The Clinical Problem

Low Back Pain

• Low Back Pain (LBP) is referred to

as pain, muscle tension or stiffness

• 50-80% of population have LBP at

some point of their life.

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 Spine and functions
• To guarantee the load transfer along the spinal column
without instability

• To allow sufficient physiologic mobility and flexibility

• To protect the spinal cord from damaging forces

and motions.

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Lumbar Spine: Anatomy

Functional spinal unit (FSU)

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 Literature Review
Vertebral structure Geometrical modelling of
vertebrae

Cortical
layer
Cancellous
bone

Reference : Kang, K.T., Koh, Y.G., Son, J., Yeom, J., Park, J.H., Kim, H.J. (2017). Biomechanical evaluation of pedicle screw fixation system in spinal
adjacent levels using PEEK, carbon-fibre-reinforced PEEK, and traditional titanium as rod materials, Composites Part B 130 (2017), 248-256. 4
 Literature Review
Material modelling

Components Material Elastic modulus Poisson’s ratio Modulus of References

model [MPa] [ν] Rigidity
[MPa]
10000 0.3 Shiraz et al. 1996,
linear elastic, Rohlmann et al. 2006
isotropic 12000 0.3 Goel et al. 2002, Zhang
Vertebral Cortical et al. 2009,2017
bone Ex = 11300 νx = 0.484 Gx = 3800
Transversely Ey = 11300 νy = 0.203 Gy = 5400 Lu et al. 1996, Kang et
isotropic Ez = 22000 νy = 0.203 Gz = 5400 al. 2017

10 0.2 Shiraz et al. 1984,

Water
linear elastic, Chen et al. 2008
isotropic 100 0.29 Zhang et al.2009
Vertebral Cancellous
bone Ex = 140 νx = 0.45 Gx = 48.3 Lu et al. 1996, Kang et
Transversely Ey = 140 νy = 0.315 Gy = 48.3 al. 2017, Rohlmann et
isotropic Ez = 200 νy = 0.315 Gz = 48.3 al. 2006
ρ = c + d × HU ρ = Apparent density (Rho et
al. 1995) c,d = calibration co-efficients
E = Young’s modulus
Posterior bone Linear elastic, 3500 0.25 Shiraz et al. 1986,
E = 4730 ρ1.56 isotropic Fantigrossi et al. 2006
( Morgan et al. 2003) 5
 Intervertebral disc (IVD) Literature Review

Geometrical modelling of
IVD

Reference : Kang, K.T et al., (2017). Biomechanical evaluation of pedicle screw fixation system in spinal adjacent levels Composites Part B 130 6
(2017), 248-256
 Literature Review
Material modelling
Components Material Elastic modulus Poisson’s ratio References
model [MPa]
linear elastic, isotropic. 1 0.49 Shiraz et al. 1984, Goel et al. 1995

Mooney-Rivlin
Nucleus pulposus incompressible -
- - Schmidt et al. 2007, Rohlmann, Zander et
al. 2006

Linear elastic,isotropic 4.2 0.45 Shiraz et al. 1984, Zhong et al. 2006

Annulus fibrous Hyperelastic - Rohlmann, Zander et al. 2006,

(Ground substance) Neo-Hookean - Kiapour et al. 2012

Mooney-Rivlin - Park et al. 2013, Guo et al. 2017

hyperelastic -

500 - Goel et al.1995, Zhang et al. 2009

Tension only elastic 450 0.3 Shiraz et al. 1984, 1986
Annulus fibrosus fibers 360/385/420/440/495/5 0.3 Chen et al. 2008, Guo et al. 2017
(fibers) 50

Bony endplate Linear elastic, 12000 0.3 Kang et al. 2017, Guo et al. 2017
Cartilaginious endplate isotropic 23.8 0.4
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 Literature Review
Ligaments & Facet joints

Material Elastic Poisson’s CS area Reference

Compone model modulus ratio [mm2] s
nts [MPa] [ν]

Ligaments
ALL 20 63.7 Goel at al.
PLL Tension 20 20 1995,
LF only truss 19.5 - 40 Zhong et
ITL elements 58.7 3.6 al. 2006
CL 32.9 60
ISL 11.6 40
SSL 15 30

Rohlmann
Facet joint Isotropic, 35 0.4 et al. 2012
Cartilage linear and
elastic
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Disc Degenerative Diseases (DDD)

• Degeneration means a specific injurious change

in the composition, structure and function of the
spine

• Leads to disc dehydration, reduction in disc

height, disruption of the concentric lamellae of
the annulus and appearance of cracks and fissures

Image Source: http://spineuniverse.com

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 Solutions for DDD

Fusion Non-fusion

• To provide a mode of
immediate and rigid
immobilization
• preserve
• to correct spinal functional
movement
deformity

