Alterations in lumbar spine mechanics due to degenerative disc disease

2010 Fall.Includes bibliographical references.Degenerative disc disease is a major source of low back pain. It is hypothesized to significantly alter the biomechanics of the lumbar spine both at the tissue and motion segment (multi-vertebral) levels. However, explicit correlations between the former and the latter has not been established, and this critical link is only possible through modeling the intervertebral disc tissue behavior within a constitutive framework and implementing it in a finite element model of the lumbar spine. In order to develop a better appreciation of the biomechanics of disc degeneration, the main objectives of this dissertation work were to investigate the degenerative disease related mechanical alterations on lumbar spine through finite element modeling and experimentation, and evaluate the contemporary treatment strategies. To meet this objective, a finite element model of the healthy human lumbar spine was generated based on computed tomography (CT) imagery. Mesh convergence was verified based on strain energy density predictions. Kinematic and mechanical predictions of clinical interest, including range of motion and intradiscal nuclear pressure, were validated under pure moment loading. The mechanical properties of healthy and degenerated annulus fibrosus tissue were quantified using an orthotropic continuum model, with empirical determination of the requisite material coefficients derived from biaxial and uniaxial tension tests. The resultant material models were implemented into the validated finite element model in order to simulate disc degeneration at the L3-L4 level. At the tissue level, degeneration was found to significantly increase the dispersion in the collagen fiber orientation and the nonlinearity of the fiber mechanical behavior. At the motion segment level, degeneration increased the mobility of the spine, with concomitant increases in the local stress predictions in the annulus and facet force transmission. Our results were in good agreement with the clinical findings of instability and injury to the intervertebral disc due to degeneration. Total disc replacement was also considered as a treatment option within the aforementioned finite element framework. The model predictions indicated that single and two-level disc replacement restored motion at the treated levels, while linearizing the kinematic response and increasing the facet force transmission. The data reflect that the successful surgical outcome is most likely obtained when maximum preservation of native disc tissue is achieved during implantation of the prosthetic device

