Current Medical Science

, Volume 39, Issue 1, pp 7–15 | Cite as

Application of Finite Element Analysis for Investigation of Intervertebral Disc Degeneration: from Laboratory to Clinic

  • Bin-wu Hu
  • Xiao Lv
  • Song-feng Chen
  • Zeng-wu ShaoEmail author


Due to the ethical concern and inability to detect inner stress distributions of intervertebral disc (IVD), traditional methods for investigation of intervertebral disc degeneration (IVDD) have significant limitations. Many researchers have demonstrated that finite element analysis (FEA) is an effective tool for the research of IVDD. However, the specific application of FEA for investigation of IVDD has not been systematically elucidated before. In the present review, we summarize the current finite element models (FEM) used for the investigation of IVDD, including the poroelastic nonlinear FEM, diffusive-reactive theory model and cell-activity coupled mechano-electrochemical theory model. We further elaborate the use of FEA for the research of IVDD pathogenesis especially for nutrition and biomechanics associated etiology, and the biological, biomechanical and clinical influences of IVDD. In addition, the application of FEA for evaluation and exploration of various treatments for IVDD is also elucidated. We conclude that FEA is an excellent technique for research of IVDD, which could be used to explore the etiology, biology and biomechanics of IVDD. In the future, FEA may help us to achieve the goal of individualized precision therapy.

