Personalised Mechanical Properties of Scoliotic Vertebrae Determined In Vivo Using Tomodensitometry

This in vivo study investigated the mechanical properties of apical scoliotic vertebrae using computed tomography (CT) and finite element (FE) meshing. CT examination was performed on seven scoliotic girls. FE meshing of each vertebral body allowed automatic mapping of the CT scan and the visualisation of the bone density distribution. Centroids and mass centres were compared to analyse the mechanical properties distribution. Compared to the centroid, the mass centre migrated into the concavity of the curvature. The three vertebrae of a same patient had the same body migration behaviour because they were located at the curvature apex. This observation was verified in the coronal plane, but not in the sagittal plane. These results represent new data over few geometrical analyses of scoliotic vertebrae. Same in vivo personalisation of mechanical properties should be performed on intervertebral discs or ligaments to personalise stiffness properties of the spine for the biomechanical modelling of human torso. Moreover, do this mechanical deformation of scoliotic vertebrae, that appears before the vertebral wedging, could be a predictive tool in scoliosis treatment?     

Analysis of the interaction between vertebral lateral deviation and axial rotation in scoliosis

There is a lack of clear biomechanical analyses to explain the interaction of the lateral and axial deformity of the spine in idiopathic scoliosis. A finite element model which represented an isolated ligamentous spine with realistic elastic properties and idealized geometry was used to analyse this interaction. Three variations of this model were used to investigate two different hypotheses about the etiology of scoliosis and to define the forces required to produce a scoliosis deformity. The first hypothesis is that coupling within a motion segment produces the interaction between lateral deviation and axial rotation. The second hypothesis is that posterior tethering by soft tissues in the growing spine produces the observed interaction. Modeling of both hypotheses failed to produce the clinically observed pattern of interaction. Therefore, to find which biomechanical forces were required to produce an idealized scoliosis, prescribed displacements were applied to the model. Production of a double curve scoliosis of 10 degrees Cobb angles required lateral forces on the order of 20 N acting 40 mm anterior to the vertebral body centers. There do not appear to be any anatomic structures capable of producing such forces. Therefore, it seems unlikely that scoliosis deformity can be explained in terms of forces acting on the spine, and understanding of its origins may come from examination of other mechanisms such as asymmetric thoracic growth, or asymmetric vertebral development.     

Biomechanical assessment of stability in the metastatic spine following percutaneous vertebroplasty: effects of cement distribution patterns and volume

Percutaneous vertebroplasty is a minimally invasive, radiologically guided procedure whereby bone cement is injected into structurally weakened vertebrae to provide added biomechanical stability. In addition to treating osteoporotic vertebral fractures, this technique is also used to relieve pain by stabilizing metastatically compromised vertebrae that are at risk of pathologic burst fracture. Optimal cement distribution patterns to improve biomechanical stability to metastatically involved vertebral bodies remain unknown. This study aimed to determine the effect of cement location and volume of cement injected during percutaneous vertebroplasty on improving vertebral stability in a metastatically-compromised spinal motion segment using a parametric poroelastic finite element model. A three-dimensional parametric finite element model of a thoracic spinal motion segment was developed and analyzed using commercially available software. A total of 16 metastatic pre and post vertebroplasty scenarios were investigated using a serrated spherical representation of tumor tissue and various geometric representations of polymethylmethacrylate (PMMA). The effect of vertebroplasty on vertebral bulge, a measure of posterior vertebral body wall motion as an indicator of burst fracture initiation, was assessed. In all cases, vertebroplasty reduced vertebral bulge, but the risk of the initiation of burst fracture was minimized with cement located posterior to the tumor, near the posterior vertebral body wall. Vertebral bulge decreased by up to 62% with 20% cement injection. These findings demonstrate that location and distribution of cement within the vertebral body has a noticeable effect on the restoration of biomechanical stability following percutaneous vertebroplasty.     

Personalised mechanical properties of scoliotic vertebrae determined in vivo using tomodensitometry

This in vivo study investigated the mechanical properties of apical scoliotic vertebrae using computed tomography (CT) and finite element (FE) meshing. CT examination was performed on seven scoliotic girls. FE meshing of each vertebral body allowed automatic mapping of the CT scan and the visualisation of the bone density distribution. Centroids and mass centres were compared to analyse the mechanical properties distribution. Compared to the centroid, the mass centre migrated into the concavity of the curvature. The three vertebrae of a same patient had the same body migration behaviour because they were located at the curvature apex. This observation was verified in the coronal plane, but not in the sagittal plane. These results represent new data over few geometrical analyses of scoliotic vertebrae. Same in vivo personalisation of mechanical properties should be performed on intervertebral discs or ligaments to personalise stiffness properties of the spine for the biomechanical modelling of human torso. Moreover, do this mechanical deformation of scoliotic vertebrae, that appears before the vertebral wedging, could be a predictive tool in scoliosis treatment?     

