The dynamic flexion/extension properties of the lumbar spine in vitro using a novel pendulum system

The biomechanical properties of the ligamentous cadaver spine have been previously examined using a variety of experimental testing protocols. Ongoing technical challenges in the biomechanical testing of the spine include the application of physiologic compressive loads and the application of dynamic bending moments while allowing unconstrained three-dimensional motion. The purpose of this study was to report the development of a novel pendulum apparatus that addressed these challenges and to determine the effects of various axial compressive loads on the dynamic biomechanical properties of the lumbar functional spinal unit (FSU). Lumbar FSUs were tested in flexion and extension under five axial compressive loads chosen to represent physiologic loading conditions. After an initial rotation, the FSUs behaved as a dynamic, underdamped vibrating elastic system. Bending stiffness and coefficient of damping increased significantly as the compressive pendulum load increased. The apparatus described herein is a relatively simple approach to determining the dynamic bending properties of the FSU, and potentially disc arthroplasty devices. It is capable of applying physiologic compressive loads at dynamic rates without constraining the kinematics of the joints, crucial requirements for testing FSUs in vitro.     

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.     

Sensitivity of lumbar spine response to follower load and flexion moment: finite element study

The follower load (FL) combined with moments is commonly used to approximate flexed/extended posture of the lumbar spine in absence of muscles in biomechanical studies. There is a lack of consensus as to what magnitudes simulate better the physiological conditions. Considering the in-vivo measured values of the intradiscal pressure (IDP), intervertebral rotations (IVRs) and the disc loads, sensitivity of these spinal responses to different FL and flexion moment magnitudes was investigated using a 3D nonlinear finite element (FE) model of ligamentous lumbosacral spine. Optimal magnitudes of FL and moment that minimize deviation of the model predictions from in-vivo data were determined. Results revealed that the spinal parameters i.e. the IVRs, disc moment, and the increase in disc force and moment from neutral to flexed posture were more sensitive to moment magnitude than FL magnitude in case of flexion. The disc force and IDP were more sensitive to the FL magnitude than moment magnitude. The optimal ranges of FL and flexion moment magnitudes were 900–1100 N and 9.9–11.2 Nm, respectively. The FL magnitude had reverse effect on the IDP and disc force. Thus, magnitude for FL or flexion that minimizes the deviation of all the spinal parameters together from the in-vivo data can vary. To obtain reasonable compromise between the IDP and disc force, our findings recommend that FL of low magnitude must be combined with flexion moment of high intensity and vice versa.     

Determination of trunk muscle forces for flexion and extension by using a validated finite element model of the lumbar spine and measured in vivo data

Muscle forces stabilize the spine and have a great influence on spinal loads. But little is known about their magnitude. In a former in vitro experiment, a good agreement with intradiscal pressure and fixator loads measured in vivo could be achieved for standing and extension of the lumbar spine. However, for flexion the agreement between in vitro and in vivo measurements was insufficient. In order to improve the determination of trunk muscle forces, a three-dimensional nonlinear finite element model of the lumbar spine with an internal fixation device was created and the same loads were applied as in a previous in vitro experiment. An extensive adaptation process of the model was performed for flexion and extension angles up to 20 degrees and -15 degrees, respectively. With this validated computer model intra-abdominal pressure, preload in the fixators, and a combination of hip- and lumbar flexion angle were varied until a good agreement between analytical and in vivo results was reached for both, intradiscal pressure and bending moments in the fixators. Finally, the fixators were removed and the muscle forces for the intact lumbar spine calculated. A good agreement with the in vivo results could only be achieved at a combination of hip- and lumbar flexion. For the intact spine, forces of 170, 100 and 600 N are predicted in the m. erector spinae for standing, 5 degrees extension and 30 degrees flexion, respectively. The force in the m. rectus abdominus for these body positions is less than 25 N. For more than 10 degrees extension the m. erector spinae is unloaded. The finite element method together with in vivo data allows the estimation of trunk muscle forces for different upper body positions in the sagittal plane. In our patients, flexion of the upper body was most likely a combination of hip- and lumbar spine bending.     

