Robotic application of a dynamic resultant force vector using real-time load-control: simulation of an ideal follower load on Cadaveric L4-L5 segments.

Standard in-vitro spine testing methods have focused on application of isolated and/or constant load components while the in-vivo spine is subject to multiple components that can be resolved into resultant dynamic load vectors. To advance towards more in-vivo like simulations the objective of the current study was to develop a methodology to apply robotically-controlled, non-zero, real-time dynamic resultant forces during flexion-extension on human lumbar motion segment units (MSU) with initial application towards simulation of an ideal follower load (FL) force vector. A proportional-integral-derivative (PID) controller with custom algorithms coordinated the motion of a Cartesian serial manipulator comprised of six axes each capable of position- or load-control. Six lumbar MSUs (L4-L5) were tested with continuously increasing sagittal plane bending to 8 Nm while force components were dynamically programmed to deliver a resultant 400 N FL that remained normal to the moving midline of the intervertebral disc. Mean absolute load-control tracking errors between commanded and experimental loads were computed. Global spinal ranges of motion and sagittal plane inter-body translations were compared to previously published values for non-robotic applications. Mean TEs for zero-commanded force and moment axes were 0.7 ± 0.4N and 0.03 ± 0.02 Nm, respectively. For non-zero force axes mean TEs were 0.8 ± 0.8 N, 1.3 ± 1.6 Nm, and 1.3 ± 1.6N for Fx, Fz, and the resolved ideal follower load vector FL(R), respectively. Mean extension and flexion ranges of motion were 2.6° ± 1.2° and 5.0° ± 1.7°, respectively. Relative vertebral body translations and rotations were very comparable to data collected with non-robotic systems in the literature. The robotically coordinated Cartesian load controlled testing system demonstrated robust real-time load-control that permitted application of a real-time dynamic non-zero load vector during flexion-extension. For single MSU investigations the methodology has potential to overcome conventional follower load limitations, most notably via application outside the sagittal plane. This methodology holds promise for future work aimed at reducing the gap between current in-vitro testing and in-vivo circumstances.