Mechanical properties of lumbar spine motion segments under large loads

The mechanical behavior of fourteen fresh human lumbar motion segments taken at autopsy from males with an average age of 29 yr was studied. Forces up to 1029 N were applied in anterior, posterior and lateral shear; and moments up to 95 Nm were applied in flexion, extension, lateral bending and torsion. In response to these loads endplate displacements up to 9 mm and rotations up to 18 degrees were measured. Stiffness values ranged from 53 to 140 N mm-1 in response to the shear forces and 6-11 Nm degree-1 in response to the moments. Lumbar motion segments can develop significant passive resistances to loads in situations where they are allowed to undergo substantial deformations.     

An experimental method for measuring force on the spinal facet joint: description and application of the method.

A technique is described for measuring load magnitude and resultant load contact location in the facet joint in response to applied loads and moments, and the technique applied to the canine lumbar spine motion segment. Due to the cantilever beam geometry of the cranial articular process, facet joint loads result in surface strains on the lateral aspect of the cranial articular process. Strains were quantified by four strain gages cemented to the bony surface of the process. Strain measured at any one gage depended on the loading site on the articular surface of the caudal facet and on the magnitude of the facet load. Determination of facet loads during in vitro motion segment testing required calibration of the strains to known loads of various magnitudes applied to multiple sites on the caudal facet. The technique is described in detail, including placement of the strain gages. There is good repeatability of strains to applied facet loads and the strains appear independent of load distribution area. Error in the technique depends on the location of the applied facet loads, but is only significant in nonphysiologic locations. The technique was validated by two independent methods in axial torsion. Application of the technique to five in vitro canine L2-3 motion segments testing resulted in facet loads (in newtons, N) of 74+ / -23 N (mean + / -STD) in 2 newton-meter, Nm, extension, to unloaded in flexion. Lateral bending resulted in loads in the right facet of 40+ / -32 N for 1 Nm right lateral bending and 54+ / -29 N for 1 Nm left lateral bending. 4 Nm Torsion with and without 100 N axial compression resulted in facet loads of 92+ / -27 N and 69+ / -19 N, respectively. The technique is applicable to dynamic and in vivo studies.     

Biomechanical evaluation of a novel lumbosacral axial fixation device

BACKGROUND: Interbody arthrodesis is employed in the lumbar spine to eliminate painful motion and achieve stability through bony fusion. Bone grafts, metal cages, composite spacers, and growth factors are available and can be placed through traditional open techniques or minimally invasively. Whether placed anteriorly, posteriorly, or laterally, insertion of these implants necessitates compromise of the anulus--an inherently destabilizing procedure. A new axial percutaneous approach to the lumbosacral spine has been described. Using this technique, vertical access to the lumbosacral spine is achieved percutaneously via the presacral space. An implant that can be placed across a motion segment without compromise to the anulus avoids surgical destabilization and may be advantageous for interbody arthrodesis. The purpose of this study was to evaluate the in vitro biomechanical performance of the axial fixation rod, an anulus sparing, centrally placed interbody fusion implant for motion segment stabilization. METHOD OF APPROACH: Twenty-four bovine lumbar motion segments were mechanically tested using an unconstrainedflexibility protocol in sagittal and lateral bending, and torsion. Motion segments were also tested in axial compression. Each specimen was tested in an intact state, then drilled (simulating a transaxial approach to the lumbosacral spine), then with one of two axial fixation rods placed in the spine for stabilization. The range of motion, bending stiffness, and axial compressive stiffness were determined for each test condition. Results were compared to those previously reported for femoral ring allografts, bone dowels, BAK and BAK Proximity cages, Ray TFC, Brantigan ALIF and TLIF implants, the InFix Device, Danek TIBFD, single and double Harms cages, and Kaneda, Isola, and University plating systems. RESULTS: While axial drilling of specimens had little effect on stiffness and range of motion, specimens implanted with the axial fixation rod exhibited significant increases in stiffness and decreases in range of motion relative to intact state. When compared to existing anterior, posterior, and interbody instrumentation, lateral and sagittal bending stiffness of the axial fixation rod exceeded that of all other interbody devices, while stiffness in extension and axial compression were comparable to plate and rod constructs. Torsional stiffness was comparable to other interbody constructs and slightly lower than plate and rod constructs. CONCLUSIONS: For stabilization of the L5-S1 motion segment, axial placement of implants offers potential benefits relative to traditional exposures. The preliminary biomechanical data from this study indicate that the axial fixation rod compares favorably to other devices and may be suitable to reduce pathologic motion at L5-S1, thus promoting bony fusion.     

