Original Article

Proc IMechE Part H:

J Engineering in Medicine
1–13
Numerical analysis of the mechanical Ó IMechE 2021
Article reuse guidelines:
behaviour of intact and implanted sagepub.com/journals-permissions
DOI: 10.1177/09544119211008343

lumbar functional spinal units: Effects journals.sagepub.com/home/pih

of loading and boundary conditions

Rahul Gautam Talukdar1, Kiran Kumar Mukhopadhyay2,

Santanu Dhara3 and Sanjay Gupta4

Abstract
The objective of this study was to develop an improved finite element (FE) model of a lumbar functional spinal unit
(FSU) and to subsequently analyse the deviations in load transfer owing to implantation. The effects of loading and
boundary conditions on load transfer in intact and implanted FSUs and its relationship with the potential risk of vertebral
fracture were investigated. The FE models of L1-L5 and L3-L4 FSUs, intact and implanted, were developed using patient-
specific CT-scan dataset and segmentation of cortical and cancellous bone regions. The effect of submodelling technique,
as compared to artificial boundary conditions, on the elastic behaviour of lumbar spine was examined. Applied forces
and moments, corresponding to physiologic movements, were used as loading conditions. Results indicated that the
loading and boundary conditions considerably affect stress-strain distributions within a FSU. This study, based on an
improved FE model of a vertebra, highlights the importance of using the submodelling technique to adequately evaluate
the mechanical behaviour of a FSU. In the intact FSU, strains of 200–400 me were observed in the cancellous bone of ver-
tebral body and pedicles. High equivalent stresses of 10–25 MPa and 1–5 MPa were generated around the pars interarti-
cularis for cortical and cancellous regions, respectively. Implantation caused reductions of 85%–92% in the range of
motion for all movements. Insertion of the intervertebral cage resulted in major deviations in load transfer across a FSU
for all movements. The cancellous bone around cage experienced pronounced increase in stresses of 10–15 MPa, which
indicated potential risk of failure initiation in the vertebra.

Keywords
Lumbar spine, functional spinal unit, finite element analysis, submodelling technique, intervertebral cage

