A Finite Element Analysis of Stress Distribution and Disk Displacement in Response to Lumbar Rotation Manipulation in the Sitting and Side-Lying Positions

Objective: This study aimed to investigate stress distribution and disk displacement in healthy and degenerated intervertebral disks during simulated lumbar rotation manipulation (LRM) in the sitting and side-lying positions. Methods: Three-dimensional (3D) finite element models of healthy, mildly degenerated and moderately degenerated L4/5 spinal units were reconstructed. Lumbar rotation manipulation in the sitting and side-lying positions were simulated, and alterations in stress distribution and disk displacement in the lumbar disks were observed. Results: The application of LRM in the sitting or side-lying position resulted in a similar stress distribution in healthy, mildly degenerated, and moderately degenerated disks. Stress was concentrated at the anterior right side of the annulus. In all disks, intradiskal pressure (IDP) and maximum von Mises stress were higher during LRM in the sitting position than during LRM in the side-lying position. During these manipulations, Intradiskal pressure and stress in the annulus of moderately degenerated disks were higher than in mildly degenerated disks. Displacement was most obvious in healthy disks. Conclusions: Mildly and moderately degenerated lumbar disks were subject to higher stress during LRM in the sitting position than during LRMin the side-lying position. Intradiskal pressure and the maximumvon Mises stress in the annulus of moderately degenerated disks increased, suggesting the need for caution when treating patients with moderately compromised disks. Although our results are in accordance with previously published data, they are simulated and preliminary and do not necessarily replicate the clinical condition.