Nonlinear gross response analysis of a lumbar motion segment in combined sagittal loadings

A 3-D nonlinear mathematical model is used to analyze the mechanical response of a lumbar L2-3 motion segment including the posterior elements when subjected to combined sagittal plane loads. The loadings consist of axial compression force, anterior and posterior shear forces, and flexion and extension moments. The facet articulation is modelled as a general moving contact problem and the ligaments as a collection of uniaxial elements. The disk nucleus is considered as an inviscid fluid and the annulus as a composite of collagenous fibers embedded in a matrix of ground substance. The presence of axial compression force reduces the segmental stiffness in flexion whereas a reverse trend is predicted in extension. In the presence of axial compression with and without sagittal shear force, flexion considerably increases the intradiscal pressure while extension reduces it. In other words, under an identical compression force, disk pressure is predicted to be noticeably larger in flexion than in extension. The segmental mechanical response in extension loadings is markedly influenced by the changes in the relative geometry of the articular surfaces at the lower regions. Finally, the deformation of the bony structures plays a significant role in the segmental mechanics under relatively large loads.     

The effect of axial compression and distraction on cervical facet mechanics during anterior shear,flexion, axial rotation,and lateral bending motions

The subaxial cervical facets are important load-bearing structures, yet little is known about their mechanical response during physiological or traumatic intervertebral motion. Facet loading likely increases when intervertebral motions are superimposed with axial compression forces, increasing the risk of facet fracture. The aim of this study was to measure the mechanical response of the facets when intervertebral axial compression or distraction is superimposed on constrained, non-destructive shear, bending and rotation motions. Twelve C6/C7 motion segments (70 ± 13 yr, nine male) were subjected to constrained quasi-static anterior shear (1 mm), axial rotation (4°), flexion (10°), and lateral bending (5°) motions. Each motion was superimposed with three axial conditions: (1) 50 N compression; (2) 300 N compression (simulating neck muscle contraction); and, (3) 2.5 mm distraction. Angular deflections, and principal and shear surface strains, of the bilateral C6 inferior facets were calculated from motion-capture data and rosette strain gauges, respectively. Linear mixed-effects models (α = 0.05) assessed the effect of axial condition. Minimum principal and maximum shear strains were largest in the compressed condition for all motions except for maximum principal strains during axial rotation. For right axial rotation, maximum principal strains were larger for the contralateral facets, and minimum principal strains were larger for the left facets, regardless of axial condition. Sagittal deflections were largest in the compressed conditions during anterior shear and lateral bending motions, when adjusted for facet side.     

Inter-laboratory variability in in vitro spinal segment flexibility testing

In vitro spine flexibility testing has been performed using a variety of laboratory-specific loading apparatuses and conditions, making test results across laboratories difficult to compare. The application of pure moments has been well established for spine flexibility testing, but to our knowledge there have been no attempts to quantify differences in range of motion (ROM) resulting from laboratory-specific loading apparatuses. Seven fresh-frozen lumbar cadaveric motion segments were tested intact at four independent laboratories. Unconstrained pure moments of 7.5 Nm were applied in each anatomic plane without an axial preload. At laboratories A and B, pure moments were applied using hydraulically actuated spinal loading fixtures with either a passive (A) or controlled (B) XY table. At laboratories C and D, pure moments were applied using a sliding (C) or fixed ring (D) cable–pulley system with a servohydraulic test frame. Three sinusoidal load-unload cycles were applied at laboratories A and B while a single quasistatic cycle was applied in 1.5 Nm increments at laboratories C and D. Non-contact motion measurement systems were used to quantify ROM. In all test directions, the ROM variability among donors was greater than single-donor ROM variability among laboratories. The maximum difference in average ROM between any two laboratories was 1.5° in flexion-extension, 1.3° in lateral bending and 1.1° in axial torsion. This was the first study to quantify ROM in a single group of spinal motion segments at four independent laboratories with varying pure moment systems. These data support our hypothesis that given a well-described test method, independent laboratories can produce similar biomechanical outcomes.     

