Cardoso Luis, Khadka Niranjan, Dmochowski Jacek P, Meneses Edson, Lee Kiwon, Kim Sungjin, Jin Youngsoo, Bikson Marom
Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Front Rehabil Sci. 2022 Aug 1;3:931274. doi: 10.3389/fresc.2022.931274. eCollection 2022.
Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.
脊柱牵引是一种物理干预措施，它向腰椎提供持续或间歇性的轴向拉伸力，以逐渐使脊柱组织伸展到更好的排列状态，降低椎间盘（IVD）压力，并缓解下背部疼痛（LBP）。然而，这种轴向牵引可能会改变正常的腰椎前凸曲率，并导致不良副作用和/或无法有效降低IVD压力。最近测试了一种轴向牵引的替代方法，即仰卧位的前后（PA）牵引，最近通过磁共振成像（MRI）显示其可有效增加椎间隙和腰椎前凸角度。PA牵引旨在在整个脊柱牵引治疗过程中维持腰椎前凸曲率，同时降低椎间盘内压力。在本研究中，我们对一种能够进行脊柱PA牵引的商用热机械按摩床所产生的机械治疗进行了有限元模拟。在具有不同体重指数（正常、超重、中度肥胖和极度肥胖体重指数病例）的人体模型上，研究了前后牵引系统对腰椎间盘产生的应力缓解情况。我们预测，典型的牵引水平会在腰椎间盘产生显著的牵张应力，从而通过降低这些组织通常所承受的压缩应力来产生应力缓解。此外，腰椎间盘所经历的应力缓解在所有体重指数模型中均有效，且在正常体重指数模型中最大。这些结果与先前关于脊柱前后牵引治疗益处的观察结果一致。