Biomechanical study of intervertebral disc degeneration

Degeneration and age affect the biomechanics of the intervertebral disc, by reducing its stiffness, flexibility and shock absorption capacities against daily movement and spinal load. The biomechanical characterization of intervertebral discs is achieved by conducting mechanical testing to vertebra-disc-vertebra segments and applying axial, shear, bend and torsion loads, statically or dynamically, with load magnitudes corresponding to the physiological range. However, traditional testing does not give a view of the load and deformation states of the disc components: nucleus pulposus, annulus fibrosus and endplate. Thus, the internal state of stress and strains of the disc can only be predicted by numerical methods, one of which is the finite element method. The objective of this thesis was, to study the biomechanics of degenerated intervertebral discs to load conditions in compression, bending and torsion, by using mechanical testing and a finite element model of disc degeneration, based on magnetic resonance imaging (MRI). Therefore, lumbar discs obtained from cadavers corresponding to spinal levels L2-L3 and L4-L5 with mild to severe degeneration were used. Intervertebral osteochondrosis and spondylosis deformans were identified, being the disc space collapse, the most striking feature. Next, all discs were tested to static and dynamic load conditions, the results gained corresponded to the disc stiffness (in compression, bending and torsion), stress relaxation and dynamic response. Of these, the stiffness response was used to validate the disc model. The testing results suggest that discs with advanced degeneration over discs with mild degeneration are, less rigid in compression, less stiffer under bending and torsion, showed less radial bulge, and reduce their viscoelastic and damping properties. This study shows that degeneration has an impact on the disc biomechanical properties which can jeopardize normal functionality. Development of one finite element model of disc degeneration started by choosing a MRI of a L2-L3 disc. Segmentation of vertebra bone and disc materials followed, and were based on pixel brightness and radiology fundamentals, then a finite element mesh was created to account for the disc irregular shape. The disc materials were modeled as hyperelastic and the bone materials were modeled as orthotropic and isotropic. Adjustment of material properties was based on integrity of the annulus fibrosus, giving a stiffness value matching that of a mild degeneration disc. Then, validation of the model was performed, and included a study of the distributions of stress and strain under loads of compression, bending and torsion. The results from all load simulations show that the disc undergoes large deformations. In contrast, the vertebrae are subjected to higher stress but with negligible deformations. In compression, the model predicted formation of symmetrical disc bulge which agree with the testing behavior. The nucleus pulposus showed to be the principal load carrier with negative principal stresses and strains. In bending and torsion, the annulus fibrosus showed to be the principal load carrier with large symmetrical principal strains and stresses for the former loading and large shearing for the latter. The study showed the importance of soft tissue deformation, mostly noticed in advanced degeneration. In contrast, the higher stresses in the vertebra over those of the intervertebral disc showed the relevance of bone predisposition to fracture. Such kind of studies, should contribute to the understanding of the biomechanics of the intervertebral disc.La degeneración y edad afectan la biomecánica del disco intervertebral, reduciendo la capacidad de rigidez, flexibilidad y atenuación de impactos, contra el movimiento y carga del raquis. La caracterización biomecánica del disco se realiza con ensayos mecánicos a segmentos de vértebra-disco-vértebra y aplicando cargas axiales, cortantes, flexión y torsión, estáticas ó dinámicas, con magnitudes de carga según el intervalo fisiológico. Sin embargo, las pruebas tradicionales no dan una visión de los estados de carga y deformación de los componentes del disco: núcleo pulposo, anillo fibroso y placa terminal. Por lo tanto, el estado interno de esfuerzos y deformaciones del disco, solo puede ser predicho con métodos numéricos, uno de los cuales es el método de elemento finito. El objetivo de esta tesis fue, estudiar la biomecánica de discos intervertebrales degenerados a las condiciones de carga en compresión, flexión y torsión, mediante el uso de ensayos mecánicos y de un modelo de elementos finitos de la degeneración de disco, basado en imágenes con resonancia magnética (MRI). Por lo tanto, se usaron discos lumbares L2-L3 y L4-L5 obtenidos de cadáveres, con degeneración leve a severa. Se identificó osteocondrosis intervertebral y espondilosis deformante, siendo el colapso del espacio intervertebral el aspecto más relevante. Luego, todos los discos fueron ensayados a condiciones de carga estática y dinámica, y los resultados correspondieron a la rigidez del disco (a compresión, flexión y torsión), a la relajación de tensiones y a la respuesta dinámica. De éstos, la rigidez fue usada para validar el modelo de disco. Los resultados de los ensayos sugieren que los discos con degeneración avanzada sobre aquellos con degeneración leve son, menos rigidos a compresión, menos rigidos a flexión y torsión, presentan menor protuberancia radial, y reducen sus propiedades viscoelásticas y de amortiguamiento. El estudio muestra que la degeneración impacta las propiedades biomecánicas del disco, poniendo en riesgo la funcionalidad normal. El desarollo de un modelo de elementos finitos de la degeneración de disco inició eligiendo una secuencia de resonancia magnética de un disco L2-L3. La segmentación de los materiales del disco y de las vértebras se realizó basado en intensidad de brillo del pixel y en fundamentos de radiología, y se creó una malla de elementos finitos correspondiente a la forma irregular del disco. Los materiales del disco se modelaron como hiperelásticos y los tejidos óseos se modelaron como materiales ortotrópicos e isotrópicos. El ajuste de propiedades de los materiales fue basado en la integridad del anillo fibroso, y dio una rigidez correspondiente a la de un disco con degeneración leve. Luego, se realizó la validación del modelo, e incluyó un estudio de las distribuciones de esfuerzo y deformación a las condiciones de carga en compresión, flexión y torsión. Los resultados de todas las simulaciones de carga mostraron que el disco es sometido a grandes deformaciones. En contraste, las vértebras fueron sometidas a mayores esfuerzos pero con deformaciones insignificantes. En compresión, el modelo predijo la formación de una protuberancia radial simétrica, en concordancia con la experimentación. El núcleo pulposo mostró ser el portador principal de carga, con tensiones y deformaciones principales negativas. En flexión y torsión, el anillo fibroso mostró ser el portador principal de carga, con grandes deformaciones y tensiones principales simétricas para la primera carga, y con grandes tensiones cortantes para la segunda carga. El estudio mostró la importancia de las deformaciones de los tejidos blandos, principalmente notados en la degeneración avanzada. Por el contrario, las tensiones mayores en los cuerpos vertebrales sobre aquellas del disco intervertebral mostraron la relevancia de la predisposición a las fracturas óseas. Este tipo de estudio debe contribuir a la comprensión de la biomecánica del disco intervertebral

