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The effect of degenerative morphological changes

of the intervertebral disc on the lumbar spine
biomechanics: a poroelastic finite element
investigation
Fabio Galbusera

a b

, Hendrik Schmidt , Cornelia Neidlinger-Wilke & Hans-Joachim Wilke

Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse

14, D-89081, Ulm, Germany
b

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Published online: 03 Mar 2011.

To cite this article: Fabio Galbusera , Hendrik Schmidt , Cornelia Neidlinger-Wilke & Hans-Joachim Wilke (2011) The
effect of degenerative morphological changes of the intervertebral disc on the lumbar spine biomechanics: a poroelastic
finite element investigation, Computer Methods in Biomechanics and Biomedical Engineering, 14:8, 729-739, DOI:
10.1080/10255842.2010.493522
To link to this article: http://dx.doi.org/10.1080/10255842.2010.493522

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Computer Methods in Biomechanics and Biomedical Engineering

Vol. 14, No. 8, August 2011, 729739

The effect of degenerative morphological changes of the intervertebral disc on the lumbar spine
biomechanics: a poroelastic finite element investigation
Fabio Galbuseraa,b*1, Hendrik Schmidta2, Cornelia Neidlinger-Wilkea3 and Hans-Joachim Wilkea4
a

Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, D-89081 Ulm, Germany;
b
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Downloaded by [University of Calgary] at 00:22 05 September 2013

(Received 23 March 2010; final version received 12 May 2010)

Intervertebral disc degeneration involves changes in the spinal anatomical structures. The mechanical relevance of the
following changes was investigated: disc height, endplate sclerosis, disc water content, permeability and depressurisation.
A poroelastic nonlinear finite element model of the L4 L5 human spine segments was employed. Loads represented a daily
cycle (500 N compression combined with flexion extension motion for 16 h followed by 200 N compression for 8 h). In
non-degenerative conditions, the model predicted a diurnal axial displacement of 1.32 mm and a peak intradiscal pressure of
0.47 MPa. Axial displacement, facet force and range of motion in flexion extension are decreased by decreasing disc
height. By decreasing the initial water content, axial displacement, facet force and fluid loss were all reduced. Endplate
sclerosis did not have a significant influence on the calculated results. Depressurisation determined an increase of the disc
effective stress, possibly inducing failure. Degenerative instability was not calculated in any simulations.
Keywords: lumbar spine; spine biomechanics; disc degeneration; finite element; poroelastic; intradiscal pressure

Introduction
Degenerative disc disease is one of the most common
causes of low back pain (Adams and Dolan 2005; Horvath
et al. in press) and has a complex multifactorial aetiology
(Hadjipavlou et al. 2008). Despite the influence of genetics
on disc degeneration has been clearly established (Battie
et al. 2008, 2009), the role of mechanical factors in the
pathogenesis and progression of the disease is still under
heated debate. It was suggested that abnormal loads
(Adams and Dolan 2005; Setton and Chen 2006;
Nakamura et al. 2009) and motion patterns may accelerate
disc degeneration (Mulholland 2008), due to mechanical
damage accumulation (Adams et al. 2000) and possibly to
impairment of nutrient diffusion (Arun et al. 2009).
The degenerative process can be associated with
different morphological changes of the intervertebral disc
and of the adjacent structures, which can be present
separately or in combination (Haefeli et al. 2006; Wilke
et al. 2006). Such changes include disc height loss,
reduced water content, tissue fibrotisation, proteoglycan
loss, sclerosis of the vertebral endplates, formation of
fissures or osteophytes and others (Vernon-Roberts and
Pirie 1977). These morphological changes have most
likely an influence on the progression of the degenerative
disease, but the significance of each individual morphological change was never clearly established. Some studies
addressed the biomechanics of the degenerated lumbar
spine, in vivo (Vaga et al. 2009; Wuertz et al. 2009), in vitro
(Fujiwara et al. 2000a, 2000b; Colloca et al. 2007) or using

