THE EFFECTS OF INTRA-ABDOMINAL PRESSURE ON THE STABILITY AND UNLOADING OF THE SPINE

Abstract

In spite of earlier experimental and modeling studies, the relative role of the intra-abdominal pressure (IAP) in spine mechanics has remained controversial. This study employs simple analytical and finite element (FE) models of the spine and its surrounding structures to investigate the contribution of IAP to spinal loading and stability. The analytical model includes the abdominal cavity surrounded by muscles, lumbar spine, rib cage and pelvic ring. The intra-abdominal cavity and its surrounding muscles are represented by a thin deformable cylindrical membrane. Muscle activation levels are simulated by changing the Young's modulus of the membrane in the direction of muscle fibers, yielding IAP values recorded under the partial Valsalva maneuver. In the FE model, the abdominal cavity is cylindrical and filled with a nearly incompressible fluid. The surrounding muscles are modeled as membrane elements with transverse isotropic material properties simulating their fiber orientation. Results indicate a good qualitative agreement between the analytical and FE models. Larger external force and/or higher levels of muscle activation generate higher IAP thereby increasing spinal stiffness. These effects are more pronounced for activation of muscles with more horizontally directed fibers, e.g., transverse abdominis (TA). The capacity of the abdominal muscles to indirectly unload and stabilize the spine by generating IAP depends mostly on their fiber orientation, and secondarily on their cross-section area.