Improvement in determining the risk of damage to the human lumbar functional spinal unit considering age, height, weight and sex using a combination of FEM and RSM.

Human functional spinal unit (FSU) is comprised of two adjacent vertebrae, the intervertebral disc (IVD), the cartilage endplates and the connecting ligamentous tissues. As humans age, trabecular, cortical bone and IVD change in mechanical properties. These changes influence the movement of the FSU (displacements, rotations and disc bulges). This paper proposes a method to determine the influence of sex, age, weight and height on the movements of the FSU using a combination of the FEM and RSM. The work concentrates on the medium-sized human FSU (L3-L4 lumbar level with standard dimensions of IVD: width = 50 mm, depth = 35 mm and height = 11 mm). Also, the proposed method could be an improvement to the determination of risk of damage based on body mass index (BMI), as well as an alternative method of searching for a healthy weight. The method was developed as follows: First, a three-dimensional parameterized human healthy FSU FE model was generated based on the standard test (for compression, flexion, extension, lateral bending, torsion and shear). The movements of the FSU FE model based on the aforementioned standardized test when the sex, age, weight and height varies in a range for each individual (30-80 years; 70-120 kg; 160-190 cm) were simulated. Quadratic regression models were generated for each standardized test using RSM. An ANOVA test showed that all of the tests have a significant influence on weight and age, whereas height influences only those tests that involve rotation of the FSU (flexion, extension and lateral bending). Normal weight, overweight and obesity BMI classifications were considered in determining the healthy weight with the following constraints: the limit angles of flexion and lateral bending, as well as the maximum posterior bulge limit of the IVD, could not exceed of one-third of the spinal canal. The proposed method concluded that: (1) normal BMI values do not cause damage to the FSU, (2) some overweight BMI values may cause damage to the FSU for a certain range of ages and heights and (3) for BMI obesity values, the risk of damage to the FSU may be imminent.