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 Solutions for DDD

Fusion Non-fusion

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 References
• Arabnejad, S., Johnston, B., Tanzer, M., Pasini, D. (2017). Fully porous 3D printed titanium femoral stem to reduce stress-shielding
following total hip arthroplasty, Journal of Orthopedics Research, 35 (8), pp 1774−1783.
• Baroud, G., Nemes, J., Heini, P., Steffen, T. (2003). Load shift of the intervertebral disc after a vertebroplasty: a finite element study,
European Spine Journal, 12(4), 421-426.
• Chen, C.S., Cheng, C.K., Liu, C.L., Lo, W.H. (2001). Stress analysis of the disc adjacent to interbody fusion in lumbar spine, Medical
Engineering and Physics, 23(7), 483-491.
• Dalby, M. J., Gadegaard, N., Tare, R., Andar, A., Riehle, M. O., Herzyk, P., Wilkinson, C. D., Oreffo, R. O. (2007). The control of human
mesenchymal cell differentiation using nanoscale symmetry and disorder, Nat. Mater, 6 (12), 997−1003.
• Fantigrossi, A., Galbusera, F., Raimondi, MT., Sassi, M., Fornari, M. (2007). Biomechanical analysis of cages for posterior lumbar
interbody fusion, Med Eng Phys. 29(1):101–9.
• Goel, V.K., Monroe, B.T., Gilbertson, L.G., Brinckmann, P. (1995). Interlaminar shear stresses and laminae separation in the disc. Finite
element analysis of the L3-L4 motion segment subjected to axial compressive loads, Spine, 20(6), pp 689-698.
• Guo, L.X., Fan, W. (2017). The Effect of Single-Level Disc Degeneration on Dynamic Response of the Whole Lumbar Spine to Vertical
Vibration, World neurosurgery, 105, 540-518.
• Huiskes, R., Weinans, H.G., Grootenboer, HJ., Dalstra, M., Fudala, B, Slooff, TJ.(1987). Adaptive bone-remodelling theory applied to
prosthetic-design analysis, J. Biomech, 20(11-12), 1135–1150.
• Kang, K.T., Koh, Y.G., Son, J., Yeom, J., Park, J.H., Kim, H.J. (2017). Biomechanical evaluation of pedicle screw fixation system in spinal
adjacent levels using polyetheretherketone, carbon-fibre-reinforced polyetheretherketone, and traditional titanium as rod materials,
Composites Part B 130 (2017), 248-256.
• Kapat, K., Srivas, P. K., Dhara, S. (2017). Coagulant assisted foaming−A method for cellular Ti6Al4V: Influence of microstructure on
mechanical properties, Mater. Sci. Eng., A, 689, 63−71.
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 References
• Noailly, J., Wilke, H.J., Planell, J.A., Lacroix, D. (2007). How does the geometry affect the internal biomechanics of a lumbar spine bi-
segment finite element model? Consequences on the validation process, Journal of Biomechanics, 40(11), 2780-2788.
• Panjabi, M.M., Greenstein, G., Duranceau, J., Nolte, L.P. (1991). Three-dimensional quantitative morphology of lumbar spinal ligaments,
J Spinal Disord 4, 54-62.
• Rohlmann, A., Burra, N.K., Zander, T., Bergmann, G. (2007). Comparison of the effect of bilateral posterior dynamic and rigid fixation
devices on the loads in the lumbar spine: a finite element analysis, European Spine Journal. 16(8), 1223-1231.
• Schmidt, H., Heuer, F., Drumm, J., Klezl, Z., Claes, L., Wilke, H-J. (2007). Application of a calibration method provides more realistic
results for a finite element model of a lumbar spinal segment, ClinBiomech, 22,377–84.
• Shirazi-Adl, A., Ahmed, A.M., Shrivastava, S.C. (1986). A finite element study of a lumbar motion segment subjected to pure sagittal
plane moments, Journal of Biomechanics, 19(4), 331-350.
• Yamamoto I, Panjabi MM, Crisco T, Oxland T. (1989). Three-dimensional movement of the whole lumbar spine and lumbosacral joint.
Spine, 14, 1256–60.
• Zhang, Q.H., Teo, Ee Chon, (2008). Finite element application in implant research for treatment of lumbar degenerative disc
disease.Med.Eng.Phys.30, 1246–1256.
• Zhong, Z.C., Wei, S.H., Wang, J.P., Feng, C.K., Chen, C.S., Yu, C.H. (2006). Finite element analysis of the lumbar spine with a new cage
using a topology optimization method, Medical Engineering and Physics, 28(1), 90-98.

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Thank you for listening

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Material Elastic Modulus Poisson’s Cross-sectional References
(MPa) ratio area (mm2)
Cortical bone 12000 0.3 -  
 
Cancellous bone 100 0.3 -  
Posterior element 3500 0.3 - Shirazi-Adl et al. 1986,
Zhong et al. 2006
Bony endplates 12000 0.3 - Chen et al. 2001
Cartilaginous end- 23.8 0.4 - Goel et al. 1988
plates  
       
 
Nucleus pulposus 1 0.45 -  
Ground substance 9 0.4 -  
Ligaments        
 
Anterior longitudinal 20 0.4 63.7  
Posterior longitudinal 20 0.4 20  
19.5 0.4 40  
Ligamentum flavum  
Inter transverse 58.7 0.4 3.6 Goel et al. 1995,
Capsular 32.9 0.4 60 Zhong et al. 2006,
Guo et al. 2017
Inter spinous 11.6 0.4 40  
Supra spinous 15 0.4 30  
 

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Cancellous bone Cortical bone

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Master node and slave nodes

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