Comparative Evaluation Between Anatomic and Nonanatomic Lateral Ligament Reconstruction Techniques in the Ankle Joint: A Computational Study.

Biomechanical studies have indicated that the conventional nonanatomic reconstruction techniques for lateral ankle sprain (LAS) tend to restrict subtalar joint motion compared to intact ankle joints. Excessive restriction in subtalar motion may lead to chronic pain, functional difficulties, and development of osteoarthritis (OA). Therefore, various anatomic surgical techniques to reconstruct both the anterior talofibular and calcaneofibular ligaments (CaFL) have been introduced. In this study, ankle joint stability was evaluated using multibody computational ankle joint model to assess two new anatomic reconstruction and three popular nonanatomic reconstruction techniques. An LAS injury, three popular nonanatomic reconstruction models (Watson-Jones, Evans, and Chrisman-Snook) and two common types of anatomic reconstruction models were developed based on the intact ankle model. The stability of ankle in both talocrural and subtalar joint were evaluated under anterior drawer test (150 N anterior force), inversion test (3 N·m inversion moment), internal rotational test (3 N·m internal rotation moment), and the combined loading test (9 N·m inversion and internal moment as well as 1800 N compressive force). Our overall results show that the two anatomic reconstruction techniques were superior to the nonanatomic reconstruction techniques in stabilizing both talocrural and subtalar joints. Restricted subtalar joint motion, which is mainly observed in Watson-Jones and Chrisman-Snook techniques, was not shown in the anatomical reconstructions. Evans technique was beneficial for subtalar joint as it does not restrict subtalar motion, though Evans technique was insufficient for restoring talocrural joint inversion. The anatomical reconstruction techniques best recovered ankle stability.

Biomechanical Effects on Cervical Spinal Cord and Nerve Root Following Laminoplasty for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Comparison Between Open-Door and Double-Door Laminoplasty Using Finite Element Analysis.

Many clinical case series have reported the predisposing factors for C5 palsy and have presented comparisons of the two types of laminoplasty. However, there have been no biomechanical studies focusing on cervical spinal cord and nerve root following laminoplasty. The purpose of this study is to investigate biomechanical changes in the spinal cord and nerve roots following the two most common types of laminoplasty, open-door and double-door laminoplasty, for cervical ossification of the posterior longitudinal ligament (OPLL). A finite element (FE) model of the cervical spine and spinal cord with nerve root complex structures was developed. Stress changes in the spinal cord and nerve roots, posterior shift of the spinal cord, and displacement of the cervical nerve roots were analyzed with two types of cervical laminoplasty models for variations in the degree of canal occupying ratio and shape of the OPLL. The shape and degree of spinal cord compression caused by the OPLL had more influence on the changes in stress, posterior shift of the spinal cord, and displacement of the nerve root than the type of laminoplasty. The lateral-type OPLL resulted in imbalanced stress on the nerve roots and the highest nerve root displacement. Type of laminoplasty and shape and degree of spinal cord compression caused by OPLL were found to influence the changes in stress and posterior displacement of the cervical spinal cord and nerve roots. Lateral-type OPLL might contribute to the development of C5 palsy due to the imbalanced stress and tension on the nerve roots after laminoplasty.

Wrist Resistance Training Improves Motor Control and Strength.

Chu, E, Kim, Y-S, Hill, G, Kim, YH, Kim, CK, and Shim, JK. Wrist resistance training improves motor control and strength. J Strength Cond Res 32(4): 962-969, 2018-The aim of this study was to investigate the effects of a 6-week direction-specific resistance training program on isometric torque control and isokinetic torque strength of the wrist joint. Nineteen subjects were randomly assigned to either the wrist training group (n = 9) or the control group (n = 10). The training group performed wrist exercises in 6 directions (flexion, extension, pronation, supination, radial deviation, and ulnar deviation), whereas the control group did not. Data were collected on the isometric torque control, 1-repetition maximum (1RM) strength, and isokinetic maximum torque (angular velocity of 60° per second wrist movements) before and after 6 weeks of resistance training and at 2-week intervals during training. The training group showed significant decreases in isometric torque control error in all 6 directions after 2 weeks of resistance training, whereas the control group did not show significant increase or decrease. After 4 weeks of training, the training group showed significant increases in maximum strength in all 6 directions as assessed by 1RM strength and isokinetic strength tests, whereas the control group did not show any statistically significant changes. This study shows that motor control significantly improves within the first 2 weeks of resistance training, whereas the wrist strength significantly improves within the first 4 weeks of resistance training. Based on the findings of this study, coaches and trainers should consider wrist resistance training to improve athletes' muscular strength and control of the wrist muscles.