Investigation of effective intrusion and extrusion force for maxillary canine using finite element analysis

Abstract

Orthodontic tooth movement is mainly regulated by the biomechanical responses of loaded periodontal ligament (PDL). We investigated the effective intervals of orthodontic force in pure maxillary canine intrusion and extrusion referring to PDL hydrostatic stress and logarithmic strain. Finite element analysis (FEA) models, including a maxillary canine, PDL and alveolar bone, were constructed based on computed tomography (CT) images of a patient. The material properties of alveolar bone were non-uniformly defined using HU values of CT images; PDL was assumed to be a hyperelastic–viscoelastic material. The compressive stress and tensile stress ranging from 0.47 to 12.8?kPa and 18.8 to 51.2?kPa, respectively, were identified as effective for tooth movement; a strain 0.24% was identified as the lower limit of effective strain. The stress/strain distributions within PDL were acquired in canine intrusion and extrusion using FEA; root apex was the main force-bearing area in intrusion–extrusion movements and was more prone to resorption. Owing to the distinction of PDL biomechanical responses to compression and tension, the effective interval of orthodontic force was substantially lower in canine intrusion (80–90?g) than in canine extrusion (230–260?g). A larger magnitude of force remained applicable in canine extrusion. This study revised and complemented orthodontic biomechanical behaviours of tooth movement with intrusive–extrusive force and could further help optimize orthodontic treatment.     

Micromechanics of the human vertebral body for forward flexion

To provide mechanistic insight into the etiology of osteoporotic wedge fractures, we investigated the spatial distribution of tissue at the highest risk of initial failure within the human vertebral body for both forward flexion and uniform compression loading conditions. Micro-CT-based linear elastic finite element analysis was used to virtually load 22 human T9 vertebral bodies in either 5° of forward flexion or uniform compression; we also ran analyses replacing the simulated compliant disc (E=8 MPa) with stiff polymethylmethacrylate (PMMA, E=2500 MPa). As expected, we found that, compared to uniform compression, forward flexion increased the overall endplate axial load on the anterior half of the vertebra and shifted the spatial distribution of high-risk tissue within the vertebra towards the anterior aspect of the vertebral body. However, despite that shift, the high-risk tissue remained primarily within the central regions of the trabecular bone and endplates, and forward flexion only slightly altered the ratio of cortical-to-trabecular load sharing at the mid-vertebral level (mean±SD for n=22: 41.3±7.4% compression; 44.1±8.2% forward flexion). When the compliant disc was replaced with PMMA, the anterior shift of high-risk tissue was much more severe. We conclude that, for a compliant disc, a moderate degree of forward flexion does not appreciably alter the spatial distribution of stress within the vertebral body.     

Patient-specific finite element model of the spine and spinal cord to assess the neurological impact of scoliosis correction: preliminary application on two cases with and without intraoperative neurological complications

Scoliosis is a 3D deformation of the spine and rib cage. For severe cases, surgery with spine instrumentation is required to restore a balanced spine curvature. This surgical procedure may represent a neurological risk for the patient, especially during corrective maneuvers. This study aimed to computationally simulate the surgical instrumentation maneuvers on a patient-specific biomechanical model of the spine and spinal cord to assess and predict potential damage to the spinal cord and spinal nerves. A detailed finite element model (FEM) of the spine and spinal cord of a healthy subject was used as reference geometry. The FEM was personalized to the geometry of the patient using a 3D biplanar radiographic reconstruction technique and 3D dual kriging. Step by step surgical instrumentation maneuvers were simulated in order to assess the neurological risk associated to each maneuver. The surgical simulation methodology implemented was divided into two parts. First, a global multi-body simulation was used to extract the 3D displacement of six vertebral landmarks, which were then introduced as boundary conditions into the personalized FEM in order to reproduce the surgical procedure. The results of the FEM simulation for two cases were compared to published values on spinal cord neurological functional threshold. The efficiency of the reported method was checked considering one patient with neurological complications detected during surgery and one control patient. This comparison study showed that the patient-specific hybrid model reproduced successfully the biomechanics of neurological injury during scoliosis correction maneuvers.     