Key words

finite element analysis intervertebral disc degeneration biomechanics spine 


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  1. 1.
    Adams MA, Dolan P. Spine biomechanics. J Biomech, 2005,38(10):1972–1983Google Scholar
  2. 2.
    Choi H, Johnson ZI, Risbud MV. Understanding nucleus pulposus cell phenotype: a prerequisite for stem cell based therapies to treat intervertebral disc degeneration. Curr Stem Cell Res Ther, 2015,10(4):307–316Google Scholar
  3. 3.
    Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 2014,73(6):968–974Google Scholar
  4. 4.
    Chen S, Lv X, Hu B, et al. RIPK1/RIPK3/MLKLmediated necroptosis contributes to compressioninduced rat nucleus pulposus cells death. Apoptosis, 2017, 22(5):626–638Google Scholar
  5. 5.
    Alini M, Eisenstein SM, Ito K, et al. Are animal models useful for studying human disc disorders/degeneration? Eur Spine J, 2008,17(1):2–19Google Scholar
  6. 6.
    Gantenbein B, Illien-Jünger S, Chan S, et al. Organ Culture Bioreactors-Platforms to Study Human Intervertebral Disc Degeneration and Regenerative Therapy. Curr Stem Cell Res Ther, 2015,10(4): 339–352Google Scholar
  7. 7.
    Moon SM, Yoder JH, Wright AC, et al. Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance imaging. Eur Spine J, 2013,22(8):1820–1828Google Scholar
  8. 8.
    Miele VJ, Panjabi MM, Benzel EC. Anatomy and biomechanics of the spinal column and cord. Handb Clin Neurol, 2012,109:31–43Google Scholar
  9. 9.
    Chadderdon RC, Shimer AL, Gilbertson LG, et al. Advances in gene therapy for intervertebral disc degeneration. Spine J, 2004,4(6 Suppl):341s–347sGoogle Scholar
  10. 10.
    Fagan MJ, Julian S, Mohsen AM. Finite element analysis in spine research. Proc Inst Mech Eng H, 2002,216(5):281–298Google Scholar
  11. 11.
    Brekelmans WA, Poort HW, Slooff TJ. A new method to analyse the mechanical behaviour of skeletal parts. Acta Orthop Scand, 1972,43(5): 301–317Google Scholar
  12. 12.
    Nikkhoo M, Hsu YC, Haghpanahi M, et al. A metamodel analysis of a finite element simulation for defining poroelastic properties of intervertebral discs. Proc Inst Mech Eng H, 2013,227(6):672–682Google Scholar
  13. 13.
    Belytschko T, Kulak RF, Schultz AB, et al. Finite element stress analysis of an intervertebral disc. J Biomec, 1974,7(3):277–285Google Scholar
  14. 14.
    Malandrino A, Noailly J, Lacroix D. The effect of sustained compression on oxygen metabolic transport in the intervertebral disc decreases with degenerative changes. PLoS Comput Biol, 2011,7(8): e1002112Google Scholar
  15. 15.
    Song C, Li XF, Liu ZD, et al. Biomechanical assessment of a novel L4/5 level interspinous implant using three dimensional finite element analysis. Eur Rev Med Pharmacol Sci, 2014,18(1): 86–94Google Scholar
  16. 16.
    Tang S. Does TLIF aggravate adjacent segmental degeneration more adversely than ALIF? A finite element study. Turk Neurosurg, 2012,22(3):324–328Google Scholar
  17. 17.
    Travascio F, Elmasry S, Asfour S. Modeling the role of IGF-1 on extracellular matrix biosynthesis and cellularity in intervertebral disc. J Biomech, 2014, 47(10):2269–2276Google Scholar
  18. 18.
    Ibarz E, Herrera A, Mas Y, et al. Development and kinematic verification of a finite element model for the lumbar spine: application to disc degeneration. Acta Bioeng Biomech, 2013,2013:705185Google Scholar
  19. 19.
    Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model. Med Eng Phys, 2012, 34(5):552–558Google Scholar
  20. 20.
    Zhu Q, Gao X, Levene HB, et al. Influences of Nutrition Supply and Pathways on the Degenerative Patterns in Human Intervertebral Disc. Spine, 2016,41(7): 568–576Google Scholar
  21. 21.
    Natarajan RN, Williams JR, Andersson GB. Modeling changes in intervertebral disc mechanics with degeneration. J Bone Joint Surg Am, 2006, 88(Suppl 2):36–40Google Scholar
  22. 22.
    Massey CJ, van Donkelaar CC, Vresilovic E, et al. Effects of aging and degeneration on the human intervertebral disc during the diurnal cycle: a finite element study. J Orthop Res, 2012,30(1):122–128Google Scholar
  23. 23.
    Qasim M, Natarajan RN, An HS, et al. Damage accumulation location under cyclic loading in the lumbar disc shifts from inner annulus lamellae to peripheral annulus with increasing disc degeneration. J Biomech, 2014,47(1): 24–31Google Scholar
  24. 24.
    von Forell GA, Stephens TK, Samartzis D, et al. Low Back Pain: A Biomechanical Rationale Based on "Patterns" of Disc Degeneration. Spine, 2015, 40(15):1165–1172Google Scholar
  25. 25.
    Wu Y, Wang Y, Wu J, et al. Study of Double-level Degeneration of Lower Lumbar Spines by Finite Element Model. World Neurosurg, 2016, 86:294–299Google Scholar
  26. 26.
    Tang S, Rebholz BJ. Does anterior lumbar interbody fusion promote adjacent degeneration in degenerative disc disease? A finite element study. J Orthop Sci, 2011,16(2):221–228Google Scholar
  27. 27.