Effects of external trunk loads on lumbar spine stability

Stability of the lumbar spine is an important factor in determining spinal response to sudden loading. Using two different methods, this study evaluated how various trunk load magnitudes and directions affect lumbar spine stability. The first method was a quick release procedure in which effective trunk stiffness and stability were calculated from trunk kinematic response to a resisted-force release. The second method combined trunk muscle EMG data with a biomechanical model to calculate lumbar spine stability. Twelve subjects were tested in trunk flexion, extension, and lateral bending under nine permutations of vertical and horizontal trunk loading. The vertical load values were set at 0, 20, and 40% of the subject's body weight (BW). The horizontal loads were 0, 10, and 20% of BW. Effective spine stability as obtained from quick release experimentation increased significantly (p<0.01) with increased vertical and horizontal loading. It ranged from 785 (S.D.=580) Nm/rad under no-load conditions to 2200 (S.D.=1015) Nm/rad when the maximum horizontal and vertical loads were applied to the trunk simultaneously. Stability of the lumbar spine achieved prior to force release and estimated from the biomechanical model explained approximately 50% of variance in the effective spine stability obtained from quick release trials in extension and lateral bending (0.53相似文献   

Position sense in the lumbar spine with torso flexion and loading

Proprioception plays an important role in appropriate sensation of spine position, movement, and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated the change in position sense as a function of altered trunk flexion and moment loading independently. Reposition sense of lumbar angle in 17 subjects was assessed. Subjects were trained to assume specified lumbar angles using visual feedback. The ability of the subjects to reproduce this curvature without feedback was then assessed. This procedure was repeated for different torso flexion and moment loading conditions. These measurements demonstrated that position sense error increased significantly with the trunk flexion (40%, p < .05) but did not increase with moment load (p = .13). This increased error with flexion suggests a loss in the ability to appropriately sense and therefore control lumbar posture in flexed tasks. This loss in proprioceptive sense could lead to more variable lifting coordination and a loss in dynamic stability that could increase low back injury risk. This research suggests that it is advisable to avoid work in flexed postures.     

A finite element model technique to determine the mechanical response of a lumbar spine segment under complex loads

This study presents a CT-based finite element model of the lumbar spine taking into account all function-related boundary conditions, such as anisotropy of mechanical properties, ligaments, contact elements, mesh size, etc. Through advanced mesh generation and employment of compound elements, the developed model is capable of assessing the mechanical response of the examined spine segment for complex loading conditions, thus providing valuable insight on stress development within the model and allowing the prediction of critical loading scenarios. The model was validated through a comparison of the calculated force-induced inclination/deformation and a correlation of these data to experimental values. The mechanical response of the examined functional spine segment was evaluated, and the effect of the loading scenario determined for both vertebral bodies as well as the connecting intervertebral disc.     

Longer static flexion duration elicits a neuromuscular disorder in the lumbar spine.

The objective of this study was to assess the impact of two sequential long, static, anterior lumbar flexions on the development of a neuromuscular disorder and to compare it with previously obtained data from a series of short static flexion periods of the same cumulative time (Sbriccoli P, Solomonow M, Zhou BH, Baratta RV, Lu Y, Zhu MP, and Burger EL, Muscle Nerve 29: 300-308, 2004). Static flexions with loads of 20, 40, and 60 N were applied to the lumbar spine over two 30-min periods with a 10-min rest in between. The reflex EMG activity from the multifidus muscles and supraspinous ligament displacement (creep) was recorded during the flexion periods. Creep and EMG were also monitored over 7 h of rest following the work-rest-work cycle. It was found that the creep that developed in the first 30-min flexion period did not recover completely during the following 10 min of rest, giving rise to a large cumulative creep at the end of the work-rest-work session. Spasms were frequently seen within the EMG during the static flexion. Initial and delayed hyperexcitabilities were observed in all of the preparations at any of the three loads explored during the 7-h rest period. ANOVA revealed a significant effect of time (P < 0.0001) on the postloading data. Larger loads elicited larger magnitudes of the initial and delayed hyperexcitabilities, yet were not statistically different. It was concluded that the 3:1 work-to-rest duration ratio resulted in a neuromuscular disorder, regardless of the load magnitude. The conclusions are reinforced in view of the results from a previous study using 60 min of flexion overall but at 1:1 work-to-rest ratio in which only the highest load elicited a delayed hyperexcitability (Sbriccoli et al., Muscle Nerve 29: 300-308, 2004). An optimal dose-to-duration ratio needs to be established to limit, attenuate, or prevent the adverse effects of static load on the lumbar spine while considering the loading duration as a major risk factor.     

