Dataset Information

Musculoskeletal Modeling of the Lumbar Spine to Explore Functional Interactions between Back Muscle Loads and Intervertebral Disk Multiphysics.

ABSTRACT: During daily activities, complex biomechanical interactions influence the biophysical regulation of intervertebral disks (IVDs), and transfers of mechanical loads are largely controlled by the stabilizing action of spine muscles. Muscle and other internal forces cannot be easily measured directly in the lumbar spine. Hence, biomechanical models are important tools for the evaluation of the loads in those tissues involved in low-back disorders. Muscle force estimations in most musculoskeletal models mainly rely, however, on inverse calculations and static optimizations that limit the predictive power of the numerical calculations. In order to contribute to the development of predictive systems, we coupled a predictive muscle model with the passive resistance of the spine tissues, in a L3-S1 musculoskeletal finite element model with osmo-poromechanical IVD descriptions. The model included 46 fascicles of the major back muscles that act on the lower spine. The muscle model interacted with activity-related loads imposed to the osteoligamentous structure, as standing position and night rest were simulated through distributed upper body mass and free IVD swelling, respectively. Calculations led to intradiscal pressure values within ranges of values measured in vivo. Disk swelling led to muscle activation and muscle force distributions that seemed particularly appropriate to counterbalance the anterior body mass effect in standing. Our simulations pointed out a likely existence of a functional balance between stretch-induced muscle activation and IVD multiphysics toward improved mechanical stability of the lumbar spine understanding. This balance suggests that proper night rest contributes to mechanically strengthen the spine during day activity.

SUBMITTER: Toumanidou T

PROVIDER: S-EPMC4525063 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Musculoskeletal Modeling of the Lumbar Spine to Explore Functional Interactions between Back Muscle Loads and Intervertebral Disk Multiphysics.

Toumanidou Themis T Noailly Jérôme J

Frontiers in bioengineering and biotechnology 20150805

During daily activities, complex biomechanical interactions influence the biophysical regulation of intervertebral disks (IVDs), and transfers of mechanical loads are largely controlled by the stabilizing action of spine muscles. Muscle and other internal forces cannot be easily measured directly in the lumbar spine. Hence, biomechanical models are important tools for the evaluation of the loads in those tissues involved in low-back disorders. Muscle force estimations in most musculoskeletal mod ...[more]

PMID: 26301218

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Project description:ContextFor patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care.ObjectiveTo compare the treatment effects of diskectomy and usual care.Design, setting, and patientsProspective observational cohort of surgical candidates with imaging-confirmed lumbar intervertebral disk herniation who were treated at 13 spine clinics in 11 US states and who met the SPORT eligibility criteria but declined randomization between March 2000 and March 2003.InterventionsStandard open diskectomy vs usual nonoperative care.Main outcome measuresChanges from baseline in the Medical Outcomes Study Short-Form Health Survey (SF-36) bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons/MODEMS version).ResultsOf the 743 patients enrolled in the observational cohort, 528 patients received surgery and 191 received usual nonoperative care. At 3 months, patients who chose surgery had greater improvement in the primary outcome measures of bodily pain (mean change: surgery, 40.9 vs nonoperative care, 26.0; treatment effect, 14.8; 95% confidence interval, 10.8-18.9), physical function (mean change: surgery, 40.7 vs nonoperative care, 25.3; treatment effect, 15.4; 95% CI, 11.6-19.2), and Oswestry Disability Index (mean change: surgery, -36.1 vs nonoperative care, -20.9; treatment effect, -15.2; 95% CI, -18.5. to -11.8). These differences narrowed somewhat at 2 years: bodily pain (mean change: surgery, 42.6 vs nonoperative care, 32.4; treatment effect, 10.2; 95% CI, 5.9-14.5), physical function (mean change: surgery, 43.9 vs nonoperavtive care 31.9; treatment effect, 12.0; 95% CI; 7.9-16.1), and Oswestry Disability Index (mean change: surgery -37.6 vs nonoperative care -24.2; treatment effect, -13.4; 95% CI, -17.0 to -9.7).ConclusionsPatients with persistent sciatica from lumbar disk herniation improved in both operated and usual care groups. Those who chose operative intervention reported greater improvements than patients who elected nonoperative care. However, nonrandomized comparisons of self-reported outcomes are subject to potential confounding and must be interpreted cautiously.Trial registrationclinicaltrials.gov Identifier: NCT00000410.

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Dataset Information

Musculoskeletal Modeling of the Lumbar Spine to Explore Functional Interactions between Back Muscle Loads and Intervertebral Disk Multiphysics.

Publications

Musculoskeletal Modeling of the Lumbar Spine to Explore Functional Interactions between Back Muscle Loads and Intervertebral Disk Multiphysics.

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