Amputee Locomotion: Ground Reaction Forces During Submaximal Running With Running-Specific Prostheses.

Individuals with lower extremity amputation must adapt the mechanical interactions between the feet and ground to account for musculoskeletal function loss. However, it is currently unknown how individuals with amputation modulate three-dimensional ground reaction forces (GRFs) when running. This study aimed to understand how running with running-specific prostheses influences three-dimensional support forces from the ground. Eight individuals with unilateral transtibial amputations and 8 control subjects ran overground at 2.5, 3.0, and 3.5 m/s. Ten force plates measured GRFs at 1000 Hz. Peak and average GRFs and impulses in each plane were compared between limbs and groups. Prosthetic limbs generated reduced vertical impulses, braking forces and impulses, and mediolateral forces while generating similar propulsive impulses compared with intact and control limbs. Intact limbs generated greater peak and average vertical forces and average braking forces than control subjects' limbs. These data indicate that the nonamputated limb experiences elevated mechanical loading compared with prosthetic and control limbs. This may place individuals with amputation at greater risk of acute injury or joint degeneration in their intact limb. Individuals with amputation adapted to running-specific prosthesis force production limitations by generating longer periods of positive impulse thus producing propulsive impulses equivalent to intact and control limbs.

The role of tactile sensation in online and offline hierarchical control of multi-finger force synergy.

The hand, one of the most versatile but mechanically redundant parts of the human body, must overcome imperfect motor commands and inherent noise in both the sensory and motor systems in order to produce desired motor actions. For example, it is nearly impossible to produce a perfectly consistent note during a single violin stroke or to produce the exact same note over multiple strokes, which we denote online and offline control, respectively. To overcome these challenges, the central nervous system synergistically integrates multiple sensory modalities and coordinates multiple motor effectors. Among these sensory modalities, tactile sensation plays an important role in manual motor tasks by providing hand-object contact information. The purpose of this study was to investigate the role of tactile feedback in individual finger actions and multi-finger interactions during constant force production tasks. We developed analytical techniques for the linear decomposition of the overall variance in the motor system in both online and offline control. We removed tactile feedback from the fingers and demonstrated that tactile sensors played a critical role in the online control of synergistic interactions between fingers. In contrast, the same sensors did not contribute to offline control. We also demonstrated that when tactile feedback was removed from the fingers, the combined motor output of individual fingers did not change while individual finger behaviors did. This finding supports the idea of hierarchical control where individual fingers at the lower level work together to stabilize the performance of combined motor output at the higher level.

Antitumor activity of trigonelline-incorporated chitosan nanoparticles.

In this study, trigonelline, a niacin-related compound was incorporated into chitosan nanoparticles through ion-complex formation between anionic carboxylic acid group of trigonelline and cationic amine group of chitosan. Morphology of trigonelline-incorporated chitosan nanoparticles have spherical shape with less than 500 nm in size and thier size distribution showed quite unimodel phase. Even though trigonelline and trigonelline-incorporated chitosan nanoparticles were not significantly affected to the proliferation of tumor cells, invasion of tumor cells was effectively inhibited by trigonelline-incorporated chitosan nanoparticles. We suggested that trigonelline-incorporated chitosan nanoparticles are promising candidate for inhibition of tumor cell invasion.

Capillary action: enrichment of retention and habitation of cells via micro-channeled scaffolds for massive bone defect regeneration.

The development of a biomaterial substitute that can promote bone regeneration in massive defects has remained as a significant clinical challenge even using bone marrow cells or growth factors. Without an active, thriving cell population present throughout and stable anchored to the construct, exceptional bone regeneration does not occur. An engineered micro-channel structures scaffold within each trabecular has been designed to overcome some current limitations involving the cultivation and habitation of cells in large, volumetric scaffolds to repair massive skeletal defect. We created a scaffold with a superior fluid retention capacity that also may absorb bone marrow cells and provide growth factor-containing body fluids such as blood clots and/or serum under physiological conditions. The scaffold is composed of 3 basic structures (1) porous trabecular network (300-400 µm) similar to that of human trabecular bones, (2) micro-size channels (25-70 µm) within each trabecular septum which mimic intra-osseous channels such as Haversian canals and Volkmann's canals with body fluid access, diffusion, nutritional supply and gas exchange, and (3) nano-size pores (100-400 nm) on the surface of each septum that allow immobilized cells to anchor. Combinatorial effects of these internal structures result in a host-adapting construct that enhances cell retention and habitation throughout the 3 cm-height and 4 cm-length bridge-shaped scaffold.

