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a b
To cite this article: Fabio Galbusera , Hendrik Schmidt , Cornelia Neidlinger-Wilke & Hans-Joachim Wilke (2011) The
effect of degenerative morphological changes of the intervertebral disc on the lumbar spine biomechanics: a poroelastic
finite element investigation, Computer Methods in Biomechanics and Biomedical Engineering, 14:8, 729-739, DOI:
10.1080/10255842.2010.493522
To link to this article: http://dx.doi.org/10.1080/10255842.2010.493522
The effect of degenerative morphological changes of the intervertebral disc on the lumbar spine
biomechanics: a poroelastic finite element investigation
Fabio Galbuseraa,b*1, Hendrik Schmidta2, Cornelia Neidlinger-Wilkea3 and Hans-Joachim Wilkea4
a
Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, D-89081 Ulm, Germany;
b
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Introduction
Degenerative disc disease is one of the most common
causes of low back pain (Adams and Dolan 2005; Horvath
et al. in press) and has a complex multifactorial aetiology
(Hadjipavlou et al. 2008). Despite the influence of genetics
on disc degeneration has been clearly established (Battie
et al. 2008, 2009), the role of mechanical factors in the
pathogenesis and progression of the disease is still under
heated debate. It was suggested that abnormal loads
(Adams and Dolan 2005; Setton and Chen 2006;
Nakamura et al. 2009) and motion patterns may accelerate
disc degeneration (Mulholland 2008), due to mechanical
damage accumulation (Adams et al. 2000) and possibly to
impairment of nutrient diffusion (Arun et al. 2009).
The degenerative process can be associated with
different morphological changes of the intervertebral disc
and of the adjacent structures, which can be present
separately or in combination (Haefeli et al. 2006; Wilke
et al. 2006). Such changes include disc height loss,
reduced water content, tissue fibrotisation, proteoglycan
loss, sclerosis of the vertebral endplates, formation of
fissures or osteophytes and others (Vernon-Roberts and
Pirie 1977). These morphological changes have most
likely an influence on the progression of the degenerative
disease, but the significance of each individual morphological change was never clearly established. Some studies
addressed the biomechanics of the degenerated lumbar
spine, in vivo (Vaga et al. 2009; Wuertz et al. 2009), in vitro
(Fujiwara et al. 2000a, 2000b; Colloca et al. 2007) or using
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F. Galbusera et al.
Figure 1. (a) FE model of the L4 L5 human spine segment. (b) Area near to the endplate which was affected by the change of the elastic
modulus and of the permeability in the parameter study representing endplate sclerosis.
e1 e0 2 M1e=1e0 21
e
;
e0 1 e
ff
;
1 2 ff
ff 1 2 J 21 1 2 ff0 ;
Material
Annulus ground
substance
Nucleus
Cartilage
Cancellous bone
Cortical bone
Posterior elements
k0 (m4/Ns)
(Equation (1))
e0
(Equation (1))
M
(Equation (1))
Nonlinear
7.5 10216
2.33
8.5
Nonlinear
5.0
0.1
100.0
0.2
10,000.0
0.3
3500.0
0.25
7.5 10216
7.5 10215
2.0 1027
5.0 10212
4.00
4.00
0.05
0.05
8.5
8.5
E
(MPa)
Ref. permeability
(k0, e0, M)
Ferguson et al. (2004)
(1996)
(1996)
(1996)
(1996)
Ferguson
Ferguson
Ferguson
Ferguson
et
et
et
et
al.
al.
al.
al.
(2004)
(2004)
(2004)
(2004)
731
Figure 2. Time history of (a) the compressive force and (b) the flexion extension moment applied. After a preliminary period in which
the structure is allowed to reach the equilibrium state with the external pressure of 0.25 MPa, a compressive force representing a daily
cycle was applied (500 N for 16 h, 200 N for 8 h, 500 N again for 16 h). Flexion extension cycles (moments of 7.5 Nm) were simulated
10 s, 1 h and 15 h after the application of the compressive load during the second day.
200
200
Unaltered
Unaltered
13
13
Disc permeability
External pressure
no wc indicates the cases in which the disc height was reduced and the water content was kept constant.