*Corresponding author. Email: fabio.galbusera@uni-ulm.de

ISSN 1025-5842 print/ISSN 1476-8259 online
q 2011 Taylor & Francis
DOI: 10.1080/10255842.2010.493522
http://www.informaworld.com

finite element (FE) models (Natarajan et al. 2006;

Rohlmann et al. 2006; Schmidt et al. 2006, 2007), but
they were limited to the investigation of the most common
combinations of more than one degenerative change in a
model or patient representing one specific degree of disc
degeneration. These studies provided data about the
mechanics of the degenerated disc, but did not give
additional insights about which specific degenerative
change could be related to each reported mechanical
alteration. In this way, any speculation about the possible
pathways of the progression of the degeneration due to
mechanical causes can only be based on a global, overall
view of the degenerative condition.
To overcome this lack of knowledge, the present study
is aimed to the identification of the possible influence of
individual parameters related with degenerative morphological changes of the disc (disc height, endplate sclerosis,
disc water content, disc permeability and depressurisation)
on variables which describe the biomechanics of the
lumbar spine (displacement, force through the facet joints,
intradiscal pressure, stress in the solid skeleton of the disc,
diurnal fluid loss and recovery, range of motion in flexion
and extension).

Materials and methods

A poroelastic nonlinear FE model of the L4 L5 human
spine segment was created in FE software ABAQUS 6.9
(Simulia, Providence, RI, USA) (Figure 1), based on a

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F. Galbusera et al.

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Figure 1. (a) FE model of the L4 L5 human spine segment. (b) Area near to the endplate which was affected by the change of the elastic
modulus and of the permeability in the parameter study representing endplate sclerosis.

previously developed model (Schmidt et al. 2007). The

model included vertebral bodies, posterior structures,
intervertebral disc and the seven major ligaments.
Quadratic hexahedral elements were used to model all
the solid structures. Membrane fibre-reinforced elements
were employed for the representation of ligaments and
annulus collagen fibres. Eight crisscross fibre layers were
defined in the radial direction and each layer contained
tension-only fibres. The nonlinear elastic material properties, the cross-sectional areas and the orientation of the
collagen fibres and ligaments were the same as those used
in previous elastostatic studies (Schmidt et al. 2007). Facet
joints were modelled using a frictionless surface-tosurface contact, having an initial gap of 0.4 mm; a layer of
solid elements having a thickness of 0.5 mm represented
the facet cartilage. Poroelasticity was considered only for
vertebral bodies, endplates and the intervertebral disc.
The solid phase of all materials was modelled as linear
elastic isotropic (Table 1), except for the annulus ground
substance and the nucleus which were represented by a
hyperfoam strain energy function obtained by fitting a
nonlinear stress strain curve which resulted in the
best fit between experimental and numerical results
(Schmidt et al. in press).

For the reference model, the values of the permeability

of the different materials were mainly derived from the
paper by Ferguson et al. (2004). The strain-dependent
permeability formulation developed by Argoubi and
Shirazi-Adl (1996) was employed:

k k0


e1 e0 2 M1e=1e0 21

e
;
e0 1 e

where k0 is the initial permeability, e is the void ratio:

e

ff
;
1 2 ff

and ff is the volume fraction of the fluid phase, dependent

on the deformation of the structure:

ff 1 2 J 21 1 2 ff0 ;

where J is the ratio dV/dV0 between the medium volume in

the current configuration and its volume in the reference
configuration. This formulation was included into the
ABAQUS code by providing the calculated permeability
values for a range of allowable void ratios. A sorption
behaviour allowing for partial saturation of the disc was

Table 1. Material properties employed in the reference model.

