Facet Joint Contact Forces Research Articles

A NONLINEAR, DYNAMIC, MULTI-BODY MODEL OF THE LUMBAR SPINE

This paper addresses the current development of a rigid-body model of the lumbar spine and those parameters affecting its calibration process in the passive state. Many rigidbody models have been developed and integrated with active muscles to obtain load and moment profiles of lumbar spine, however, the effects of the passive elements were not individually validated. The present model includes a 6-DOF non-linear constraint representation of the intervertebral disc, individual ligaments and non-linear facet contacts. The model is evaluated by applying typical flexibility inputs similar to in vitro testing protocols in all planes (i.e. flexion/extension, lateral bending and axial rotation). The values of facet forces as well as range of motion are measured. The main range of motion showed satisfactory results, contrary to the facet forces and coupled motions. The facet forces in extension were at least two times larger than those measured in in vitro studies. It is concluded that such a model lacks the flexibility of the pedicle bone and therefore improvements of this aspect are required to more closely approximate facet joint contact forces.

Lower cervical spine facet cartilage thickness mapping

Finite element (FE) models of the cervical spine have been used with increasing geometric fidelity to predict load transfer and range of motion (ROM) for normal, injured, and treated spines. However, FE modelers frequently treat the facet cartilage as a simple slab of constant thickness, impeding the accuracy of FE analyzes of spine kinematics and kinetics. Accurate prediction of facet joint contact forces and stresses, ROM, load transfer, and the effects of facet arthrosis require accurate representation of the geometry of the articular cartilage of the posterior facets. Previous research has described the orientations of the facet surfaces, their size and aspect ratio, and mean and maximum thickness. However, the perimeter shape of the cartilaginous region and the three-dimensional distribution of cartilage thickness remain ill-defined. As such, it was the intent of this research to further quantify these parameters. Vertebrae from seven fresh-frozen unembalmed human cadavers were serially sectioned and the osteochondral interface and the articulating surface of each facet on each slice were identified. The cartilage thickness was recorded at nine equidistant points along the length of each facet. It was observed that facets tended to have elliptic or ovoid shapes, and best-fit ovoid perimeter shapes were calculated for each facet. The thickness distribution data were used to represent the entire three-dimensional cartilage distribution as a function of one variable, and a thickness distribution function was optimized to fit the thickness distribution. The antero-posterior and medial/lateral shifts of the thickness center relative to the geometric were calculated and reported. High correlation was observed between the ovoid perimeter shapes and the measured facet shapes in radial coordinates, indicating that the ovoid approximation is able to accurately represent the range of facet geometries observed. High correlation between the measured and fitted thickness distributions indicates that the fitting function used is able to accurately represent the range of cartilage thickness distributions observed. Utilization of a more physiologic cartilage thickness distribution in FE models will result in improved representation of cervical spine kinematics and increased predictive power. The consistency observed in the thickness distribution function in this study indicates that such a representation can be generated relatively easily.

Can extra-articular strains be used to measure facet contact forces in the lumbar spine? An in-vitro biomechanical study

Experimental measurement of the load-bearing patterns of the facet joints in the lumbar spine remains a challenge, thereby limiting the assessment of facet joint function under various surgical conditions and the validation of computational models. The extra-articular strain (EAS) technique, a non-invasive measurement of the contact load, has been used for unilateral facet joints but does not incorporate strain coupling, i.e. ipsilateral EASs due to forces on the contralateral facet joint. The objectives of the present study were to establish a bilateral model for facet contact force measurement using the EAS technique and to determine its effectiveness in measuring these facet joint contact forces during three-dimensional flexibility tests in the lumbar spine. Specific goals were to assess the accuracy and repeatability of the technique and to assess the effect of soft-tissue artefacts. In the accuracy and repeatability tests, ten uniaxial strain gauges were bonded to the external surface of the inferior facets of L3 of ten fresh lumbar spine specimens. Two pressure-sensitive sensors (Tekscan) were inserted into the joints after the capsules were cut. Facet contact forces were measured with the EAS and Tekscan techniques for each specimen in flexion, extension, axial rotation, and lateral bending under a +/- 7.5 N m pure moment. Four of the ten specimens were tested five times in axial rotation and extension for repeatability. These same specimens were disarticulated and known forces were applied across the facet joint using a manual probe (direct accuracy) and a materials-testing system (disarticulated accuracy). In soft-tissue artefact tests, a separate set of six lumbar spine specimens was used to document the virtual facet joint contact forces during a flexibility test following removal of the superior facet processes. Linear strain coupling was observed in all specimens. The average peak facet joint contact forces during flexibility testing was greatest in axial rotation (71 +/- 25 N), followed by extension (27 +/- 35 N) and lateral bending (25 +/- 28 N), and they were most repeatable in axial rotation (coefficient of variation, 5 per cent). The EAS accuracy was about 20 per cent in the direct accuracy assessment and about 30 per cent in the disarticulated accuracy test. The latter was very similar to the Tekscan accuracy in the same test. Virtual facet loads (r.m.s.) were small in axial rotation (12 N) and lateral bending (20 N), but relatively large in flexion (34 N) and extension (35 N). The results suggested that the bilateral EAS model could be used to determine the facet joint contact forces in axial rotation but may result in considerable error in flexion, extension, and lateral bending.

