Lumbar Facet Loads During Physiological Range of Motion

Goel VK, Yap MC, Shaw MN, Vishnubhotla S, Felon L, Faizan A Spine Research Center, University of Toledo, Medical University of Ohio, Toledo, OH Facet Solutions, Inc. Logan, UT
INTRODUCTION Motion preserving spinal implant technologies have emerged as attractive alternatives to fusion in the treatment of degenerative lumbar conditions. These new technologies allow surgeons to treat a patients pain while providing benefits over contemporary methods of treatment. The development of facet joint replacements in the spine requires basic research as a foundation for its design and evaluation. Among the many considerations that enter into the development of a facet joint replacement system is an understanding of the loading conditions within the facet joint itself. Both experimental and finite element model analysis facet load data have been reported. The reported facet loads and finite element analyses in the literature1-10 focus on data resulting from loading conditions up to and including maximum physiological bending moments (10Nm)2 and axial preload applications (400N)3. The study of facet joint loads is essential for the determination and justification of appropriate parameters for pre-clinical safety and effectiveness testing of facet joint replacement implants. METHODS A 3-dimensional, non-linear, ligamentous, experimentally validated, finite element model of the L3-S1 segment shown in Figure 1 was used to determine the facet loads at L3/4, L4/5, and L5/S1. The details of the model are as follows. The L3-S1 intact model consists of 31,054 elements, 38,664 nodes, and is symmetric about the mid-sagittal plane (Figure 1). Model dimensions were obtained from computer tomography (CT) scans (transverse sections of 1.5 mm thickness) of a healthy, deformity free cadaveric spine. A lordotic curve of approximately 8 was simulated at the L3-L5 level. The model was constructed and analyzed with the commercial software package ABAQUS 6.4. The intact L3-L5 model was validated at The University of Toledo, Spine Research Center against the in vitro cadaver test data11,12. The vertebral bodies and posterior bone was defined as a cancellous bone core surrounded by a 0.5mm thick cortical bone shell (Table 1). All of the bony elements were constructed with a threedimensional hexagonal element (C3D8). A C3D8 element is defined using eight nodes with each node possessing three degrees of freedom. Anatomically, the inferior and superior facets contain a thin cartilaginous layer lining the articular surface. This thin layer was simulated with three dimensional gap contact elements (GAPUNI). These elements transfer force along a single direction as a specified gap closes between nodes. An initial gap of 0.5mm was assumed based on CT images of cadaveric specimens. The thin cartilaginous layer was simulated with ABAQUSs softened contact parameter which adjusts force transfer between nodes exponentially, depending on the gap size. Upon full closure of the gap, the stiffness of the joint assumed the same stiffness as the surrounding bone. The lumbar facet joints are oriented at an inclination of 72 from horizontal, determined from several CT images. The intervetebral disc was modeled as a composite of a solid matrix with embedded fibers in concentric rings around a pseudofluid nucleus. Seven concentric rings of ground substance about the nucleus each contained two evenly spaced layers of fibers (plus one ground substance ring with one layer of fibers) oriented at 30 to the horizontal. The fibers were defined via the REBAR command. It was assumed that an overall collagenous fiber content of 16% of the annular volume was distributed amongst the seven layers. The fiber thickness and stiffness increased in the radial direction and is shown in Table 1. A no compression option was defined for the annulus fibers so that the fibers resist tension only. The hydrostatic properties of the nucleus were simulated with hexagonal C3D8 elements assigned low stiffness (1MPa) values and near incompressibility (Poissons ratio is 0.4999). All seven major ligaments were represented in the intact spine model. These ligaments are as follows: anterior longitudinal, posterior longitudinal, intertransverse, ligamentum flavum, interspinous, supraspinous, and capsular. The ligaments were modeled as three dimensional, two node truss elements (T3D2) and assigned nonlinear material properties such that at initially low strains, the ligaments exhibit low stiffness, but as the strains increase the ligament stiffness increases. This material property was simulated using the hypoelastic material designation which allows the axial stiffness to be a function of axial strain. The material properties as well as cross-sectional areas of the ligaments are given in Table 1 and were chosen based on literature. The models ligament elements were aligned in the direction of anatomical fiber orientation. Material properties defined in the above mentioned model are summarized in Table 1. The model material properties were assumed to be isotropic and homogenous. The ligament material properties were nonlinear and hypoelastic. The inferior most nodes of S1 were fully constrained in all directions allowing unconstrained motion of all superior elements. These nodes included the S1 vertebral body and posterior elements. Compressive loads were equally distributed amongst the superior most nodes of the L3 vertebral body simulating physiological spinal loading conditions. The compressive loads were applied normal to the vertebral body throughout analysis, thus the load acted as a follower load. Loads of 400N and 1200N were applied to predict facet loads under axial compression. A compressive load of 400N was also applied for analysis along with 10 Nm of moment. This model was used to predict facet loads in extension, lateral bending and axial rotation modes. RESULTS The total load transmitted across one facet as well as its components along the three axes in axial compression, extension, lateral bending and axial rotation are shown in Table 2. The x, y, z, directions are shown in Figure 1. The y-axis is the anteroposterior direction and z-axis the cephalad-caudal direction. DISCUSSION The finite element model study yielded facet joint loads resulting from the application of axial compressive loads and/or pure bending moments considered to be physiological maximums The model analyses show that the total load across a L5-S1 facet joint can reach 182.9N for 10 N-m of axial torque and 400 N of axial compression. As one would expect, these values are a function of the facet joint morphology, the external loads applied to the model and the material properties of the spinal elements. The anatomic based design and biomechanically accurate material properties of the finite element model along with the application of maximum physiologic loading make this data useful for developing mechanical testing criteria and design requirements for facet joint replacements.
Superior Facet Annulus Fibrosis L3 Pedicle

