Follower Load Path Research Articles

A finite element study on the effects of follower load on the continuous biomechanical responses of subaxial cervical spine

In spine biomechanics, follower loads are used to mimic the in vivo muscle forces acting on a human spine. However, the effects of the follower load on the continuous biomechanical responses of the subaxial cervical spines (C2-T1) have not been systematically clarified. This study aims at investigating the follower load effects on the continuous biomechanical responses of C2-T1. A nonlinear finite element model is reconstructed and validated for C2-T1. Six levels follower loads are considered along the follower load path that is optimized through a novel range of motion-based method. A moment up to 2 Nm is subsequently superimposed to produce motions in three anatomical planes. The continuous biomechanical responses, including the range of motion, facet joint force, intradiscal pressure and flexibility are evaluated for each motion segment. In the sagittal plane, the change of the overall range of motion arising from the follower loads is less than 6%. In the other two anatomical planes, both the magnitude and shape of the rotation-moment curves change with follower loads. At the neutral position, over 50% decrease in flexibility occurs as the follower load increases from zero to 250 N. In all three anatomical planes, over 50% and 30% decreases in flexibility occur in the first 0.5 Nm for small (≤100 N) and large (≥150 N) follower loads, respectively. Moreover, follower loads tend to increase both the facet joint forces and the intradiscal pressures. The shape of the intradiscal pressure-moment curves changes from nonlinear to roughly linear with increased follower load, especially in the coronal and transverse planes. The results obtained in this work provide a comprehensive understanding on the effects of follower load on the continuous biomechanical responses of the C2-T1.

Cross-link is a risk factor for rod fracture at pedicle subtraction osteotomy site: A finite element study

BackgroundWe aim to investigate using finite element model (FEM) whether the use of a cross-link is a risk factor for rod fracture at the pedicle subtraction osteotomy (PSO) site. MethodsThe geometry and dimensions of the FEM were obtained from a high-resolution computed tomography scan data of a 65 years old female patient with spinal sagittal imbalance. The intact model was modified to place PSO on the L4 spine. A cross-link was placed at the PSO site. A multisegment spinal fusion model from L1 to the pelvis was used to compare and analyze the peak von Mises stress (PVMS) values of the implants. A compressive follower load of 400 N was added to the validated intact lumbar spinal model in the follower load path direction. ResultsAfter PSO surgery, the PVMS of the rod was significantly increased during flexion and extension at the PSO site. With the cross-link at the PSO site, the PVMS of the rod was further significantly increased during flexion and extension. ConclusionThe cross-link at the PSO site increased the risk of rod facture, especially during flexion and extension stress.

The Path to Deliver the Most Realistic Follower Load for a Lumbar Spine in Standing Posture: A Finite Element Study

A spine is proven to be subjected to a follower load which is a compressive load of physiologic magnitude acting on the whole spine. The path of the follower load approximates the tangent to the curve of the spine in in vivo neutral standing posture. However, the specific path location of the follower load is still unclear. The aim of this study is to find out the most realistic location of the follower load path (FLP) for a lumbar spine in standing. A three-dimensional (3D) nonlinear finite element model (FEM) of lumbosacral vertebrae (L1-S1) with consideration of the calibrated material properties was established and validated by comparing with the experimental data. We show that the shape of the lumbosacral spine is strongly affected by the location of FLP. An evident nonlinear relationship between the FLP location and the kinematic response of the L1-S1 lumbosacral spine exists. The FLP at about 4 and 3 mm posterior to the curve connecting the center of the vertebral bodies delivers the most realistic location in standing for healthy people and patients having low back pains (LPBs), respectively. Moreover, the "sweeping" method introduced in this study can be applicable to all individualized FEM to determine the location of FLP.

