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He W, Li JL, Wang JY, He D, Song K. Optimization of traction parameters for lumbar scoliosis. BMC Musculoskelet Disord 2024; 25:472. [PMID: 38880874 PMCID: PMC11181601 DOI: 10.1186/s12891-024-07583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Scoliosis is a high incidence disease that endangers the physical and mental health of adolescents. Traction therapy, as a conservative treatment plan, is helpful to improve the recovery speed of patients by studying the influence of different traction factors on the therapeutic effect. METHODS Based on the thin layer CT data of the lumbar spine of a 16-year-old patient with scoliosis, Mimics21.0 was used to extract the 3D digital model, and Geomagic Wrap2021 was used to perform the smooth surface. After that, SolidWorks was used to manually construct the structures, such as the intervertebral disc, and Ansys17.0 was used to add constraints, ligaments, and other features. Three-factor ANOVA was carried out after an orthogonal experiment that considered traction mode, traction angle, and traction force was finished. RESULTS ① A three-dimensional biomechanical model of lumbar scoliosis was created. ② The model's correctness was confirmed by comparing it to the corpse and other finite element models, as well as by verifying it under a range of working settings. ③ Traction force (P = 0.000), traction angle (P = 0.000), the interaction between traction force and traction angle (P = 0.000), and the interaction between traction mode and traction angle (P = 0.045) were all significant. ④ The interaction between traction force and traction angle has the most significant effect on Cobb, and traction with a certain angle is better than traditional axial traction. ⑤ Traction mode is not significant, but the interaction between traction mode and traction angle is significant. CONCLUSIONS A certain angle of traction can aid in improving outcomes and the traction force can be suitably decreased in the clinical formulation of the traction plan. The uniformity of correcting effect is more favorable when higher fixation techniques like positive suspension or traction bed traction are used, as opposed to overhanging traction.
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Affiliation(s)
- Wei He
- Spine of Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Jia-Long Li
- Mechanical and Vehicle Engineering, Hunan University, 2 Lushan South Road, Yuelu District, Changsha, 410082, China
| | - Jia-Yu Wang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Da He
- Spine of Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Kai Song
- Mechanical and Vehicle Engineering, Hunan University, 2 Lushan South Road, Yuelu District, Changsha, 410082, China.
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Fu Y, Yan YC, Ru XL, Qu HB. Analysis of Chronic Low Back Pain Caused by Lumbar Microinstability After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study. J Pain Res 2022; 15:2821-2831. [PMID: 36120089 PMCID: PMC9480581 DOI: 10.2147/jpr.s380060] [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: 07/10/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinstability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED. Methods This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinstability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP. Results Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors. Conclusion Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.
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Affiliation(s)
- Yang Fu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ying-Chao Yan
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xuan-Liang Ru
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hang-Bo Qu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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AKINCI SALIHAZEYNEB, ARSLAN YUNUSZIYA. FINITE ELEMENT SPINE MODELS AND SPINAL INSTRUMENTS: A REVIEW. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is considerable biomechanics literature on finite element modeling and analysis of the spine. To accurately mimic the biomechanical behavior of the vertebral column, a generated computational model has to include anatomical structures that are consistent with physiological reality. In this review article, we focused on the finite element spine models that have been developed by various approaches in the literature. Firstly, the anatomical features of the spine and the spinal components have been briefly explained. We then focused on the modeling stages of vertebrae, ligaments, facet joints, intervertebral discs, and spinal instruments. With this paper, we expect to provide a comprehensive resource regarding the modeling preferences used in spine modeling.
