0
Research Papers

Changes in Vertebral Strain Energy Correlate With Increased Presence of Schmorl's Nodes in Multi-Level Lumbar Disk Degeneration

[+] Author and Article Information
Gregory A. Von Forell

Department of Mechanical Engineering,
Brigham Young University,
Provo, UT 84602
e-mail: gregvonforell@gmail.com

Todd G. Nelson

Department of Mechanical Engineering,
Brigham Young University,
Provo, UT 84602
e-mail: toddgn@gmail.com

Dino Samartzis

Department of Orthopaedics and Traumatology,
The University of Hong Kong,
Pokfulam, Hong Kong
e-mail: dsamartzis@msn.com

Anton E. Bowden

Department of Mechanical Engineering,
Brigham Young University,
Provo, UT 84602
e-mail: abowden@byu.edu

1Corresponding author.

Manuscript received November 19, 2013; final manuscript received March 5, 2014; accepted manuscript posted March 26, 2014; published online April 18, 2014. Assoc. Editor: James C. Iatridis.

J Biomech Eng 136(6), 061002 (Apr 18, 2014) (6 pages) Paper No: BIO-13-1546; doi: 10.1115/1.4027301 History: Received November 19, 2013; Revised March 05, 2014; Accepted March 26, 2014

Patients with skipped-level disk degeneration (SLDD) were recently reported as having a higher prevalence of Schmorl's nodes than patients with contiguous multi-level disk degeneration (CMDD). Fourteen versions of a nonlinear finite element model of a lumbar spine, representing different patterns of single and multi-level disk degeneration, were simulated under physiological loading. Results show that vertebral strain energy is a possible predictor in the development of Schmorl's nodes. The analysis also shows evidence that the development of Schmorl's nodes may be highly dependent on the location of the degeneration disk, with a higher prevalence at superior levels of the lumbar spine.

FIGURES IN THIS ARTICLE
<>
Copyright © 2014 by ASME
Topics: Disks , Lumbar spine , Bone
Your Session has timed out. Please sign back in to continue.