The Effect of Dynamic Posterior Stabilization on Facet Joint Contact Forces

Facet contact forces in the lumbar spine were measured during flexibility tests using thin film electroresistive sensors in intact cadaveric spine specimens and in injured specimens stabilized with a dynamic posterior system. The purpose of this study was to investigate the effect of the Dynesys system on the loading in the facet joints. The Dynesys, a posterior nonfusion device, aims to preserve intersegmental kinematics and reduce facet loads. Recent biomechanical evidence showed that overall motion is less with the Dynesys than in the intact spine, but no studies have shown its effect on facet loads. Ten human cadaveric lumbar spine specimens (L2-L5) were tested by applying a pure moment of +/-7.5 N m in 3 directions of loading with and without a follower preload of 600 N. Test conditions included an intact specimen and an injured specimen stabilized with 3 Dynesys spacer lengths. Bilateral facet contact forces were measured during flexibility tests using thin film electroresistive sensors (Tekscan 6900). Implanting the Dynesys significantly increased peak facet contact forces in flexion (from 3 N to 22 N per side) and lateral bending (from 14 N to 24 N per side), but had no significant effect on the magnitude of the peak forces in extension and axial rotation. Peak facet loads were significantly lower with the long spacer compared with the short spacer in flexion and lateral bending. Implantation of the Dynesys did not affect peak facet contact forces in extension or axial rotation compared with an intact specimen, but did alter these loads in flexion and lateral bending. The spacer length affected the compression of the posterior elements, with a shorter spacer typically producing greater facets loads than a longer one.

Neuromechanical characterization of in vivo lumbar spinal manipulation. Part I. Vertebral motion

Objective To quantify in vivo spinal motions and coupling patterns occurring in human subjects in response to mechanical force, manually assisted, short-lever spinal manipulative thrusts (SMTs) applied to varying vertebral contact points and utilizing various excursion (force) settings. Methods Triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1, L3, or L4 lumbar spinous process of 4 patients (2 male, 2 female) undergoing lumbar decompressive surgery. Lumbar spine acceleration responses were recorded during the application of 14 externally applied posteroanterior (PA) impulsive SMTs (4 force settings and 3 contact points) in each of the 4 subjects. Displacement time responses in the PA, axial (AX), and medial-lateral (ML) axes were obtained, as were intervertebral (L3-4) motion responses in 1 subject. Statistical analysis of the effects of facet joint (FJ) contact point and force magnitude on peak-to-peak displacements was performed. Motion coupling between the 3 coordinate axes of the vertebrae was examined using a least squares linear regression. Results SMT forces ranged from 30 N (lowest setting) to 150 N (maximum setting). Peak-to-peak ML, PA, and AX vertebral displacements increased significantly with increasing applied force. For thrusts delivered over the FJs, pronounced coupling was observed between all axes (AX-ML, AX-PA, PA-ML) (linear regression, R 2 = 0.35-0.52, P < .001), whereas only the AX and PA axes showed a significant degree of coupling for thrusts delivered to the spinous processes (SPs) (linear regression, R 2 = 0.82, P < .001). The ML and PA motion responses were significantly ( P < .05) greater than the AX response for all SMT force settings. PA vertebral displacements decreased significantly ( P < .05) when the FJ contact point was caudal to the pin compared with FJ contact cranial to the pin. FJ contact at the level of the pin produced significantly greater ML vertebral displacements in comparison with contact above and below the pin. SMTs over the spinous processes produced significantly ( P < .05) greater PA and AX displacements in comparison with ML displacements. The combined ML, PA, and AX peak-to-peak displacements for the 4 force settings and 2 contact points ranged from 0.15 to 0.66 mm, 0.15 to 0.81 mm, and 0.07 to 0.45 mm, respectively. Intervertebral motions were of similar amplitude as the vertebral motions. Conclusions In vivo kinematic measurements of the lumbar spine during the application of SMTs over the FJs and SPs corroborate previous spinous process measurements in human subjects. Our findings demonstrate that PA, ML, and AX spinal motions are coupled and dependent on applied force and contact point.