Effect of an interspinous implant on loads in the lumbar spine.

Interspinous process implants are increasingly used to treat canal stenoses. Little information exists about the effects of implant height and stiffness on the biomechanical behavior of the lumbar spine. Therefore, a three-dimensional nonlinear finite element model of the osseoligamentous lumbar spine (L1 to L5) was created with a slightly degenerated disc at L3/L4. An interspinous implant was inserted at that segment. Implants with different heights and stiffnesses were studied. The model was loaded with the upper body weight and muscle forces to simulate walking and 25 degrees extension. Implant forces are influenced strongly by the height and negligibly by the elastic modulus of the implant. Intersegmental rotation at implant level is markedly reduced, while intradiscal pressure is slightly increased. Implant size and stiffness have only a minor effect on intradiscal pressure. The maximum von Mises stress in the vertebral arch is strongly increased by the implant.     

A patient-specific finite element methodology to predict damage accumulation in vertebral bodies under axial compression, sagittal flexion and combined loads

Due to the inherent limitations of DXA, assessment of the biomechanical properties of vertebral bodies relies increasingly on CT-based finite element (FE) models, but these often use simplistic material behaviour and/or single loading cases. In this study, we applied a novel constitutive law for bone elasticity, plasticity and damage to FE models created from coarsened pQCT images of human vertebrae, and compared vertebral stiffness, strength and damage accumulation for axial compression, anterior flexion and a combination of these two cases. FE axial stiffness and strength correlated with experiments and were linearly related to flexion properties. In all loading modes, damage localised preferentially in the trabecular compartment. Damage for the combined loading was higher than cumulated damage produced by individual compression and flexion. In conclusion, this FE method predicts stiffness and strength of vertebral bodies from CT images with clinical resolution and provides insight into damage accumulation in various loading modes.     

Accuracy and repeatability of a new method for measuring facet loads in the lumbar spine

We assessed the repeatability and accuracy of a relatively new, resistance-based sensor (Tekscan 6900) for measuring lumbar spine facet loads, pressures, and contact areas in cadaver specimens. Repeatability of measurements in the natural facet joint was determined for five trials of four specimens loaded in pure moment (+/- 7.5 N m) flexibility tests in axial rotation and flexion-extension. Accuracy of load measurements in four joints was assessed by applying known compressive loads of 25, 50, and 100 N to the natural facet joint in a materials testing machine and comparing the known applied load to the measured load. Measurements of load were obtained using two different calibration approaches: linear and two-point calibrations. Repeatability for force, pressure, and area (average of standard deviation as a percentage of the mean for all trials over all specimens) was 4-6% for axial rotation and 7-10% for extension. Peak resultant force in axial rotation was 30% smaller when calculated using the linear calibration method. The Tekscan sensor overestimated the applied force by 18 +/- 9% (mean+/-standard deviation), 35 +/- 7% and 50 +/- 9% for compressive loads of 100, 50, and 25 N, respectively. The two-point method overestimated the loads by 35 +/- 16%, 45 +/- 7%, and 56 +/- 10% for the same three loads. Our results show that the Tekscan sensor is repeatable. However, the sensor measurement range is not optimal for the small loads transmitted by the facets and measurement accuracy is highly dependent on calibration protocol.     