PLAD (personal lift assistive device) stiffness affects the lumbar flexion/extension moment and the posterior chain EMG during symmetrical lifting tasks

The PLAD (personal lift assistive device) was designed to reduce the lumbar moment during lifting and bending tasks via elastic elements. This investigation examined the effects of modulating the elastic stiffness. Thirteen men completed 90 lifts (15 kg) using 6 different PLAD stiffnesses in stoop, squat and freestyle lifting postures. The activity of 8 muscles were recorded (latissimus dorsi, thoracic and lumbar erector spinae, rectus abdominis, external oblique, gluteus maximus, biceps femoris and rectus femoris), 3D electromagnetic sensors tracked the motion of each segment and strain gauges measured the elastic tension. EMG data were rectified, filtered, normalized and integrated as a percentage of the lifting task. The highest PLAD tension elicited the greatest reduction in erector spinae activity (mean of thoracic and lumbar) in comparison to the no-PLAD condition for the stoop (37%), squat (38%), and freestyle (37%) lifts, while prompting comparable reductions in gluteus maximums and biceps femoris activity. The highest PLAD stiffness also elicited the greatest reduction in the integrated L4/L5 flexion moment for the stoop (19.0%), squat (18.4%) and freestyle (17.4%) lifts without changing peak lumbar flexion. Each increase in PLAD stiffness further reduced the muscle activity of the posterior chain and the dynamic lumbar moment.     

Contribution of vertebral [corrected] bodies, endplates, and intervertebral discs to the compression creep of spinal motion segments

Spinal segments show non-linear behavior under axial compression. It is unclear to what extent this behavior is attributable to the different components of the segment. In this study, we quantified the separate contributions of vertebral bodies and intervertebral discs to creep of a segment. Secondly, we investigated the contribution of bone and osteochondral endplate (endplates including cartilage) to the deformation of the vertebral body. From eight porcine spines a motion segment, a disc and a vertebral body were dissected and subjected to mechanical testing. In an additional test, cylindrical samples, machined from the lowest thoracic vertebrae of 11 porcine spines, were used to compare the deformation of vertebral bone and endplate. All specimens were subjected to three loading cycles, each comprising a loading phase (2.0 MPa, 15 min) and a recovery phase (0.001 MPa, 30 min). All specimens displayed substantial time-dependent height changes. Average creep was the largest in motion segments and smallest in vertebral bodies. Bone samples with endplates displayed substantially more creep than samples without. In the early phase, behavior of the vertebra was similar to that of the disc. Visco-elastic deformation of the endplate therefore appeared dominant. In the late creep phase, behavior of the segment was similar to that of isolated discs, suggesting that in this phase the disc dominated creep behavior, possibly by fluid flow from the nucleus. We conclude that creep deformation of vertebral bodies contributes substantially to creep of motion segments and that within a vertebral body endplates play a major role.     

Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments—A finite element model study

The current study investigated mechanical predictors for the development of adjacent disc degeneration. A 3-D finite element model of a lumbar spine was modified to simulate two grades of degeneration at the L4–L5 disc. Degeneration was modeled by changes in geometry and material properties. All models were subjected to follower preloads of 800 N and moment loads in the three principal directions of motion using a hybrid protocol. Degeneration caused changes in the loading and motion patterns of the segments above and below the degenerated disc. At the level (L3–L4) above the degenerated disc, the motion increased due to moderate degeneration by 21% under lateral bending, 26% under axial rotation and 28% under flexion/extension. At the level (L5-S1) below the degenerated disc, motion increased only during lateral bending by 20% due to moderate degeneration. Both the L3–L4 and L5-S1 segment showed a monotonic increase in both the maximum von Mises stress and shear stress in the annulus as degeneration progressed for all loading directions, expect extension at L3–L4. The most significant increase in stress was observed at the L5-S1 level during axial rotation with nearly a ten-fold increase in the maximum shear stress and 103% increase in the maximum von Mises stress. The L5-S1 segment also showed a progressive increase in facet contact force for all loading directions with degeneration. Nucleus pressure did not increase significantly for any loading direction at either the caudal or cephalic adjacent segment. Results suggest that single-level degeneration can increase the risk for injury at the adjacent levels.     

