-dynamics (FD) simulations provided a full kinematic description of a flexion-extension movement. By using the obtained in silico kinematics, ID analysis was performed. The individual contribution of passive elements to the generalised net joint forces and torques was evaluated in a step-wise approach increasing the model complexity by adding individual biological structures of the spine. Results: The implementation of intervertebral discs and ligaments has significantly reduced compressive loading and anterior torque that is attributed to the acting net muscle forces by -200% and -75%, respectively. The ID model kinematics and kinetics were cross-validated against the FD simulation results. Conclusion: This study clearly shows the importance of incorporating passive spinal structures on the accurate computation of remaining joint loads. Furthermore, for the first time, a generic spine model was used and cross-validated in two different musculoskeletal modelling platforms, i.e., demoa and OpenSim, respectively. In future, a comparison of neuromuscular control strategies for spinal movement can be investigated using both approaches.
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Affiliation(s)
- Laura Meszaros-Beller
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
| | - Maria Hammer
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
- Stuttgart Center for Simulation Science (SC SimTech), University of Stuttgart, Stuttgart, Germany
| | - Syn Schmitt
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
- Stuttgart Center for Simulation Science (SC SimTech), University of Stuttgart, Stuttgart, Germany
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia
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Meszaros-Beller L, Antico M, Fontanarosa D, Pivonka P. Assessment of thoracic spinal curvatures in static postures using spatially tracked 3D ultrasound volumes: a proof-of-concept study. Phys Eng Sci Med 2023; 46:197-208. [PMID: 36625994 PMCID: PMC10030537 DOI: 10.1007/s13246-022-01210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023]
Abstract
The assessment of spinal posture is a difficult endeavour given the lack of identifiable bony landmarks for placement of skin markers. Moreover, potentially significant soft tissue artefacts along the spine further affect the accuracy of marker-based approaches. The objective of this proof-of-concept study was to develop an experimental framework to assess spinal postures by using three-dimensional (3D) ultrasound (US) imaging. A phantom spine model immersed in water was scanned using 3D US in a neutral and two curved postures mimicking a forward flexion in the sagittal plane while the US probe was localised by three electromagnetic tracking sensors attached to the probe head. The obtained anatomical 'coarse' registrations were further refined using an automatic registration algorithm and validated by an experienced sonographer. Spinal landmarks were selected in the US images and validated against magnetic resonance imaging data of the same phantom through image registration. Their position was then related to the location of the tracking sensors identified in the acquired US volumes, enabling the localisation of landmarks in the global coordinate system of the tracking device. Results of this study show that localised 3D US enables US-based anatomical reconstructions comparable to clinical standards and the identification of spinal landmarks in different postures of the spine. The accuracy in sensor identification was 0.49 mm on average while the intra- and inter-observer reliability in sensor identification was strongly correlated with a maximum deviation of 0.8 mm. Mapping of landmarks had a small relative distance error of 0.21 mm (SD = ± 0.16) on average. This study implies that localised 3D US holds the potential for the assessment of full spinal posture by accurately and non-invasively localising vertebrae in space.
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Affiliation(s)
- Laura Meszaros-Beller
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia.
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia.
| | - Maria Antico
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
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Banks JJ, Alemi MM, Allaire BT, Lynch AC, Bouxsein ML, Anderson DE. Using static postures to estimate spinal loading during dynamic lifts with participant-specific thoracolumbar musculoskeletal models. APPLIED ERGONOMICS 2023; 106:103869. [PMID: 36055036 DOI: 10.1016/j.apergo.2022.103869] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Static biomechanical simulations are sometimes used to estimate in vivo kinetic demands because they can be solved efficiently, but this ignores any potential inertial effects. To date, comparisons between static and dynamic analyses of spinal demands have been limited to lumbar joint differences in young males performing sagittal lifts. Here we compare static and dynamic vertebral compressive and shear force estimates during axial, lateral, and sagittal lifting tasks across all thoracic and lumbar vertebrae in older men and women. Participant-specific thoracolumbar full-body musculoskeletal models estimated vertebral forces from recorded kinematics both with and without consideration of dynamic effects, at an identified frame of peak vertebral loading. Static analyses under-predicted dynamic compressive and resultant shear forces, by an average of about 16% for all three lifts across the thoracic and lumbar spine but were highly correlated with dynamic forces (average r2 > .95). The study outcomes have the potential to enable standard clinical and occupational estimates using static analyses.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.
