Thoracolumbar spine loading associated with kinematics of the young and the elderly during activities of daily living

Ignasiak, Dominika; Rüeger, Andrea; Sperr, Ramona; Ferguson, Stephen J.

doi:10.1016/j.jbiomech.2017.11.033

Cited by 30 publications

(28 citation statements)

References 46 publications

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“…Lastly, age differences between our patient subjects and healthy controls could confound our analyses. However, one study found loads on the lower lumbar spine during STS to be similar between relatively younger and older individuals provided both were asymptomatic [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

et al. 2019

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Study design A longitudinal cohort study. Objective To define a set of objective biomechanical metrics that are representative of adult spinal deformity (ASD) post-surgical outcomes and that may forecast post-surgical mechanical complications. Summary of background data Current outcomes for ASD surgical planning and post-surgical assessment are limited to static radiographic alignment and patient-reported questionnaires. Little is known about the compensatory biomechanical strategies for stabilizing sagittal balance during functional movements in ASD patients. Methods We collected in-clinic motion data from 15 ASD patients and 10 controls during an unassisted sit-to-stand (STS) functional maneuver. Joint motions were measured using noninvasive 3D depth mapping sensor technology. Mathematical methods were used to attain high-fidelity joint-position tracking for biomechanical modeling. This approach provided reliable measurements for biomechanical behaviors at the spine, hip, and knee. These included peak sagittal vertical axis (SVA) over the course of the STS, as well as forces and muscular moments at various joints. We compared changes in dynamic sagittal balance (DSB) metrics between pre- and post-surgery and then separately compared pre- and post-surgical data to controls. Results Standard radiographic and patient-reported outcomes significantly improved following realignment surgery. From the DSB biomechanical metrics, peak SVA and biomechanical loads and muscular forces on the lower lumbar spine significantly reduced following surgery (− 19 to − 30%, all p < 0.05). In addition, as SVA improved, hip moments decreased (− 28 to − 65%, all p < 0.05) and knee moments increased (+ 7 to + 28%, p < 0.05), indicating changes in lower limb compensatory strategies. After surgery, DSB data approached values from the controls, with some post-surgical metrics becoming statistically equivalent to controls. Conclusions Longitudinal changes in DSB following successful multi-level spinal realignment indicate reduced forces on the lower lumbar spine along with altered lower limb dynamics matching that of controls. Inadequate improvement in DSB may indicate increased risk of post-surgical mechanical failure. Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Electronic supplementary material The online version of this article (10.1007/s00586-019-05925-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

et al. 2019

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“…For the lifting activity, we additionally applied a quintic polynomial function to all sagittal plane spinal marker trajectories (i.e. C7 to S1) to derive segmental angles (angles between the normal lines passing through the individual marker positions) of the L1/L2, L2/L3, L3/L4, L4/L5 and L5/S1 spinal units [23,24]. Information on maker placement accuracy and soft tissue artifacts can be found elsewhere [52,67].…”

Section: Methodsmentioning

confidence: 99%

Fear avoidance beliefs limit lumbar spine flexion during object lifting in pain-free adults

Knechtle

Schmid

Suter

et al. 2020

Preprint

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There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially nurturing fear avoidance beliefs underlying pain-related fear. In chronic LBP patients, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, indicating distinct and probably protective psychomotor responses to pain. However, despite short term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pro-nociceptive consequences of altered spinal kinematics, reflected by increased loading on lumbar tissues and persistent muscle tension. Yet, it is unknown if similar psychomotor interactions already exist in pain-free individuals which would yield potential insights into how a person might react when they experience LBP. Therefore, the aim of this study is to test the impact of pain-related fear on spinal kinematics in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N=57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, yielding important implications regarding unfavorable psychomotor interactions that might become relevant in a future LBP incident.

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“…study, in several cases these load levels yielded high creep and elastic deformations (>5% strain), which was attributed to pre-existing damage. Despite being in line with theoretical estimates of load levels encountered during physiological tasks (Ignasiak et al, 2017; Iyer et al, 2010), this load level was too high for the lowest density specimens. The current findings are expected to help inform loading protocols for future creep studies of vertebral bodies.…”

Section: Discussionmentioning

confidence: 49%

“…The vertebra-endcap construct was constrained in metal platens. The specimens were loaded to 1000 N in uniaxial compression (Point A, Figure 3) in order to apply a physiologic load level representative of that experienced during standing (Ignasiak et al, 2017; Iyer et al, 2010; Pollintine et al, 2009; Sato et al, 1999) and kept at that level for 2 hours. After 2 hours (Point C, Figure 3), specimens were unloaded to a finite minimum load of 100 N and displacement was recorded during recovery for another 2 hours.…”

Section: Methodsmentioning

confidence: 99%

The relationship of whole human vertebral body creep to geometric, microstructural, and material properties

Oravec

Kim

Flynn

et al. 2018

Journal of Biomechanics

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Creep, the time dependent deformation of a structure under load, is an important viscoelastic property of bone and may play a role in the development of permanent deformity of the vertebrae in vivo leading to clinically observable spinal fractures. To date, creep properties and their relationship to geometric, microstructural, and material properties have not been described in isolated human vertebral bodies. In this study, a range of image-based measures of vertebral bone geometry, bone mass, microarchitecture and mineralization were examined in multiple regression models in an effort to understand their contribution to creep behavior. Several variables, such as measures of mineralization heterogeneity, average bone density, and connectivity density persistently appeared as significant effects in multiple regression models (adjusted r: 0.17-0.56). Although further work is needed to identify additional tissue properties to fully describe the portion of variability not explained by these models, these data are expected to help understand mechanisms underlying creep and improve prediction of vertebral deformities that eventually progress to a clinically observable fracture.

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Thoracolumbar spine loading associated with kinematics of the young and the elderly during activities of daily living

Cited by 30 publications

References 46 publications

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

Fear avoidance beliefs limit lumbar spine flexion during object lifting in pain-free adults

The relationship of whole human vertebral body creep to geometric, microstructural, and material properties

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