Study design: Review of the most recent advances in the development of poro-elastic analytical models that include physiologic parameters used for understanding lumbar disc degeneration due to repetitive loading.
Objectives: To discuss how poro-elastic finite element models that include physiologic parameters such as strain-dependent permeability and porosity and regional variation of poro-elastic material properties of a motion segment can be used to understand the effect of disc degeneration due to cyclic loading on the disc biomechanical properties.
Summary of background data: Mechanical response of the spine to various dynamic loading conditions can be analyzed using in vitro and in vivo studies. Ethical concerns, interpretation of conclusions reached using animal studies, and lack of detailed stress distributions in the disc components are the major disadvantages in using in vivo studies for understanding disc degeneration process. Intraspecimen variability, noninclusion of muscle activity, and difficulty of influx of fluid into the disc during unloading are some of the disadvantages while using in vitro models to understand disc degeneration. The poro-elastic finite element models can provide a method that can circumvent the disadvantages mentioned above and allow a way to understand the relationship between biomechanical performance of the disc due to cyclic loading and disc degeneration.
Methods: Several types of finite element model were developed in understanding relationship between disc degeneration and associated changes in biomechanical properties. Simplest among them include material and geometric nonlinearity of the disc and was used to predict failure in the disc anulus and endplates under static loading conditions. Response of the lumbar disc under creep loading was studied using poro-elastic models. These models were further refined by including swelling pressure and variable permeability due to change in porosity under load to understand time-dependent deformation of a lumbar disc in a multiple creep compression expansion loading. Regional variation of strain dependent permeability and osmotic pressure was included to further refine the poro-elastic finite element model. This refined model was used to study the effect of disc degeneration on biomechanical properties when cyclic loading was applied to the lumbar disc.
Results: The refined model that included regional variation of strain-dependent permeability and osmotic pressure was validated by comparing diurnal change in total stature measured in vivo. The study showed that disc height loss was larger after considerable number of cyclic loadings both in normal and degenerated discs. Cyclic loading also showed that Grade I discs were much more flexible than Grade IV discs. The disc stiffness also decreased as the load cycle increased.
Conclusions: A number of different approaches have been used to address the issue of disc degeneration. Poro-elastic finite element model including strain-dependent permeability and osmotic pressure is the most popular analytical tool currently available that can be used to understand how cyclic loading affects the biomechanical characteristics of a degenerated lumbar disc. However, it is important to note that a complete understanding of the behavior of the intervertebral disc will ultimately be arrived using a combination of analytical models, such as the models presented here, in addition to in vitro and in vivo experimental methods.