Comparison of Two Intervertebral Disc Failure Models in a Numerical C4-C5 Trauma Model.

The intervertebral disc (IVD) is essential for the mobility and stability of the spine. During flexion-distraction injuries, which are frequent at the cervical spine level, the IVD is often disrupted. Finite element studies have been done to investigate injury mechanisms and patterns at the cervical spine. However, they rarely include IVD failure model. The aim of this paper was to implement and compare two types of IVD failure models and their impact on hyperflexion and hyperflexion-compression injuries simulations. The failure models were tested on a detailed C4-C5 finite elements model. The first failure model consisted in a maximal strain model applied to the elements of the annulus and nucleus. The second failure model consisted in the implementation of a rupture plane in the middle of the IVD with a tied interface created between the two sections. This interface is defined by threshold stress values of detachment in traction and shearing. The two failure models were tested in flexion only and in flexion-compression. The model without inclusion of an IVD failure model was also tested. Loads at failure and injury patterns were reported. Both failure models produce failure loads that were consistent with experimental data. Injury patterns observed were in agreement with experimental and numerical studies. However, in flexion-compression, the rupture plane model simulation reached important energy error due to high deformations in the IVD elements. Also, without inclusion of an IVD failure model, energy error forced the end of the simulation in flexion-compression. Therefore, inclusion of IVD failure model is important since it leads to realistic results, but the maximal strain failure model is recommended.

A 3D visualization tool for the design and customization of spinal braces.

A new tool was developed and validated on an X-ray dummy to allow personalized design and adjustment of spinal braces. The 3D visualization of the external trunk surface registered with the underlying 3D bone structures permits the clinicians to select pressure areas on the trunk surface for proper positioning of correcting pads inside the brace according to the patient's specific trunk deformities. After brace fabrication, the clinicians can evaluate the actual 3D patient-brace interface pressure distribution visualized simultaneously with the 3D model of the trunk in order to customize brace adjustment and validate brace design with respect to the treatment plan.

Electromyogram and kinematic analysis of lateral bending in idiopathic scoliosis patients.

In adolescent idiopathic scoliosis (AIS), surgical planning currently relies on spinal flexibility evaluation using lateral bending radiographs. The aim was to evaluate the feasibility of non-invasive dynamic analysis of trunk kinematics and muscle activity in patients with AIS before surgical correction. During various lateral trunk bending tasks, erector spinae (18 sites) and abdominal (four sites) muscle activity was sampled using surface electrodes in ten AIS patients and in ten controls. Simultaneously, the spatial displacements of infrared emitting diodes located on the trunk were sampled. Parameters considered were the heterolateral-to-homolateral root-mean-square EMG ratios R at each site and total lateral bending and thoracic and lumbar curvature angle courses. Main alterations concerned apical muscle activity during left bending tasks. ANOVA results showed a significant effect of side (p = 2.1 x 10(-9)), EMG recording site (p = 1.9 x 10(-16)), pathology (p = 3.9 x 10(-16)) and task (p = 2.2 x 10(-11)) on R ratios. The R ratio at T10 and L1 for a simple lateral bending task during left bending averaged 4.8 (SD 4.3) and 3.0 (SD 3.1) in AIS patients, and 2.3 (SD 2.8) and 1.3 (SD 0.4) in controls (p = 6.4 x 10(-4) and 2.5 x 10(-3), LSD post hoc). This preliminary study allowed the development of a functional, non-invasive, non-irradiating dynamic tool for pre-operative evaluation in AIS.

Self-calibration of biplanar radiographs for a retrospective comparative study of the 3D correction of adolescent idiopathic scoliosis.

A novel technique for the 3D reconstruction of the spine from X-ray images is presented. The algorithm is based on the self-calibration of biplanar radiographs. It allows the 3D reconstruction of spines from old uncalibrated preoperative and postoperative radiographs. The reliability of the new self-calibration technique was investigated by validating its results against those of the Direct Linear Transform (DLT) on real images. An accuracy experiment was also performed using a dry spine specimen under controlled conditions. The results indicate that self-calibration is a viable technique, accurate enough to extract meaningful 3D clinical data for retrospective studies.