Date received: 25 September 2020; accepted: 14 March 2021

Introduction accurate FE model of the healthy spine is necessary to

An accurate numerical model of the lumbar spine is
necessary to gain an insight into the load transfer dur-
ing physiologic movements and to investigate the
effects of surgical intervention and associated risk of
vertebral fracture. Finite element (FE) analysis has
been used for the evaluation of biomechanical function-
alities, effects of implantation, development of new
implants and customised treatments, based on subject-
specific geometry.1–4 Accordingly computational mod-
els were developed to study the mechanical behaviour
of degenerated and implanted spines.5–8 However,
before analysing a degenerated or implanted spine, it is
required to analyse a healthy spine, subjected to physio-
logic loading conditions. Hence, the development of an
assess detailed stress-strain distributions, realistically.
1
Advanced Technology and Development Centre, Indian Institute of
Technology Kharagpur, Kharagpur, West Bengal, India
2
Department of Orthopedics, NRS Medical College Hospital, Kolkata,
West Bengal, India
3
School of Medical Science and Technology, Indian Institute of Technology
Kharagpur, Kharagpur, West Bengal, India
4
Department of Mechanical Engineering, Indian Institute of Technology
Kharagpur, Kharagpur, West Bengal, India
Corresponding author:
Sanjay Gupta, Department of Mechanical Engineering, Indian Institute of
Technology Kharagpur, Kharagpur, West Bengal 721 302, India.
Email: sangupta@mech.iitkgp.ac.in
2 Proc IMechE Part H: J Engineering in Medicine 00(0)
The advances in numerical technique and medical
imaging have led researchers to develop more and more
realistic models of the complex spinal components.
Several studies have developed FE models of the spine
containing different components, the material proper-
ties of which were based on experimental values.9–12
The vertebral geometry strongly influences the simu-
lated biomechanics of the spine.13 However, the cortical
and cancellous bone regions of the posterior aspect of
the vertebrae were modelled as a single unit and were
allocated a single set of material properties. The study
by Shirazi-Adl et al.14 first proposed elastic modulus
value of 12,000 MPa for the cortical region and
100 MPa for the cancellous region. These values have
been widely used for the anterior part, whereas an aver-
age value of 3500 MPa was assumed for the posterior
part of the vertebrae.5–14 Only a few have modelled the
vertebral bodies by mapping the properties from com-
puted tomography (CT) scan dataset of subject-specific
bones.15–17 However, the cortical and cancellous bone
regions were not explicitly modelled. It appears, there-
fore, that the assumptions in material properties for a
vertebra are inappropriate and might lead to an inaccu-
rate evaluation of stresses and strains in intact and
implanted spine models.
A few studies have considered bone anisotropy
or orthotropy in their spine models, but have assumed
a constant cortical thickness over the whole verteb-
rae.18–20 Whereas, other studies have assumed homoge-
nous isotropic bone model for the lumbar spine.10,14,21
An experimental study by Mosekilde et al.22 reported a
highly significant positive correlation (p \ 0.01) in
both vertical and horizontal directions between the bio-
mechanical properties and ash density. Mizrahi et al.23
remarked that since the anisotropy of trabecular bone
in the lumbar spine is relatively weak, it is unlikely to
have any appreciable effect on the stress distribution.
Another experimental study by Wolfram et al.24 inves-
tigated the effects of rehydration on the anisotropy of
vertebral trabecular bone; hardly any difference was
found while evaluating the elastic energy with regard to
indentation in axial and transverse directions (p
\ 0.05). Moreover, a comparison of heterogeneous
isotropic and orthotropic bone models used for FE
analyses of proximal femurs suggested that the ortho-
tropic bone material property assignment can be
ignored in FE analyses of the proximal femur if a het-
erogeneous isotropic bone model with a fine mesh is
used.25–27
Small segment models or functional spinal unit
(FSU) have been widely used to evaluate the effect of
different types of surgical interventions on stress-strain
related failure mechanisms. Parametric analysis was
performed using a FSU model to assess the role of dif-
ferent input variables on stress-strain distributions.28
Earlier studies have investigated intervertebral disc
pressure (IDP), range of motion (RoM), interbody cage
stress, where compression loads, bending moments and
torques were either applied separately or in a combina-
tion to simulate the physiologic movements.29–31 Kim
and Vanderby32 performed a FE analysis on the L4-L5
lumbar FSU, after insertion of interbody cage. The
study predicted local regions of stress concentration and
micromotion near cages that may cause bone resorption
and fibrous tissue formation. The study by Poliket
et al.33 investigated different factors that influenced
stresses in a lumbar FSU, due to insertion of interbody
fusion cages. They concluded that bone density played
a key role in the overall stress distribution in a motion
segment. Another study by Lee et al.34 compared three
different posterior lumbar fusion techniques, using an
L3-L4 lumbar FSU instrumented with porous cages.
However, posterior instrumentation (pedicle rods and
screws), which is typically employed along with cages to
augment the stability of spine, was not considered in
these models.
Loading and boundary conditions have considerable
influence on the outcome of FE analysis. Previous FE
studies have investigated the effects of various loading
regimes, boundary conditions, follower load technique
and muscle forces on load transfer in a lumbar spine.35–
37
A follower load technique, representing the stabilisa-
tion of muscle force and upper body weight, was
employed for high compressive load that follows the
spine curvature without causing instability.36 Zander
et al.37 estimated muscle forces during upper-body
inclination and found that the flexion angle had a
strong influence on the stresses in the lumbar spine,
while the influence of local muscles was small. A recent
review on in vitro and numerical studies discussed the
effects of various loading and boundary conditions on
healthy, aged, degenerated and altered FSUs.38 The
FSU is supported rigidly at the inferior end of the lower
vertebral segment, and the loading conditions (as forces
or displacements) were prescribed on the superior sur-
face of the upper vertebrae.18,39 A maximum compres-
sive load of 2000 N, combined with a bending moment
of 60 N-m and an additional preload of 1000 N, were
used to simulate different physiologic movements in the
L4-L5 segment.18 Baroud et al.39 applied displacement
type quasi-static compressive loads of 2.8 mm in steps
of 0.2 mm in the L4-L5 segment in his FE analysis of
vertebroplasty. However, in the studies on FSU, fixed
boundary condition was prescribed at the inferior end
of the vertebral segment as an artificial constraint con-
dition.29–34,39 Evaluation of stresses and strains adja-
cent to the fixed boundary condition for a small spinal
segment appears to be inappropriate and may lead to
dubious results. The elastic behaviour of the whole
lumbar spine, owing to physiologic loads, needs to be
adequately included in the small segment model,
instead of artificially prescribed boundary conditions.
It appears, therefore, that the development of a 3-D
model of a lumbar FSU is necessary to study load
Talukdar et al. 3

transfer within different spinal components and to

determine the influence of posterior instrumentation on
the vertebrae under physiologic loading conditions.
The aim of this study was to develop an improved
FE model of a lumbar functional spinal unit and to
subsequently analyse the deviations in load transfer
owing to implantation. The effects of loading and
boundary conditions on the load transfer in intact and
implanted FSUs and its relationship with the potential
risk of vertebral fracture have been investigated.

