Load Distribution in the Lumbar Spine During Modeled Compression Depends on Lordosis.

Excessive or incorrect loading of lumbar spinal structures is commonly assumed as one of the factors to accelerate degenerative processes, which may lead to lower back pain. Accordingly, the mechanics of the spine under medical conditions, such as scoliosis or spondylolisthesis, is well-investigated. Treatments via both conventional therapy and surgical methods alike aim at restoring a "healthy" (or at least pain-free) load distribution. Yet, surprisingly little is known about the inter-subject variability of load bearings within a "healthy" lumbar spine. Hence, we utilized computer tomography data from 28 trauma-room patients, whose lumbar spines showed no visible sign of degeneration, to construct simplified multi-body simulation models. The subject-specific geometries, measured by the corresponding lumbar lordosis (LL) between the endplates of vertebra L1 and the sacrum, served as ceteris paribus condition in a standardized forward dynamic compression procedure. Further, the influence of stimulating muscles from the M. multifidus group was assessed. For the range of available LL from 28 to 66°, changes in compressive and shear forces, bending moments, as well as facet joint forces between adjacent vertebrae were calculated. While compressive forces tended to decrease with increasing LL, facet forces were tendentiously increasing. Shear forces decreased between more cranial vertebrae and increased between more caudal ones, while bending moments remained constant. Our results suggest that there exist significant, LL-dependent variations in the loading of "healthy" spinal structures, which should be considered when striving for individually appropriate therapeutic measures.

Muscle-driven and torque-driven centrodes during modeled flexion of individual lumbar spines are disparate.

Lumbar spine biomechanics during the forward-bending of the upper body (flexion) are well investigated by both in vivo and in vitro experiments. In both cases, the experimentally observed relative motion of vertebral bodies can be used to calculate the instantaneous center of rotation (ICR). The timely evolution of the ICR, the centrode, is widely utilized for validating computer models and is thought to serve as a criterion for distinguishing healthy and degenerative motion patterns. While in vivo motion can be induced by physiological active structures (muscles), in vitro spinal segments have to be driven by external torque-applying equipment such as spine testers. It is implicitly assumed that muscle-driven and torque-driven centrodes are similar. Here, however, we show that centrodes qualitatively depend on the impetus. Distinction is achieved by introducing confidence regions (ellipses) that comprise centrodes of seven individual multi-body simulation models, performing flexion with and without preload. Muscle-driven centrodes were generally directed superior-anterior and tail-shaped, while torque-driven centrodes were located in a comparably narrow region close to the center of mass of the caudal vertebrae. We thus argue that centrodes resulting from different experimental conditions ought to be compared with caution. Finally, the applicability of our method regarding the analysis of clinical syndromes and the assessment of surgical methods is discussed.

Lumbar spinal ligament characteristics extracted from stepwise reduction experiments allow for preciser modeling than literature data.

Lumbar ligaments play a key role in stabilizing the spine, particularly assisting muscles at wide-range movements. Hence, valid ligament force-strain data are required to generate physiological model predictions. These data have been obtained by experiments on single ligaments or functional units throughout the literature. However, contrary to detailed spine geometries, gained, for instance, from CT data, ligament characteristics are often inattentively transferred to multi-body system (MBS) or finite element models. In this paper, we use an elaborated MBS model of the lumbar spine to demonstrate how individualized ligament characteristics can be obtained by reversely reenacting stepwise reduction experiments, where the range of motion (ROM) was measured. We additionally validated the extracted characteristics with physiological experiments on intradiscal pressure (IDP). Our results on a total of in each case 160 ROM and 49 IDP simulations indicated superiority of our procedure (seven and eight outliers) toward the incorporation of classical literature data (on average 71 and 31 outliers).