Effects of follower load and rib cage on intervertebral disc pressure and sagittal plane curvature in static tests of cadaveric thoracic spines

The clinical relevance of mechanical testing studies of cadaveric human thoracic spines could be enhanced by using follower preload techniques, by including the intact rib cage, and by measuring thoracic intervertebral disc pressures, but studies to date have not incorporated all of these components simultaneously. Thus, this study aimed to implement a follower preload in the thoracic spine with intact rib cage, and examine the effects of follower load, rib cage stiffening and rib cage removal on intervertebral disc pressures and sagittal plane curvatures in unconstrained static conditions. Intervertebral disc pressures increased linearly with follower load magnitude. The effect of the rib cage on disc pressures in static conditions remains unclear because testing order likely confounded the results. Disc pressures compared well with previous reports in vitro, and comparison with in vivo values suggests the use of a follower load of about 400N to approximate loading in upright standing. Follower load had no effect on sagittal plane spine curvature overall, suggesting successful application of the technique, although increased flexion in the upper spine and reduced flexion in the lower spine suggest that the follower load path was not optimized. Rib cage stiffening and removal both increased overall spine flexion slightly, although with differing effects at specific spinal locations. Overall, the approaches demonstrated here will support the use of follower preloads, intact rib cage, and disc pressure measurements to enhance the clinical relevance of future studies of the thoracic spine.

Feasibility of compressive follower load on spine in a simplified dynamic state: a simulation study.

This study investigated that the spinal MFs can create compressive follower loads (CFLs) in the lumbar spine in a dynamic state. Three-dimensional optimization and finite element (FE) models of the spinal system were developed and validated using reported experimental data. An optimization analysis was performed to determine the MFs that create CFLs in the lumbar spine in various sagittal postures from 10° extension to 40° flexion. Optimization solutions for the MFs, CFLs, and follower load path (FLP) location were feasible for all studied postures. The FE predictions demonstrated that MFs which created CFLs along the base spinal curve connecting the geometrical centers or along a curve in its vicinity (within anterior or posterior shift by 2 mm) produced stable deformation of the lumbar spine in the neutral standing and flexed postures, whereas the MFs which created the smallest CFLs resulted in unstable deformation. For extended postures, however, finding CFLs creating MFs that produce stable deformation of the extended spine was not possible. The results of this study support the hypothesis that the spinal muscles may stabilize the spine via the CFL mechanism.

Investigation of optimal follower load path generated by trunk muscle coordination

It has been reported that the center of rotation of each vertebral body is located posterior to the vertebral body center. Moreover, it has been suggested that an optimized follower load (FL) acts posterior to the vertebral body center. However, the optimal position of the FL with respect to typical biomechanical characteristics regarding spinal stabilization, such as joint compressive force, shear force, joint moment, and muscle stress, has not been studied. A variation in the center of rotation of each vertebra was formulated in a three-dimensional finite element model of the lumbar spine with 117 pairs of trunk muscles. Then, the optimal translation of the FL path connecting the centers of rotations was estimated by solving the optimization problem that was to simultaneously minimize the compressive forces, the shear forces, and the joint moments or to minimize the cubic muscle stresses. An upright neutral standing position and a standing position with 200N in both hands were considered. The FL path moved posterior, regardless of the optimization criteria and loading conditions. The FL path moved 5.0 and 7.8mm posterior in upright standing and 4.1mm and 7.0mm posterior in standing with 200N in hands for each optimization scheme. In addition, it was presented that the optimal FL path may have advantages in comparison to the body center FL path. The present techniques may be important in understanding the spine stabilization function of the trunk muscles.

A non-optimized follower load path may cause considerable intervertebral rotations

Osseoligamentous spinal specimens buckle under even a small vertical compressive force. To allow higher axial forces, a compressive follower load (FL) was suggested previously that approximates the curvature of the spine without inducing intervertebral rotation in both the frontal and the sagittal planes. In in vitro experiments and finite element analyses, the location of the FL path is subjected to estimation by the investigator. Such non-optimized FLs may induce bending and so far it is still unknown how this affects the results of the study and their comparability. A symmetrical finite element model of the lumbar spine was employed to simulate upright standing while applying a follower load. In analogy to in vitro experiments, the path of this FL was estimated seven times by different members of our institute’s spine group. Additionally, an optimized FL path was determined and additional moments of ±7.5 Nm were applied to simulate flexion and extension. Application of the optimized 500 N compressive FL causes only a marginal alteration of the curvature (cardan angle L1–S1 in sagittal plane <0.25°). An individual estimation of the FL path, however, results in flexions of up to 10.0° or extensions of up to 12.3°. The resulting angles for the different non-optimized FL paths depend on the magnitude of the bending moment applied and whether a differential or an absolute measurement is taken. A preceding optimization of the location of the FL path would increase the comparability of different studies.

