The Clinical Research And Finite Element Analysis Of Lumbar Rolling Movement With Forward Bending In Treating Degenerative Lumbar Spinal Stenosis

ObjectiveIn order to evaluate the effectiveness and safety of this therapy system, to discuess its possible mechanism in structure. Then to supply more completed theory for the therapy system, and provides a feasible conservative treatment for treating degenerative lumbar spinal stenosis.Methods(1) Clinical research53cases meet the inclusion and exclusion criteria who has suffered degenerative lumbar spinal stenosis and treated by orthopedics treatment department during March2012to September2013. Of which25were male and29were female, the average age was67.04±9.05years old, ranging from52to85years; the average Course of disease was9years from3months to40years. Group divided:there are27patients belong to the Lumbar rolling movement with forward bending group and22of them complete the follow-up.26people were conventional therapy group while24of them finish the follow-up. Two groups were compared with sexual, age, length of the history data and show no significant difference(P<0.05).2cases of the Lumbar rolling movement with forward bending group were unable to return on time and remove,3cases was lost due to the contact loss, lcase Relapse and go to the other hosipital,1case take the operation during the follow-up period. At last46of53cases have completed the follow-up successfully.Compared the two group with VAS scores, JOA scores, ACD, ICD, MacNab scores and also the recurrence during the period. Statistical analysis the data with SPSS19.0software.(2)Three-dimensional finite element analysisChoose3volunteers who are consistent with the degenerative lumbar spinal stenosis and meeting the requirements of this subject. Let them take Lumbar CT scan, and the scan thick layer is0.75mm. Storing the CT images and input to the Mimisc10.01software to generate three-dimensional images. We can get the Contour data of lumbar vertebras through different thresholds in Mimisc, and save as Binary STL files, which are inputed to the Geomagic Studio. We divide the vertebra into several parts according to the curvature of different vertebra, and then we can generate the lumbar geometric model by using the point cloud data of each region. Input it to the MARC2005software, and establish the finite element modeling according to the modeling parameters of different structure, and simulate biomechanical experiment. First we should measure the intervertebral height, the facet joints’relative displacement, foramen intervertebral height and area in the neutral position, then we make the lumbar vertebra forward-bend for50°and applied500N force that in Sagittal, vertical spinous process and point to the anterior, measure the same data and deal with the SPSS19.0softwareResults(1)Clinical researchThe statistical analysis results:both the Lumbar rolling movement with forward bending group and the conventional therapy group can achieve a significant effect in clinic(P<0.05); The clinical curative effect between the Lumbar rolling movement with forward bending group and the conventional therapy group shows no significant differences(P>0.05); the Improvement of intermittent claudication distance between two groups shows significant differences(P<0.05); the recurrence between two groups shows significant differences(P<0.05).(2)Three-dimensional finite element analysis4cases were included in the case, and successful completion of modeling and analysis. Statistical analysis showed that after the treatment, the L1/2level shows no significant improvements in each index (P>0.05), the L2/3level shows significant improvements in the height and area of the intervertebral foramen(P<0.05), the L3/4level shows significant improvements in the area of the intervertebral foramen and the facet joints’ relative displacement (P<0.05), the L4/5level shows significant improvements in each index(P<0.05), the L5/S1level shows significant improvements in the height of the intervertebral foramen and the facet joints’ relative displacement(P<0.05).ConclusionUsing the Lumbar rolling movement with forward bending is effective in the treatment of degenerative lumbar spinal stenosis and control its recurrence. By improving the height and area of the intervertebral foramen to produce a therapeutic effect may be the mechanism.