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Bioengineering
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Recent Advances of Spine Biomechanics
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Recent Advances of Spine Biomechanics

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomechanics and Sports Medicine".

Deadline for manuscript submissions: closed (15 June 2023) | Viewed by 23529

Special Issue Editor

Dr. Aurélien Courvoisier

E-Mail Website
Guest Editor
Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Saint Martin d'Heres, France
Interests: scoliosis; pediatric spine; biomechanics; motion analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of Bioengineering focuses on recent advances in spine biomechanics.

Our knowledge of spine biomechanics and spine deformities has evolved during the past decade with the development of spine 3D imaging in standing position, trunk motion, and gait analysis. We foresee that integration of spine motion analysis in routine will play a key role in improving patients’ evaluation and will help us to create realistic numerical avatars in the future. Patient-specific numerical models will lead to a better understanding of spinal disorders and will also provide us with simulations for treatments such as bracing or surgery. Spine motion preservation is a main objective in novel surgical strategies for pediatric spine deformities such as vertebral body tethering today. This technique requires a subtle evaluation of spine 3D geometry, spine motion, and spine remaining growth that recent advances in spine biomechanics have made possible.

Dr. Aurélien Courvoisier
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • scoliosis
  • motion capture
  • medical device
  • vertebral body tethering

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Published Papers (9 papers)