Role of endplates in contributing to compression behaviors of motion segments and intervertebral discs

The purpose of this study was to gain an improved understanding of the mechanical behavior of the intervertebral disc in the presence and absence of the vertebral endplates. Mechanical behaviors of rat caudal motion segments, vertebrae and isolated disc explants under two different permeability conditions were investigated and viscoelastic behaviors were evaluated using a stretched-exponential function to describe creep and recovery behaviors. The results demonstrated that both vertebrae and discs underwent significant deformations in the motion segment even under relatively low-loading conditions. Secondly, disruption of the collagenous network had minimal impact on equilibrium deformations of disc explants as compared to disc deformations occurring in the motion segments provided that vertebral deformations were accounted for; however, differences in endplate permeability conditions had a significant effect on viscoelastic behaviors. Creep occurred more quickly than recovery for motion segment and explant specimens. In addition, disc explants and motion segments both exhibited non-recoverable deformations under axial compression under low- and high-loading conditions. Results have important implications for interpreting the role of vertebral endplates in contributing to disc mechanical behaviors and direct application to mechanobiology studies involving external loading to rodent tail intervertebral discs.     

The role of the nucleus pulposus in neutral zone human lumbar intervertebral disc mechanics

To study the effect of denucleation on the mechanical behavior of the human lumbar intervertebral disc through a 2mm incision, two groups of six human cadaver lumbar spinal units were tested in axial compression, axial rotation, lateral bending and flexion/extension after incremental steps of "partial" denucleation. Neutral zone, range of motion, stiffness, intradiscal pressure and energy dissipation were measured; the results showed that the contribution of the nucleus pulposus to the mechanical behavior of the intervertebral disc was more dominant through the neutral zone than at the farther limits of applied loads and moments.     

Analysis of large compression loads on lumbar spine in flexion and in torsion using a novel wrapping element

Axial compression on the spine could reach large values especially in lifting tasks which also involve large rotations. Experimental and numerical investigations on the spinal multi motion segments in presence of physiological compression loads cannot adequately be carried out due to the structural instability and artefact loads. To circumvent these problems, a novel wrapping cable element is used in a nonlinear finite element model of the lumbosacral spine (L1-S1) to investigate the role of moderate to large compression loads on the lumbar stiffness in flexion and axial moments/rotations. The compression loads up to 2,700 N was applied with no instability or artefact loads. The lumbar stiffness substantially increased under compression force, flexion moment, and axial torque when applied alone. The presence of compression preloads significantly stiffened the load-displacement response under flexion and axial moments/rotations. This stiffening effect was much more pronounced under larger preloads and smaller moments/rotations. Compression preloads also increased intradiscal pressure, facet contact forces, and maximum disc fibre strain at different levels. Forces in posterior ligaments were, however, diminished with compression preload. The significant increase in spinal stiffness, hence, should be considered in biomechanical studies for accurate investigation of the load partitioning, system stability, and fixation systems/disc prostheses.     

Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle

Many investigators have performed studies on specific defect situations or determined the contribution on isolated structures. Investigating the contribution of functional structures requires obtaining the kinematic response directly on spinal segments. The purpose of this study was to quantify the function of anatomical components on lumbar segments for different loading magnitudes. Eight spinal segments (L4-5) with a median age of 52 years (ranging from 38 to 59 years) and a low degree of disc degeneration were utilized for the in vitro testing. Specimens were mounted in a custom-built spine tester and loaded with pure moments (1-10 N m) to move within three anatomical planes at a loading rate of 1.0 degrees /s. Anatomy was successively reduced by: ligaments, facet capsules, joints and nucleus. Data were evaluated for range of motion, neutral zone and lordosis angle. Transection of posterior ligaments predominantly increased specimen flexion for all bending moments applied. Supraspinous ligament also indicated to resist in extension slightly, whereas the facet capsules did not. Facet joints contributed to axial rotation, but not in lateral bending. The anterior longitudinal ligament was found to slightly resist in axial rotation, but strongly in extension. Nucleotomy caused largest increase of all movements. The unloaded posture of the specimens changed after ligament dissection, indicating ligament pretension. The region of lumbar spine is interesting for finite element (FE) simulation due to the high evidence of disc degeneration and injuries. This study may help to understand the function of specific anatomical structures and assists in FE model calibration. We suggest to start a calibration procedure for such models with the smallest functional structure (annulus) and to cumulatively add further structures.     