P47. Increasing Compressive Preload Reduces the Segmental Instability Produced by Progressive Destabilization

BACKGROUND CONTEXT: The human spine experiences significant compressive preloads in vivo due to spinal musculature and gravity. We previously demonstrated that when the preload is applied along the lordotic curve of the lumbar spine (follower load path), the spine maintains full range of motion (ROM) under loads experienced in vivo. While the effect of destabilization procedures on spinal motion has been studied, the effect of compressive preload on the motion response of destabilized, multi-segment lumbar spine has not been reported.

Flexion–Extension Response of the Thoracolumbar Spine Under Compressive Follower Preload

The authors conducted an in vitro biomechanical flexibility study of T2-S1 specimens in flexion-extension under compressive follower preloads of physiological magnitudes. The objectives of this study were to test the hypotheses that 1) the thoracolumbar spine will support compressive preloads of in vivo magnitudes and 2) allow physiological mobility under flexion-extension moments if the preload is applied along an optimized follower load path that approximates the kypholordotic curve of the thoracolumbar spine. In the absence of muscle forces, the ligamentous thoracolumbar spine specimens cannot support the compressive loads expected in vivo. As a result, the flexibility of the thoracolumbar spine in flexion-extension has not been studied in vitro under physiological compressive preloads. Seven human thoracolumbar spines (T2-sacrum) were subjected to flexion and extension moments (up to 8 and 6 Nm, respectively) under compressive preloads from 0 to 800 N applied along an optimized follower preload path. The experimental technique applied the compressive preload such that: 1) it minimized the internal shear forces and bending moments resulting from the preload application, 2) made the internal force resultant compressive, and 3) caused the preload path to approximate the tangent to the curve of the thoracolumbar spine. The range of motion was measured in the T2-sacrum, T2-T11, T11-L1, and L1-sacrum regions. All thoracolumbar specimens supported the compressive follower preload up to 800 N without damage or instability. At 800 N preload, the total flexion-extension range of motion of the T2-sacrum region decreased by 22%, from a mean of 73 degrees to 57 degrees (P < 0.05). The range of motion of the T2-T11 and L1-sacrum regions decreased from the baseline value by 23% and 30%, respectively, at a preload of 800 N. The sagittal mobility of the thoracolumbar junction (T11-L1) was not affected by the preload. The follower preload did not significantly affect the proportion of the total T2-sacrum flexion-extension range of motion contributed by the T2-T11 and L1-sacrum regions of the thoracolumbar spine. The optimized follower preload vector minimizes the effects of artifact moment and shear force on the range of motion of the thoracolumbar spine in flexion-extension. This model allows the entire thoracolumbar spine to be investigated under physiological loading for different clinical applications.

Numerical Analysis on Quantitative Role of Trunk Muscles in Spinal Stabilization

The human lumbar spine can support much larger compressive loads if it is applied along a follower load path that approximates the tangent to the curve of the lumbar spine compared with the vertical load path. In this study, a musculoskeletal finite element model of the simplified lumbar spine including idealized psoas major muscles in the frontal plane was developed and the quantitative role of psoas major muscles was investigated to generate the follower load by using stiffness methods when vertical loads are given. The muscle force distributions were analyzed under various loading cases and follower load constraints. The validity of the developed model was assessed through comparison with previous modeling and experimental studies.