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Research

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13 pages, 2985 KiB  
Article
Influence of Lateral Sitting Wedges on the Rasterstereographically Measured Scoliosis Angle in Patients Aged 10–18 Years with Adolescent Idiopathic Scoliosis
by Andreas Feustel, Jürgen Konradi, Claudia Wolf, Janine Huthwelker, Ruben Westphal, Daniel Chow, Christian Hülstrunk, Philipp Drees and Ulrich Betz
Bioengineering 2023, 10(9), 1086; https://doi.org/10.3390/bioengineering10091086 - 14 Sep 2023
Viewed by 3564
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional axial deviation of the spine diagnosed in adolescence. Despite a long daily sitting duration, there are no studies on whether scoliosis can be positively influenced by sitting on a seat wedge. For the prospective study, 99 [...] Read more.
Adolescent idiopathic scoliosis (AIS) is a three-dimensional axial deviation of the spine diagnosed in adolescence. Despite a long daily sitting duration, there are no studies on whether scoliosis can be positively influenced by sitting on a seat wedge. For the prospective study, 99 patients with AIS were measured with the DIERS formetric III 4D average, in a standing position, on a level seat and with three differently inclined seat wedges (3°, 6° and 9°). The rasterstereographic parameters ‘scoliosis angle’ and ‘lateral deviation RMS’ were analysed. The side (ipsilateral/contralateral) on which the optimal correcting wedge was located in relation to the lumbar/thoraco-lumbar convexity was investigated. It was found that the greatest possible correction of scoliosis occurred with a clustering in wedges with an elevation on the ipsilateral side of the convexity. This clustering was significantly different from a uniform distribution (p < 0.001; chi-square = 35.697 (scoliosis angle); chi-square = 54.727 (lateral deviation RMS)). It should be taken into account that the effect of lateral seat wedges differs for individual types of scoliosis and degrees of severity. The possibility of having a positive effect on scoliosis while sitting holds great potential, which is worth investigating in follow-up studies. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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13 pages, 2776 KiB  
Article
Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model
by Chih-Kun Hsiao, Hao-Yuan Hsiao, Yi-Jung Tsai, Chao-Ming Hsu and Yuan-Kun Tu
Bioengineering 2023, 10(9), 1042; https://doi.org/10.3390/bioengineering10091042 - 5 Sep 2023
Viewed by 1321
Abstract
Spinal fusion surgery leads to the restriction of mobility in the vertebral segments postoperatively, thereby causing stress to rise at the adjacent levels, resulting in early degeneration and a high risk of adjacent vertebral fractures. Thus, to address this issue, non-fusion surgery applies [...] Read more.
Spinal fusion surgery leads to the restriction of mobility in the vertebral segments postoperatively, thereby causing stress to rise at the adjacent levels, resulting in early degeneration and a high risk of adjacent vertebral fractures. Thus, to address this issue, non-fusion surgery applies some pedicle screw-based dynamic stabilisation systems to provide stability and micromotion, thereby reducing stress in the fusion segments. Among these systems, the hybrid performance stabilisation system (HPSS) combines a rigid rod, transfer screw, and coupler design to offer a semi-rigid fixation method that preserves some mobility near the fusion site and reduces the adjacent segment compensatory effects. However, further research and confirmation are needed regarding the biomechanical effects of the dynamic coupler stiffness of the HPSS on the intrinsic degenerated adjacent segment. Therefore, this study utilised the finite element method to investigate the impact of the coupler stiffness of the HPSS on the mobility of the lumbar vertebral segments and the stress distribution in the intervertebral discs under flexion, extension, and lateral bending, as well as the clinical applicability of the HPSS on the discs with intrinsic moderate and severe degeneration at the adjacent level. The analytical results indicated that, regardless of the degree of disc degeneration, the use of a dynamic coupler stiffness of 57 N/mm in the HPSS may reduce the stress concentrations at the adjacent levels. However, for severely degenerated discs, the postoperative stress on the adjacent segments with the HPSS was still higher compared with that of the discs with moderate degeneration. We conclude that, when the discs had moderate degeneration, increasing the coupler stiffness led to a decrease in disc mobility. In the case of severe disc degeneration, the effect on disc mobility by coupler stiffness was less pronounced. Increasing the coupler stiffness ked to higher stress on intervertebral discs with moderate degeneration, while its effect on stress was less pronounced for discs with severe degeneration. It is recommended that patients with severe degeneration who undergo spinal dynamic stabilisation should remain mindful of the risk of accelerated adjacent segment degeneration. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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11 pages, 1798 KiB  
Article
Multi-Modal Data Correspondence for the 4D Analysis of the Spine with Adolescent Idiopathic Scoliosis
by Nicolas Comte, Sergi Pujades, Aurélien Courvoisier, Olivier Daniel, Jean-Sébastien Franco, François Faure and Edmond Boyer
Bioengineering 2023, 10(7), 874; https://doi.org/10.3390/bioengineering10070874 - 24 Jul 2023
Cited by 2 | Viewed by 1581
Abstract
Adolescent idiopathic scoliosis is a three-dimensional spinal deformity that evolves during adolescence. Combined with static 3D X-ray acquisitions, novel approaches using motion capture allow for the analysis of the patient dynamics. However, as of today, they cannot provide an internal analysis of the [...] Read more.
