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Instability of the lumbar spine due to disc degeneration. A finite element simulation

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DOI: 10.4236/abb.2013.44072    5,459 Downloads   10,378 Views   Citations

ABSTRACT

Low back pain, which most common cause is degenerative disc disease, currently represents a serious problem due to its socio-economic repercussions. Different factors are involved in the degenerative process, being the most common: the loads on the spine, repeated flexion movements and individual genetic characteristics. Nowadays, there is no agreement on whether instability is the main cause of low back pain, or only one reason among many, and on whether increased spinal mobility, associated with instability, occurs either locally or at the lumbar spine as a whole. In this work, the simulation of disc degeneration is based on a finite element model of lumbar spine. A parametric study based on mechanical properties was established, for each lumbar spine movement, by evaluating the disc degeneration in 10% steps, from healthy disc to maximum degeneration. The results show as general trend a progressive mobility increase as the disc degeneration level raises. As main conclusion, disc degeneration causes increased mobility at all vertebral levels, with moderate values for incipient degeneration and much higher values for advanced degeneration, affecting more severely to the levels closest to degenerated disk. The great mobility increase detected at L5 could explain the instability detected as a clinical symptom.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Ibarz, E. , Más, Y. , Mateo, J. , Lobo-Escolar, A. , Herrera, A. and Gracia, L. (2013) Instability of the lumbar spine due to disc degeneration. A finite element simulation. Advances in Bioscience and Biotechnology, 4, 548-556. doi: 10.4236/abb.2013.44072.