A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain.

BACKGROUND: A number of studies have evaluated exercise interventions compared with other treatment strategies for subjects with recurrent low back pain (LBP); however, subject pain level and balance were not carefully considered. The purpose of this study was to investigate the effectiveness of spinal stabilization exercises (SSE) for managing pain and increasing balance strategy changes following unexpected perturbations in patients diagnosed with recurrent LBP. MATERIAL/METHODS: Twenty-one age- and gender-matched patients participated in a supervised SSE or control exercise program 5 times a week over a 4-week period. The Million Visual Analogue Scale (MVAS) and Oswestry Disability Index (ODI) were used to measure each patient's level of pain and disability. Balance measurements were derived from recordings of the anterior-posterior (A/P) and medio-lateral (M/L) center of pressure (COP) displacements during 3 consecutive, unexpected random perturbations. RESULTS: The level of reported pain and disability significantly decreased following treatment for both groups. Although the M/L sway was not significantly different in either group (p=0.86), there was a significant difference between group and measurement time during A/P sway (p=0.04). The A/P displacement of the SSE group significantly decreased compared with the control group. The decreased A/P displacement can be linked to the SSE intervention, which helps prevent further injury by limiting an individual's response rate to external perturbations. CONCLUSIONS: Clinicians might consider SSE for LBP patients as a possible rehabilitation strategy to reduce A/P displacement.

Factors affecting shoulder-pelvic integration during axial trunk rotation in subjects with recurrent low back pain.

INTRODUCTION: Shoulder-pelvic integration could play a central role in the control of dynamic posture and movement. However, kinematic coordination during axial trunk rotation has not been carefully investigated in subjects with recurrent low back pain (LBP). The purpose of this study was to compare the maximum rotational angles of the shoulders and pelvis in the transverse plane between subjects with and without recurrent LBP. MATERIALS AND METHODS: A total of 38 age-matched subjects (19 control subjects: 69.00 ± 5.75 years old and 19 subjects with LBP: 68.79 ± 5.40 years old) participated in the study. The axial trunk rotation test was conducted in the upright position with bilateral hips and knees fully extended and both feet shoulder width apart. RESULTS: The results of this study indicated that there was a difference in pelvic girdle rotation between groups (100.79 ± 26.46 in the control group, 82.12 ± 23.16 in the LBP group; t = 2.31, p = 0.02); however, there was no difference for the shoulder girdle (177.63 ± 36.98 in the control group, 156.42 ± 30.09 in the LBP group; t = 1.91, p = 0.06). There were interactions with age (F = 9.27, p = 0.004) and BMI (F = 7.50, p = 0.01) with the rotational angles of the shoulder and pelvis. CONCLUSION: These results indicated a different pattern of trunk rotation movement with the age and BMI serving as important factors to consider for recurrent LBP. The results of our study also indicated a different pattern of shoulder and pelvic coordination with age and gender. Clinicians need to consider the consequences of limited shoulder-pelvic rotational angles, especially limited rotational angle on the pelvis during trunk axial rotation. Further studies are required to determine the causes of the underlying problems for clinical decision-making and altered shoulder-pelvic rotation in subjects with recurrent LBP.

Three-dimensional kinematic lumbar spine motion analyses of trunk motion during axial rotation activities.