    Hussain M, Natarajan RN, An HS, et al. Reduction in segmental flexibility because of disc degeneration is accompanied by higher changes in facet loads than changes in disc pressure: a poroelastic C5-C6 finite element investigation. Spine J, 2010,10(12):1069–1077Google Scholar
  28. 28.
    Ellingson AM, Shaw MN, Giambini H, et al. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin, 2016,19(9):1009–1018Google Scholar
  29. 29.
    Schmidt H, Galbusera F, Rohlmann A, et al. Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: a finite element analysis. Eur Spine J, 2012, 21(Suppl 5):S663–S674Google Scholar
  30. 30.
    Little JP, Adam CJ, Evans JH, et al. Nonlinear finite element analysis of anular lesions in the L4/5 intervertebral disc. J Biomech, 2007,40(12):2744–2751Google Scholar
  31. 31.
    Homminga J, Aquarius R, Bulsink VE, et al. Can vertebral density changes be explained by intervertebral disc degeneration? Med Eng Phys, 2012,34(4): 453–458Google Scholar
  32. 32.
    Elmasry S, Asfour S, de Rivero Vaccari JP, et al. Effects of Tobacco Smoking on the Degeneration of the Intervertebral Disc: A Finite Element Study. PLoS One, 2015,10(8): e0136137Google Scholar
  33. 33.
    Han I, Ropper AE, Konya D, et al. Biological Approaches to Treating Intervertebral Disk Degeneration: Devising Stem Cell Therapies. Cell Transplantation, 2015,24(11): 2197–2208Google Scholar
  34. 34.
    Asfour S, Travascio F, Elmasry S, et al. A computational analysis on the implications of age-related changes in the expression of cellular signals on the role of IGF-1 in intervertebral disc homeostasis. J Biomech, 2015,48(2): 332–339Google Scholar
  35. 35.
    Zhu Q, Gao X, Gu W. Temporal changes of mechanical signals and extracellular composition in human intervertebral disc during degenerative progression. J Biomech, 2014,47(15):3734–3743Google Scholar
  36. 36.
    Zhu Q, Jackson AR, Gu WY. Cell viability in intervertebral disc under various nutritional and dynamic loading conditions: 3d finite element analysis. J Biomech, 2012,45(16):2769–2777Google Scholar
  37. 37.
    Jackson AR, Huang CY, Brown MD, et al. 3D finite element analysis of nutrient distributions and cell viability in the intervertebral disc: effects of deformation and degeneration. J Biomech Eng, 2011,133(9):091006Google Scholar
  38. 38.
    Zhu Q, Gao X, Brown MD, et al. Simulation of water content distributions in degenerated human intervertebral discs. J Orthop Res, 2017,35(1):147–153Google Scholar
  39. 39.
    Chagnon A, Aubin CE, Villemure I. Biomechanical influence of disk properties on the load transfer of healthy and degenerated disks using a poroelastic finite element model. J Biomech Eng, 2010,132(11):111006Google Scholar
  40. 40.
    Galbusera F, Schmidt H, Neidlinger-Wilke C, et al. The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models. Eur Spine J, 2011,20(4):563–571Google Scholar
  41. 41.
    Huang CY, Travascio F, Gu WY. Quantitative analysis of exogenous IGF-1 administration of intervertebral disc through intradiscal injection. J Biomech, 2012,45(7):1149–1155Google Scholar
  42. 42.
    Hussain M, Natarajan RN, An HS, et al. Motion changes in adjacent segments due to moderate and severe degeneration in C5-C6 disc: a poroelastic C3-T1 finite element model study. Spine, 2010,35(9): 939–947Google Scholar
  43. 43.
    Gu W, Zhu Q, Gao X, et al. Simulation of the progression of intervertebral disc degeneration due to decreased nutritional supply. Spine, 2014,39(24): E1411–E1417Google Scholar
  44. 44.
    Smith LJ, Nerurkar NL, Choi KS, et al. Degeneration and regeneration of the intervertebral disc: lessons from development. Dis Model Mech, 2011,4(1): 31–41Google Scholar
  45. 45.
    Huang CY, Gu WY. Effects of mechanical compression on metabolism and distribution of oxygen and lactate in intervertebral disc. J Biomech, 2008, 41(6):1184–1196Google Scholar
  46. 46.
    Soukane DM, Shirazi-Adl A, Urban JP. Computation of coupled diffusion of oxygen, glucose and lactic acid in an intervertebral disc. J Biomech, 2007,40(12):2645–2654Google Scholar
  47. 47.
    Wu Y, Cisewski S, Sachs BL, et al. Effect of cartilage endplate on cell based disc regeneration: a finite element analysis. Mol Cell Biomech, 2013,10(2):159–182Google Scholar
  48. 48.
    Jackson AR, Huang CY, Gu WY. Effect of endplate calcification and mechanical deformation on the distribution of glucose in intervertebral disc: a 3D finite element study. Comput Methods Biomech Biomed Engin, 2011,14(2):195–204Google Scholar
  49. 49.
    Shirazi-Adl A, Taheri M, Urban JP. Analysis of cell viability in intervertebral disc: Effect of endplate permeability on cell population. J Biomech, 2010, 43(7):1330–1336Google Scholar
  50. 50.
    Malandrino A, Noailly J, Lacroix D. Numerical exploration of the combined effect of nutrient supply, tissue condition and deformation in the intervertebral disc. J Biomech, 2014,47(6):1520–1525Google Scholar
  51. 51.
