• Hendrik Schmidt, Annette Kettler, Frank Heuer, Ulrich Simon, Lutz Claes, and Hans-Joachim Wilke.
• Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.
• Spine. 2007 Apr 1; 32 (7): 748-55.

Study DesignFinite element study.ObjectiveTo investigate intradiscal pressure, shear strain between anulus and adjacent endplates, and fiber strain in the anulus under pure and combined moments.Summary Of Background DataConcerning anulus failures such as fissures and disc prolapses, the mechanical response of the intervertebral disc during combined load situations is still not well understood.MethodsA 3-dimensional, nonlinear finite element model of a lumbar spinal segment L4-L5 was used. Pure unconstraint moments of 7.5 Nm in all anatomic planes with and without an axial preload of 500 N were applied to the upper vertebral body. The load direction was incrementally changed with an angle of 15 degrees between the 3 anatomic planes to realize not only moments in the principle motion planes but also moment combinations.ResultsIntradiscal pressure was highest in flexion and lowest in lateral bending. Load combinations did not increase the pressure. A combination of lateral bending plus flexion or lateral bending plus extension strongly increased the maximum shear strains. Lateral bending plus axial rotation yielded the highest increase in fiber strains, followed by axial rotation plus flexion or axial rotation plus extension. The highest shear and fiber strains were both located posterolaterally. An additional axial preload tended to increase the pressure, the shear, and fiber strains essentially for all load scenarios.ConclusionsCombined moments seem to lead to higher stresses in the disc, especially posterolaterally. This region might be more susceptible to disc failure and prolapses. These results may help clinicians better understand the mechanical causes of disc prolapses and may also be valuable in developing preventive clinical strategies and postoperative treatments.

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