Finite element analysis of moment-rotation relationships for human cervical spine

A comprehensive, geometrically accurate, nonlinear C0-C7 FE model of head and cervical spine based on the actual geometry of a human cadaver specimen was developed. The motions of each cervical vertebral level under pure moment loading of 1.0 Nm applied incrementally on the skull to simulate the movements of the head and cervical spine under flexion, tension, axial rotation and lateral bending with the inferior surface of the C7 vertebral body fully constrained were analysed. The predicted range of motion (ROM) for each motion segment were computed and compared with published experimental data. The model predicted the nonlinear moment-rotation relationship of human cervical spine. Under the same loading magnitude, the model predicted the largest rotation in extension, followed by flexion and axial rotation, and least ROM in lateral bending. The upper cervical spines are more flexible than the lower cervical levels. The motions of the two uppermost motion segments account for half (or even higher) of the whole cervical spine motion under rotational loadings. The differences in the ROMs among the lower cervical spines (C3-C7) were relatively small. The FE predicted segmental motions effectively reflect the behavior of human cervical spine and were in agreement with the experimental data. The C0-C7 FE model offers potentials for biomedical and injury studies.     

The effect of follower load on the intersegmental coupled motion characteristics of the human thoracic spine: An in vitro study using entire rib cage specimens

The mechanical coupling behaviour of the thoracic spine is still not fully understood. For the validation of numerical models of the thoracic spine, however, the coupled motions within the single spinal segments are of importance to achieve high model accuracy. In the present study, eight fresh frozen human thoracic spinal specimens (C7-L1, mean age 54 ± 6 years) including the intact rib cage were loaded with pure bending moments of 5 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) with and without a follower load of 400 N. During loading, the relative motions of each vertebra were monitored. Follower load decreased the overall ROM (T1-T12) significantly (p < 0.01) in all primary motion directions (extension: −46%, left LB: −72%, right LB: −72%, left AR: −26%, right AR: −26%) except flexion (−36%). Substantial coupled motion was found in lateral bending with ipsilateral axial rotation, which increased after a follower load was applied, leading to a dominant axial rotation during primary lateral bending, while all other coupled motions in the different motion directions were reduced under follower load. On the monosegmental level, the follower load especially reduced the ROM of the upper thoracic spine from T1-T2 to T4-T5 in all motion directions and the ROM of the lower thoracic spine from T9-T10 to T11-T12 in primary lateral bending. The facet joints, intervertebral disc morphologies, and the sagittal curvature presumably affect the thoracic spinal coupled motions depending on axial compressive preloading. Using these results, the validation of numerical models can be performed more accurately.     

Between-session reliability of opto-electronic motion capture in measuring sagittal posture and 3-D ranges of motion of the thoracolumbar spine

This study evaluated between-session reliability of opto-electronic motion capture to measure trunk posture and three-dimensional ranges of motion (ROM). Nineteen healthy participants aged 24–74 years underwent spine curvature, pelvic tilt and trunk ROM measurements on two separate occasions. Rigid four-marker clusters were attached to the skin overlying seven spinous processes, plus single markers on pelvis landmarks. Rigid body rotations of spine marker clusters were calculated to determine neutral posture and ROM in flexion, extension, total lateral bending (left-right) and total axial rotation (left-right). Segmental spine ROM values were in line with previous reports using opto-electronic motion capture. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated as measures of between-session reliability and measurement error, respectively. Retroreflective markers showed fair to excellent between-session reliability to measure thoracic kyphosis, lumbar lordosis, and pelvic tilt (ICC = 0.82, 0.63, and 0.54, respectively). Thoracic and lumbar segments showed highest reliabilities in total axial rotation (ICC = 0.78) and flexion-extension (ICC = 0.77–0.79) ROM, respectively. Pelvic segment showed highest ICC values in flexion (ICC = 0.78) and total axial rotation (ICC = 0.81) trials. Furthermore, it was estimated that four or fewer repeated trials would provide good reliability for key ROM outcomes, including lumbar flexion, thoracic and lumbar lateral bending, and thoracic axial rotation. This demonstration of reliability is a necessary precursor to quantifying spine kinematics in clinical studies, including assessing changes due to clinical treatment or disease progression.     