    Nachemson A, Lewin T, Maroudas A, et al. In vitro diffusion of dye through the end-plates and the annulus fibrosus of human lumbar inter-vertebral discs. Acta Orthop Scand, 1970,41(6):589–607Google Scholar
  52. 52.
    DeLucca JF, Cortes DH, Jacobs NT, et al. Human cartilage endplate permeability varies with degeneration and intervertebral disc site. J Biomech, 2016,49(4): 550–557Google Scholar
  53. 53.
    Ayturk UM, Gadomski B, Schuldt D, et al. Modeling degenerative disk disease in the lumbar spine: a combined experimental, constitutive, and computational approach. J Biomech Eng, 2012,134(10):101003Google Scholar
  54. 54.
    Galbusera F, Schmidt H, Neidlinger-Wilke C, et al. The effect of degenerative morphological changes of the intervertebral disc on the lumbar spine biomechanics: a poroelastic finite element investigation. Comput Methods Biomech Biomed Engin, 2011,14(8):729–739Google Scholar
  55. 55.
    Maquer G, Schwiedrzik J, Huber G, et al. Compressive strength of elderly vertebrae is reduced by disc degeneration and additional flexion. J Mech Behav Biomed Mater, 2015,42:54–66Google Scholar
  56. 56.
    Hussain M, Natarajan RN, An HS, et al. Patterns of height changes in anterior and posterior cervical disc regions affects the contact loading at posterior facets during moderate and severe disc degeneration: a poroelastic C5-C6 finite element model study. Spine, 2010,35(18):E873–E881Google Scholar
  57. 57.
    Kim YE, Goel VK, Weinstein JN, et al. Effect of disc degeneration at one level on the adjacent level in axial mode. Spine, 1991,16(3):331–335Google Scholar
  58. 58.
    Ruberte LM, Natarajan RN, Andersson GB. Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments—a finite element model study. J Biomech, 2009,42(3):341–348Google Scholar
  59. 59.
    Lu YM, Hutton WC, Gharpuray VM. Do bending, twisting, and diurnal fluid changes in the disc affect the propensity to prolapse? A viscoelastic finite element model. Spine, 1996,21(22):2570–2579Google Scholar
  60. 60.
    von Forell GA, Nelson TG, Samartzis D, et al. Changes in vertebral strain energy correlate with increased presence of Schmorl’s nodes in multi-level lumbar disk degeneration. J Biomech Eng, 2014,136(6):061002Google Scholar
  61. 61.
    Maidhof R, Alipui DO, Rafiuddin A, et al. Emerging trends in biological therapy for intervertebral disc degeneration. Discov Med, 2012,14(79):401–411Google Scholar
  62. 62.
    Zagra A, Scaramuzzo L, Galbusera F, et al. Biomechanical and clinical study of single posterior oblique cage POLIF in the treatment of degenerative diseases of the lumbar spine. Eur Spine J, 2015, 24(Suppl 7):924–930Google Scholar
  63. 63.
    Erbulut DU, Kiapour A, Oktenoglu T, et al. A computational biomechanical investigation of posterior dynamic instrumentation: combination of dynamic rod and hinged (dynamic) screw. J Biomech Eng, 2014,136(5):051007Google Scholar
  64. 64.
    Chien CY, Kuo YJ, Lin SC, et al. Kinematic and mechanical comparisons of lumbar hybrid fixation using Dynesys and Cosmic systems. Spine (Phila Pa 1976), 2014,39(15):E878–E884Google Scholar
  65. 65.
    Cegonino J, Calvo-Echenique A, Perez-del Palomar A. Influence of different fusion techniques in lumbar spine over the adjacent segments: A 3D finite element study. J Orthop Res, 2015,33(7):993–1000Google Scholar
  66. 66.
    Faizan A, Goel VK, Biyani A, et al. Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine—a finite element based study. Clin Biomech, 2012,27(3):226–233Google Scholar
  67. 67.
    Chung TT, Hueng DY, Lin SC. Hybrid Strategy of Two-Level Cervical Artificial Disc and Intervertebral Cage: Biomechanical Effects on Tissues and Implants. Medicine, 2015,94(47):e2048Google Scholar
  68. 68.
    Zhu Q, Gao X, Temple HT, et al. Simulation of biological therapies for degenerated intervertebral discs. J Orthop Res, 2016,34(4):699–708Google Scholar
  69. 69.
    Gan JC, Ducheyne P, Vresilovic E, et al. Bioactive glass serves as a substrate for maintenance of phenotype of nucleus pulposus cells of the intervertebral disc. J Biomed Mater Res, 2000,51(4): 596–604Google Scholar
  70. 70.
    Yao J, Turteltaub SR, Ducheyne P. A three-dimensional nonlinear finite element analysis of the mechanical behavior of tissue engineered intervertebral discs under complex loads. Biomaterials, 2006,27(3):377–387Google Scholar
  71. 71.
    Strange DG, Fisher ST, Boughton PC, et al. Restoration of compressive loading properties of lumbar discs with a nucleus implant-a finite element analysis study. Spine J, 2010,10(7):602–609Google Scholar

Copyright information

© Huazhong University of Science and Technology 2019

Authors and Affiliations

  • Bin-wu Hu
    • 1
  • Xiao Lv
    • 1
  • Song-feng Chen
    • 2
  • Zeng-wu Shao
    • 1
    Email author
  1. 1.Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Department of Orthopaedic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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