Material
Annulus ground
substance
Nucleus
Cartilage
Cancellous bone
Cortical bone
Posterior elements

k0 (m4/Ns)
(Equation (1))

e0
(Equation (1))

M
(Equation (1))

Nonlinear

7.5 10216

2.33

8.5

Schmidt et al. (in press)

Nonlinear
5.0
0.1
100.0
0.2
10,000.0
0.3
3500.0
0.25

7.5 10216
7.5 10215
2.0 1027
5.0 10212

4.00
4.00
0.05
0.05

8.5
8.5

Schmidt et al. (in press)

Argoubi and Shirazi-Adl
Argoubi and Shirazi-Adl
Argoubi and Shirazi-Adl
Argoubi and Shirazi-Adl

E
(MPa)

Ref. elastic properties

(E, y )

Ref. permeability
(k0, e0, M)
Ferguson et al. (2004)

(1996)
(1996)
(1996)
(1996)

Ferguson
Ferguson
Ferguson
Ferguson

et
et
et
et

al.
al.
al.
al.

(2004)
(2004)
(2004)
(2004)

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Computer Methods in Biomechanics and Biomedical Engineering

specified in order to avoid negative pressures which can be
related to suction-type pore pressures during unloading
(Schmidt et al. in press).
The swelling of the disc due to the osmotic potential
was simulated by imposing a pressure of 0.25 MPa
(Ferguson et al. 2004; Schmidt et al. in press) on the outer
surfaces of all structures. The loading conditions
represented a daily cycle (Figure 2(a)), consisting of a
compressive load of 500 N simulating the average day load
for 16 h, followed by 8 h of rest modelled with a 200 N
load. All loads were applied in 10 s. Two days and one
night were actually simulated; only the second day and the
night were taken into consideration for data analysis.
Before the simulation of the first day, the model was given
the time to reach the steady state with the external
pressure.
In additional simulations, three flexion extension
cycles were considered during the second day. Flexion and
extension moments of 7.5 Nm were superimposed on the
500-N compressive load for 10 s, 1 h and 15 h after the
application of the axial load (Figure 2(b)), to model motion
during the morning and the evening. Each moment was
applied and removed in 10 s. The ratio between the ranges
of motion (RoMs) in the evening (15 h after load
application) and in the morning (10 s after load
application) was then calculated for each simulation.

731

Before starting with the simulation of the degenerative

conditions, the model was tested for the sensitivity to the
mesh size and the maximum pore pressure change in each
time step.
Different parameters were considered for the simulations of the degenerative changes (Table 2). The model
described above was considered as a reference for all the
parametric investigations described in the following
paragraphs. All parameter values were chosen in order to
represent conditions that may be related with disc
degeneration.
The disc height was stepwise reduced from the
reference value of 13 mm in the anterior area to 3 mm,
which is coherent to the highest degree of disc
degeneration (Wilke et al. 2006). The lordotic angle
between L4 and L5 was adjusted in order to have parallel
endplates for the lowest disc condition (3 mm) and the
physiological angle, as reconstructed from the CT data, for
the 13-mm height. For each disc height, two different
simulations were run: (1) the initial water content of both
the annulus and the nucleus was reduced (Gu et al. 1999;
Natarajan et al. 2006) plus fibre buckling related to the
reduction of the disc height was considered by offsetting
the stress strain curve and (2) the fibre buckling was
simulated but the water content of the disc was constant.
The initial gap and relative positions of the articulating

Figure 2. Time history of (a) the compressive force and (b) the flexion extension moment applied. After a preliminary period in which
the structure is allowed to reach the equilibrium state with the external pressure of 0.25 MPa, a compressive force representing a daily
cycle was applied (500 N for 16 h, 200 N for 8 h, 500 N again for 16 h). Flexion extension cycles (moments of 7.5 Nm) were simulated
10 s, 1 h and 15 h after the application of the compressive load during the second day.

200
200
Unaltered
Unaltered
13
13
Disc permeability
External pressure

no wc indicates the cases in which the disc height was reduced and the water content was kept constant.

