Effect of personalized spinal profile on its biomechanical response in an EMG-assisted optimization musculoskeletal model of the trunk.

Recent developments in musculoskeletal (MS) modeling have been geared towards model customization. Personalization of the spine profile could affect estimates of spinal loading and stability, particularly in the upright standing posture where large inter-subject variations in the lumbar lordosis have been reported. This study investigates the biomechanical consequences of changes in the spinal profile. In 31 participants (healthy and with back pain), (1) the spine external profile was measured, (2) submaximal contractions were recorded in a dynamometer to calibrate the EMG-driven MS model and finally (3) static lifting in the upright standing challenging spine stability while altering load position and magnitude were considered. EMG signals of 12 trunk muscles and angular kinematics of 17 segments were recorded. For each participant, the MS model was constructed using either a generic or a personalized spinal profile and 17 biomechanical outcomes were computed, including individual muscle forces, ratios of muscle group forces, spinal loading and stability parameters. According to the ANOVA results and corresponding effect sizes, personalizing the spine profile induced medium and large effects on about half MS model outcomes related to the trunk muscle forces and negligible to small effects on spinal loading and stability as more aggregate outcomes. These effects are explained by personalized spine profiles that were a little more in extension as well as more pronounced spine curvatures (lordosis and kyphosis). These findings suggest that spine profile personalization should be considered in MS spine modeling as it may impact muscle force prediction and spinal loading.

Subject-specific regression equations to estimate lower spinal loads during symmetric and asymmetric static lifting.

Workplace safety assessment, personalized treatment design and back pain prevention programs require accurate subject-specific estimation of spinal loads. Since no noninvasive method can directly estimate spinal loads, easy-to-use regression equations that are constructed based on the results of complex musculoskeletal models appear as viable alternatives. Thus, we aim to develop subject-specific regression equations of L4-L5 and L5-S1 shear and compression forces during various symmetric/asymmetric tasks using a nonlinear personalized finite element musculoskeletal trunk model. Kinematics and electromyography (EMG) activities of 19 young healthy subjects were collected during 64 different symmetric/asymmetric tasks. To investigate the reliability and accuracy of the musculoskeletal model and regression equations, we compared estimated trunk muscle activities and L4-L5 intradiscal pressures (IDPs) respectively with our own electromyography data (EMGs) and reported in vivo pressure measurements. Although in general, six independent rotation components (three trunk T11 rotations and three pelvic S1 rotations) are required to determine kinematics along the spine, only two surrogate variables (trunk flexion and its asymmetric angles) satisfactorily predicted all six rotation components (R2 > 0.94). Regression equations, developed based on subject-specific inputs, predicted spinal loads in satisfactory agreement with IDP measurements (R2 = 0.85). Predicted muscle activities in the personalized musculoskeletal models were in moderate to weak agreements with our measured EMGs in 19 participants. Based on dominance analysis, trunk flexion and its asymmetry angle, hand-load weight, hand-load lever arm, and body weight were the most important variables while the effects of body height and sex on spinal loads remained small.

Trunk musculoskeletal response in maximum voluntary exertions: A combined measurement-modeling investigation.

Maximum voluntary exertion (MVE) tasks quantify trunk strength and maximal muscle electromyography (EMG) activities with both clinical and biomechanical implications. The aims here are to evaluate the performance of an existing trunk musculoskeletal model, estimate maximum muscle stresses and spinal forces, and explore likely differences between males and females in maximum voluntary exertions. We, therefore, measured trunk strength and EMG activities of 19 healthy right-handed subjects (9 females and 10 males) in flexion, extension, lateral and axial directions. MVEs for all subjects were then simulated in a subject-specific trunk musculoskeletal model, and estimated muscle activities were compared with EMGs. Analysis of variance was used to compare measured moments and estimated spinal loads at the L5-S1 level between females and males. MVE moments in both sexes were greatest in extension (means of 236 Nm in males and 190 Nm in females) and least in left axial torque (97 Nm in males and 64 Nm in females). Being much greater in lateral and axial MVEs, coupled moments reached ∼50% of primary moments in average. Females exerted less moments in all directions reaching significance except in flexion. Muscle activity estimations were strongly correlated with measurements in flexion and extension (Pearson's r = 0.69 and 0.76), but the correlations were very weak in lateral and axial MVEs (Pearson's r = 0.27 and 0.13). Maximum muscle stress was in average 0.80 ±â€¯0.42 MPa but varied among muscles from 0.40 ±â€¯0.22  MPa in rectus abdominis to 0.99 ±â€¯0.29 MPa in external oblique. To estimate maximum muscle stresses and evaluate validity of a musculoskeletal model, MVEs in all directions with all coupled moments should be considered.

Effects of motion segment simulation and joint positioning on spinal loads in trunk musculoskeletal models.

