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Obesity and Obesity Shape Markedly Influence Spine Biomechanics: A Subject-Specific Risk Assessment Model

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Abstract

Underlying mechanisms of obesity-related back pain remain unexplored. Thus, we aim to determine the effect of obesity and its shapes on the spinal loads and the associated risks of injury. Obesity shapes were initially constructed by principal component analysis based on datasets on 5852 obese individuals. Spinal loads, cycles to vertebral failure and trunk stability margin were estimated in a subject-specific trunk model taking account of personalized musculature, passive ligamentous spine, obesity shapes, segmental weights, spine kinematics and bone mineral density. Three obesity shapes (mean and extreme abdominal circumferences) at three body weights (BWs) of 86, 98 and 109 kg were analyzed. Additional BW (12 kg) increased spinal loads by ~11.8%. Higher waist circumferences at identical BW increased spinal forces to the tune of ~20 kg additional BW and the risk of vertebral fatigue compression fracture by 3–7 times when compared with smaller waist circumferences. Forward flexion, greater BW and load in hands increased the trunk stability margin. Spinal loads markedly increased with BW, especially at greater waist circumferences. The risk of vertebral fatigue fracture also substantially increased at greater waist circumferences though not at smaller ones. Obesity and its shape should be considered in spine biomechanics.

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References

  1. Adams, M. A., and P. J. Roughley. What is intervertebral disc degeneration, and what causes it? Spine 31:2151–2161, 2006.

    Article  PubMed  Google Scholar 

  2. Allin, L. J., X. Wu, M. A. Nussbaum, and M. L. Madigan. Falls resulting from a laboratory-induced slip occur at a higher rate among individuals who are obese. J Biomech 49:678–683, 2016.

    Article  PubMed  Google Scholar 

  3. Anderson, D. E., J. M. D’Agostino, A. G. Bruno, R. K. Manoharan, and M. L. Bouxsein. Regressions for estimating muscle parameters in the thoracic and lumbar trunk for use in musculoskeletal modeling. J Biomech 45:66–75, 2012.

    Article  PubMed  Google Scholar 

  4. Arjmand, N., and A. Shirazi-Adl. Sensitivity of kinematics-based model predictions to optimization criteria in static lifting tasks. Med Eng Phys 28:504–514, 2006.

    Article  CAS  PubMed  Google Scholar 

  5. Arjmand, N., A. Shirazi-Adl, and B. Bazrgari. Wrapping of trunk thoracic extensor muscles influences muscle forces and spinal loads in lifting tasks. Clin Biomech 21:668–675, 2006.

    Article  CAS  Google Scholar 

  6. Arjmand, N., A. Shirazi-Adl, and M. Parnianpour. Relative efficiency of abdominal muscles in spine stability. Comput Method Biomec 11:291–299, 2008.

    Article  CAS  Google Scholar 

  7. Bergmark, A. Stability of the lumbar spine: a study in mechanical engineering. Acta Orthop Scand Suppl 60:1–54, 1989.

    Article  Google Scholar 

  8. Berrigan, F., M. Simoneau, A. Tremblay, O. Hue, and N. Teasdale. Influence of obesity on accurate and rapid arm movement performed from a standing posture. Int J Obesity 30:1750–1757, 2006.

    Article  CAS  Google Scholar 

  9. Body Labs. Body Hub. New York: Body Labs, 2016.

    Google Scholar 

  10. Brinckmann, P., M. Biggemann, and D. Hilweg. Fatigue fracture of human lumbar vertebrae. Clin Biomech 3:S1–S23, 1988.

    Article  Google Scholar 

  11. Bruno, A. G., K. E. Broe, X. Zhang, E. J. Samelson, C. A. Meng, R. Manoharan, J. D’Agostino, L. A. Cupples, D. P. Kiel, and M. L. Bouxsein. Vertebral size, bone density, and strength in men and women matched for age and areal spine BMD. J Bone Miner Res 29:562–569, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cholewicki, J., and S. M. McGill. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech 11:1–15, 1996.

    Article  CAS  Google Scholar 

  13. Corbeil, P., M. Simoneau, D. Rancourt, A. Tremblay, and N. Teasdale. Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Sys Rehabil Eng 9:126–136, 2001.

    Article  CAS  Google Scholar 

  14. Crawford, R. P., C. E. Cann, and T. M. Keaveny. Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33:744–750, 2003.

    Article  PubMed  Google Scholar 

  15. De Leva, P. Adjustments to Zatsiorsky–Seluyanov’s segment inertia parameters. J Biomech 29:1223–1230, 1996.

    Article  PubMed  Google Scholar 

  16. Dudli, S., S. J. Ferguson, and D. Haschtmann. Severity and pattern of post-traumatic intervertebral disc degeneration depend on the type of injury. Spine J 14:1256–1264, 2014.