13
Water content

Unaltered
Unaltered

13

Results

0.25

50 100% of values
in Table 1
See Table 1
See Table 1
Nucleus: 71 80%; annulus:
50 70%
Nucleus: 80%; annulus: 70%
Nucleus: 80%; annulus: 70%

3 13

Disc height
(no wca)
Endplate sclerosis

Unaltered

surfaces constituting the facet joints were not altered with

respect to the reference model.
Endplate sclerosis was simulated by stiffening the
bony area close to the endplate, up to the elastic modulus
of cortical bone. At the same time, the permeability of the
same area was modified from the original value to that
employed for cortical bone. The portion of the vertebrae in
which these changes were modelled consisted of the
bony endplate and the first 5 mm of the vertebral trabecular
bone (Figure 1(b)).
The disc water content was linearly reduced from the
reference values (80% in the nucleus and 70% in the
annulus) to values coherent with a high degree of disc
degeneration (71% in the nucleus and 50% in the annulus)
(derived from Natarajan et al. 2006). The initial disc
permeability was reduced by half, in both the nucleus and
the annulus. The boundary pressure was lowered from 0.25
to 0.01 MPa, in order to take into account the reduced
swelling and consequent disc depressurisation due to the
loss of proteoglycans observed in the degeneration process
(Sivan et al. 2006), which directly induce a decrease in the
osmotic potential.

0.25
0.01 0.25

200

200
0.25
Nucleus: 80%; annulus: 70%

See Table 1

Permeability and stiffness

linearly approaching those
of cortical bone
Unaltered

200
Unaltered
0.25
See Table 1

Unaltered
0.25
See Table 1

Nucleus: 71 80%; annulus:

50 70%
Nucleus: 80%; annulus: 70%
3 13
Disc height

Buckling due to
height reduction
Buckling due to
height reduction
Unaltered

Endplates
External
pressure (MPa)
Disc permeability
Disc water content
Annulus fibres
Disc
height (mm)
Parameter

Parameters considered in the simulations of the degenerative changes.

Table 2.

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200

F. Galbusera et al.
Night
load (N)

732

The total axial displacement predicted by the reference

model was 1.32 mm at the end of the second day
(Figure 3(a)). The facet joints transmitted a total force of
24 N during the day and were unloaded during the night
(Figure 3(b)). The intradiscal pore pressures were 0.23 and
0.26 MPa at the end of the night and day, respectively
(Figure 3(c)).
A qualitative summary of the potential impact of the
parameters on the calculated results is reported in Table 3.
All the results of the sensitivity analysis are quantitatively
shown in Figures 4 7.
The total axial displacement and the facet force
(Figure 4(a)) decreased with reducing the disc height. The
peak intradiscal pore pressure in the centre of the nucleus
after application of 500 N was only marginally affected by
changing the disc height (Figure 4(b)). However, the
difference between the equilibrium pressure of 0.25 MPa
and the predicted pressures at the end of the night and day
increased with decreasing disc height, except for the
simulations in which the water content was not altered.
The axial effective stress (Figure 4(c)) decreased with
decreasing disc height. For the simulations in which the
water content was not altered, the effective stress change
was less pronounced, thus highlighting the significance of
this parameter. The relative fluid losses (Figure 4(c))
increased with decreasing disc height in all simulations.
Flexion extension RoMs (Figure 4(d)) were found to
decrease with decreasing the disc height, without any
strong dependency on the water content. The relative

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Computer Methods in Biomechanics and Biomedical Engineering

733

Figure 3. Axial displacement representing disc height change (a), facet force (b), and intradiscal pore pressure in the nucleus pulposus
(c) calculated with the reference model. The time points for which the results were considered in the data analysis are indicated.

decrease was similar in flexion and extension. In general,

RoMs were found to increase during the day, up to 32% in
flexion, especially in the first hour after the application of
the compressive load. In extension, the RoM increase
during the day was less pronounced, in particular for the
lower disc height losses.
The intradiscal pressures were not affected by the
endplate sclerosis (Figure 5(b)) (, 0.01 MPa). Small
reductions of the axial displacement (0.1 mm), the facet
force (1 N) (Figure 5(a)), the fluid loss (1.5%) and the axial
effective stress (, 0.01 MPa) (Figure 5(c)) were predicted.
Table 3.