Adolescent idiopathic scoliosis is a three-dimensional spinal deformity that evolves during adolescence. Combined with static 3D X-ray acquisitions, novel approaches using motion capture allow for the analysis of the patient dynamics. However, as of today, they cannot provide an internal analysis of the spine in motion. In this study, we investigated the use of personalized kinematic avatars, created with observations of the outer (skin) and internal shape (3D spine) to infer the actual anatomic dynamics of the spine when driven by motion capture markers. Towards that end, we propose an approach to create a subject-specific digital twin from multi-modal data, namely, a surface scan of the back of the patient and a reconstruction of the 3D spine (EOS). We use radio-opaque markers to register the inner and outer observations. With respect to the previous work, our method does not rely on a precise palpation for the placement of the markers. We present the preliminary results on two cases, for which we acquired a second biplanar X-ray in a bending position. Our model can infer the spine motion from mocap markers with an accuracy below 1 cm on each anatomical axis and near 5 degrees in orientations. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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12 pages, 4222 KiB  
Article
Carbon Fiber-Reinforced PolyEtherEtherKetone (CFR-PEEK) Instrumentation in Degenerative Disease of Lumbar Spine: A Pilot Study
by Riccardo Ghermandi, Giovanni Tosini, Alberto Lorenzi, Cristiana Griffoni, Luigi La Barbera, Marco Girolami, Valerio Pipola, Giovanni Barbanti Brodano, Stefano Bandiera, Silvia Terzi, Giuseppe Tedesco, Gisberto Evangelisti, Annalisa Monetta, Luigi Emanuele Noli, Luigi Falzetti and Alessandro Gasbarrini
Bioengineering 2023, 10(7), 872; https://doi.org/10.3390/bioengineering10070872 - 23 Jul 2023
Cited by 3 | Viewed by 2548
Abstract
CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar [...] Read more.
CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar degenerative diseases (DDs) and considered the biomechanical potential of the carbon fiber in relation to its modulus of elasticity being similar to that of bone. Twenty-eight patients with DDs were treated using CRF-PEEK instrumentation. The clinical and radiographic outcomes were collected at a 12-month FU. Spinal fusion was evaluated in the CT scans using Brantigan scores, while the clinical outcomes were evaluated using VAS, SF-12, and EQ-5D scores. Out of the patients evaluated at the 12-month FU, 89% showed complete or almost certain fusion (Brantigan score D and E) and presented a significant improvement in all clinical parameters; the patients also presented VAS scores ranging from 6.81 ± 2.01 to 0.85 ± 1.32, EQ-5D scores ranging from 53.4 ± 19.3 to 85.0 ± 13.7, SF-12 physical component scores (PCSs) ranging from 29.35 ± 7.04 to 51.36 ± 9.75, and SF-12 mental component scores (MCSs) ranging from 39.89 ± 11.70 to 53.24 ± 9.24. No mechanical complications related to the implant were detected, and the patients reported a better tolerance of the instrumentation compared with titanium. No other series of patients affected by DD that was stabilized using carbon fiber implants have been reported in the literature. The results of this pilot study indicate the efficacy and safety of these implants and support their use also for spinal degenerative diseases. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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12 pages, 2581 KiB  
Article
The Effect of Concave-Side Intertransverse Ligament Laxity on the Stress of AIS Lumbar Spine Based on Finite Element Method
by Linjie Zhang, Qiaolin Zhang, Yan Zhang, Musinguzi Arthur, Ee-Chon Teo, István Bíró and Yaodong Gu
Bioengineering 2022, 9(12), 724; https://doi.org/10.3390/bioengineering9120724 - 23 Nov 2022
Cited by 4 | Viewed by 2159
Abstract
(1) Background: Scoliosis has the mechanical characteristic of asymmetric stress distribution, which is one of the reasons for the aggravation of scoliosis. Bracing therapy is the best treatment for AIS, but it is difficult and costly to operate. Is it possible to reduce [...] Read more.
(1) Background: Scoliosis has the mechanical characteristic of asymmetric stress distribution, which is one of the reasons for the aggravation of scoliosis. Bracing therapy is the best treatment for AIS, but it is difficult and costly to operate. Is it possible to reduce pressure in the concave side by relaxing the ITL in the concave side of scoliosis, so as to improve the abnormal stress distribution of scoliosis? In this paper, a finite element method was used to simulate the effect of the relaxation of concave-side ITL on the stress of a lumbar spine with scoliosis, which provides some guidance for the treatment of scoliosis. (2) Methods: Using CT images of a patient with scoliosis whose Cobb Angle was 43° and Lordosis Angle was 45, a scoliosis lumbar was established, and Young’s modulus of the ITL of the concave-side lumbar spine was reduced by 95% to simulate ligament relaxation. By comparing the stress condition of the model vertebral body with no ligament relaxation, the effect of concave-side ITL relaxation on the mechanical characteristics of scoliosis lumbar spine was explored. (3) Results: An effective and complete model of the lumbar spine was established. The concave ITL relaxed, which only had a great impact on the bending loads. After the ligament was relaxed, the stability of the spine was reduced. Stress concentration on the concave side of vertebrae and the IVD was aggravated. Under loads on the convex side, the maximum stress on the vertebral body and the IVD increased significantly, making lumbar vertebrae more vulnerable to injury. (4) Conclusions: Laxity of the ITL on the concave side of the AIS lumbar only affects the bending load. Laxity of the concave-side ligament will reduce the stability of the lumbar, aggravate the uneven stress distribution of scoliotic lumbar vertebrae, increase the risk of IVD injury, and be unfavorable for the scoliotic lumbar spine. Relaxation of the concave ITL alone is not an effective way to treat scoliosis. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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9 pages, 566 KiB  
Article
The Scores and Manner of Performing the Stand and Reach Test in Girls and Boys of Different Body Weight
by Agnieszka Jankowicz-Szymańska, Justyna Kawa, Katarzyna Wódka, Eliza Smoła, Marta A. Bibro and Aneta Bac
Bioengineering 2022, 9(10), 538; https://doi.org/10.3390/bioengineering9100538 - 9 Oct 2022
Viewed by 3120
Abstract
Introduction: Flexibility is one of the components of Health-Related Fitness. The range of flexion has been the participant of numerous publications, but research into the quality of flexibility is lacking. The aim of the study has been to compare the scores and the [...] Read more.
