Moderately degenerated lumbar motion segments: Are they truly unstable?
The two main load bearing tissues of the intervertebral disc are the nucleus pulposus and the annulus fibrosus. Both tissues are composed of the same basic components, but differ in their organization and relative amounts. With degeneration, the clear distinction between the two tissues disappears. The changes in biochemical content lead to changes in mechanical behaviour of the intervertebral disc. The aim of the current study was to investigate if well-documented moderate degeneration at the biochemical and fibre structure level leads to instability of the lumbar spine. By taking into account biochemical and ultrastructural changes to the extracellular matrix of degenerating discs, a set of constitutive material parameters were determined that described the individual tissue behaviour. These tissue biomechanical models were then used to simulate dynamic behaviour of the degenerated spinal motion segment, which showed instability in axial rotation, while a stabilizing effect in the other two principle bending directions. When a shear load was applied to the degenerated spinal motion segment, no sign of instability was found. This study found that reported changes to the nucleus pulposus and annulus fibrosus matrix during moderate degeneration lead to a more stable spinal motion segment and that such biomechanical considerations should be incorporated into the general pathophysiological understanding of disc degeneration and how its progress could affect low back pain and its treatments thereof.
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
M M
MM
van Rijsbergen
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
V M P
VM
Barthelemy
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
A C T
AC
Vrancken
Imaging Division, Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
S P M
SP
Crijns
Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research Ulm (ZMFU), University Hospital Ulm, Ulm, Germany.
H-J
HJ
Wilke
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
W
W
Wilson
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
B
B
van Rietbergen
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands. k.ito@tue.nl.
K
K
Ito
D001696:Biomechanical Phenomena; D003198:Computer Simulation; D005109:Extracellular Matrix / Q000737:chemistry; D006801:Humans; D007403:Intervertebral Disc / Q000737:chemistry / Q000502:physiology*; D055959:Intervertebral Disc Degeneration / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000502:physiology*; D008954:Models, Biological
Biochemical composition; Degeneration; Finite element analysis; Intervertebral disc; Spinal motion segment
J Orthop Res. 2016 Aug;34(8):1389-98
26990567
Spine (Phila Pa 1976). 2009 Nov 1;34(23):2537-44
19841613
Comput Methods Biomech Biomed Engin. 2011 Aug;14(8):729-39
21390934
Spine (Phila Pa 1976). 1996 Nov 15;21(22):2558-69
8961443
Osteoarthritis Cartilage. 2006 Jun;14(6):554-60
16476555
Eur Spine J. 1994;3(2):91-7
7874556
Spine (Phila Pa 1976). 1994 Jan 15;19(2):212-21
8153833
Spine (Phila Pa 1976). 2005 Jan 15;30(2):167-73
15644751
Clin Biomech (Bristol, Avon). 1991 May;6(2):88-96
23915481
Eur Spine J. 1998;7(2):148-54
9629939
Spine (Phila Pa 1976). 1998 Dec 1;23 (23 ):2545-51
9854753
Biomech Model Mechanobiol. 2012 Mar;11(3-4):493-503
21748426
Biochim Biophys Acta. 1981 Apr 3;673(4):443-53
7225426
Spine (Phila Pa 1976). 2007 Nov 15;32(24):E708-12
18007231
J Biomech. 2006;39(8):1410-8
15950233
Spine J. 2001 Jan-Feb;1(1):47-56
14588368
Biomech Model Mechanobiol. 2011 Apr;10(2):203-19
20532944
Global Spine J. 2016 Aug;6(5):439-46
27433427
Spine (Phila Pa 1976). 2005 Dec 15;30(24):E724-9
16371889
Arch Orthop Trauma Surg. 1994;113(6):297-301
7833204
Spine (Phila Pa 1976). 1999 Dec 1;24(23):2449-55
10626306
Eur Spine J. 2011 Apr;20(4):578-84
21125299
J Spinal Disord. 2000 Oct;13(5):444-50
11052356
J Orthop Res. 2015 Apr;33(4):450-7
25418948
Spine (Phila Pa 1976). 1994 Jun 15;19(12 ):1371-80
8066518
J Orthop Res. 1997 Nov;15(6):814-9
9497805
J Clin Invest. 1996 Aug 15;98(4):996-1003
8770872
J Bone Joint Surg Am. 1995 Jan;77(1):32-8
7822353
Eur Spine J. 2006 Jun;15(6):705-18
16172902
Magn Reson Imaging. 2004 Sep;22(7):963-72
15288137
Clin Orthop Relat Res. 1982 May;(165):110-23
6210480
J Mech Behav Biomed Mater. 2016 Feb;54:194-204
26469631
Biomech Model Mechanobiol. 2005 Mar;3(3):125-40
15778871
Spine (Phila Pa 1976). 2000 Aug 15;25(16):2020-7
10954631
Spine (Phila Pa 1976). 2001 Sep 1;26(17):1873-8
11568697
Biorheology. 1985;22(2):145-57
3986322
Clin Biomech (Bristol, Avon). 2006 May;21(4):337-44
16439042
Comput Methods Biomech Biomed Engin. 2013;16(9):923-8
22224724
J Biomech. 1998 Jun;31(6):535-44
9755038
Front Bioeng Biotechnol. 2015 Feb 11;3:5
25717471
Spine (Phila Pa 1976). 1985 Apr;10(3):255-6
3992345
Biochem J. 1997 Aug 15;326 ( Pt 1):235-41
9337874
J Biomech. 2000 May;33(5):575-80
10708778
Biomech Model Mechanobiol. 2007 Jan;6(1-2):43-53
16710737
Spine (Phila Pa 1976). 1996 Feb 15;21(4):415-20
8658243
Biomech Model Mechanobiol. 2010 Oct;9(5):641-50
20229171
J Biomech. 2004 Mar;37(3):357-66
14757455
Eur Spine J. 2006 Jun;15(6):720-30
16328226
J Biomech. 2006;39(13):2484-90
16198356
Eur Spine J. 2011 Apr;20(4):563-71
20936308