Materials and methods

The FE models of the intact and implanted lumbar
spine (L1-L5) were developed using CT-scan dataset of
a 31-year-old male subject. The CT scan dataset in
DICOM format (Philips/Brilliance 64 model; 120 kV;
230 slices; 0.684 3 0.684 mm, 0.5 mm gap) were
imported in an image processing software MIMICS
(Materialise Inc., Belgium) for geometric reconstruc-
tion. A brief description of the models is presented in
the following sections.

Intact model
The FE models were developed by segmenting a verte-
bra into cortical and cancellous regions, based on
thresholding of the CT grey value. The CT grey value
of the bone ranged from 0 to 1341 Hounsfield units
(HU). Manual thresholding method was used to deter-
mine the periosteal and endocortical boundaries in
order to avoid partial volume effect. A manual thresh-
old CT value of 654 HU that corresponded to the den-
sity value of 0.85 g cm23 for the cortical layer was used
to segment the cortical bone from the cancellous bone
in the posterior region only.40 Since the cortical thick-
ness of the anterior region could not be extracted using
automated or manual segmentation, a constant thick-
ness of 0.5 mm was assumed for the cortical layer in the
anterior part of the vertebrae. The intervertebral disc
(IVD) was segmented into nucleus pulposus and annu-
lus fibrosus. The nucleus pulposus covers approxi-
mately 44% of the entire disc volume. A thickness of
0.5 mm was assumed for the bony end-plates and the
cartilaginous end-plates. The FE model of L3-L4 ver-
tebrae with IVD is shown in Figure 1. Non-linear 3-D
contact simulation was undertaken at the articulating
facet joints, using 3-D surface-to-surface contact ele-
ments having a friction coefficient of 0.1.41 The carti-
lage layer thickness and the initial gap for the facet
joint were considered to be 0.5 and 0.1 mm, respec-
tively. Seven types of ligaments, namely anterior longi-
tudinal ligament (ALL), ligamentum flavum (LF),
posterior longitudinal ligament (PLL), inter spinous
ligament (ISL), supra spinous ligament (SSL), inter
transverse ligament (ITL) and facet capsulary ligament
(FCL), were modelled as tension members using node-
Figure 1. Finite element model of the components of intact
L3-L4 FSU.
to-node link (truss) element. The solid model was
meshed with linear four-node tetrahedral elements,
with skewness values ranging between 0.25 and 0.95.
The aspect ratios of elements ranged between 1 and 3,
and there were no distorted elements. The FE analysis
was carried out in ANSYS software v15 (ANSYS, Inc.,
PA, USA).
The material properties of the FE model were
assumed to be linear elastic and isotropic, as presented
in Table 1. The cancellous bone material properties
were calibrated with the pixel-grey value of the CT-
scan dataset, using a linear relationship between the
apparent bone density (r in g cm23) and CT number in
HU, given by
r = 0:022 + 0:00124HU ð1Þ
This linear relationship was derived using the CT num-
ber of water, that is, 0, which corresponds to a bone
density of 0.022 g cm23 and the highest CT number of
cortical bone, 1341 corresponding to the highest corti-
cal bone density of 1.73 g cm23. Any negative CT value
was assigned 0 HU, which represented no bone condi-
tion. The elastic modulus (E in MPa) was obtained by
4 Proc IMechE Part H: J Engineering in Medicine 00(0)

Table 1. Material properties used in the finite element models of intact and implanted lumbar spine.