人工半骨盆假体置换联合腰椎椎弓根螺钉固定术后生物力学的有限元分析

目的:建立人工半骨盆假体置换与联合腰椎椎弓根螺钉固定后的三维有限元模型,评价腰骶段生物力学改变后半骨盆假体力学结构的特点。方法:采用CT薄层扫描采集原始数据,分别建立正常骨盆、半骨盆假体置换术后以及半骨盆假体置换联合腰椎椎弓根螺钉固定术后骨盆的三维有限元模型,分别在第4腰椎上终板平面施以500 N的垂直纵向载荷,分析不同骨盆模型的应力分布特点。结果:与正常骨盆有限元模型相比,半骨盆假体置换术后健侧骨盆应力分布以骶髂关节、髋臼窝及耻骨为主,置换侧半骨盆假体以耻骨连接棒、髋臼杯及髂骨座为主,最大应力出现在耻骨连接棒,应力峰值为65.62 MPa。联合腰椎椎弓根螺钉固定后健侧应力相对减小,置换侧髂骨固定座与骶骨固定处应力相对减小,应力分布以腰椎椎弓根钉棒、耻骨连接棒及髋臼杯为主,最大应力出现在椎弓根螺钉,应力峰值为107 MPa。结论:半骨盆假体置换联合腰椎椎弓根螺钉固定后钉棒分担了半骨盆置换后健侧骨盆及置换侧髂骨固定座与骶骨固定处附近的部分应力,缓解应力集中现象,降低术后骨盆破坏风险,一定程度上增加了半骨盆置换后骨盆的稳定性。     

Tridimensional evaluation and optimization of the orthotic treatment of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis involves complex tridimensional deformities of the spine, rib cage and pelvis. Moderate curves generally are treated using an orthosis. This paper presents different studies performed over the last fifteen years related to the biomechanical evaluation and optimization of the orthopedic treatment of scoliotic deformities. Patient specific 3D models of the spine, pelvis and rib cage are computed from calibrated radiographs, and are used to calculate 2D and 3D clinical indices. The torso shape is acquired using surface topography. With such internal and external 3D models, the efficacy of the most frequently used orthoses can be analyzed and new treatments can be developed. Pressures generated by a brace on the patient's trunk were measured using a flexible matrix of pressure sensors and displayed over the patient's internal geometry in order to analyze the brace efficacy. Patient specific finite element models have been developed, including the osseo-ligamentous structures as well as the muscles, the neuro-control, trunk growth and its adaptation to the stress. These models were used to analyze the effects of the Boston brace. The electro-myographic activity also was measured to analyze the < active > correction mechanisms. Adjustment techniques and software are used to help the orthotists with real time feedback when the brace is being fabricated and adjusted to the patient. Residual growth potential is also being added to the computer model to simulate the long term effect of a brace. The improvement of the orthotic treatments of scoliotic deformities is very encouraging. The exploitation of such tools is expected to allow reaching optimal treatment personalized to each patient. double dagger.     

Biomechanical analysis of the anterior cervical fusion

This paper presents a biomechanical analysis of the cervical C5–C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage.     

Finite element analysis of peri-implant bone volume affected by stresses around Morse taper implants: effects of implant positioning to the bone crest

Abstract

Objectives: The purpose of the present study was to evaluate the distribution and magnitude of stresses through the bone tissue surrounding Morse taper dental implants at different positioning relative to the bone crest. Materials and Methods: A mandibular bone model was obtained from a computed tomography scan. A three-dimensional (3D) model of Morse taper implant-abutment systems placed at the bone crest (equicrestal) and 2?mm bellow the bone crest (subcrestal) were assessed by finite element analysis (FEA). FEA was carried out on axial and oblique (45°) loading at 150 N relatively to the central axis of the implant. The von Mises stresses were analysed considering magnitude and volume of affected peri-implant bone. Results: On vertical loading, maximum von Mises stresses were recorded at 6-7?MPa for trabecular bone while values ranging from 73 up to 118?MPa were recorded for cortical bone. On oblique loading at the equiquestral or subcrestal positioning, the maximum von Mises stresses ranged from 15 to 21?MPa for trabecular bone while values at 150?MPa were recorded for the cortical bone. On vertical loading, >99.9vol.% cortical bone volume was subjected to a maximum of 2?MPa while von Mises stress values at 15?MPa were recorded for trabecular bone. On oblique loading, >99.9vol.% trabecular bone volume was subjected to maximum stress values at 5?MPa, while von Mises stress values at 35?MPa were recorded for >99.4vol.% cortical bone. Conclusions: Bone volume-based stress analysis revealed that most of the bone volume (>99% by vol) was subjected to significantly lower stress values around Morse taper implants placed at equicrestal or subcrestal positioning. Such analysis is commentary to the ordinary biomechanical assessment of dental implants concerning the stress distribution through peri-implant sites.     