Three-dimensional bending,torsion and axial compression of the femoropopliteal artery during limb flexion

High failure rates of femoropopliteal artery reconstruction are commonly attributed to complex 3D arterial deformations that occur with limb movement. The purpose of this study was to develop a method for accurate assessment of these deformations. Custom-made stainless-steel markers were deployed into 5 in situ cadaveric femoropopliteal arteries using fluoroscopy. Thin-section CT images were acquired with each limb in the straight and acutely bent states. Image segmentation and 3D reconstruction allowed comparison of the relative locations of each intra-arterial marker position for determination of the artery’s bending, torsion and axial compression. After imaging, each artery was excised for histological analysis using Verhoeff–Van Gieson staining. Femoropopliteal arteries deformed non-uniformly with highly localized deformations in the proximal superficial femoral artery, and between the adductor hiatus and distal popliteal artery. The largest bending (11±3–6±1 mm radius of curvature), twisting (28±9–77±27°/cm) and axial compression (19±10–30±8%) were registered at the adductor hiatus and the below knee popliteal artery. These deformations were 3.7, 19 and 2.5 fold more severe than values currently reported in the literature. Histology demonstrated a distinct sub-adventitial layer of longitudinally oriented elastin fibers with intimal thickening in the segments with the largest deformations. This endovascular intra-arterial marker technique can quantify the non-uniform 3D deformations of the femoropopliteal artery during knee flexion without disturbing surrounding structures. We demonstrate that 3D arterial bending, torsion and compression in the flexed lower limb are highly localized and are substantially more severe than previously reported.     

Optimised loads for the simulation of axial rotation in the lumbar spine

Simplified loading modes (pure moment, compressive force) are usually applied in the in vitro studies to simulate flexion-extension, lateral bending and axial rotation of the spine. The load magnitudes for axial rotation vary strongly in the literature. Therefore, the results of current investigations, e.g. intervertebral rotations, are hardly comparable and may involve unrealistic values. Thus, the question 'which in vitro applicable loading mode is the most realistic' remains open. A validated finite element model of the lumbar spine was employed in two sensitivity studies to estimate the ranges of results due to published load assumptions and to determine the input parameters (e.g. torsional moment), which mostly affect the spinal load and kinematics during axial rotation. In a subsequent optimisation study, the in vitro applicable loading mode was determined, which delivers results that fit best with available in vivo measurements. The calculated results varied widely for loads used in the literature with potential high deviations from in vivo measured values. The intradiscal pressure is mainly affected by the magnitude of the compressive force, while the torsional moment influences mainly the intervertebral rotations and facet joint forces. The best agreement with results measured in vivo were found for a compressive follower force of 720N and a pure moment of 5.5Nm applied to the unconstrained vertebra L1. The results reveal that in many studies the assumed loads do not realistically simulate axial rotation. The in vitro applicable simplified loads cannot perfectly mimic the in vivo situation. However, the optimised values lead to the best agreement with in vivo measured values. Their consequent application would lead to a better comparability of different investigations.     

An EMG-assisted model of loads on the lumbar spine during asymmetric trunk extensions

An EMG-assisted, low-back, lifting model is presented which simulates spinal loading as a function of dynamic, asymmetric, lifting exertions. The purpose of this study has been to develop a model which overcomes the limitations of previous models including static or isokinetic mechanics, inaccurate predictions of muscle coactivity, static interpretation of myoelectric activity, and physiologically unrealistic or variable muscle force per unit area. The present model predicts individual muscle forces from processed EMG data, normalized as a function of trunk angle and asymmetry, and modified to account for muscle length and velocity artifacts. The normalized EMGs are combined with muscle cross-sectional area and intrinsic strength capacity as determined on a per subject basis, to represent tensile force amplitudes. Dynamic internal and external force vectors are employed to predict trunk moments, spinal compression, lateral and anterior shear forces. Data from 20 subjects performing a total of 2160 exertions showed good agreement between predicted and measured values under all trunk angle, asymmetry, velocity, and acceleration conditions. The design represents a significant step toward accurate, fully dynamic modeling of the low-back in multiple dimensions. The benefits of such a model are the insights provided into the effects of motion induced, muscle co-activity on spinal loading in multiple dimensions.     