    Article  PubMed  Google Scholar 

  17. El Maghraoui, A., S. Sadni, A. El Maataoui, A. Majjad, A. Rezqi, Z. Ouzzif, and A. Mounach. Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women. Nutr Metab 12:1, 2015.

    Article  Google Scholar 

  18. Fagan, A. B., G. Sarvestani, R. J. Moore, R. D. Fraser, B. Vernon-Roberts, and P. C. Blumbergs. Innervation of anulus tears: an experimental animal study. Spine 35:1200–1205, 2010.

    Article  PubMed  Google Scholar 

  19. Ghezelbash, F., N. Arjmand, and A. Shirazi-Adl. Effect of intervertebral translational flexibilities on estimations of trunk muscle forces, kinematics, loads, and stability. Comput Method Biomec 18:1760–1767, 2015.

    Article  Google Scholar 

  20. Ghezelbash, F., A. Shirazi-Adl, N. Arjmand, Z. El-Ouaaid, and A. Plamondon. Subject-specific biomechanics of trunk: musculoskeletal scaling, internal loads and intradiscal pressure estimation. Biomech Model Mechanobiol 15:1699–1712, 2016.

    Article  CAS  PubMed  Google Scholar 

  21. Ghezelbash, F., A. Shirazi-Adl, N. Arjmand, Z. El-Ouaaid, A. Plamondon, and J. Meakin. Effects of sex, age, body height and body weight on spinal loads: sensitivity analyses in a subject-specific trunk musculoskeletal model. J Biomech 49:3492–3501, 2016.

    Article  CAS  PubMed  Google Scholar 

  22. Gonnelli, S., C. Caffarelli, and R. Nuti. Obesity and fracture risk. Clin Cases Miner Bone Metab 11:9–14, 2014.

    PubMed  PubMed Central  Google Scholar 

  23. Green, T., M. Adams, and P. Dolan. Tensile properties of the annulus fibrosus. Eur Spine J 2:209–214, 1993.

    Article  CAS  PubMed  Google Scholar 

  24. Hamilton, K. C., G. Fisher, J. L. Roy, B. A. Gower, and G. R. Hunter. The effects of weight loss on relative bone mineral density in premenopausal women. Obesity 21:441–448, 2013.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Han, T., J. Schouten, M. Lean, and J. Seidell. The prevalence of low back pain and associations with body fatness, fat distribution and height. Int J Obes 21:600–607, 1997.

    Article  CAS  Google Scholar 

  26. Han, K.-S., A. Rohlmann, T. Zander, and W. R. Taylor. Lumbar spinal loads vary with body height and weight. Med Eng Phys 35:969–977, 2013.

    Article  PubMed  Google Scholar 

  27. Haschtmann, D., J. V. Stoyanov, P. Gédet, and S. J. Ferguson. Vertebral endplate trauma induces disc cell apoptosis and promotes organ degeneration in vitro. Eur Spine J 17:289–299, 2008.

    Article  PubMed  Google Scholar 

  28. Heuch, I., K. Hagen, I. Heuch, Ø. Nygaard, and J.-A. Zwart. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine 35:764–768, 2010.

    Article  PubMed  Google Scholar 

  29. Huber, G., K. Nagel, D. M. Skrzypiec, A. Klein, K. Püschel, and M. M. Morlock. A description of spinal fatigue strength. J Biomech 49:875–880, 2016.

    Article  PubMed  Google Scholar 

  30. Hue, O., M. Simoneau, J. Marcotte, F. Berrigan, J. Doré, P. Marceau, S. Marceau, A. Tremblay, and N. Teasdale. Body weight is a strong predictor of postural stability. Gait Posture 26:32–38, 2007.

    Article  PubMed  Google Scholar 

  31. Khosla, S., E. J. Atkinson, B. L. Riggs, and L. J. Melton. Relationship between body composition and bone mass in women. J Bone Miner Res 11:857–863, 1996.

    Article  CAS  PubMed  Google Scholar 

  32. Kim, K.-C., D.-H. Shin, S.-Y. Lee, J.-A. Im, and D.-C. Lee. Relation between obesity and bone mineral density and vertebral fractures in Korean postmenopausal women. Yonsei Med J 51:857–863, 2010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Laslett, L., S. J. Nee Foley, S. Quinn, T. Winzenberg, and G. Jones. Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporos Int 23:67–74, 2012.

    Article  CAS  PubMed  Google Scholar 

  34. Lean, M., T. Han, and J. Seidell. Impairment of health and quality of life in people with large waist circumference. Lancet 351:853–856, 1998.