Components Elastic Poisson’s Cross-sectional References

modulus ratio area (mm2)
(MPa)

Cortical bone 12,000 0.3 –

Bony endplates 12,000 0.3 – (Ayturk and Puttlitz,1
Cartilaginous end-plates 23.8 0.4 – Kang et al.,5 Goel et al.,9 and Zhang et al.60)
Nucleus pulposus 1 0.45 –
Ground substance 9 0.4 –
Ligaments
Anterior longitudinal 20 0.4 63.7
Posterior longitudinal 20 0.4 20
Ligamentum flavum 19.5 0.4 40
Inter transverse 58.7 0.4 3.6 (Zhong et al.50and Zhang et al.60)
Capsular 32.9 0.4 60
Inter spinous 11.6 0.4 40
Supra spinous 15 0.4 30
Cage (titanium)
Pedicle screws 110,000 0.3
(titanium alloy)

using the following apparent density and modulus rela-
tionship by Morgan et al.42
E = 4730r1:56
A public domain software Bonemat v2.0 was used to
allocate heterogeneous cancellous bone material prop-
erties in the FE model.43–45
Implanted model
The implanted model was virtually developed following
the surgical technique of transforaminal lumbar inter-
body fusion (TLIF). In order to simulate the procedure,
discectomy with unilateral total facetectomy was per-
formed. The disc, end-plates and the left facets were
removed along with the ligamental flavum. Cage made
of titanium (Ardisä, Zimmer Biomet, Warsaw, IN,
USA, 26 3 11 3 8 mm) was placed at the L3-L4 disc
space, through a postero-lateral window of the annulus
fibrosus, and augmented with pedicle screws (Figure
2(d)–(f)). From structural point-of-view, the L3-L4 seg-
ment has the maximum curvature, wherein disc bulging
may be a problem.46 The Ti-alloy pedicle screws and
rods were modelled following the EXPEDIUM system
(Depuy Synthes Spine, Inc., Raynham, MA). Pedicle
screws of 6.5 mm diameter were inserted with an inward
inclination angle of 15° towards the mid-sagittal plane.
The contact between the cage and the vertebrae was
assumed to be fully bonded, to represent the bony
fusion process. The FE models (L1-L5) of the intact
and implanted spine contained 705,623 and 675,358 ele-
ments, respectively (Figure 2(a) and (d)). The mesh size
was determined using a convergence study, presented
later.
Submodelling technique
The overall lumbar spine (L1-L5) models of intact and
implanted spinal units, corresponding to applied load-
ð2Þ
ing and boundary conditions, served as a reference
solution. The purpose of using a submodel, with a finer
mesh size, was to focus our investigation in the FSU
L3-L4 segment. The submodels of the intact and
implanted FSUs contained 577,488 and 528,653 ele-
ments, respectively (Figure 2(b) and (e)). The elastic
behaviour of the whole lumbar spine can be effectively
incorporated in the submodel of FSU L3-L4. The effect
of the forces and moments acting on the vertebrae
and IVD’s attached to the L3-L4 segment cannot be
ignored. In order to fulfil these two objectives, a link
between the FSU submodel and the full reference
model was established by transferring the nodal displa-
cements at the cut-boundaries of the reference model to
the submodel.44,45,47 Stress distributions at the cut-
boundaries of FSU submodel were compared with
those of the reference solution to assess the validity of
submodelling technique.
Loading and boundary conditions
Two different sets of loading and boundary conditions
were applied on the intact and implanted L3-L4 FSU
models. In the cases of intact and implanted FSU mod-
els with artificial (fixed) constraints, the nodes located
on the superior surface of L3 vertebra were specified as
the slave nodes, whereas a master node was created to
connect all the slave nodes. A rigid coupling was
defined between the slave nodes and the master nodes
so that the slave nodes move similar to the master
node. A massless element MASS21 was defined at the
master node, in order to provide rotational DOF. In
Talukdar et al. 5

Figure 2. FE models of lumbar spine with variations in loading and boundary conditions: (a) intact full model, (b) intact FSU
submodel with prescribed displacements, (c) intact FSU with artificial constraints, (d) implanted full model, (e) implanted FSU
submodel with prescribed displacements and (f) implanted FSU with artificial constraints.