STUDY DESIGN: An experimental design was conducted to investigate kinematic changes in 3-dimensional trunk motions between subjects with and without chronic low back pain (LBP) while demonstrating axial rotation. OBJECTIVES: The purpose of this study was to compare 3-dimensional kinematic data for the upper and lower thorax and the lumbar spine from the axis of the core spine during axial rotation activities in the standing position while considering anthropometric factors in subjects with and without LBP. SUMMARY OF BACKGROUND DATA: Rotation of the trunk is associated with a large number of LBP cases and surrounding spinal tissue injuries. METHODS: Fifteen subjects with chronic LBP (5 men, 10 women) and 15 subjects without LBP (9 men, 6 women) participated in this study. The outcome measures included kinematic data of actual trunk rotation angles for the upper and lower thorax and the lumbar regions relative to the core spine (spinal root) in sagittal, coronal, and transverse axes. RESULTS: The spinal range of motion was significantly different for each spinal region (F=240.25, P=0.001) and axis (F=213.91, P=0.001). There was a significant interaction between the spinal region and the group (F=4.34, P=0.04). There was also a 3-way interaction with the spinal region, the axis, and the group (F=11.04, P=0.001). These results indicated that spinal region and axes are important to consider because the upper thorax demonstrated a significantly greater rotational displacement in subjects with chronic LBP. Among the anthropometric factors, age (F=6.24, P=0.02) interacted with the spinal region and the axis. CONCLUSIONS: Decreased spinal range of motion in older subjects might result in a stiffened spine in addition to possible poor proprioception from back injuries to passive structures in subjects with chronic LBP.

Investigation of the compressive stiffness of spinal cages in various experimental conditions based on finite element analysis.

Recently, novel polymers, including polyetheretherketone and carbon fibre reinforced polymer, have been used for spinal implants. Because the in vitro experimental test uses metal blocks with different material properties from those of polymer cages in standard test protocols for prediction of the mechanical performance, it is necessary to analyse the influence of various experimental conditions, such as the material of the blocks. In this study, the compressive stiffness of spinal cages was investigated for different materials (polyetheretherketone, carbon fibre reinforced polymer, and titanium) under simulations of the mechanical experimental tests and the in vivo situation based on finite element analysis. The stiffness was affected by shapes of cage as well as experimental conditions, such as the load application method or fixation block. In the open cages, the polymer cages showed a greater dependence on the experimental situation than the metal cages. Hence, it may be necessary to consider the experimental conditions during in vitro mechanical tests for the stiffness evaluation of spinal cages made of novel polymers to obtain results relevant for an in vivo situation.

Prehension synergy: use of mechanical advantage during multifinger torque production on mechanically fixed and free objects.

The aim of this study was to test the mechanical advantage (MA) hypothesis in multifinger torque production tasks in humans: fingers with longer moment arms produce greater force magnitudes during torque production tasks. There were eight experimental conditions: two prehension types determined by different mechanical constraints (i.e., fixed- and free-object prehension) with two torque directions (supination and pronation) and two torque magnitudes (0.24 and 0.48 N·m). The subjects were asked to produce prescribed torques during the fixed-object prehension or to maintain constant position of the free hand-held object against external torques. The index of MA was calculated for agonist and antagonist fingers, which produce torques in the same and opposite directions to the target torques, respectively. Within agonist fingers, the fingers with longer moment arms produced greater grasping forces while within antagonist fingers, the fingers with shorter moment arms produced greater forces. The MA index was greater in the fixed-object condition as compared with the free-object condition. The MA index was greater in the pronation condition than in the supination condition. This study supports the idea that the CNS utilizes the MA of agonist fingers, but not of antagonist fingers, during torque production in both fixed- and free-object conditions.

Reliability in measurement of three-dimensional anterior pelvic plane orientation by registration with an inertial measurement unit.

It is strongly challenging to obtain functional movement of the pelvis based on the three-dimensional (3D) dynamic anterior pelvic plane (APP) orientation information. This study provided the 3D APP orientation measurement technique by registration with an inertial measurement unit (IMU), and its reliability was tested. The local coordinate systems of the APP and the IMU sensor were registered using two images of the pelvic part from the frontal and left sagittal views in a neutral standing posture. Then, the measurement errors in the APP orientation were analyzed by comparing the values obtained from manually measured four points in the IMU sensor and the known exact values in 10 different postures. Moreover, the errors between values obtained from manually measured three anatomical points and the known exact values were also compared. The average errors were quite small (less than 0.6°) when measuring from three anatomical points and were acceptable (1.6°-3.4°) when measuring from four points in the IMU sensor. These results indicate that the measurement of APP direction using four points in the IMU sensor could be considered reliable in terms of intra-participant and inter-participant. The present technique to register the IMU sensor position and the APP direction by taking X-ray images from the frontal and sagittal directions can be fundamental information to measure the APP direction during dynamic motion when the IMU position is obtained from the IMU sensor data instead of the four-point location information.

Multi-finger pressing synergies change with the level of extra degrees of freedom.