Investigation of muscle recruitment patterns in scoliosis using a biomechanical finite element model.

The objective of this project is to study the characteristics of trunk muscle recruitment strategies experimentally observed for scoliotic subjects using a finite element model of the trunk. The personalized biomechanical model includes elements representing the osseo-ligamentous structures of the spine, rib cage and pelvis. It also integrates the principal agonistic muscles necessary for trunk movement and a neural control model based on the Equilibrium Point hypothesis (lambda model of Feldman). Muscle recruitment patterns of normal and scoliotic subjects obtained from the simulation of lateral bending movements were qualitatively compared. The generation process of motor control variables was studied by analysing the relationships between central commands and spine segment mobility. Differences in recruitment patterns between normal and scoliotic subjects were observed, especially for paraspinal fascicles crossing the thoracic curve segment. The generation of central commands for normal subjects was strongly correlated with the amplitude of bending, but this relation was weaker for scoliotic subjects and this difference was worst at the apex vertebra. These results show that neuromuscular disorders could occur at a local level. The proposed approach should provide a simulation tool to study the multifactorial origin of scoliosis, and to investigate the implication of muscles and central commands in spinal dysfunctions.

Spinal mobility and EMG activity in idiopathic scoliosis through dynamic lateral bending tests.

Lateral bending test is a common evaluation of AIS patients prior to their surgical correction. Traditionally this evaluation is made by the assessment of the curve's flexibility from side-bending radiographs. As a complement to this static test, dynamic bending was experimented while simultaneously quantifying muscular and kinematic behavior of the spine. The biggest contribution to total EMG output was 36% from lumbar muscles in healthy and 35% from abdominal muscles in scoliotic subjects. Continuous measuring of kinematics and muscle activation patterns throughout lateral bending could be an evaluation tool for distinguishing pathological from normal behavior.

[Simulation of lateral bending tests using a musculoskeletal model of the trunk]. / Simulations de tests d'inflexion latérale à l'aide d'un modèle musculo-squelettique du tronc.

INTRODUCTION: The lateral bending test is used for the preoperative evaluation of scoliotic patients in order to determine the type of spinal curvatures as well as to assess spine flexibility and possible corrections. However, very few biomechanical studies have been dedicated to the analysis of lateral bending. In this article, a biomechanical model of the human trunk has been used in order to evaluate the possibility of simulating lateral bending tests. METHODS: This model includes elements representing the osseo-ligamentous structures of the spine, rib cage and pelvis, as well as 160 muscle fascicles represented by bilinear cable elements. For 4 scoliotic patients (right thoracic and left lumbar curvatures), 3D upright standing and bending reconstructions were generated from calibrated x-rays and used to calculate the displacements of the vertebrae T1 and L5. These displacements were applied to the model in standing position in order to simulate lateral bending. The resulting geometry of the deformed model was compared to the reconstructed geometry in lateral bending for the other vertebral levels (T2 to L4). RESULTS: The model allows the reproduction of the thoracic Cobb angle modifications with an accuracy superior to 2 degrees, as well as the vertebral rotations in the frontal plane (agreement greater than 85%). The positions of the vertebral body centroids following the simulations showed an agreement of over 77% with reconstructed positions. The direction of the axial angulation for the thoracic and lumbar apical vertebrae is correctly reproduced by the model. The axial rotation for these vertebrae does not result in a common pattern for the 4 patients, which is consistent with the diversity of published data concerning the direction of this coupling. CONCLUSIONS: This study shows the feasibility of simulating lateral bending tests using a 3D biomechanical model integrating muscles. The effect of muscle forces on trunk stiffness and intersegmental mobility can also be assessed using this approach. Future developments should enable the evaluation of the biomechanical properties of scoliotic deformities, thus providing a useful tool for preoperative surgical planning.