this study, a maximum possible compressive preload of
150 N along with moments were applied on the super-
ior surface of the vertebra, without causing spinal
injury.41,48–50 The loading condition was achieved in
two sequential steps. First, a 150 N preload was applied
on the master node. Subsequently, a moment of 10 N-
m was applied to simulate flexion, extension, lateral
bending and torsion. The nodes located on the inferior
surface of L4 vertebra were fully constrained.41,48–50
For the intact and implanted FSU submodel, displa-
cements were prescribed at the nodes located on the
superior surface of L3 vertebrae and inferior surface of
L4 vertebrae, described earlier (Section 2.3). The displa-
cement values of the nodes at the cut-boundaries were
obtained for each load step from the reference model of
the lumbar spine (L1-L5).
Verification and validation of FE model
The mesh size in the FE model was determined using a
convergence study by comparing the results of von-
Mises stress of cortical and cancellous region of L3 ver-
tebrae and L3-L4 intervertebral disc pressure (IDP).
The components were meshed with different element
size varying from 0.25 to 1.25 mm, 0.5 to 1.5 mm and 1
to 2.5 mm that corresponds to model A, model B and
model C, respectively. The superior surface of L3 ver-
tebrae was loaded with different compressive loads
varying between 100 and 500 N.51 The percentage dif-
ference in von-Mises stress and IDP between model A
and B and model B and C subjected to pure compres-
sive loads is presented in Figure 3. A comparison
between the Model A (615,731 elements) and Model B
(577,488 elements) revealed a 1.87% deviation in von
6 Proc IMechE Part H: J Engineering in Medicine 00(0)

Figure 3. Percentage difference in Von Mises stress and IDP between models with variation in total number of elements (Models A,
B, C) subject to axial compression.

Figure 4. Comparison of FE predicted results with earlier studies: (a) RoM of the L1-L5 full model and (b) RoM of the L3-L4 FSU
model.

Mises stress of cancellous region and 11.46% deviation
between the models B and C (409,989 elements). The
difference in IDP was 4.85% between model A and B
and 21.2% between model B and C. Hence the Model
B (577,488 elements), having element size ranging
between 0.5 and 1.5 mm, was chosen for the study.
Indirect validation was used in this study to test the
validity of FE predicted results. Direct one-to-one
experimental validation approach was not possible,
since the CT-scan dataset belonged to a living subject.
The RoM of the full L1-L5 intact model and L3-L4
FSU model, subjected to applied forces and moments,
were validated with previous in vitro cadaveric tests
and numerical studies (Figure 4(a) and (b)). The RoM
is calculated as the angular deformation corresponding
to static loading conditions during different physiologic
movements. The total RoM for the full L1-L5 model
was found to be 13.92° for flexion, 11.25° for extension,
14° for lateral bending and 16° for torsional movement.
Whereas for the L3-L4 FSU model, the RoM was
calculated as 3.4° in flexion, 3.3° in extension, 3.2° in
lateral bending and 2.3° in torsion.41,48,49 The predicted
values RoM of the current FE models were well com-
parable with those reported earlier,41,48,49 which serves
as a validation for the numerically predicted results of
this study.
The von-Mises yield criterion (stresses and strains)
has frequently been used for vertebral trabecular
bone.28,32,52 Whilst load transfer and strength is most
commonly expressed in terms of stress, the strain based
descriptions may be more mathematically simple and
statistically powerful for human trabecular bone.53–57
Results
The results of the FE analysis of spinal units, corre-
sponding to different load cases, are presented sequen-
tially. The deviations in RoM owing to implantation,
and strain distribution in the intact vertebrae have been