Introduction: Flexibility is one of the components of Health-Related Fitness. The range of flexion has been the participant of numerous publications, but research into the quality of flexibility is lacking. The aim of the study has been to compare the scores and the quality of the stand and reach test in both overweight girls and boys and girls and boys with normal body weight. We have checked whether the forward bend movement is symmetrically distributed over the hip joints and the lumbar and thoracic spine and how it influences the position of the knee and ankle joints. Material and methods: 100 girls and 100 boys aged 10–14 years were examined. Flexibility was measured using the stand and reach test. The quality of the bend was assessed by examining the range of movement in individual body segments: the range of flexion of the thoracic and lumbar spine (linear measurements), the range of flexion of the hip joint, and the position of the knee and ankle joints at maximum flexion (angular measurements). The results were subjected to statistical analysis. Results: The participants, especially boys, had poor flexibility. A poor stand and reach test result correlated with a lower range of flexion of the thoracic and lumbar spine, greater flexion of the hip and knee joints, and greater plantar flexion at maximum torso bend position. Although the mean stand and reach score was slightly greater for the girls, gender did not significantly differentiate the way in which the stand and reach test was performed. Being overweight also did not affect the quantity or quality of the stand and reach test. Conclusions: Limitation of flexibility is common in 10–14-year-old children and results mainly from limited mobility of the spine. The compensation for this is excessive movement in the joints of the lower extremities. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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13 pages, 7616 KiB  
Article
Virtual Scoliosis Surgery Using a 3D-Printed Model Based on Biplanar Radiographs
by Aurélien Courvoisier, Antonio Cebrian, Julien Simon, Pascal Désauté, Benjamin Aubert, Célia Amabile and Lucie Thiébaut
Bioengineering 2022, 9(9), 469; https://doi.org/10.3390/bioengineering9090469 - 14 Sep 2022
Cited by 5 | Viewed by 3074
Abstract
The aim of this paper is to describe a protocol that simulates the spinal surgery undergone by adolescents with idiopathic scoliosis (AIS) by using a 3D-printed spine model. Patients with AIS underwent pre- and postoperative bi-planar low-dose X-rays from which a numerical 3D [...] Read more.
The aim of this paper is to describe a protocol that simulates the spinal surgery undergone by adolescents with idiopathic scoliosis (AIS) by using a 3D-printed spine model. Patients with AIS underwent pre- and postoperative bi-planar low-dose X-rays from which a numerical 3D model of their spine was generated. The preoperative numerical spine model was subsequently 3D printed to virtually reproduce the spine surgery. Special consideration was given to the printing materials for the 3D-printed elements in order to reflect the radiopaque and mechanical properties of typical bones most accurately. Two patients with AIS were recruited and operated. During the virtual surgery, both pre- and postoperative images of the 3D-printed spine model were acquired. The proposed 3D-printing workflow used to create a realistic 3D-printed spine suitable for virtual surgery appears to be feasible and reliable. This method could be used for virtual-reality scoliosis surgery training incorporating 3D-printed models, and to test surgical instruments and implants. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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16 pages, 14027 KiB  
Article
A Population-Based 3D Atlas of the Pathological Lumbar Spine Segment
by Vincenza Sciortino, Salvatore Pasta, Tommaso Ingrassia and Donatella Cerniglia
Bioengineering 2022, 9(8), 408; https://doi.org/10.3390/bioengineering9080408 - 22 Aug 2022
Cited by 5 | Viewed by 2136
Abstract
The spine is the load-bearing structure of human beings and may present several disorders, with low back pain the most frequent problem during human life. Signs of a spine disorder or disease vary depending on the location and type of the spine condition. [...] Read more.
The spine is the load-bearing structure of human beings and may present several disorders, with low back pain the most frequent problem during human life. Signs of a spine disorder or disease vary depending on the location and type of the spine condition. Therefore, we aim to develop a probabilistic atlas of the lumbar spine segment using statistical shape modeling (SSM) and then explore the variability of spine geometry using principal component analysis (PCA). Using computed tomography (CT), the human spine was reconstructed for 24 patients with spine disorders and then the mean shape was deformed upon specific boundaries (e.g., by ±3 or ±1.5 standard deviation). Results demonstrated that principal shape modes are associated with specific morphological features of the spine segment such as Cobb’s angle, lordosis degree, spine width and height. The lumbar spine atlas here developed has evinced the potential of SSM to investigate the association between shape and morphological parameters, with the goal of developing new treatments for the management of patients with spine disorders. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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Review

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10 pages, 271 KiB  
Review
Negative Pressure Wound Therapy in Spinal Surgery
by Alexandra Jeanne White, Ronit Gilad, Soriaya Motivala, Brian Fiani and Jonathan Rasouli
Bioengineering 2022, 9(11), 614; https://doi.org/10.3390/bioengineering9110614 - 26 Oct 2022
Cited by 5 | Viewed by 2629
Abstract
Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in [...] Read more.
Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices. There is nominal but promising prospective evidence on NPWT’s efficacy in select at-risk populations for post-operative wound complications after spinal surgery. As there is currently a paucity of robust clinical evidence on its efficacy, rigorous randomized prospective clinical trials are needed. Full article
(This article belongs to the Special Issue Recent Advances of Spine Biomechanics)
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