Representation of passive spinal element contributions to in vitro flexion-extension using a polynomial model: illustration using the porcine lumbar spine

A polynomial modeling approach was developed to describe the contribution of individual passive spinal elements to the lumbar spinal motion segment flexion-extension motion. Flexion-extension moment-angle curves from porcine lumbar spines tested using a robotic testing system were described using sixth-order polynomials; the polynomials describing different dissection conditions were subtracted to describe the contribution of individual spinal elements to the motion segment flexion-extension properties. This modeling approach is a powerful and straightforward method for representing the mechanics of individual spinal tissues in biomechanical models and could easily be expanded to incorporate other features such as axial load.     

Validation of an OpenSim full-body model with detailed lumbar spine for estimating lower lumbar spine loads during symmetric and asymmetric lifting tasks

There is currently no validated full-body lifting model publicly available on the OpenSim modelling platform to estimate spinal loads during lifting. In this study, the existing full-body-lumbar-spine model was adapted and validated for lifting motions to produce the lifting full-body model. Back muscle activations predicted by the model closely matched the measured erector spinae activation patterns. Model estimates of intradiscal pressures and in vivo measurements were strongly correlated. The same spine loading trends were observed for model estimates and reported vertebral body implant measurements. These results demonstrate the suitability of this model to evaluate changes in lumbar loading during lifting.     

A three-dimensional nonlinear finite element model of lumbar intervertebral joint in torsion

Torsion as a cause of failure in the lumbar intervertebral joint was studied using a three-dimensional nonlinear finite element model. The role of facets and ligaments as well as the stress distributions in the posterior elements, the disk, the ligaments, and the vertebral body were examined. For physiological range of torsion, the facets carried 10 to 40 percent of the torque. The fiber stresses in the disk were the highest at the lateral margin of the outer layer of the annulus. Therefore, torsion itself is unlikely to cause posterior or posterolateral disk prolapse.     

Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine

The primary objective of this study was to generate a finite element model of the human lumbar spine (L1–L5), verify mesh convergence for each tissue constituent and perform an extensive validation using both kinematic/kinetic and stress/strain data. Mesh refinement was accomplished via convergence of strain energy density (SED) predictions for each spinal tissue. The converged model was validated based on range of motion, intradiscal pressure, facet force transmission, anterolateral cortical bone strain and anterior longitudinal ligament deformation predictions. Changes in mesh resolution had the biggest impact on SED predictions under axial rotation loading. Nonlinearity of the moment-rotation curves was accurately simulated and the model predictions on the aforementioned parameters were in good agreement with experimental data. The validated and converged model will be utilised to study the effects of degeneration on the lumbar spine biomechanics, as well as to investigate the mechanical underpinning of the contemporary treatment strategies.     

Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine

The primary objective of this study was to generate a finite element model of the human lumbar spine (L1-L5), verify mesh convergence for each tissue constituent and perform an extensive validation using both kinematic/kinetic and stress/strain data. Mesh refinement was accomplished via convergence of strain energy density (SED) predictions for each spinal tissue. The converged model was validated based on range of motion, intradiscal pressure, facet force transmission, anterolateral cortical bone strain and anterior longitudinal ligament deformation predictions. Changes in mesh resolution had the biggest impact on SED predictions under axial rotation loading. Nonlinearity of the moment-rotation curves was accurately simulated and the model predictions on the aforementioned parameters were in good agreement with experimental data. The validated and converged model will be utilised to study the effects of degeneration on the lumbar spine biomechanics, as well as to investigate the mechanical underpinning of the contemporary treatment strategies.     

Biomechanical evaluation on a novel design of biodegradable embossed locking compression plate for orthopaedic applications using finite element analysis

Biomechanics and Modeling in Mechanobiology - In orthopaedics, conventional implant plates such as locking compression plate (LCP) made from non-biodegradable materials play a vital role in the...