reported. Thereafter, comparison of the equivalent
Talukdar et al.
Figure 5. Percentage reduction in RoM of the implanted model
as compared to the intact model.
stresses in spinal models has been presented to evaluate
load transfer in the intact and implanted lumbar spinal
units.
Range of motion of the implanted model
The decrease in RoM of the full implanted model (L1-
L5) and the surgical segment (L3-L4) subjected to com-
bined loading of forces and moments is shown in
Figure 5. The percentage reduction in RoM as com-
pared to the intact model was found to be 66% in flex-
ion, 49% in extension, 55% in lateral bending and
41% in torsion. However, the RoM in the surgical seg-
ment L3-L4 reduced by more than 85% for all physio-
logic movements. The reduction in RoM was 91.7% in
flexion, 89% in extension, 90% in lateral bending and
85.2% in torsion, owing to implantation.
Strain distribution in the intact model
The equivalent strain distributions, corresponding to a
compressive load of 500N, for the FSU submodel L3-
L4 vertebrae and cancellous region are shown in Figure
6. Localised high equivalent strains of 500–650 me were
observed adjacent to the base of the pedicle region in
both the vertebrae and cancellous region. The anterior
part of the vertebrae, which carries the maximum load,
experienced high strains of 200–450 me as compared to
the posterior part of the vertebrae. Strains were low in
the range of 1–50 me in the transverse process, around
the lamina and articulating surface of the vertebrae.
The cancellous region exhibited similar trends with
strains ranging between 200 and 400 me in the vertebral
body and pedicles.
Stress distribution in the intact model
The equivalent (von Mises) stress distribution in the
vertebral bodies and cancellous regions for the intact
7
Figure 6. Equivalent strain distribution in the L3-L4 FSU: (a)
L3-L4 vertebral body and (b) L3-L4 cancellous region,
corresponding to 500 N compressive load. Area of high strain is
encircled.
FSU model and FSU submodel for flexion and exten-
sion movements is shown in Figure 7. The stress pat-
terns were more or less similar in both the models
corresponding to different movements; for brevity stress
distribution during flexion and extension is presented.
However, high stresses of 25–30 MPa were observed in
the FSU model adjacent to the area of the applied load
as compared to the FSU submodel. The increase in
equivalent stress was 17.7% for flexion, 74% for exten-
sion, 192% for lateral bending and 11.42% for torsion
for the FSU model in comparison to the FSU submo-
del. The cancellous region exhibited a similar trend,
with a greater increase in stress as compared to the
stresses in the vertebral bodies. The increase in stress
was 261.4% for flexion, 288% for extension, 204% for
lateral bending and 132.7% for torsion in the FSU
model.
Stress distribution in the implanted models
There is hardly any difference in the equivalent stress
distribution within the cage between the implanted
FSU model and the implanted FSU submodel. The dif-
ference in stresses varied between 2% and 14% corre-
sponding to different physiologic movements. However,
a notable difference was observed in the stress distribu-
tion in the L3 pedicle screws and the cancellous region,
adjacent to the pedicle screws between the two
implanted models, as depicted in Figure 8. Stresses in
the pedicle screw were high in the FSU model, ranging
between 24 and 42 MPa, as compared to lower stresses
(0.1–24 MPa) in the FSU submodel. The cancellous
region around the pedicle screws of the FSU model was
subjected to higher stresses ranging between 2 and
15 MPa, as compared to lower range of stresses (0.1–
1 MPa) in the FSU submodel. These results indicate
that the FSU submodel, with prescribed displacements
at the cut-boundaries, is better suited to evaluate load
transfer in the intact and implanted FSUs.
8 Proc IMechE Part H: J Engineering in Medicine 00(0)