L3/4 Disc Nucleus Pulposus L4 Inferior Facet

L4/5 Disc Lamina L5 L5/S1 Disc S1

Spinous Process

Y X Figure 1: Intact L3-S1 finite element mesh and a midsagittal cross-section of L3-S1 lumbar spine finite element model indicating important anatomical features. X axis represents lateral (Lat), Y axis Anterior posterior (A-P) and Z axis represents axial (Ax).
Element Set Bony Regions Vertebral Cortical Bone Vertebral Cancellous Bone Posterior Cortical Bone Posterior Cancellous Bone Intervertebral Disc Annulus (Ground Substance) Annulus Fibers Nucleus Pulposus Joints Apophyseal Joints Ligaments Anterior Longitudinal Posterior Longitudinal Intertransverse Ligamentum Flavum Interspinous Supraspinous Capsular 216 144 30 21 21 9 84 T3D2 T3D2 T3D2 T3D2 T3D2 T3D2 T3D2 15.6 20.0 10.0 20.0 12.0 59.0 13.0 19.5 9.8 12.0 8.8 15.0 8.48 32.9 0.30 0.30 0.30 0.30 0.30 0.30 0.30 74 14.4 1.8 40 40 30 34 216 GAPUNI Softened, 12000 5376 2685 1920 C3D8 REBAR C3D8 1.2 357.5 - 550 1.0 0.45 0.30 0.4999 0.00601 0.00884 3312 10608 3632 1834 C3D8 C3D8 C3D8 C3D8 12000 100 12000 100 0.30 0.20 0.30 0.20 Number of Elements ABAQUS Element Library Type Modulus of Elasticity (MPa) Poissons Ratio, Cross-Sectional Area (mm2)

Table 1: Material property definitions and element types for the intact L3-S1 finite element spine model. For bilateral structures (facet joints and capsular ligaments), the total number of elements is listed12.
L3-L4 Axial Compression x(Lat) y(A-P) z (Ax) 400N 1200N Extension 0N+10Nm Lateral Bending 0N+10Nm 400N & 10Nm Axial Rotation 0N+10Nm 103.7 400N & 10Nm 109.8 78.1 82.8 62.1 143.9 103.6 65.7 152.4 114.6 78.0 86.4 62.0 143.7 111.9 68.6 159.1 131.8 84.4 99.3 67.0 155.4 78.9 182.9 32.1 48.9 24.2 36.8 19.2 29.3 44.5 67.9 30.5 43.7 23.0 32.9 18.2 26.1 42.3 60.6 44.7 62.0 33.7 46.7 26.8 37.1 62.0 86.1 93.0 70.1 82.1 55.7 129.1 93.6 70.5 83.9 56.0 129.9 66.7 154.6 83.2 92.6 62.7 69.8 49.8 115.4 55.5 128.6 400N & 10Nm 109.0 65.2 151.2 111.4 14.3 44.7 10.8 33.7 8.6 26.8 19.8 62.0 15.1 47.0 L4-L5 11.4 35.4 9.0 28.1 20.9 23.4 L5-S1 17.6 96.8 14.0 32.5 Total x(Lat) y(A-P) z (Ax) Total x(Lat) y(A-P) z (Ax) Total 65.2 128.5 77.0 178.4

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Table 2: Facet loads in newtons (N) in the x, y, and z directions for loading modes with 400N or 1200N compression load or with 10Nm bending moment and 0N or 400N compression load.