Flexion extension RoMs were more significantly reduced

by endplate sclerosis (2 6% for flexion, 2 13% for
extension). In the evening, the RoMs increased, especially
in flexion; this change was not strongly dependent on
endplate sclerosis. All the listed effects were more
substantial in the first stages of endplate sclerosis.
Axial displacement (2 0.35 mm), facet force (2 2.5 N)
(Figure 6(a)) and fluid loss (2 9%) (Figure 6(c)) were all
reduced by decreasing the initial water content. Although
the peak pressure and the pressure at the end of the night
were basically unaffected, the pressure at the end of the

Potential effect of the parameters (first column) on the calculated results (first line).

Disc height
Endplate sclerosis
Water content
Disc permeability
External pressure

Axial displacement

Facet force

Intradiscal pressure

Axial effective stress

Fluid loss

RoM

/
/

2a
/
2a
/

/
2

2
/

/
/
/
/

Notes: , an increase of the parameter value leads to an increase of the result; 2 , an increase of the parameter value leads to a decrease of the result; /, changing the
parameter value has no remarkable effect on the result.
a
Only for the pressure recording at the end of the day, no marked effect on the peak pressure or the pressure at the end of the night.

Downloaded by [University of Calgary] at 00:22 05 September 2013

734

F. Galbusera et al.

Figure 4. Effects of changing the initial disc height (see Table 2) on the axial displacement and the facet force (a), the intradiscal pore
pressures (b), the axial effective stress and the total relative fluid loss (c), the ratios between the RoMs in flexion and extension in the
evening for the different disc height conditions and the RoMs obtained with the reference model (disc height 13 mm) (d), and the ratios
between the RoMs calculated with each specific model in the evening (15 h after application of the 500-N load) and in the morning (10 s
after load application) (d). no wc indicates the cases in which the disc height was reduced and the water content was kept constant.
current indicates the RoMs predicted with the model having the specific disc height relevant to the x-axis of the plot (d).

day significantly increased with water loss ( 54%)

(Figure 6(b)). The amount of the axial effective stress in
the nucleus at the end of the day was strongly decreased
(2 98%) with decreasing water content. This result is
probably linked with the observed increase in the
intradiscal pressure at the same time. The RoMs were
only marginally affected by changing this parameter.
Similarly to the endplate sclerosis, changing the
permeability of the intervertebral disc did not significantly
affect any of the observed results.
The axial displacement noticeably decreased with
reducing the boundary pressure (2 0.64 mm) (Figure 7(a)).
All the pressure recordings almost linearly decreased with
decreasing the boundary pressure (Figure 7(b)). A small
negative pressure value was found at the end of the night
for a 0.01 MPa external pressure. The axial effective stress
increased up to values four times higher than that found
with the reference model (Figure 7(c)). The fluid loss
remained almost constant for slight pressure reductions,
and decreased for lower values of the imposed pressure

(2 10% at 0.01 MPa). The RoM showed a slight increase

in extension ( 13%) with decreasing the external
pressure; in flexion, the RoM was basically unaffected
by changing the external pressure. A tendency to a higher
flexion RoM in the evening with respect to the morning
was calculated for high external pressure values.

Discussion
The present work addressed the study of the biomechanical significance of the individual morphological changes
that are associated with degenerative disc disease, which
can be highly different from patient to patient (Haefeli
et al. 2006). Different degeneration parameters may have
opposite effects, thus requiring different therapeutic
options or inducing a different progression of the
degenerative disease. Their study is therefore critical,
although clinical scenarios in which a single degenerative
change is observable may not be common. The topic
addressed here by means of models was able to take into

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Computer Methods in Biomechanics and Biomedical Engineering

