LATERAL BENDING AND FLEXION PLACE INTERVERTEBRAL DISC TISSUE AT GREATEST RISK OF INJURY

Abstract

During certain motions, the disc is at risk of annular injury. Axial compression coupled with various combinations of excessive flexion, lateral bending or axial rotation has been shown to lead to disc injury. However, similar injuries have also been caused by repetitive activity at lower, more physiological ranges of motion. The primary objectives of this study were to determine the regions of largest shear strain experienced by disc tissues in six degrees of freedom (DOF), since shear is considered a likely tissue failure criterion, and to identify the physiological motions that may place the disc at greatest risk of injury. A grid of wires was inserted into the mid-transverse plane of nine human lumbar discs that were subjected to each of six principal displacements and rotations. Stereo-radiographs were taken in each position and digitised for reconstruction of the 3D position of each grid intersection. Maximum shear strains (MSS) were calculated from relative grid-intersection displacements and normalised by the input displacement or rotation. Physiological MSS were calculated using the maximum reported physiological lumbar segmental motion for each DOF. The largest MSS were found in the posterior, posterolateral and lateral regions of the disc. For the translation motions, lateral shear and compression produced the largest MSS (approx. 9%/mm). For the rotation motions, lateral bending had significantly larger MSS than all other tests (5.8±1.6 %/°, P The physiological MSS was greatest for lateral bending, being significantly larger than all other motions (57.8±16.2%, P This study has identified lateral bending and flexion as the lumbar segmental motions that may place the disc at greatest risk of injury. The exact failure criterion for intervertebral disc tissue is not known, and MSS was used because it is related to maximum and minimum principal strains, and it was shown that disc tears may be initiated by large interlamellar shear strains that dominate over radial and circumferential annular fibre strains. These results provide improved understanding of disc behaviours under loading and may also be of value validating finite element models.