References

Kyere, K. A., Than, K. D., Wang, A. C., Rahman, S. U., Valdivia-Valdivia, J. M., La Marca, F., and Park, P., 2012, “Schmorl's Nodes,” Eur. Spine J., 21(11), pp. 2115–2121. [CrossRef] [PubMed]
Schmorl, G., and Junghanns, H., 1971, The Human Spine in Health and Disease, Grune and Stratton, New York.
Williams, F. M., Manek, N. J., Sambrook, P. N., Spector, T. D., and Macgregor, A. J., 2007, “Schmorl's Nodes: Common, Highly Heritable, and Related to Lumbar Disc Disease,” Arthritis Rheum., 57(5), pp. 855–860. [CrossRef] [PubMed]
Hilton, R. C., Ball, J., and Benn, R. T., 1976, “Vertebral End-Plate Lesions (Schmorl's Nodes) in the Dorsolumbar Spine,” Ann. Rheum. Dis., 35(2), pp. 127–132. [CrossRef] [PubMed]
Pfirrmann, C. W., and Resnick, D., 2001, “Schmorl Nodes of the Thoracic and Lumbar Spine: Radiographic-Pathologic Study of Prevalence, Characterization, and Correlation With Degenerative Changes of 1,650 Spinal Levels in 100 Cadavers,” Radiology, 219(2), pp. 368–374. [CrossRef] [PubMed]
Jang, J. S., Kwon, H. K., Lee, J. J., Hwang, S. M., and Lim, S. Y., 2010, “Rami Communicans Nerve Block for the Treatment of Symptomatic Schmorl's Nodes: A Case Report,” Korean J. Pain, 23(4), pp. 262–265. [CrossRef] [PubMed]
Park, P., Tran, N. K., Gala, V. C., Hoff, J. T., and Quint, D. J., 2007, “The Radiographic Evolution of a Schmorl's Node,” Br J Neurosurg, 21(2), pp. 224–227. [CrossRef] [PubMed]
Sakellariou, G. T., Chatzigiannis, I., and Tsitouridis, I., 2005, “Infliximab Infusions for Persistent Back Pain in Two Patients With Schmorl's Nodes,” Rheumatology (Oxford), 44(12), pp. 1588–1590. [CrossRef] [PubMed]
Takahashi, K., Miyazaki, T., Ohnari, H., Takino, T., and Tomita, K., 1995, “Schmorl's Nodes and Low-Back Pain. Analysis of Magnetic Resonance Imaging Findings in Symptomatic and Asymptomatic Individuals,” Eur. Spine J., 4(1), pp. 56–59. [CrossRef] [PubMed]
Hamanishi, C., Kawabata, T., Yosii, T., and Tanaka, S., 1994, “Schmorl's Nodes on Magnetic Resonance Imaging. Their Incidence and Clinical Relevance,” Spine (Phila PA1976), 19(4), pp. 450–453. [CrossRef]
Mok, F. P., Samartzis, D., Karppinen, J., Luk, K. D., Fong, D. Y., and Cheung, K. M., 2010, “ISSLS Prize Winner: Prevalence, Determinants, and Association of Schmorl Nodes of the Lumbar Spine With Disc Degeneration: A Population-Based Study of 2449 Individuals,” Spine (Phila Pa 1976), 35(21), pp. 1944–1952. [CrossRef] [PubMed]
Cheung, K. M., Samartzis, D., Karppinen, J., and Luk, K. D., 2012, “Are "Patterns" of Lumbar Disc Degeneration Associated With Low Back Pain?: New Insights Based on Skipped Level Disc Pathology,” Spine (Phila Pa 1976), 37(7), pp. E430–E438. [CrossRef] [PubMed]
Fyhrie, D. P., and Carter, D. R., 1986, “A Unifying Principle Relating Stress to Trabecular Bone Morphology,” J. Orthop Res., 4(3), pp. 304–317. [CrossRef] [PubMed]
Huiskes, R., Weinans, H., Grootenboer, H. J., Dalstra, M., Fudala, B., and Slooff, T. J., 1987, “Adaptive Bone-Remodeling Theory Applied to Prosthetic-Design Analysis,” J. Biomech., 20(11-12), pp. 1135–1150. [CrossRef] [PubMed]
Wheeldon, J. A., Yoganandan, N., and Pintar, F. A., 2009, “Strain Energy Density Used as the Biomechanical Signal for Osteophyte Growth in the Cervical spine—Biomed 2009,” Biomed. Sci. Instrum., 45, pp. 143–148. [PubMed]
Goel, V. K., Ramirez, S. A., Kong, W., and Gilbertson, L. G., 1995, “Cancellous Bone Young's Modulus Variation Within the Vertebral Body of a Ligamentous Lumbar Spine—Application of Bone Adaptive Remodeling Concepts,” J. Biomech. Eng., 117(3), pp. 266–271. [CrossRef] [PubMed]
Grosland, N., and Goel, V. K., 2007, “Vertebral Endplate Morphology Follows Bone Remodeling Principles,” Spine, 32(23), pp. E667–E673. [CrossRef] [PubMed]
Agarwal, A., Agarwal, A. K., and Goel, V. K., 2013, “The Endplate Morphology Changes With Change in Biomechanical Environment Following Discectomy,” Int. J. Clin. Med., 4, pp. 8–17. [CrossRef]
Von Forell, G. A., and Bowden, A. E., 2013, “Biomechanical Implications of Lumbar Spinal Ligament Transection,” Comput. Methods Biomech. Biomed. Eng. (in press). [CrossRef]
Goel, V. K., Monroe, B. T., Gilbertson, L. G., and Brinckmann, P., 1995, “Interlaminar Shear Stresses and Laminae Separation in a Disc. Finite Element Analysis of the L3-L4 Motion Segment Subjected to Axial Compressive Loads,” Spine (Phila Pa 1976), 20(6), pp. 689–698. [CrossRef] [PubMed]
Polikeit, A., Nolte, L. P., and Ferguson, S. J., 2003, “The Effect of Cement Augmentation on the Load Transfer in an Osteoporotic Functional Spinal Unit: Finite-Element Analysis,” Spine (Phila Pa 1976), 28(10), pp. 991–996. [PubMed]
Ulrich, D., van Rietbergen, B., Laib, A., and Ruegsegger, P., 1999, “The Ability of Three-Dimensional Structural Indices to Reflect Mechanical Aspects of Trabecular Bone,” Bone, 25(1), pp. 55–60. [CrossRef] [PubMed]
Morgan, E. F., Bayraktar, H. H., and Keaveny, T. M., 2003, “Trabecular Bone Modulus-Density Relationships Depend on Anatomic site,” J. Biomech., 36(7), pp. 897–904. [CrossRef] [PubMed]
LSTC, 2011, “LS-Dyna Keyword User's Manual. 1.,” Livermore, CA, p. Livermore Software Technology Corporation.
Elliott, D. M., and Setton, L. A., 2001, “Anisotropic and Inhomogeneous Tensile Behavior of the Human Anulus Fibrosus: Experimental Measurement and Material Model Predictions,” ASME J. Biomech. Eng., 123(3), pp. 256–263. [CrossRef]
O'Connell, G. D., Guerin, H. L., and Elliott, D. M., 2009, “Theoretical and Uniaxial Experimental Evaluation of Human Annulus Fibrosus Degeneration,” ASME J. Biomech. Eng., 131(11), 111007. [CrossRef]
Wilke, H. J., Rohlmann, F., Neidlinger-Wilke, C., Werner, K., Claes, L., and Kettler, A., 2006, “Validity and Interobserver Agreement of a New Radiographic Grading System for Intervertebral Disc Degeneration: Part I. Lumbar Spine,” Eur. Spine J., 15(6), pp. 720–730. [CrossRef] [PubMed]
Meakin, J. R., 2001, “Replacing the Nucleus Pulposus of the Intervertebral Disk: Prediction of Suitable Properties of a Replacement Material Using Finite Element Analysis,” J. Mater. Sci. Mater. Med., 12(3), pp. 207–213. [CrossRef] [PubMed]
Rohlmann, A., Zander, T., Bergmann, G., and Boustani, H. N., 2012, “Optimal Stiffness of a Pedicle-Screw-Based Motion Preservation Implant for the Lumbar Spine,” Eur. Spine J., 21(4), pp. 666–673. [CrossRef] [PubMed]
Patwardhan, A. G., Havey, R. M., Carandang, G., Simonds, J., Voronov, L. I., Ghanayem, A. J., Meade, K. P., Gavin, T. M., and Paxinos, O., 2003, “Effect of Compressive Follower Preload on the Flexion-Extension Response of the Human Lumbar Spine,” J. Orthop. Res., 21(3), pp. 540–546. [CrossRef] [PubMed]
Fahey, V., Opeskin, K., Silberstein, M., Anderson, R., and Briggs, C., 1998, “The Pathogenesis of Schmorl's Nodes in Relation to Acute Trauma. An Autopsy Study,” Spine (Phila Pa 1976), 23(21), pp. 2272–2275. [CrossRef] [PubMed]
Yaszemski, M., White, A., and Panjabi, M., 1992, “Biomechanics of the Spine,” Handbook of Clinical Neurology, H.Frankel, ed., Elsevier Science Publishers, Amsterdam.
Sward, L., Hellstrom, M., Jacobsson, B., Nyman, R., and Peterson, L., 1991, “Disc Degeneration and Associated Abnormalities of the Spine in Elite Gymnasts. A Magnetic Resonance Imaging Study,” Spine (Phila Pa 1976), 16(4), pp. 437–443. [CrossRef] [PubMed]
Dar, G., Masharawi, Y., Peleg, S., Steinberg, N., May, H., Medlej, B., Peled, N., and Hershkovitz, I., 2010, “Schmorl's Nodes Distribution in the Human Spine and Its Possible Etiology,” Eur. Spine J., 19(4), pp. 670–675. [CrossRef] [PubMed]
Goel, V. K., Panjabi, M. M., Patwadhan, A. G., Dooris, A. P., and Serhan, H., 2006, “Test protocols for evaluation of spinal implants,” J. Bone Joint Surg. Am., 88, pp. 103–109. [CrossRef] [PubMed]
Panjabi, M., Malcolmson, G., Teng, E., Tominaga, Y., Henderson, G., and Serhan, H., 2007, “Hybrid Testing of Lumbar CHARITE Discs Versus Fusions,” Spine (Phila Pa 1976), 32(9), pp. 959–966. [CrossRef] [PubMed]
Eck, J. C., Humphreys, S. C., Lim, T. H., Jeong, S. T., Kim, J. G., Hodges, S. D., and An, H. S., 2002, “Biomechanical Study on the Effect of Cervical Spine Fusion on Adjacent-Level Intradiscal Pressure and Segmental Motion,” Spine (Phila Pa 1976), 27(22), pp. 2431–2434. [CrossRef] [PubMed]
Hilibrand, A. S., Carlson, G. D., Palumbo, M. A., Jones, P. K., and Bohlman, H. H., 1999, “Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis,” J. Bone Joint Surg. Am., 81(4), pp. 519–528. [PubMed]
Goffin, J., Geusens, E., Vantomme, N., Quintens, E., Waerzeggers, Y., Depreitere, B., Van Calenbergh, F., and van Loon, J., 2004, “Long-Term Follow-Up After Interbody Fusion of the Cervical Spine,” J. Spinal Disord. Tech., 17(2), pp. 79–85. [CrossRef] [PubMed]
Singer, K., Edmondston, S., Day, R., Breidahl, P., and Price, R., 1995, “Prediction of Thoracic and Lumbar Vertebral Body Compressive Strength: Correlations With Bone Mineral Density and Vertebral Region,” Bone, 17(2), pp. 167–174. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