13
Water content
Unaltered
Unaltered
13
Results
0.25
50 100% of values
in Table 1
See Table 1
See Table 1
Nucleus: 71 80%; annulus:
50 70%
Nucleus: 80%; annulus: 70%
Nucleus: 80%; annulus: 70%
3 13
Disc height
(no wca)
Endplate sclerosis
Unaltered
0.25
0.01 0.25
200
200
0.25
Nucleus: 80%; annulus: 70%
See Table 1
200
Unaltered
0.25
See Table 1
Unaltered
0.25
See Table 1
Buckling due to
height reduction
Buckling due to
height reduction
Unaltered
Endplates
External
pressure (MPa)
Disc permeability
Disc water content
Annulus fibres
Disc
height (mm)
Parameter
200
F. Galbusera et al.
Night
load (N)
732
733
Figure 3. Axial displacement representing disc height change (a), facet force (b), and intradiscal pore pressure in the nucleus pulposus
(c) calculated with the reference model. The time points for which the results were considered in the data analysis are indicated.
Potential effect of the parameters (first column) on the calculated results (first line).
Disc height
Endplate sclerosis
Water content
Disc permeability
External pressure
Axial displacement
Facet force
Intradiscal pressure
Fluid loss
RoM
/
/
2a
/
2a
/
/
2
2
/
/
/
/
/
Notes: , an increase of the parameter value leads to an increase of the result; 2 , an increase of the parameter value leads to a decrease of the result; /, changing the
parameter value has no remarkable effect on the result.
a
Only for the pressure recording at the end of the day, no marked effect on the peak pressure or the pressure at the end of the night.
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F. Galbusera et al.
Figure 4. Effects of changing the initial disc height (see Table 2) on the axial displacement and the facet force (a), the intradiscal pore
pressures (b), the axial effective stress and the total relative fluid loss (c), the ratios between the RoMs in flexion and extension in the
evening for the different disc height conditions and the RoMs obtained with the reference model (disc height 13 mm) (d), and the ratios
between the RoMs calculated with each specific model in the evening (15 h after application of the 500-N load) and in the morning (10 s
after load application) (d). no wc indicates the cases in which the disc height was reduced and the water content was kept constant.
current indicates the RoMs predicted with the model having the specific disc height relevant to the x-axis of the plot (d).
Discussion
The present work addressed the study of the biomechanical significance of the individual morphological changes
that are associated with degenerative disc disease, which
can be highly different from patient to patient (Haefeli
et al. 2006). Different degeneration parameters may have
opposite effects, thus requiring different therapeutic
options or inducing a different progression of the
degenerative disease. Their study is therefore critical,
although clinical scenarios in which a single degenerative
change is observable may not be common. The topic
addressed here by means of models was able to take into
735
Figure 5. Influence of the endplate sclerosis on the axial displacement and the facet force (a), the intradiscal pressures (b), the axial
effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different sclerotic conditions and the RoMs
obtained with the reference model (no endplate sclerosis) (d), and the ratios between the RoMs in the evening (15 h after application of the
500 N load) and in the morning (10 s after load application) (d). The x-axes of the plots refer to an arbitrary degeneration scale: 0
corresponds to healthy endplates, 6 to endplates totally consisting of cortical bone, the 1 5 values correspond to a linear interpolation
between the two extreme values. current indicates the RoMs predicted with the model having the specific endplate degeneration relevant
to the x-axis of the plot (d).
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F. Galbusera et al.
Figure 6. Influence of the disc initial water content on the axial displacement and the facet force (a), the intradiscal pressures (b), the
axial effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different water loss conditions and the RoMs
obtained with the reference model (no water loss) (d), and the ratios between the RoMs in the evening (15 h after application of the 500 N
load) and in the morning (10 s after load application) (d). current indicates the RoMs predicted with the model having the specific water
content relevant to the x-axis of the plot (d).
737
Figure 7. Influence of the external boundary pressure on the axial displacement and the facet force (a), the intradiscal pressures (b), the
axial effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different external pressure values and the
RoMs obtained with the reference model (pressure of 0.25 MPa) (d), and the ratios between the RoMs in the evening (15 h after
application of the 500 N load) and in the morning (10 s after load application) (d). current indicates the RoMs predicted with the model
having the specific external boundary pressure relevant to the x-axis of the plot (d).
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F. Galbusera et al.
Acknowledgement
This project is funded by the EU project GENODISC (HEALTHF2-2008-201626).
Notes
1.
2.
3.
4.
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