Figure 7. Equivalent stress distribution of the FSU model and FSU submodel during flexion and extension movement in:
(a) L3-L4 vertebrae and (b) L3-L4 cancellous region. Area of high stress is encircled.

Figure 8. Equivalent stress distribution in the implanted L3 vertebral body and top pedicle screws in the (a) FSU model and
(b) FSU submodel. A sagittal sectional view through the cancellous bone of L3 vertebrae is plotted and areas of difference
in stresses are encircled.

The changes in equivalent (von Mises) stress distri-
bution within the FSU submodel, owing to the inser-
tion of the interbody cage, during different physiologic
movements are presented as sectional (mid-sagittal)
plots in Figure 9. In the intact FSU submodel, these
stresses varied between 0.1 and 20 MPa with high
equivalent stresses of 6–20 MPa in the pars
interarticularis and base of pedicle region (Figure 9).
Following cage insertion, high stresses in the range of
1–15 MPa was generated in the cancellous bone around
the cage. The increase in maximum equivalent stresses
within the vertebrae varied between 14% and 65%,
depending on the physiologic movements; the more
pronounced changes were observed for lateral bending
Talukdar et al.
Figure 9. A sectional (A-A) view of the equivalent (Von Mises)
stress distribution in the intact and implanted L3-L4 FSU
submodel during flexion, extension, lateral bending and torsion.
and torsion. In comparison, the stresses around the
pedicle and pars interarticularis were reduced to a max-
imum of ;10 MPa for all movements. Within the cage,
a maximum stress of 172 MPa was generated during
torsion, which is however, far below the strength of
titanium alloy. It is evident from Figure 9 that high
stresses in the range of 5–15 MPa were evoked in the
cancellous bone region of the implanted FSU during
lateral bending and torsional movements. However,
there were hardly any changes in stress distributions
within the vertebrae due to insertion of the pedicle
screws (Figure 8(b)).
Discussion
The study sought to develop an improved 3-D detailed
FE model of the lumbar spinal unit that could be useful
to evaluate the stresses and strains in intact condition
and to determine the deviations in load transfer owing
to implantation. It appears from earlier studies that
loading and boundary conditions have a considerable
effect on stresses and strains of the lumbar FSU.58,59 In
this study a novel methodology, using the submodelling
technique, has been employed to determine the differ-
ences in load transfer quantitatively, due to the pre-
scription of artificial constraints.
9
The trends of RoMs in the intact L1-L5 full model
and L3-L4 FSU model were found to be in agreement
with those reported earlier.41,48,49 The deviations in the
predicted RoMs were found to be less in the range of
3%–29% during all movements.41,48 However, this
deviation was restricted to a maximum of 43% when
compared to the in vitro study by Yamamoto et al.49
The specimen used in the in vitro test was from an aged
cadaver that revealed disc degeneration. Hence, lesser
stiffness and stability as compared to a younger spine
model might be the reason behind deviations in RoM.
Despite deviations in RoM owing to differences in
subject-specific data, the present model was found to
be a valid predictor of the mechanical behaviour of the
lumbar spine. The RoM for the full implanted model
after the insertion of cage was reduced by more than
50% for all physiologic movements, except torsion, for
which the reduction was 41%. The RoM at the surgical
segment decreased by more than 85% for all move-
ments. These results were consistent with the findings
of Zhang et al.60
The equivalent strain distribution in the L3-L4 FSU
submodel ranged between 200 and 400 me in the verteb-
ral body, corresponding to a compressive load of
500 N. Peak strains of 500–650 me were observed near
the base of the pedicle region, whereas the strains (1–
50 me) were low at the posterior region around the
lamina and transverse process.61 These results were well
below the mean compressive yield strain of 0.70%
6 0.06% for vertebrae (Morgan and Keaveny).53 The
stress distribution in the vertebrae for the intact models
during different physiologic movements, were similar to
those reported in earlier studies.62,63 The generation of
high equivalent stress of 6–20 MPa in the pars interarti-
cularis and the base of the pedicle region, and low stres-
ses in the posterior region corroborated with earlier
studies.63,64 The segmentation of the full vertebrae into
cortical and cancellous bone regions, helped to gain an
insight into the stress-strain distribution in the cancel-
lous bone region of the posterior part, wherein the
equivalent stresses varied between 0.1 and 5 MPa
(Figure 7(b)). It can also be observed that high stresses
in the range of 10–25 MPa and 1–5 MPa were generated
in and around the pars interarticularis for the cortical
and cancellous bone regions, respectively. The bending
moment generated in vivo in the lamina by the down-
ward force of the superior articular process is balanced
out by the upward force of the inferior articular pro-
cess, leaving the pars interarticularis more stressed and
prone to fracture.65
A follower load technique, representing the stabilisa-
tion of muscle force and upper body weight, has been
mostly employed for a high compressive load of 400 to
2800 N that follows the spine curvature without causing
any instability or artefact moments.36,52,66,67 The study
by Patwardhan et al.67 revealed that the RoM was
significantly affected for preloads of 400 N and higher
magnitudes. However, the optimised path of follower
10
preload had significant influence on the RoM for pre-
loads greater than 800 N. It seems therefore, the fol-
lower load technique is more appropriate for high
compressive preloads of 400 N and larger magnitudes.
For monosegment and FSUs, preload was applied
since the load acts close to the spine curvature.68 In this
study, a maximum possible compressive preload of
150 N was applied on the superior surface of the verteb-
rae along with moments, without causing spinal
injury.39,48,50 The loading and boundary conditions
were based on an in vitro experiment, wherein muscle
loads, abdominal loads and pelvis movement were not