Mesh of the finite element model of the lumbar spine

Grahic Jump Location
Fig. 2

Bone mineral density of the vertebrae (L1–L5). Bone mineral densities were calculated using previously published equations comparing bone mineral density to quantitative computed tomography data.

Grahic Jump Location
Fig. 3

The 13 cases that were tested. Cases I–V are single level disk degeneration cases, Cases VI–VIII are contiguous level disk degeneration (CMDD) cases. Cases IX–XIII are SLDD cases.

Grahic Jump Location
Fig. 4

Disk pressure results for each of the cases. Results were determining by averaging element pressures throughout the entire disk.

Grahic Jump Location
Fig. 5

Changes in strain energy for the single level degeneration cases. Changes within 30% of the control were considered minor changes. Changes between 30% and 60% were shown as increases or decreases. Both positive and negative changes greater than 60% were considered major increases or decreases.

Grahic Jump Location
Fig. 6

Changes in strain energy for the contiguous level degeneration cases. Changes within 30% of the control were considered minor changes. Changes between 30% and 60% were shown as increases or decreases. Both positive and negative changes greater than 60% were considered major increases or decreases.

Grahic Jump Location
Fig. 7

Changes in strain energy for the skipped level degeneration cases. Changes within 30% of the control were considered minor changes. Changes between 30% and 60% were shown as increases or decreases. Both positive and negative changes greater than 60% were considered major increases or decreases.

Tables

Errata

Discussions

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In