Pure moment testing for spinal biomechanics applications: fixed versus 3D floating ring cable-driven test designs

Pure moment testing has become a standard protocol for in vitro assessment of the effect of surgical techniques or devices on the bending rigidity of the spine. Of the methods used for pure moment testing, cable-driven set-ups are popular due to their low requirements and simple design. Fixed loading rings are traditionally used in conjunction with these cable-driven systems. However, the accuracy and validity of the loading conditions applied with fixed ring designs have raised some concern, and discrepancies have been found between intended and prescribed loading conditions for flexion-extension. This study extends this prior work to include lateral bending and axial torsion, and compares this fixed ring design with a novel "3D floating ring" design. A complete battery of multi-axial bending tests was conducted with both rings in multiple different configurations using an artificial lumbar spine. Applied moments were monitored and recorded by a multi-axial load cell at the base of the specimen. Results indicate that the fixed ring design deviates as much as 77% from intended moments and induces non-trivial shear forces (up to 18 N) when loaded to a non-destructive maximum of 4.5 Nm. The novel 3D floating ring design largely corrects the inherent errors in the fixed ring design by allowing additional directions of unconstrained motion and producing uniform loading conditions along the length of the specimen. In light of the results, it is suggested that the 3D floating ring set-up be used for future pure moment spine biomechanics applications using a cable-driven apparatus.     

Stepwise reduction of functional spinal structures increase disc bulge and surface strains

Previous studies postulated that an axial compression of lumbar intervertebral discs causes a complex strain pattern on the annulus. This pattern is not fully understood, since most studies measured only the uniaxial ultimate tensile strain of the annulus. The aim of this study was to investigate surface strains and their relation to disc bulging. This work was extended to study some defects that are relevant for the intermediate process of finite element modeling. Six specimens (L2-3) with a median age of 51 years were utilized for this in vitro study. Specimens were loaded with pure moments (2.5-7.5Nm) in the principal directions. The anatomy was subsequently reduced in three steps: (1) ligamentous and bony posterior structures, (2) anterior and posterior ligaments and (3) nucleus. Measured were ranges of motion, three-dimensional disc bulging and surface strains of the outer annulus. Lateral bending showed the largest axial strains (9.7%) for intact specimens, which increased to 15.1% after the removal of posterior structures. Disc bulging was largest in flexion with 1.56mm, which increased to 2.06mm after step (1). Defect (2) caused that flexion yielded the largest axial strains with 22.6% and 2.17mm of bulging. We could also determine a constriction effect of these ligaments. Nucleotomy did not essentially increase anterior disc bulging in flexion, but inward disc bulging increased by 0.55mm, in extension. Due to the increase in the complexity of finite element models, it is difficult to obtain data from the literature for validation purposes. This study presents new data, which assist in the development of such models.     

A technique for quantifying the bending moment acting on the lumbar spine in vivo

The bending properties of cadaveric lumbar spines were measured and used to convert in vivo measurements of lumbar flexion into bending moments ('stresses'). Forty-two lumbar motion segments were subjected to complex physiological loading and graphs were obtained of bending moment vs flexion angle. Variability was reduced by expressing both variables as a percentage of their values at the elastic limit. Data were averaged for each lumbar level, and a composite bending curve was compiled for the lumbar spine, L1-S1. A linear relationship was established between lumbar flexion measured in vitro and in vivo. This enabled values of 'per cent lumbar flexion' measured in vivo to be converted into 'per cent maximum bending moment' with a maximum likely error of about +/- 8%, which is equivalent to about +/- 5 Nm at L5-S1 for an average person. The technique was applied to 28 subjects, using dynamic measurements of lumbar flexion obtained with the '3-Space Isotrack' system. The bending moment at L5-S1 was 12 Nm on average when picking a pen up off the floor. Highly significant increases in bending moment were observed when heavier and bulkier objects were lifted.     

Damage accumulation location under cyclic loading in the lumbar disc shifts from inner annulus lamellae to peripheral annulus with increasing disc degeneration

It is difficult to study the breakdown of lumbar disc tissue over several years of exposure to bending and lifting by experimental methods. In our earlier published study we have shown how a finite element model of a healthy lumbar motion segment was used to predict the damage accumulation location and number of cyclic to failure under different loading conditions. The aim of the current study was to extend the continuum damage mechanics formulation to the degenerated discs and investigate the initiation and progression of mechanical damage. Healthy disc model was modified to represent degenerative discs (Thompson grade III and IV) by incorporating both geometrical and biochemical changes due to degeneration. Analyses predicted decrease in the number of cycles to failure with increasing severity of disc degeneration. The study showed that the damage initiated at the posterior inner annulus adjacent to the endplates and propagated outwards towards its periphery in healthy and grade III degenerated discs. The damage accumulated preferentially in the posterior region of the annulus. However in grade IV degenerated disc damage initiated at the posterior outer periphery of the annulus and propagated circumferentially. The finite element model predictions were consistent with the infrequent occurrence of rim lesions at early age but a much higher incidence in severely degenerated discs.