735

Figure 5. Influence of the endplate sclerosis on the axial displacement and the facet force (a), the intradiscal pressures (b), the axial
effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different sclerotic conditions and the RoMs
obtained with the reference model (no endplate sclerosis) (d), and the ratios between the RoMs in the evening (15 h after application of the
500 N load) and in the morning (10 s after load application) (d). The x-axes of the plots refer to an arbitrary degeneration scale: 0
corresponds to healthy endplates, 6 to endplates totally consisting of cortical bone, the 1 5 values correspond to a linear interpolation
between the two extreme values. current indicates the RoMs predicted with the model having the specific endplate degeneration relevant
to the x-axis of the plot (d).

account fluid flow in the disc and diurnal variations of the

loads and output parameters.
Some limitations of the work can be identified. First,
the reference model was not comprehensively validated.
However, the aim of the current study was not to present a
detailed FE model of a specific lumbar condition, but to
investigate the potential impact of the parameters related
to degenerative changes of the intervertebral disc. To this
aim, and taking into account the comparative nature of the
presented results, the model proved to be able to fulfil the
requirements.
The osmotic potential causing fluid imbibition was not
explicitly modelled with a triphasic approach including
fixed charges (Schroeder et al. 2006), but with a constant
pressure at the boundary pushing fluid into the disc. Thus,
the alterations in the swelling pressure due to strain were
not considered here. This approach was successfully used
in previous studies (Argoubi and Shirazi-Adl 1996;

Ferguson et al. 2004; Schmidt et al. in press); within the

strain ranges of the present work, the swelling pressure
was found to vary by 25% or less (Urban and McMullin
1988; Riches et al. 2002; Ferguson et al. 2004). However,
a model including an internal swelling pressure acting at
each element instead of a boundary pressure would allow
for more realistic results and is currently under
development.
The modelling approach employed for the investigation of endplate sclerosis was arbitrary and not based on
previous works. To our knowledge, experimental data
regarding sclerotic endplate permeability are currently not
available. Formation of blood clots after death is one of the
aspects that makes these measurements extremely
demanding (Accadbled et al. 2008). Understanding the
influence of endplate sclerosis would be highly remarkable, because fluid flow through the endplate is tightly
connected to nutrient supply, other than for the mechanical

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736

F. Galbusera et al.

Figure 6. Influence of the disc initial water content on the axial displacement and the facet force (a), the intradiscal pressures (b), the
axial effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different water loss conditions and the RoMs
obtained with the reference model (no water loss) (d), and the ratios between the RoMs in the evening (15 h after application of the 500 N
load) and in the morning (10 s after load application) (d). current indicates the RoMs predicted with the model having the specific water
content relevant to the x-axis of the plot (d).

aspects. Thus, an experimental campaign addressing the

permeability of sclerotic endplates would be very helpful.
The facet joints were assumed not to be altered by disc
degeneration, and had the same initial gap in all
simulations. The initial length of the ligaments was also
not adjusted to take into account buckling due to disc
height loss. An approach similar to that described in
Rohlmann et al. (2006), who adjusted the initial ligament
length and changed the orientation and the initial gap of
the facet joints to simulate the alteration in the lordotic
angle related to the disc height reduction, may allow for
the calculation of more realistic results, possibly including
an increase of the facet forces and higher stress peaks in
the facet cartilage.
Despite a general agreement between the results and
literature data could be established, direct comparisons
between the reference model and published data are not
straightforward, because different boundary conditions
were generally employed. Ferguson et al. (2004) predicted
a total axial displacement of 1.6 mm, higher than the

present value of 1.25 mm, but obtained by imposing a

higher compressive load (circa 800 N). For a load of
1000 N, Adams et al. (1987) reported a disc height
reduction of 1.53 ^ 0.34 mm after 6 h of creeping in an
in vitro experiment. Argoubi and Shirazi-Adl (1996) found
with their FE model an axial displacement of circa 0.7 mm
2 h after the application of a 400-N load. This finding
compares apparently unfavourably with the current
correspondent result (1.1 mm), but is coherent with the
displacement found with an external pressure of 0.1 MPa
(0.8 mm) as done in the cited study. The in vivo intradiscal
pressure data measured during the night reported by Wilke
et al. (1999), ending with an average value of 0.24 MPa,
show a clear agreement with the current results.
Coherently with the present study, Rohlmann et al.
(2006) found a decrease in the intervertebral mobility in
flexion with decreasing disc height and water content.
Extension RoM was found to increase with disc
degeneration, in contrast to the current results. This is
probably due to the fact that facet degeneration was also