    Article  CAS  PubMed  Google Scholar 

  35. Liuke, M., S. Solovieva, A. Lamminen, K. Luoma, P. Leino-Arjas, R. Luukkonen, and H. Riihimäki. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes 29:903–908, 2005.

    Article  CAS  Google Scholar 

  36. Maden-Wilkinson, T., H. Degens, D. Jones, and J. McPhee. Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles. J Musculoskelet Neuronal Interact 13:320–328, 2013.

    CAS  PubMed  Google Scholar 

  37. Marras, W. S., S. A. Lavender, S. E. Leurgans, F. A. Fathallah, S. A. Ferguson, W. Gary Allread, and S. L. Rajulu. Biomechanical risk factors for occupationally related low back disorders. Ergonomics 38:377–410, 1995.

    Article  CAS  PubMed  Google Scholar 

  38. Matrangola, S. L., M. L. Madigan, M. A. Nussbaum, R. Ross, and K. P. Davy. Changes in body segment inertial parameters of obese individuals with weight loss. J Biomech 41:3278–3281, 2008.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Meakin, J. R., F. W. Smith, F. J. Gilbert, and R. M. Aspden. The effect of axial load on the sagittal plane curvature of the upright human spine in vivo. J Biomech 41:2850–2854, 2008.

    Article  PubMed  Google Scholar 

  40. Melton, L. J., B. L. Riggs, T. M. Keaveny, S. J. Achenbach, P. F. Hoffmann, J. J. Camp, P. A. Rouleau, M. L. Bouxsein, S. Amin, and E. J. Atkinson. Structural determinants of vertebral fracture risk. J Bone Miner Res 22:1885–1892, 2007.

    Article  PubMed  Google Scholar 

  41. National Center for Health Statistics (1999-2014). National Health and Nutrition Examination Survey Data. Hyattsville.

  42. Park, W., J. Ramachandran, P. Weisman, and E. S. Jung. Obesity effect on male active joint range of motion. Ergonomics 53:102–108, 2010.

    Article  PubMed  Google Scholar 

  43. Pavlova, A. V., S. Muthuri, F. R. Saunders, J. Adams, D. Kuh, R. M. Aspden, J. Gregory, and R. Barr. Variations in spine shape with body size, BMD and sex in individuals entering early old age. Osteoarthr Cartil 24:S246–S247, 2016.

    Article  Google Scholar 

  44. Perry, W., A. Broers, F. El-Baz, W. Harris, B. Healy, and W. D. Hillis. Grand Challenges for Engineering. Washington, DC: National Academy of Engineering, 2008.

    Google Scholar 

  45. Pirro, M., G. Fabbriciani, C. Leli, L. Callarelli, M. R. Manfredelli, C. Fioroni, M. R. Mannarino, A. M. Scarponi, and E. Mannarino. High weight or body mass index increase the risk of vertebral fractures in postmenopausal osteoporotic women. J Bone Miner Res 28:88–93, 2010.

    Article  Google Scholar 

  46. Pries, E., M. Dreischarf, M. Bashkuev, M. Putzier, and H. Schmidt. The effects of age and gender on the lumbopelvic rhythm in the sagittal plane in 309 subjects. J Biomech 48:3080–3087, 2015.

    Article  PubMed  Google Scholar 

  47. Samartzis, D., J. Karppinen, J. P. Y. Cheung, and J. Lotz. Disk degeneration and low back pain: are they fat-related conditions? Glob Spine J 3:133–144, 2013.

    Article  Google Scholar 

  48. Seo H., F. Cordier and N. Magnenat-Thalmann. Synthesizing animatable body models with parameterized shape modifications. In: Proceedings of the 2003 ACM SIGGRAPH/Eurographics Symposium on Computer Animation. Switzerland: Eurographics Association, 2003, pp. 120–125.

  49. Sheldon, W. H., S. S. Stevens, and W. B. Tucker. The varieties of human physique. New York: Harper & Row Publishers, 1940.

    Google Scholar 

  50. Shi, X., L. Cao, M. P. Reed, J. D. Rupp, C. N. Hoff, and J. Hu. A statistical human rib cage geometry model accounting for variations by age, sex, stature and body mass index. J Biomech 47:2277–2285, 2014.

    Article  PubMed  Google Scholar 

  51. Shiri, R., S. Solovieva, K. Husgafvel-Pursiainen, R. Telama, X. Yang, J. Viikari, O. T. Raitakari, and E. Viikari-Juntura. The role of obesity and physical activity in non-specific and radiating low back pain: the Young Finns study. Semin Arthritis Rheum 42:640–650, 2013.