Finite Element Analysis of Human Lumbar Vertebrae in Pedicle Screw Fixation

In totality of 100%, near about 85% of adult’s falls back pain, which directly related to their daily assignments and activities and 25% of people, reported lower back pain,which is associated with the vertebral compression. Spinal de-generation is also a medical situation which directly affecting men and women of different age groups.Spine injury is mostly found on vertebrae L1– L5 and corresponding intervertebral disk and in this analysis, the purposes of the present research are conclude the appropriate dimensions of pedicle screw (diameter and length) for its fixation in L2–L3-L4 vertebral region. In this analysis pedicle screw of Titanium with different diameters 5, 5.5, 6.0, 6.5 mm. and length 45, 50 mm have been considered. Further to this Finite element analysis (FEA) with boundary condition, i.e. fixed bottom surface of the L4 vertebrae and loads were applied on top surface of L2 vertebrae. The different loading condition has been considered for various body weights. Results were analyzed to provide appropriate pedicle screw size

Multi-Surface Simplex Spine Segmentation for Spine Surgery Simulation and Planning

This research proposes to develop a knowledge-based multi-surface simplex deformable model for segmentation of healthy as well as pathological lumbar spine data. It aims to provide a more accurate and robust segmentation scheme for identification of intervertebral disc pathologies to assist with spine surgery planning. A robust technique that combines multi-surface and shape statistics-aware variants of the deformable simplex model is presented. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user-assistance is allowed to disable the prior shape influence during deformation. Results have been validated against user-assisted expert segmentation

Modelling spinal injury due to high-rate axial loading

This thesis focuses on the injuries of the lumbar spine due to high rate loading, using both cadaveric experiments and numerical modelling. Insurgent warfare has been characterised by the use of improvised explosive devices, often targeting military personnel inside vehicles. Those incidents are associated with spinal injuries of poor clinical outcome. Currently, spinal injury tolerance levels do not exist for the loading seen by blast casualties, and the biomechanics of the lumbar spine are not understood under impact loading. Experimental and numerical models were developed to investigate the response of single segments and bi-segments of the lumbar spine under impact loading conditions. A novel methodology for controlling posture and ensuring axial loading during experiments was developed. A single segment numerical model was developed using the finite element method; the load transmission through the segment and its stress distributions were analysed. A bi-segment numerical model was also developed and three different positions on the sagittal plane were simulated; flexed (10 ͦ), neutral (0 ͦ) and extended (-5 ͦ). Differences between postures were predicted and areas prone to injury were identified. The neutral posture was found to be the most severe for the same loading conditions. Injurious impact tests of bi-segment cadaveric specimens were performed for the aforementioned postures, and the neutral posture was found to sustain injuries associated with the poorest outcome compared to the flexed or extended specimens. The methodologies and technologies developed in this thesis can be used further to look into the injury biomechanics aspects of the lumbar spine and used as a test-bed for assessing current and develop new mitigation strategies. Immediate next steps would be to include the rest of the lumbar spine in the numerical model and then the pelvis so that the loading pathway from the seat through to the spine can be quantified.Open Acces

On the Finite Element Modeling of the Lumbar Spine: A Schematic Review

Finite element modelling of the lumbar spine is a challenging problem. Lower back pain is among the most common pathologies in the global populations, owing to which the patient may need to undergo surgery. The latter may differ in nature and complexity because of spinal disease and patient contraindications (i.e., aging). Today, the understanding of spinal column biomechanics may lead to better comprehension of the disease progression as well as to the development of innovative therapeutic strategies. Better insight into the spine’s biomechanics would certainly guarantee an evolution of current device-based treatments. In this setting, the computational approach appears to be a remarkable tool for simulating physiological and pathological spinal conditions, as well as for various aspects of surgery. Patient-specific computational simulations are constantly evolving, and require a number of validation and verification challenges to be overcome before they can achieve true and accurate results. The aim of the present schematic review is to provide an overview of the evolution and recent advances involved in computational finite element modelling (FEM) of spinal biomechanics and of the fundamental knowledge necessary to develop the best modeling approach in terms of trustworthiness and reliability

A predictive mechanical model for evaluating vertebral fracture probability in lumbar spine under different osteoporotic drug therapies

Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements.A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body.For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls.This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions

Development and application of a non invasive image matching method to study spine biomechanics

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2008.Includes bibliographical references (p. 83-92).Research on spine biomechanics is critical to understand pathology such as degenerative changes and low back pain. However, current study on in-vivo spine biomechanics is limited by the complex anatomy and invasive methodology. Modem clinical imaging techniques such as magnetic resonance and fluoroscope images, which are widely accessible nowadays, have the potential to study in-vivo spine biomechanics accurately and non-invasively. This research presents a new combined magnetic resonance and fluoroscope imaging matching method to study human lumbar vertebral kinematics and disc deformation during various physiologic functional activities. Validation and application of this method as well as discussion of its performance and applicability are detailed herein.by Shaobai Wang.S.M