Biomechanical analysis of the anterior cervical fusion

This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage.     

Statistical factorial analysis on the material property sensitivity of the mechanical responses of the C4-C6 under compression, anterior and posterior shear

A systematic approach using factorial analysis was conducted on the C4-C6 finite element model to analyse the influence of six spinal components (cortical shell, vertebral body, posterior elements, endplate, disc annulus and disc nucleus) on the internal stresses and external biomechanical responses under compression, anterior and posterior shear. Results indicated that the material properties variation of the disc annulus has a significant influence on both the external biomechanical responses and internal stress of the disc annulus and its neighboring hard bones. The study reveals for the first time, the significant influence of the cancellous bone under compression, while variation in the cortical shell modulus has a high influence under anterior and posterior shear. The study also reveals that the effects of interaction between two main components are insignificant.     

Biomechanical spinal growth modulation and progressive adolescent scoliosis – a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE

There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this debate was written by Dr Ian A Stokes. It evaluates the hypothesis that in progressive scoliosis vertebral body wedging during adolescent growth results from asymmetric muscular loading in a "vicious cycle" (vicious cycle hypothesis of pathogenesis) by affecting vertebral body growth plates (endplate physes). A frontal plane mathematical simulation tested whether the calculated loading asymmetry created by muscles in a scoliotic spine could explain the observed rate of scoliosis increase by measuring the vertebral growth modulation by altered compression. The model deals only with vertebral (not disc) wedging. It assumes that a pre-existing scoliosis curve initiates the mechanically-modulated alteration of vertebral body growth that in turn causes worsening of the scoliosis, while everything else is anatomically and physiologically 'normal' The results provide quantitative data consistent with the vicious cycle hypothesis. Dr Stokes' biomechanical research engenders controversy. A new speculative concept is proposed of vertebral symphyseal dysplasia with implications for Dr Stokes' research and the etiology of AIS. What is not controversial is the need to test this hypothesis using additional factors in his current model and in three-dimensional quantitative models that incorporate intervertebral discs and simulate thoracic as well as lumbar scoliosis. The growth modulation process in the vertebral body can be viewed as one type of the biologic phenomenon of mechanotransduction. In certain connective tissues this involves the effects of mechanical strain on chondrocytic metabolism a possible target for novel therapeutic intervention.     

Titanium Elastic Nail (TEN) versus Reconstruction Plate Repair of Midshaft Clavicular Fractures: A Finite Element Study

BackgroundThe biomechanical characteristics of midshaft clavicular fractures treated with titanium elastic nail (TEN) is unclear. This study aimed to present a biomechanical finite element analysis of biomechanical characteristics involved in TEN fixation and reconstruction plate fixation for midshaft clavicular fractures.MethodsFinite element models of the intact clavicle and of midshaft clavicular fractures fixed with TEN and with a reconstruction plate were built. The distal clavicle displacement, peak stress, and stress distribution on the 3 finite element models were calculated under the axial compression and cantilever bending.ResultsIn both loading configurations, TEN generated the highest displacement of the distal clavicle, followed by the intact clavicle and the reconstruction plate. TEN showed higher peak bone and implant stresses, and is more likely to fail in both loading configurations compared with the reconstruction plate. TEN led to a stress distribution similar to that of the intact clavicle in both loading configurations, whereas the stress distribution with the reconstruction plate was nonphysiological in cantilever bending.ConclusionsTEN is generally preferable for treating simple displaced fractures of the midshaft clavicle, because it showed a stress distribution similar to the intact clavicle. However, TEN provides less stability, and excessive exercise of and weight bearing on the ipsilateral shoulder should be avoided in the early postoperative period. Fixation with a reconstruction plate was more stable but showed obvious stress shielding. Therefore, for patients with a demand for early return to activity, reconstruction plate fixation may be preferred.     

