Volz Mallory, Elmasry Shady, Jackson Alicia R, Travascio Francesco
Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States.
Department of Biomechanics, Hospital for Special Surgery, New York, NY, United States.
Front Physiol. 2022 Jan 13;12:750668. doi: 10.3389/fphys.2021.750668. eCollection 2021.
Lower back pain is a medical condition of epidemic proportion, and the degeneration of the intervertebral disc has been identified as a major contributor. The etiology of intervertebral disc (IVD) degeneration is multifactorial, depending on age, cell-mediated molecular degradation processes and genetics, which is accelerated by traumatic or gradual mechanical factors. The complexity of such intertwined biochemical and mechanical processes leading to degeneration makes it difficult to quantitatively identify cause-effect relationships through experiments. Computational modeling of the IVD is a powerful investigative tool since it offers the opportunity to vary, observe and isolate the effects of a wide range of phenomena involved in the degenerative process of discs. This review aims at discussing the main findings of finite element models of IVD pathophysiology with a special focus on the different factors contributing to physical changes typical of degenerative phenomena. Models presented are subdivided into those addressing role of nutritional supply, progressive biochemical alterations stemming from an imbalance between anabolic and catabolic processes, aging and those considering mechanical factors as the primary source that induces morphological change within the disc. Limitations of the current models, as well as opportunities for future computational modeling work are also discussed.
下背痛是一种具有流行程度的医学病症,而椎间盘退变已被确认为主要成因。椎间盘(IVD)退变的病因是多因素的,取决于年龄、细胞介导的分子降解过程和遗传因素,创伤性或渐进性机械因素会加速其退变。导致退变的这种生物化学和机械过程相互交织,十分复杂,使得通过实验定量确定因果关系变得困难。IVD的计算模型是一种强大的研究工具,因为它提供了改变、观察和分离椎间盘退变过程中涉及的各种现象的影响的机会。本综述旨在讨论IVD病理生理学有限元模型的主要发现,特别关注导致退变现象典型物理变化的不同因素。所呈现的模型分为几类,一类探讨营养供应的作用、合成代谢和分解代谢过程失衡导致的渐进性生物化学改变、衰老,另一类则将机械因素视为诱导椎间盘内形态变化的主要来源。还讨论了当前模型的局限性以及未来计算建模工作的机会。
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