Prediction of the Spinal Musculoskeletal Loadings during Level Walking and Stair Climbing after Two Types of Simulated Interventions in Patients with Lumbar Disc Herniation.

Background: Low back pain (LBP) continues to be a severe global healthy problem, and a lot of patients would undergo conservative or surgical treatments. However, the improving capacity of spinal load sharing during activities of daily living (ADLs) after interventions is largely unknown. The objective of this study was to quantitatively predict the improvement of spinal musculoskeletal loadings during level walking and stair climbing after two simulated interventions. Material and Methods: Twenty-six healthy adults and seven lumbar disc herniation patients performed level walking and stair climbing in sequence. The spinal movement was recorded using a motion capture system. The experimental data were applied to drive a musculoskeletal model to calculate all the lumbar joint resultant forces and muscle activities of seventeen main trunk muscle groups. Rehabilitation and reconstruction were selected as the representative of conservative and surgical treatment, respectively. The spinal load sharing after rehabilitation and reconstruction was predicted by replacing the patients' spine rhythm with healthy subjects' spine rhythm and altering the center of rotation at the L5S1 level, respectively. Results: During both level walking and stair climbing, the joint resultant forces of the lower lumbar intervertebral discs were predicted to reduce after the two simulated inventions. In addition, the maximum muscle activities of the most trunk muscle groups decreased after simulated rehabilitation and conversely increased after simulated reconstruction. Conclusion: The predictions revealed the different compensatory responses on the spinal load sharing after two simulated interventions, severing as guidance for making preoperative planning and rehabilitation planning.