Effect of compressive follower preload on the flexion–extension response of the human lumbar spine

Traditional experimental methods are unable to study the kinematics of whole lumbar spine specimens under physiologic compressive preloads because the spine without active musculature buckles under just 120 N of vertical load. However, the lumbar spine can support a compressive load of physiologic magnitude (up to 1200 N) without collapsing if the load is applied along a follower load path. This study tested the hypothesis that the load–displacement response of the lumbar spine in flexion–extension is affected by the magnitude of the follower preload and the follower preload path. Twenty-one fresh human cadaveric lumbar spines were tested in flexion–extension under increasing compressive follower preload applied along two distinctly different optimized preload paths. The first (neutral) preload path was considered optimum if the specimen underwent the least angular change in its lordosis when the full range of preload (0–1200 N) was applied in its neutral posture. The second (flexed) preload path was optimized for an intermediate specimen posture between neutral and full flexion. A twofold increase in flexion stiffness occurred around the neutral posture as the preload was increased from 0 to 1200 N. The preload magnitude (400 N and larger) significantly affected the range of motion (ROM), with a 25% decrease at 1200 N preload applied along the neutral path. When the preload was applied along a path optimized for an intermediate forward-flexed posture, only a 15% decrease in ROM occurred at 1200 N. The results demonstrate that whole lumbar spine specimens can be subjected to compressive follower preloads of in vivo magnitudes while allowing physiologic mobility under flexion–extension moments. The optimized follower preload provides a method to simulate the resultant vector of the muscles that allow the spine to support physiologic compressive loads induced during flexion–extension activities.

A frontal plane model of the lumbar spine subjected to a follower load: implications for the role of muscles.

Compression on the lumbar spine is 1000 N for standing and walking and is higher during lifting. Ex vivo experiments show it buckles under a vertical load of 80-100 N. Conversely, the whole lumbar spine can support physiologic compressive loads without large displacements when the load is applied along a follower path that approximates the tangent to the curve of the lumbar spine. This study utilized a two-dimensional beam-column model of the lumbar spine in the frontal plane under gravitational and active muscle loads to address the following question: Can trunk muscle activation cause the path of the internal force resultant to approximate the tangent to the spinal curve and allow the lumbar spine to support compressive loads of physiologic magnitudes? The study identified muscle activation patterns that maintained the lumbar spine model under compressive follower load, resulting in the minimization of internal shear forces and bending moments simultaneously at all lumbar levels. The internal force resultant was compressive, and the lumbar spine model, loaded in compression along the follower load path, supported compressive loads of physiologic magnitudes with minimal change in curvature in the frontal plane. Trunk muscles may coactivate to generate a follower load path and allow the ligamentous lumbar spine to support physiologic compressive loads.

A follower load increases the load-carrying capacity of the lumbar spine in compression.

An experimental approach was used to test human cadaveric spine specimens. To assess the response of the whole lumbar spine to a compressive follower load whose path approximates the tangent to the curve of the lumbar spine. Compression on the lumbar spine is 1000 N for standing and walking and is higher during lifting. Ex vivo experiments show it buckles at 80-100 N. Differences between maximum ex vivo and in vivo loads have not been satisfactorily explained. A new experimental technique was developed for applying a compressive follower load of physiologic magnitudes up to 1200 N. The experimental technique applied loads that minimized the internal shear forces and bending moments, made the resultant internal force compressive, and caused the load path to approximate the tangent to the curve of the lumbar spine. A compressive vertical load applied in the neutral lordotic and forward-flexed postures caused large changes in lumbar lordosis at small load magnitudes. The specimen approached its extension or flexion limits at a vertical load of 100 N. In sharp contrast, the lumbar spine supported a load of up to 1200 N without damage or instability when the load path was tangent to the spinal curve. Until this study, an experimental technique for applying compressive loads of in vivo magnitudes to the whole lumbar spine was unavailable. The load-carrying capacity of the lumbar spine sharply increased under a compressive follower load, as long as the load path remained within a small range around the centers of rotation of the lumbar segments. The follower load path provides an explanation of how the whole lumbar spine can be lordotic and yet resist large compressive loads. This study may have implications for determining the role of trunk muscles in stabilizing the lumbar spine.