considered.49
The applied loading and boundary conditions used
in the FE models, were found to have a considerable
effect on the stress distribution in the vertebrae.
Notable differences in equivalent stress distributions
were observed between the intact FSU model and FSU
submodel. Application of loads (forces and moments)
on the superior surface of the L3 vertebrae generated
stress concentration in the superior periosteal surface
of the vertebrae. A similar trend, yet more significant,
was observed in the stress distribution of the cancellous
region for the FSU model. The increase in stress near
the applied loads was as high as 288% for extension in
the cancellous region. High stresses of 14 MPa in the
cancellous bone and 30 MPa in the cortical bone were
observed for the FSU model, which appears to be an
overestimation. The implanted models also exhibited
similar trends. The top pedicle screws and the vertebral
cancellous bone around the top pedicle screw of FSU
model, which were in close proximity to the load appli-
cation area, exhibited higher stress (3–15 MPa) as com-
pared to the FSU submodel as presented in Figure 8.
However, for the two implanted models, there were
hardly any differences in the stresses generated within
the cage, which was located at a sufficient distance
from the load application points.
Insertion of intervertebral cage in the lumbar FSU
evoked considerable alteration of the load transfer in
the vertebrae. Before insertion, the load was predomi-
nantly transferred through the regions around pedicles,
pars interarticularis and the cortex of the vertebral
body, leaving the inner cancellous core at a relatively
low range of stresses, less than 1 MPa (Figure 9). After
insertion of the cage, high stresses were observed within
the cages and the core vertebral cancellous bone. In
contrast, the stresses were relatively low around the
pedicle and pars interarticularis as compared to the
intact model for all movements (Figure 9). Similar
increase in stresses within the vertebra was observed by
Polikeit et al.33 who remarked, the denser the cancel-
lous bone, the more pronounced was the effect of stress
concentration in the bone underneath the cage, while
the remaining region remained unloaded. During lat-
eral bending and torsional movements, the cancellous
bone around the cage experienced pronounced increase
in stresses of 10–15 MPa. These high stresses, generated
even during normal physiologic loading, indicated
Proc IMechE Part H: J Engineering in Medicine 00(0)
potential risk of failure initiation in local bone.32
Moreover, the marked deviations in load transfer
might trigger bone remodelling, thereby leading to
structural changes in a vertebra.
The study, however, has the following limitations. A
constant thickness of 0.5 mm was assumed for the corti-
cal layer in the anterior vertebrae, whereas the mean
thickness of the cortical layer varies from 0.40 to
0.86 mm.69 A thickness less than the image pixel size
(0.684 mm) could not be measured from the CT-scan
dataset. Although the material behaviour of IVD is
non-linear and viscoelastic, with collagen fibres in
annulus fibrosus, linear elastic material properties have
been assumed.1,60 A comparative study with a basic lin-
ear model (IVD modelled as linear elastic) and non-
linear model (IVD modelled as non-linear) has found
no significant differences between the two models.70 It
was further concluded that this might be the reason
why some researchers employed linear parameters in
their FE spine model and were able to validate their
model with experimental data.70 Since stress analysis of
the associated ligaments is not the objective, ligaments
have been modelled as tension members with linear
elastic properties to account for the transfer of loads
for the static analysis of the FSU.48,60 Bone material
property was assumed to be isotropic. It was reported
that the vertebral cancellous core has a non-uniform
bone mineral distribution over the trabecular cross-sec-
tion, which requires a high spatial resolution to evalu-
ate the degree of mineralisation and anisotropic
material properties.24 Moreover anisotropy of trabecu-
lar bone is relatively weak in lumbar spine, hence it is
less likely to have any appreciable effect in the stress
distribution.23 The present model is based on a CT-scan
dataset of a healthy lumbar spine (31-year-old male
subject), wherein the effect of anisotropy or orthotropic
is assumed to be less prevalent. An improved FE model
for the vertebrae has been developed, which was based
on a single CT-scan dataset. A multi-spine analysis,
reflecting inter-patient variability in bone density distri-
bution, would have been more useful in drawing gen-
eral conclusions on load transfer in a vertebra. Despite
these limitations, the modelling technique and analysis
have been useful in the quantitative evaluation of the
mechanical behaviour of a patient-specific vertebrae
and deviations in load transfer owing to implantation.
Conclusions
An improved FE model of the vertebrae was developed
that was useful in detailed understanding of the load
transfer in an intact and implanted FSU. It appeared
from this study that the loading and boundary condi-
tions have considerable effect on the stress-strain distri-
butions in the vertebrae. The study highlights the
importance of using the submodelling technique to ade-
quately evaluate the elastic behaviour of the intact and
implanted FSUs (with posterior instrumentation).
Talukdar et al.
Insertion of the intervertebral cage resulted in major
deviations in load transfer across a FSU for all move-
ments. A pronounced increase of stress was concen-
trated in the vertebral cancellous bone adjacent to the
cage during physiologic loading, which indicated poten-
tial risk of failure initiation in local bone within a
vertebra.
Acknowledgements
The authors wish to thank Indian Institute of
Technology, Kharagpur for supporting this study.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest
with respect to the research, authorship, and/or publi-
cation of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this article.
ORCID iD
Sanjay Gupta https://orcid.org/0000-0003-0745-1448
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