    Article  PubMed  Google Scholar 

  52. Smuck, M., M.-C. J. Kao, N. Brar, A. Martinez-Ith, J. Choi, and C. C. Tomkins-Lane. Does physical activity influence the relationship between low back pain and obesity? Spine J 14:209–216, 2014.

    Article  PubMed  Google Scholar 

  53. Streuber, S., M. A. Quiros-Ramirez, M. Q. Hill, C. A. Hahn, S. Zuffi, A. O’Toole, and M. J. Black. Body talk: crowdshaping realistic 3D avatars with words. ACM Trans Graphics 35:54, 2016.

    Article  Google Scholar 

  54. Tafazzol, A., N. Arjmand, A. Shirazi-Adl, and M. Parnianpour. Lumbopelvic rhythm during forward and backward sagittal trunk rotations: combined in vivo measurement with inertial tracking device and biomechanical modeling. Clin Biomech 29:7–13, 2014.

    Article  CAS  Google Scholar 

  55. Takatalo, J., J. Karppinen, S. Taimela, J. Niinimäki, J. Laitinen, R. B. Sequeiros, D. Samartzis, R. Korpelainen, S. Näyhä, and J. Remes. Association of abdominal obesity with lumbar disc degeneration—a magnetic resonance imaging study. PLoS ONE 8:e56244, 2013.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Tomlinson, D., R. Erskine, C. Morse, K. Winwood, and G. Onambélé-Pearson. The impact of obesity on skeletal muscle strength and structure through adolescence to old age. Biogerontology 17:467–483, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Ulrich, J. A., E. C. Liebenberg, D. U. Thuillier, and J. C. Lotz. ISSLS prize winner: repeated disc injury causes persistent inflammation. Spine 32:2812–2819, 2007.

    Article  PubMed  Google Scholar 

  58. Urban, J. P., S. Smith, and J. C. Fairbank. Nutrition of the intervertebral disc. Spine 29:2700–2709, 2004.

    Article  PubMed  Google Scholar 

  59. van Dieën, J., H. Weinans, and H. Toussaint. Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain. Med Hypotheses 53:246–252, 1999.

    Article  PubMed  Google Scholar 

  60. Vergroesen, P.-P., I. Kingma, K. S. Emanuel, R. J. Hoogendoorn, T. J. Welting, B. J. van Royen, J. H. van Dieën, and T. H. Smit. Mechanics and biology in intervertebral disc degeneration: a vicious circle. Osteoarthr Cartil 23:1057–1070, 2015.

    Article  PubMed  Google Scholar 

  61. Vismara, L., F. Menegoni, F. Zaina, M. Galli, S. Negrini, and P. Capodaglio. Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. J Neuroeng Rehabil 7:1, 2010.

    Article  Google Scholar 

  62. Wang, Y. C., K. McPherson, T. Marsh, S. L. Gortmaker, and M. Brown. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 378:815–825, 2011.

    Article  PubMed  Google Scholar 

  63. Wang, X., A. Sanyal, P. M. Cawthon, L. Palermo, M. Jekir, J. Christensen, K. E. Ensrud, S. R. Cummings, E. Orwoll, and D. M. Black. Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res 27:808–816, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Wang, Y., T. Videman, and M. C. Battié. ISSLS prize winner: lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine 37:1490–1496, 2012.

    Article  PubMed  Google Scholar 

  65. Webb, R., T. Brammah, M. Lunt, M. Urwin, T. Allison, and D. Symmons. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine 28:1195–1202, 2003.

    PubMed  Google Scholar 

  66. WHO. Controlling the Global Obesity Epidemic, 2016.

  67. WHO. Global Health Observatory (GHO) Data, 2016.

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Acknowledgments

This work was supported by the Institut de recherche Robert-Sauvé en santé et en Sécurité du travail (IRSST-2014-0009) and the Fonds de recherche du Québec en Nature et technologies (FRQNT; merit scholarship program for foreign students - 200564).

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Authors and Affiliations

  1. Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, QC, Canada

    Farshid Ghezelbash & Aboulfazl Shirazi-Adl

  2. Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada

    André Plamondon

  3. Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran

    Navid Arjmand & Mohamad Parnianpour

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  1. Farshid Ghezelbash
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  2. Aboulfazl Shirazi-Adl
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  4. Navid Arjmand
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Correspondence to Aboulfazl Shirazi-Adl.

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Associate Editor Sean S. Kohles oversaw the review of this article.

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Ghezelbash, F., Shirazi-Adl, A., Plamondon, A. et al. Obesity and Obesity Shape Markedly Influence Spine Biomechanics: A Subject-Specific Risk Assessment Model. Ann Biomed Eng 45, 2373–2382 (2017). https://doi.org/10.1007/s10439-017-1868-7

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