Musculoskeletal models represent spinal motion segments by spherical joints/beams with linear/nonlinear properties placed at various locations. We investigated the fidelity of these simplified models (i.e., spherical joints with/without rotational springs and beams considering nonlinear/linear properties) in predicting kinematics of the ligamentous spine in comparison with a detailed finite element (FE) model while considering various anterior-posterior joint placements. Using the simplified models with different joint offsets in a subject-specific musculoskeletal model, we computed local spinal forces during forward flexion and compared results with intradiscal pressure measurements. In comparison to the detailed FE model, linearized beam and spherical joint models failed to reproduce kinematics whereas the nonlinear beam model with joint offsets at -2 to +4mm range (+: posterior) showed satisfactory performance. In the musculoskeletal models without a hand-load, removing rotational springs, linearizing passive properties and offsetting the joints posteriorly (by 4mm) increased compression (∼32%, 17% and 11%) and shear (∼63%, 26% and 15%) forces. Posterior shift in beam and spherical joints increased extensor muscle active forces but dropped their passive force components resulting in delayed flexion relaxation and lower antagonistic activity in abdominal muscles. Overall and in sagittally symmetric tasks, shear deformable beams with nonlinear properties performed best followed by the spherical joints with nonlinear rotational springs. Using linear rotational springs or beams is valid only in small flexion angles (<30°) and under small external loads. Joints should be placed at the mid-disc height within -2 to +4mm anterior-posterior range of the disc geometric center and passive properties (joint stiffnesses) should not be overlooked.

Effects of sex, age, body height and body weight on spinal loads: Sensitivity analyses in a subject-specific trunk musculoskeletal model.

Subject-specific parameters influence spinal loads and the risk of back disorders but their relative effects are not well understood. The objective of this study is to investigate the effects of changes in age (35-60 years), sex (male, female), body height (BH: 150-190cm) and body weight (BW: 50-120kg) on spinal loads in a full-factorial simulation using a personalized (spine kinematics, geometry, musculature and passive properties) kinematics driven musculoskeletal trunk finite element model. Segmental weight distribution (magnitude and location along the trunk) was estimated by a novel technique to accurately represent obesity. Five symmetric sagittal loading conditions were considered, and main effect plots and analyses of variance were employed to identify influential parameters. In all 5 tasks simulated, BW (98.9% in compression and 96.1% in shear) had the greatest effect on spinal loads at the L4-L5 and L5-S1 levels followed by sex (0.7% in compression and 2.1% in shear), BH (0.4% in compression and 1.5% in shear) and finally age (<5.4%). At identical BH and BW, spinal loads in females were slightly greater than those in males by ~4.7% in compression and ~8.7% in shear. In tasks with no loads in hands, BW-normalized spinal loads further increased with BW highlighting the exponential increase in spinal loads with BW that indicates the greater risk of back disorders especially in obese individuals. Uneven distribution of weight in obese subjects, with more BW placed at the lower trunk, further (though slightly <7.5%) increased spinal loads.

Subject-specific biomechanics of trunk: musculoskeletal scaling, internal loads and intradiscal pressure estimation.

Development of a subject-specific computational musculoskeletal trunk model (accounting for age, sex, body weight and body height), estimation of muscle forces and internal loads as well as subsequent validation by comparison with measured intradiscal pressure in various lifting tasks are novel, important and challenging. The objective of the present study is twofold. First, it aims to update and personalize the passive and active structures in an existing musculoskeletal kinematics-driven finite element model. The scaling scheme used an existing imaging database and biomechanical principles to adjust muscle geometries/cross-sectional-areas and passive joint geometry/properties in accordance with subjects' sex, age, body weight and body height. Second, using predictions of a detailed passive finite element model of the ligamentous lumbar spine, a novel nonlinear regression equation was proposed that relates the intradiscal pressure (IDP) at the L4-L5 disc to its compression force and intersegmental flexion rotation. Predicted IDPs and muscle activities of the personalized models under various tasks are found in good-to-excellent agreement with reported measurements. Results indicate the importance of personal parameters when computing muscle forces and spinal loads especially at larger trunk flexion angles as minor changes in individual parameters yielded up to 30 % differences in spinal forces. For more accurate subject-specific estimation of spinal loads and muscle activities, such a comprehensive trunk model should be used that accounts for subject's personalized features on active musculature and passive spinal structure.

Harvest of the radial artery: technique of the skeletonization and pedicle preparation.

Nowadays, radial artery grafts play a significant role in coronary artery revascularization, however, harvesting techniques are not standardized. We developed various surgical techniques for radial artery harvesting considering the anatomic landmarks of the foramen, including conventional surgery (with scissors and clips) and procedures with ultrasonic scalpel and retrieving the radial artery graft in a pedicle or in a skeletonized manner.