References

[1] Manchikanti, L., Singh, V., Datta, S., Cohen, S.P. and Hirsch, J.A. (2009) Comprehensive review of epidemiology, scope and impact of spinal pain. Pain Physician, 12, E35-E70.
[2] Modic, M.T. and Ross, J.S. (2007) Lumbar degenerative disk disease. Radiology, 245, 43-61. doi:10.1148/radiol.2451051706
[3] Griffith, L.E., Wells, R.P. and Shannon, H.S. (2008) Developing common metrics of mechanical exposures across aetiological studies of low back pain in working populations for use in meta-analysis. Occupational and Environmental Medicine, 65, 467-481. doi:10.1136/oem.2007.034801
[4] Latridis, J.C., McLean, J.J., Roughley, P.J. and Alini, M. (2006) Effects of mechanical loading on intervertebral disc metabolism in vivo. Journal of Bone Joint Surgery American, 88, 41-46. doi:10.2106/JBJS.E.01407
[5] Wong, K.C.H., Lee, R.Y.W. and Yeung, S.S. (2009) The association between back pain and trunk posture of workers in a special school for the severe handicaps. BMC Musculoskeletal Disorders, 29, 10-43. doi:10.1186/1471-2474-10-43
[6] Battié, M.C., Videman, T. and Parent, E. (2004) Lumbar disc degeneration: Epidemiology and genetic influences. Spine, 29, 2679-2690. doi:10.1097/01.brs.0000146457.83240.eb
[7] Battié, M.C. and Videman, T. (2006) Lumbar Disc Degeneration: Epidemiology and Genetics. Journal of Bone Joint Surgery American, 88, 3-9. doi:10.2106/JBJS.E.01313
[8] Borenstein, D.G., O’Mara Jr., J.W., Boden, S.D., Lauerman, W.C., Jacobson, A., Platenberg, C., Schellinger, D. and Wiesel, S.W. (2001) The value of magnetic resonance imaging of the lumbar spine to predict low back pain in asymptomatic subjects: A 7-year follow-up study. Journal of Bone Joint Surgery American, 83-A, 13061311.
[9] Deyo, R.A. (1993) Practice variations, treatment fads, rising disability: Do we need a new clinical research paradigm? Spine, 18, 2153-2162. doi:10.1097/00007632-199311000-00002
[10] Kirkaldy-Willis, W.H., Wedge, J.H., Yong-Hing, K., Tchang, S., de Korompay, V. and Shannon, R. (1982) Instability of the lumbar spine. Clinical Orthopaedics and Related Research, 165, 110-123.
[11] Yong-Hing, K. and Kirkaldy-Willis, W.H. (1983) The pathophysiology of degenerative disease of the lumbar spine. Orthopedic Clinics of North America, 14, 491-504.
[12] Leone, A., Guglielmi, G., Cassar-Pullicino, V.N. and Bonomo, L. (2007) Lumbar intervertebral instability. A Review. Radiology, 245, 62-77. doi:10.1148/radiol.2451051359
[13] Fujiwara, A., Lim, T.H., An, H.S., Tanaka, N., Jeon, C.H., Andersson, G.B.J. and Haughton, V.M. (2000) The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine, 25, 3036-3044. doi:10.1097/00007632-200012010-00011
[14] Tanaka, N., An, H.S., Lim, T.H., Fujiwara, A., Jeon, C.H. and Haughton, V.M. (2001) The relationship between disc degeneration and flexibility of the lumbar spine. Spine, 1, 47-56. doi:10.1016/S1529-9430(01)00006-7
[15] Krismer, M., Haid, C., Behensky, H., Kapfinger, P., Landauer, F. and Rachbauer, F. (2000) Motion in lumbar functional spine units during side bending and axial rotation moments depending on the degree of degeneration. Spine, 25, 2020-2027. doi:10.1097/00007632-200008150-00004
[16] Iguchi, T., Ozaki, T., Chin, T., Tsumura, N., Kanemura, A., Kasahara, K., Kuroda, R., Doita, M. and Nishida, K. (2011) Intimate relationship between instability and degenerative signs at L4-L5 segment examined by flexionextension radiography. European Spine Journal, 20, 13491354. doi:10.1007/s00586-011-1793-7
[17] Mimura, M., Panjabi, M.M., Oxland, T.R., Crisco, J.J., Yamamoto, I. and Vasavada, A. (1994) Disc degeneration affects the multi-directional flexibility of the lumbar spine. Spine, 19, 1371-1380. doi:10.1097/00007632-199406000-00011
[18] Kettler, A., Rohlmann, F., Ring, C., Mack, C. and Wilke, H.J. (2011) Do early stages of lumbar intervertebral disc degeneration really cause instability? Evaluation of an in vitro database. European Spine Journal, 20, 578-584. doi:10.1007/s00586-010-1635-z
[19] Kulig, K., Powers, C.M., Landel, R.F., Chen, H., Fredericson, M., Guillet, M. and Butts, K. (2007) Segmental lumbar mobility in individuals with low back pain: In vivo assessment during manual and self-imposed motion using dynamic MRI. BMC Musculoskeletal Disorders, 8, 8. doi:10.1186/1471-2474-8-8
[20] Natarajan, R.N., Williams, J.R. and Andersson, G.B.J. (2004) Recent advances in analytical modeling of lumbar disc degeneration. Spine, 29, 2733-2741. doi:10.1097/01.brs.0000146471.59052.e6
[21] Iatridis, J.C. and Gwynn, I. (2004) Mechanisms for mechanical damage in the intervertebral disc annulus fibrosus. Journal of Biomechanics, 37, 1165-1175. doi:10.1016/j.jbiomech.2003.12.026
[22] Natarajan, R.N., Williams, J.R. and Andersson, G.B.J. (2006) Modeling changes in intervertebral disc mechanics with degeneration. Journal of Bone and Joint Surgery, 88, 36-40. doi:10.2106/JBJS.F.00002
[23] An, H.S. and Masuda, K. (2006) Relevance of in vitro and in vivo models for intervertebral disc degeneration. Journal of Bone and Joint Surgery, 88, 88-94. doi:10.2106/JBJS.E.01272
[24] Rohlmann, A., Zander, T., Schmidt, H., Wilke, H.J. and Bergmann, G. (2006) Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method. Journal of Biomechanics, 39, 2484-2490. doi:10.1016/j.jbiomech.2005.07.026
[25] Schmidt, H., Kettler, A., Rohlmann, A., Claes, L. and Wilke, H.J. (2007) The risk of disc prolapses with complex loading in different degrees of disc degeneration. A finite element analysis. Clinical Biomechanics, 22, 988998. doi:10.1016/j.clinbiomech.2007.07.008
[26] Little, J.P., Adam, C.J., Evans, J.H., Pettet, G.J. and Pearcy, M.J. (2007) Non-linear finite element analysis of annular lesions in the L4-L5 intervertebral disc. Journal of Biomechanics, 40, 2744-2751. doi:10.1016/j.jbiomech.2007.01.007
[27] Ruberté, L.M., Natarajan, R.N. and Andersson, G.B.J. (2009) Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments. A finite element model study. Journal of Biomechanics, 42, 341348. doi:10.1016/j.jbiomech.2008.11.024
[28] Kapandji, I.A. (2008) The Physiology of the Joints. 2nd Edition, Churchill Livingstone Inc., New York.
[29] White, A.A. and Panjabi, M.M. (1990) Clinical Biomechanics of the Spine.
[30] Abaqus Program (2012) Dassault Systèmes. http://www.3ds.com/
[31] Burton, A.K., Battié, M.C., Gibbons, L., Videman, T. and Tillotson, K.M. (1996) Lumbar disc degeneration and sagittal flexibility. Journal of Spinal Disorders, 9, 418-424. doi:10.1097/00002517-199610000-00010
[32] Axelsson, P. and Karlsson, B.S. (2004) Intervertebral mobility in the progressive degenerative process. A radiostereometric analysis. European Spine Journal, 13, 567572. doi:10.1007/s00586-004-0713-5
[33] Kong, M.H., Morishita, Y., He, W., Miyazaki, M., Zhang, H., Wu, G., Hymanson, H.J. and Wang, J.C. (2009) Lumbar segmental mobility according to the grade of the disc, the facet joint, the muscle, and the ligament pathology by using kinetic magnetic resonance imaging. Spine (Phila Pa 1976), 34, 2537-2544. doi:10.1097/BRS.0b013e3181b353ea
[34] Li, W., Wang, S., Xia, Q., Passias, P., Kozanek, M., Wood, K. and Li, G. (2011) Lumbar facet joint motion in patients with degenerative disc disease at affected and adjacent levels: An in vivo biomechanical study. Spine (Phila Pa 1976), 36, E629-E637. doi:10.1097/BRS.0b013e3181faaef7
[35] Inoue, N. and Espinoza Orías, A.A. (2011) Biomechanics of intervertebral disk degeneration. Orthopedic Clinics of North America, 42, 487-499. doi:10.1016/j.ocl.2011.07.001
[36] Taher, F., Essig, D., Lebl, D.R., Hughes, A.P., Sama, A.A., Cammisa, F.P. and Girardi, F.P. (2012). Lumbar degenerative disc disease: Current and future concepts of diagnosis and management. Advances in Orthopedics, 970752. doi:10.1155/2012/970752
[37] Iguchi, T., Nishida, K., Ozaki, T., Kitagawa, A., Tsumura, N., Kakutani, K., Yurube, T. and Kuroda, R. (2012) Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine. European Spine Journal, 21, 2134-2139. doi:10.1007/s00586-012-2288-x

  
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