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Affiliation(s)
- SALIHA ZEYNEB AKINCI
- Department of Biomedical Engineering and Bioinformatics, Graduate School of Engineering and Natural Sciences, Istanbul Medipol University, 34810 Beykoz, Istanbul, Turkey
| | - YUNUS ZIYA ARSLAN
- Department of Robotics and Intelligent Systems, Institute of Graduate Studies in Science and Engineering, Turkish-German University, Beykoz, Istanbul 34820, Turkey
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Yoon YS, Lee JH, Lee M, Kim KE, Jang HY, Lee KJ, Bajgai J, Kim CS, Cho IY. Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People. Healthcare (Basel) 2021; 9:healthcare9070900. [PMID: 34356278 PMCID: PMC8307674 DOI: 10.3390/healthcare9070900] [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: 06/10/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions of the spinal curve. Lumbar lordosis plays a pivotal function in maintaining sagittal balance. Recently, vertical traction and combination traction have been attracting attention due to improving therapeutic outcomes, although evidence of their clinical application is rare; therefore, this study was conducted to investigate the mechanical changes of lumbar intervertebral space, lordotic angle, and the central spinal canal area through vertical traction treatment using a spinal massage device in healthy participants. Methods: In total, 10 healthy subjects with no musculoskeletal disorders and no physical activity restrictions participated. The participants lay on the experimental device (CGM MB-1901) in supine extended posture and vertical traction force was applied in a posterior-to-anterior direction on the L3–4 and L4–5 lumbar sections at level 1 (baseline) and level 9 (traction mode). Magnetic resonance (MR) images were recorded directly under traction mode using the MRI scanner. The height values of the intervertebral space (anterior, center, and posterior parts) and lordosis angle of the L3–4 and L4–5 sections were measured using Image J software and the central spinal canal area (L4–5) was observed through superimposition method using the MR images. All measurement and image analyses were conducted by 2 experienced radiologists under a single-blinded method. Results: The average height values of the intervertebral space under traction mode were significantly increased in both L3–4 and L4–5 sections compared to baseline, particularly in the anterior and central parts but not in the posterior part. Cobb’s angle also showed significant increases in both L3–4 and L4–5 sections compared to baseline (p < 0.001). The central spinal canal area showed a slightly expanded feature in traction mode. Conclusions: In this pilot experiment, posterior-to-anterior vertical traction on L3–4 and L4–5 sections using a spinal massage device caused positive and significant changes based on increases of the intervertebral space height, lumbar lordosis angle, and central spinal canal area compared to the baseline condition. Our results are expected to be useful as underlying data for the clinical application of vertical traction.
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Affiliation(s)
- Yong-Soon Yoon
- Presbyterian Medical Center, Department of Physical Medicine & Rehabilitation, 365, Seowon-ro, Wansan-gu, Jeonju-si 54987, Korea; (Y.-S.Y.); (J.-H.L.)
| | - Jong-Hoo Lee
- Presbyterian Medical Center, Department of Physical Medicine & Rehabilitation, 365, Seowon-ro, Wansan-gu, Jeonju-si 54987, Korea; (Y.-S.Y.); (J.-H.L.)
| | - Mihyun Lee
- Department of Physical Education, Sungkyul University, 53, Seonggyeoldaehak-ro, Manan-gu, Anyang-si 14097, Korea;
| | - Ka-Eun Kim
- College of Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
| | - Hong-Young Jang
- Department of Medical Sciences Convergence Research Center for Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
| | - Kyu-Jae Lee
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Johny Bajgai
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Cheol-Su Kim
- Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea; (K.-J.L.); (J.B.); (C.-S.K.)
| | - Il-Young Cho
- Department of Medical Sciences Convergence Research Center for Medical Sciences, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Korea;
- Correspondence: ; Tel.: +82-63-220-3125
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Zaïri F, Moulart M, Fontaine C, Zaïri F, Tiffreau V, Logier R. Relevance of a novel external dynamic distraction device for treating back pain. Proc Inst Mech Eng H 2020; 235:264-272. [PMID: 33243076 DOI: 10.1177/0954411920971401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low back pain is a common, expensive, and disabling condition in industrialized countries. There is still no consensus for its ideal management. Believing in the beneficial effect of traction, we developed a novel external dynamic distraction device. The purpose of this work was to demonstrate that external distraction allows limiting the pressure exerted in standing-up position on the lower intervertebral discs. Numerical and cadaveric studies were used as complementary approaches. Firstly, we implemented the device into a numerical model of a validated musculoskeletal software (Anybody Modeling System) and we calculated the lower disc pressure while traction forces were applied. Secondly, we performed an anatomical study using a non-formalin preserved cadaver placed in a sitting position. A pressure sensor was placed in the lower discs under fluoroscopic control through a Jamshidi needle. The intradiscal pressure was then measured continuously at rest while applying a traction force of 200 N. Both numerical and cadaveric studies demonstrated a decrease in intradiscal pressures after applying a traction force with the external device. Using the numerical model, we showed that tensile forces below 500 N in total were sufficient. The application of higher forces seems useless and potentially deleterious. External dynamic distraction device is able to significantly decrease the intradiscal pressure in a sitting or standing position. However, the therapeutic effects need to be proven using clinical studies.
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Affiliation(s)
- Fahed Zaïri
- Department of Neurosurgery, Hôpital privé Le Bois, Ramsay Générale de Santé, Lille, France
| | | | | | - Fahmi Zaïri
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | | | - Régis Logier
- CIC-IT, Lille University Hospital, Lille, France
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