Resumen de Biomechanical study of intervertebral disc degeneration
Ramiro Arturo González Gutiérrez
Degeneration and age affect the biomechanics of the intervertebral disc, by reducing its stiffness, flexibility and shock absorption capacities against daily movement and spinal load. The biomechanical characterization of intervertebral discs is achieved by conducting mechanical testing to vertebra-disc-vertebra segments and applying axial, shear, bend and torsion loads, statically or dynamically, with load magnitudes corresponding to the physiological range. However, traditional testing does not give a view of the load and deformation states of the disc components: nucleus pulposus, annulus fibrosus and endplate. Thus, the internal state of stress and strains of the disc can only be predicted by numerical methods, one of which is the finite element method. The objective of this thesis was, to study the biomechanics of degenerated intervertebral discs to load conditions in compression, bending and torsion, by using mechanical testing and a finite element model of disc degeneration, based on magnetic resonance imaging (MRI). Therefore, lumbar discs obtained from cadavers corresponding to spinal levels L2-L3 and L4-L5 with mild to severe degeneration were used. Intervertebral osteochondrosis and spondylosis deformans were identified, being the disc space collapse, the most striking feature. Next, all discs were tested to static and dynamic load conditions, the results gained corresponded to the disc stiffness (in compression, bending and torsion), stress relaxation and dynamic response. Of these, the stiffness response was used to validate the disc model. The testing results suggest that discs with advanced degeneration over discs with mild degeneration are, less rigid in compression, less stiffer under bending and torsion, showed less radial bulge, and reduce their viscoelastic and damping properties. This study shows that degeneration has an impact on the disc biomechanical properties which can jeopardize normal functionality. Development of one finite element model of disc degeneration started by choosing a MRI of a L2-L3 disc. Segmentation of vertebra bone and disc materials followed, and were based on pixel brightness and radiology fundamentals, then a finite element mesh was created to account for the disc irregular shape. The disc materials were modeled as hyperelastic and the bone materials were modeled as orthotropic and isotropic. Adjustment of material properties was based on integrity of the annulus fibrosus, giving a stiffness value matching that of a mild degeneration disc. Then, validation of the model was performed, and included a study of the distributions of stress and strain under loads of compression, bending and torsion. The results from all load simulations show that the disc undergoes large deformations. In contrast, the vertebrae are subjected to higher stress but with negligible deformations. In compression, the model predicted formation of symmetrical disc bulge which agree with the testing behavior. The nucleus pulposus showed to be the principal load carrier with negative principal stresses and strains. In bending and torsion, the annulus fibrosus showed to be the principal load carrier with large symmetrical principal strains and stresses for the former loading and large shearing for the latter. The study showed the importance of soft tissue deformation, mostly noticed in advanced degeneration. In contrast, the higher stresses in the vertebra over those of the intervertebral disc showed the relevance of bone predisposition to fracture. Such kind of studies, should contribute to the understanding of the biomechanics of the intervertebral disc.