The purpose of this study was to test the principle of motor abundance, which has been hypothesized as the principle by which the central nervous system controls the excessive degrees of freedom of the human movements, in contrast to the traditional negative view of motor redundancy. This study investigated the changes in force stabilizing and moment stabilizing synergies for multi-finger pressing tasks involving different number of fingers. Twelve healthy subjects produced a constant pressing force while watching visual feedback of the total pressing force for the fingers involved in each task. Based on the principle of motor abundance, it was hypothesized that the multi-finger synergies for the total force stabilizing synergy and the total moment stabilizing synergy would be greater as the number of task finger increases. Force stabilizing and moment stabilizing synergies were quantified using the framework of the uncontrolled manifold analysis. It was found that strong force stabilizing synergies existed for all the finger combinations. The index of force stabilizing synergies was greater when the task involved more number of fingers. The index of moment stabilizing synergies was negative for the two-finger combination, representing moment destabilizing synergies. However, the index of moment stabilizing synergies was positive for three-finger and four-finger combinations, representing strong moment stabilizing synergies for these finger combinations. We interpret the findings as an evidence for the principle of abundance for stabilization of both, total force as well as total moment.

A comparison of pain level and entropy changes following core stability exercise intervention.

BACKGROUND: As reported in our previous studies, the complexity of physiologic time series is a sensitive measure of muscle fatigability. This study compared the differences between 2 different analyses following 4 weeks of core stability exercises (CSE) in subjects with and without chronic low back pain (LBP). We examined whether the observed Shannon (information) entropy, as compared with median frequency (MF), was able to differentiate fatigability of the thoracic and lumbar parts of the erector spinae (ES) muscles following the intervention. MATERIAL/METHODS: In total, 32 subjects participated in this study. There were 13 subjects in the CSE intervention group (average age 50.4 ± 9.1 years) and 19 subjects in the control group (average age 46.6 ± 9.1 years). The CSE group performed the specific exercise intervention, but the control group was asked to maintain their current activity and/or exercise levels. The endurance of the back muscles was determined by using a modified version of the isometric fatigue test as originally introduced by Sorensen. RESULTS: Pain level decreased significantly for all subjects (F=25.29, p=0.001), but there was no difference between groups (F=0.42, p=0.52). The MF was not different between groups following treatment (F=0.81, p=0.37). Although there was no entropy level changes following treatment (F=0.01, p=0.93), the interactions between muscles and groups following treatment were significant (F=7.25, p=0.01). The entropy level decreased in both thoracic ES muscles following intervention in the exercise group, while remaining the same in the control group. CONCLUSIONS: Although the change in pain level was not different between groups, the Shannon entropy measure more sensitively differentiated the exercise intervention than did MF. In addition, the results also suggested that complexity is related to muscle fatigue, which corresponds to the values of entropy between groups. Further studies are needed to investigate the effectiveness of nonlinear time series of EMG data for fatigability.

A kinematic analysis of relative stability of the lower extremities between subjects with and without chronic low back pain.

Even though a number of studies have evaluated postural adjustments based on kinematic changes in subjects with low back pain (LBP), kinematic stability has not been examined for abnormal postural responses during the one leg standing test. The purpose of this study was to evaluate the relative kinematic stability of the lower extremities and standing duration in subjects with and without chronic LBP. In total, 54 subjects enrolled in the study, including 28 subjects without LBP and 26 subjects with LBP. The average age of the subjects was 37.8 ± 12.6 years and ranged from 19 to 63 years. The outcome measures included normalized holding duration and relative kinematic stability. All participants were asked to maintain the test position without visual input (standing on one leg with his/her eyes closed and with the contra lateral hip flexed 90°) for 25 s. The age variable was used as a covariate to control confounding effects for the data analyses. The control group demonstrated significantly longer holding duration times (T = -2.78, p = 0.007) than the LBP group (24.6 ± 4.2 s vs. 20.5 ± 6.7 s). For the relative kinematic stability, there was a difference in dominance side (F = 9.91, p = 0.003). There was a group interaction between side and lower extremities (F = 11.79, p = 0.001) as well as an interaction between age and dominance side (F = 7.91, p = 0.007). The relative kinematic stability had a moderate negative relationship with age (r = -0.60, p = 0.007) in subjects without LBP. Clinicians need to understand the effects of age and relative stability, which decreased significantly in the single leg holding test, in subjects with LBP in order to develop effective rehabilitation strategies.

Causes and patterns of aborting a robot-assisted arthroplasty.