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Computer Methods in Biomechanics and Biomedical Engineering

737

Figure 7. Influence of the external boundary pressure on the axial displacement and the facet force (a), the intradiscal pressures (b), the
axial effective stress and the total relative fluid loss (c), the ratios between the RoMs for the different external pressure values and the
RoMs obtained with the reference model (pressure of 0.25 MPa) (d), and the ratios between the RoMs in the evening (15 h after
application of the 500 N load) and in the morning (10 s after load application) (d). current indicates the RoMs predicted with the model
having the specific external boundary pressure relevant to the x-axis of the plot (d).

considered in the previous study. Natarajan et al. (2006)

calculated a tendency to a stiffening of the intervertebral
disc with decreasing disc height, coherently with the
present study.
The predicted RoM reduction due to disc height loss,
water content loss and disc depressurisation is in contrast
with some papers which described spinal instability
(Kirkaldy-Willis and Farfan 1982; Fujiwara et al. 2000a,
2000b), defined as abnormal or increased motion (Pope
and Panjabi 1985), related to disc degeneration. Thus,
although the topic of instability is still debated (Mulholland 2008), from the present results it may be argued that
spinal instability, if existing, should not be related to these
degenerative changes but possibly with others such as
fissures, delamination and clefts.
Endplate sclerosis was found to have a small effect on
all the calculated results. This may be related to the
relatively high value used for the permeability of cortical
bone, used as end point for the sclerotic endplates, which is

in average four orders of magnitude higher than that of the

intervertebral disc, thus letting the fluid flow between the
endplate and the disc being dominated by the disc
permeability. This finding is in accordance with the paper
by Riches and McNally (2005), in which the authors found
a marked relevance of the endplate permeability only for
values lower than the disc permeability. Preliminary
simulations in which the value provided by Argoubi and
Shirazi-Adl (1996) (10220 m4 N21 s21) showed that the
use of such a permeability would have a more significant
effect on the fluid flow during compression and recovery.
Recent investigations showed the domination of vascular
permeability in cortical bone, i.e. through haversian and
Volkmanns canals, thus leading to a relatively high global
permeability value (Malachanne et al. 2008). Values in the
same range were found in experimental works regarding
the vertebral endplate (Accadbled et al. 2008). In the
authors opinion, this point will remain an open problem

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738

F. Galbusera et al.

until accurate and reliable experimental measures of the

sclerotic endplate permeability will be available.
Disc depressurisation, which may be linked to a
proteoglycan loss, played a relevant role in determining
the results. Notably, the axial effective stress dramatically
increased with decreasing external boundary pressure.
Thus, it can be expected that the risk of disc failure
phenomena may increase with disc degeneration. This
finding can explain the results of Vernon-Roberts et al.
(2007) who demonstrated that the incidence of disc tears is
strongly correlated with age. However, a detailed analysis
of the stresses and strains in the annulus ground substance
and fibres, necessary for the study of disc failure, was not
carried out here.
In conclusion, disc height, water content and
depressurisation were found to have the highest influence
on the spine biomechanics. Degenerative instability could
not be assessed with the present models. Further
developments will concern the inclusion on the models
of other common degenerative features such as tears,
osteophytes and facet joint degeneration. Combinations of
different degenerative changes that are found in clinical
cases will be also taken into account.

Acknowledgement
This project is funded by the EU project GENODISC (HEALTHF2-2008-201626).

Notes
1.
2.
3.
4.

Fabio Galbusera is a Ph.D. student at the University of Ulm,

Germany, and has an exclusive research collaboration with
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Email: h.schmidt@uni-ulm.de
Email: cornelia.neidlinger-wilke@uni-ulm.de
Email: hans-joachim.wilke@uni-ulm.de

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