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10
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Fayad J, Eltes PE, Lazary A, Cristofolini L, Stagni R. Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskelet Disord 2022; 23:1080. [PMID: 36503435 PMCID: PMC9743750 DOI: 10.1186/s12891-022-05925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment. METHODS Electronic databases (PubMed, Scopus and ScienceDirect) were searched until February 2022. Studies published in English, investigating the intersegmental kinematics of the thoracolumbar spine using stereophotogrammetric motion analysis were identified. All information relating to measurement reliability; measurement suitability and clinical significance was extracted from the studies identified. RESULTS Seventy-four studies met the inclusion criteria. 33% of the studies reported on the repeatability of their measurement. In terms of suitability, only 35% of protocols were deemed suitable for clinical application. The spinous processes of C7, T3, T6, T12, L1, L3 and L5 were the most widely used landmarks. The spine segment definitions were, however, found to be inconsistent among studies. Activities of daily living were the main tasks performed. Comparable results between protocols are however still missing. CONCLUSION The literature to date offers various stereophotogrammetric protocols to quantify the multi-segmental motion of the thoracolumbar spine, without a standard guideline being followed. From a clinical point of view, the approaches are still limited. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance.
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Affiliation(s)
- Jennifer Fayad
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy ,National Centre for Spinal Disorders, Budapest, Hungary
| | - Peter Endre Eltes
- National Centre for Spinal Disorders, Budapest, Hungary ,In Silico Biomechanics Laboratory, National Centre for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- National Centre for Spinal Disorders, Budapest, Hungary
| | - Luca Cristofolini
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy
| | - Rita Stagni
- grid.6292.f0000 0004 1757 1758Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum – Università Di Bologna, Bologna, Italy
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Mousavi SJ, Lynch AC, Allaire BT, White AP, Anderson DE. Walking Biomechanics and Spine Loading in Patients With Symptomatic Lumbar Spinal Stenosis. Front Bioeng Biotechnol 2021; 9:751155. [PMID: 34869263 PMCID: PMC8636982 DOI: 10.3389/fbioe.2021.751155] [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: 07/31/2021] [Accepted: 10/06/2021] [Indexed: 12/05/2022] Open
Abstract
Symptomatic lumbar spinal stenosis is a leading cause of pain and mobility limitation in older adults. It is clinically believed that patients with lumbar spinal stenosis adopt a flexed trunk posture or bend forward and alter their gait pattern to improve tolerance for walking. However, a biomechanical assessment of spine posture and motion during walking is broadly lacking in these patients. The purpose of this study was to evaluate lumbar spine and pelvic sagittal angles and lumbar spine compressive loads in standing and walking and to determine the effect of pain and neurogenic claudication symptoms in patients with symptomatic lumbar spinal stenosis. Seven participants with symptomatic lumbar spinal stenosis, aged 44–82, underwent a 3D opto-electronic motion analysis during standing and walking trials in asymptomatic and symptomatic states. Passive reflective marker clusters (four markers each) were attached to participants at T1, L1, and S2 levels of the spine, with additional reflective markers at other spinal levels, as well as the head, pelvis, and extremities. Whole-body motion data was collected during standing and walking trials in asymptomatic and symptomatic states. The results showed that the spine was slightly flexed during walking, but this was not affected by symptoms. Pelvic tilt was not different when symptoms were present, but suggests a possible effect of more forward tilt in both standing (p = 0.052) and walking (p = 0.075). Lumbar spine loading during symptomatic walking was increased by an average of 7% over asymptomatic walking (p = 0.001). Our results did not show increased spine flexion (adopting a trunk-flexed posture) and only indicate a trend for a small forward shift of the pelvis during both symptomatic walking and standing. This suggests that provocation of symptoms in these patients does not markedly affect their normal gait kinematics. The finding of increased spine loading with provocation of symptoms supports our hypothesis that spine loading plays a role in limiting walking function in patients with lumbar spinal stenosis, but additional work is needed to understand the biomechanical cause of this increase.
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Affiliation(s)
- Seyed Javad Mousavi
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Andrew C Lynch
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brett T Allaire
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrew P White
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
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