For a successful robot-assisted arthroplasty, every step should be executed harmoniously. However, when we encounter serious obstacles during surgery, it is sometimes better to abort the procedure in a timely manner. This study investigated the possible causes and patterns of aborted robot-assisted arthroplasties. Of 100 consecutively planned robot-assisted arthroplasties, 22 cases were aborted. Most involved total knee arthroplasty (21/22 cases). We classified the causes according to the stage at which they occurred and the type of error. Abortions after starting the milling procedure and abortions due to an interactive factor were the most common. We believe that this study can guide surgeons to effective decision making during robot-assisted arthroplasty.

Inter-joint coordination in producing kicking velocity of taekwondo kicks.

The purpose of this study was to investigate joint kinematics of the kicking leg in Taekwondo and to examine the role of inter-joint coordination of the leg in producing the kicking velocity. A new inter-joint coordination index that encompasses three- dimensional hip and knee motions, was defined and applied to the joint kinematic results. Twelve elite Taekwondo athletes participated in this study and performed the back kick, thrashing kick, turning-back kick and roundhouse kick. Our results indicate that the back kick utilized a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement. The thrashing kick and turning-back kick utilized a greater degree of hip abduction than the roundhouse kick and back kick, and included complicated knee motions. The new index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum, indicating a change from negative index (opposite direction) to positive index (same direction) of hip and knee motions at the end of the movement. This strategy of push-throw continuum increases the kicking velocity at the moment of impact by applying a throwlike movement pattern. Key pointsA variety of Taekwondo kicks have unique inter-joint coordination of the kicking leg.The back kick used a combination of hip and knee extension to produce the kicking velocity, and was characterized by a pushlike movement.The new index explained well the inter-joint coordination of three DOF joint motions of two joints in producing kicking velocity (positive values for throwlike movements and negative values for pushlike movements).The index successfully categorized the thrashing kick and turning-back kick into a push-throw continuum.

Contribution of a distal radioulnar joint stabilizer on forearm stability: A modeling study.

Instability of the forearm is a complex problem that leads to pain and limited motions. Up to this time, no universal consensus has yet been reached as regards the optimal treatment for forearm instability. In some cases, conservative treatments are recommended for forearm instability injuries. However, quantitative studies on the conservative treatment of forearm instability are lacking. The present study developed a finite element model of the forearm to investigate the contribution of the distal radioulnar joint stabilizer on forearm stability. The stabilizer was designed to provide stability between the radius and ulna. The forearm model with and without the stabilizer was tested using the pure transverse separation and radial pull test for the different ligament sectioned models. The percentage contribution of the stabilizer and ligament structures resisting the load on the forearm was estimated. For the transverse stability of the forearm, the central band resisted approximately 50% of the total transverse load. In the longitudinal instability, the interosseous membrane resisted approximately 70% of the axial load. With the stabilizer, models showed that the stabilizer provided the transverse stability and resisted almost 1/4 of the total transverse load in the ligament sectioned models. The stabilizer provided transverse stability and reduced the loading on the ligaments. We suggested that a stabilizer can be applied in the conservative management of patients who do not have the gross longitudinal instability with the interosseous membrane and the triangular fibrocartilage complex disruption.

Stress analysis in a pedicle screw fixation system with flexible rods in the lumbar spine.

Breakage of screws has been one of the most common complications in spinal fixation systems. However, no studies have examined the breakage risk of pedicle screw fixation systems that use flexible rods, even though flexible rods are currently being used for dynamic stabilization. In this study, the risk of breakage of screws for the rods with various flexibilities in pedicle screw fixation systems is investigated by calculating the von Mises stress as a breakage risk factor using finite element analysis. Three-dimensional finite element models of the lumbar spine with posterior one-level spinal fixations at L4-L5 using four types of rod (a straight rod, a 4 mm spring rod, a 3 mm spring rod, and a 2 mm spring rod) were developed. The von Mises stresses in both the pedicle screws and the rods were analysed under flexion, extension, lateral bending, and torsion moments of 10 Nm with a follower load of 400 N. The maximum von Mises stress, which was concentrated on the neck region of the pedicle screw, decreased as the flexibility of the rod increased. However, the ratio of the maximum stress in the rod to the yield stress increased substantially when a highly flexible rod was used. Thus, the level of rod flexibility should be considered carefully when using flexible rods for dynamic stabilization because the intersegmental motion facilitated by the flexible rod results in rod breakage.