Passive Stiffness Characteristics of the Scoliotic Lumbar Torso in Trunk Flexion, Extension, Lateral bending, and Axial Rotation

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Virginia Tech

As the average American age increases, there is a need to study the spine biomechanics of adults with scoliosis. Most studies examining the mechanics of scoliosis have focused on in vitro testing or computer simulations, but in vivo testing of the mechanical response of a scoliotic spine has not yet been reported. The purpose of this study was to quantitatively define the passive stiffness properties of the in vivo scoliotic spine in three principle anatomical motions and identify differences relative to healthy controls.

Scoliotic (n=14) and control (n=17) participants with no history of spondylolisthesis, spinal fracture, or spinal surgery participated in three different tests (torso lateral side bending, torso axial rotation, and torso flexion/extension) that isolated mobility to the in vivo lumbar spine. Scoliotic individuals with Cobb angles ranging 15-75 degrees were accepted. Applied torque was measured using a uni-directional load cell, and inertial measurement units (IMU) recorded angular displacement of the upper torso relative to the pelvis and lower extremities. Torque-rotational displacement data were fit using a double sigmoid function, resulting in excellent overall fit (R2 > 0.901). The neutral zone (NZ) width, or the range of motion where there is minimal internal resistance, was then calculated. Stiffnesses within the NZ and outside of the NZ were also calculated. Stiffness asymmetries were also computed within each trial. These parameters were statistically compared between factor of population and within factor of direction.

There was an interaction effect between populations when comparing axial twist NZ width and lateral bend NZ width. The lateral bend NZ width magnitude was significantly smaller in scoliotic patients. NZ stiffness in the all three directions was greater in the scoliotic population. There was no significant difference in asymmetrical stiffness between populations.

The present study is the first investigation to quantify the in vivo neutral zone and related mechanics of the scoliotic lumbar spine. Future research is needed to determine if the measured lumbar spine mechanical characteristics can help explain progression of scoliosis and complement scoliosis classification systems.

Scoliosis, Stiffness, Neutral Zone