Abstract
Purpose
The mechanical link between the pleural physiology and the development of scoliosis is still unresolved. The intrapleural pressure (IPP) which is distributed across the inner chest wall has yet been widely neglected in etiology debates. With this study, we attempted to investigate the mechanical influence of the IPP distribution on the shape of the spinal curvature.
Methods
A finite element model of pleura, chest and spine was created based on CT data of a patient with no visual deformities. Different IPP distributions at a static end of expiration condition were investigated, such as the influence of an asymmetry in the IPP distribution between the left and right hemithorax. The results were then compared to clinical data.
Results
The application of the IPP resulted in a compressive force of 22.3 N and a flexion moment of 2.8 N m at S1. An asymmetrical pressure between the left and right hemithorax resulted in lateral deviation of the spine towards the side of the reduced negative pressure. In particular, the pressure within the dorsal section of the rib cage had a strong influence on the vertebral rotation, while the pressure in medial and ventral region affected the lateral displacement.
Conclusions
An asymmetrical IPP caused spinal deformation patterns which were comparable to deformation patterns seen in scoliotic spines. The calculated reaction forces suggest that the IPP contributes in counterbalancing the weight of the intrathoracic organs. The study confirms the potential relevance of the IPP for spinal biomechanics and pathologies, such as adolescent idiopathic scoliosis.
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Abbreviations
- ACC:
-
Articulatio capitis costae
- ACT:
-
Articulatio costotransversalis
- ALL:
-
Anterior longitudinal
- c.b.:
-
Cardiac border
- CL:
-
Capsular
- CT:
-
Computed tomography
- CVJ:
-
Costovertebral joint
- FEM:
-
Finite element model
- FL:
-
Flaval ligament
- i.c.s:
-
Intercostal space
- IPP:
-
Intrapleural pressure
- ISL:
-
Interspinal ligament
- LCT:
-
Lig. costotransversarium
- LCTS:
-
Lig. costotransversarium superius
- PLL:
-
Posterior longitudinal
- RoM:
-
Range of motion
- SSL:
-
Supraspinal ligament
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Acknowledgements
We thank many colleagues for their assistance and expertise for this study. Special thanks goes to Joachim Kabitz, David Walker, Gabriel Schlager and Daniel Schlager. This project was supported by the German Research Foundation (DFG), Project WI 1352/20-1.
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Conceptualization, BS; Methodology, BS, FN and FG; Investigation, BS; Writing—Original Draft, BS; Writing—Review and Editing, BS, FN, FG and HW; Funding Acquisition, HW; Resources, HW; Supervision, HW.
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Communicated by Guido Ferretti.
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421_2018_3864_MOESM1_ESM.eps
Relative displacements and rotations of vertebrae in-between vertebral levels (VL) caused by a constant IPP gradient of 6 (black) and by a stepwise gradient distribution (green) of − 9 Pa/mm below T6 and − 3 Pa/mm above T6 (according to Fig. 5). We adapted the range of the scales in each plot to better visualize and comprehend the data; thus, also the scale of the lateral displacement was reversed that left displacement points to left. The bottom sketch of the vertebra indicates the positive direction of displacement/rotation (EPS 109 KB)
421_2018_3864_MOESM2_ESM.eps
Calculated displacements of the ribs on the left and right hemithorax caused by an asymmetrical IPP distribution, with an IPP gradient of – 6 Pa/mm on the left and an IPP gradient of -5 Pa/mm on the right side. The displacements were obtained on a dorsal, middle and ventral point of each rib, as illustrated in the top left sketch (EPS 137 KB)
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Schlager, B., Niemeyer, F., Galbusera, F. et al. Asymmetrical intrapleural pressure distribution: a cause for scoliosis? A computational analysis. Eur J Appl Physiol 118, 1315–1329 (2018). https://doi.org/10.1007/s00421-018-3864-5
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DOI: https://doi.org/10.1007/s00421-018-3864-5