有限元分析法在腰椎生物力学研究中的应用及新进展

有限元分析法是指对复杂形态物体的应力及应变进行分析,具有力学性能测试全面、客观、可重复性的特点。目前,有限元分析法已被广泛应用于脊柱畸形、腰椎损伤以及假体植入等人体复杂结构生物力学的研究中。本文主要介绍有限元分析法在腰椎的椎体、间盘、韧带及肌肉组织中的应用,结合其概念、原理、建模方法等,总结该方法在新型内固定物力学特性研究中的优势,探讨其对不同植骨内固定术式选择的临床意义。     

Finite Element Analysis of Interbody Cages in a Human Lumbar Spine

Abstract

An innovative surgical procedure is vertebral stabilization by interbody cages. It is currently being used to separate and stabilize vertebral bodies and to promote bony fusion of the vertebrae onto or through the cages. This surgery, at some spine levels, can be performed through a laparoscope as an outpatient procedure with low morbidity. Because the procedure is new, little structural information is available on the interbody cages. The objective of this study was to evaluate the human lumbar spine stabilized by interbody cages biomechanically. The finite element method was used to compare cage designs by considering stresses in the cage and in the bone as well as relative displacements between the cage and the adjacent bone at the interface. The biomechanical evaluation considered different bone densities and considered axial, torsional, and bending loads on the lumbar spine. Stress analysis predicts local regions of stress concentration that could be damaging to cancellous bone and will likely require a remodeling response for local damage. This study predicts relative micromotion that could cause the bone resorption and fibrous tissue formation on the contact surfaces of the cage. The geometric constraints caused by the use of two cages will reduce the relative motion and therefore be more likely to allow bone ingrowth at the posterocentral contact region. Finite element analysis suggests that cages are a promising method for separation and stabilization of the vertebral bodies.     

Numerical analysis of the influence of nucleus pulposus removal on the biomechanical behavior of a lumbar motion segment

Nucleus replacement was deemed to have therapeutic potential for patients with intervertebral disc herniation. However, whether a patient would benefit from nucleus replacement is technically unclear. This study aimed to investigate the influence of nucleus pulposus (NP) removal on the biomechanical behavior of a lumbar motion segment and to further explore a computational method of biomechanical characteristics of NP removal, which can evaluate the mechanical stability of pulposus replacement. We, respectively, reconstructed three types of models for a mildly herniated disc and three types of models for a severely herniated disc based on a L4–L5 segment finite element model with computed tomography image data from a healthy adult. First, the NP was removed from the herniated disc models, and the biomechanical behavior of NP removal was simulated. Second, the NP cavities were filled with an experimental material (Poisson's ratio = 0.3; elastic modulus = 3 MPa), and the biomechanical behavior of pulposus replacement was simulated. The simulations were carried out under the five loadings of axial compression, flexion, lateral bending, extension, and axial rotation. The changes of the four biomechanical characteristics, i.e. the rotation degree, the maximum stress in the annulus fibrosus (AF), joint facet contact forces, and the maximum disc deformation, were computed for all models. Experimental results showed that the rotation range, the maximum AF stress, and joint facet contact forces increased, and the maximum disc deformation decreased after NP removal, while they changed in the opposite way after the nucleus cavities were filled with the experimental material.     

Implementation of controlling strategy in a biomechanical lower limb model with active muscles for coupling multibody dynamics and finite element analysis

Computational biomechanics for human body modeling has generally been categorized into two separated domains: finite element analysis and multibody dynamics. Combining the advantages of both domains is necessary when tissue stress and physical body motion are both of interest. However, the method for this topic is still in exploration. The aim of this study is to implement unique controlling strategies in finite element model for simultaneously simulating musculoskeletal body dynamics and in vivo stress inside human tissues. A finite element lower limb model with 3D active muscles was selected for the implementation of controlling strategies, which was further validated against in-vivo human motion experiments. A unique feedback control strategy that couples together a basic Proportion-Integration-Differentiation (PID) controller and generic active signals from Computed Muscle Control (CMC) method of the musculoskeletal model or normalized EMG singles was proposed and applied in the present model. The results show that the new proposed controlling strategy show a good correlation with experimental test data of the normal gait considering joint kinematics, while stress distribution of local lower limb tissue can be also detected in real-time with lower limb motion. In summary, the present work is the first step for the application of active controlling strategy in the finite element model for concurrent simulation of both body dynamics and tissue stress. In the future, the present method can be further developed to apply it in various fields for human biomechanical analysis to monitor local stress and strain distribution by simultaneously simulating human locomotion.