The incidence of adjacent segment degeneration (ASD) after lumbar spinal fusion have not been precisely verified. In the presence of mild degeneration in the proximal segment adjacent to the fused segment, selection of additional fusion is not agreed upon. Muscle activity change and ASD after fusion was analyzed with a developed three-dimensional finite element model of musculoskeletal system. The paraspinal muscle activities were calculated based on a hypothesis, the intervertebral disc was assumed to have a transducer function and the muscle is activated according to a sensor driven control mechanism to maintain the stability of the lumbar spine. Simulation was conducted for erect standing and 60° isometric forward flexed posture. Total muscle force produced in each deep muscle group was similar however activity of some muscle fascicles which inter-connected to the vertebrae above the fused segment showed increased value. In the presence of mild degeneration in the proximal adjacent segment, muscle activity across the degenerated segment was reduced. Despite changes in muscle activity, nucleus pressure at adjacent segment was increased in both cases. This change would eventually lead to the ASD.

Spinal stability is controlled by two interrelated systems: the spinal column including ligaments and the muscular control system. In addition to these systems, the thoracolumbar fascia (TLF) also interacts with the muscular system to maintain the stability of the spine. The effects of the tensioning of TLF on the spinal stability was investigated using computational analysis. The stability of the spine was analyzed with a three-dimensional finite element model of musculoskeletal system including TLF. The paraspinal muscle activities were calculated based on a hypothesis: the intervertebral disc was assumed to have a transducer function and the muscle is activated according to a sensor driven control mechanism to maintain stability of the lumbar spine. Muscle forces were calculated in examining 40o isometric forward flexed and erect standing postures. As a result, the fascial tension induced a decrease in superficial muscle activity while maintaining the spinal stability.

Recently, we have proposed a hypothesis that spinal structures have a stress sensor driving feedback mechanism. In the human spine, spinal structure could react to modify muscular action in such a way so as to equalize stress at the disc, therefore reduce the risk of injury. In this analysis, abdominal muscle and abdominal pressure, which were not included in the previous study, were added to identify those effects in spine stability during upright stance posture for the case where the intervertebral disc plays the role of mechanoreceptor. The musculoskeletal FE model was consisted with detailed whole lumbar spine, pelvis, sacrum, coccyx and simplified trunk model. Muscle architecture with 46 local muscles containing paraspinal muscle and 6 rectus abdominal muscles were assigned according to the acting directions. The magnitude of 4㎪ was considered for abdominal pressure. Minimization of the nucleus pressure deviation and annulus fiber average tension stress deviation was chosen for cost function. Developed model provide nice coincidence with in-vivo measurement (nucleus pressure). Analysis was conducted according to existence of co-activation of abdominal muscle and abdominal pressure. Antagonistic activity of abdominal muscle produced stability of spinal column with relatively small amount of total muscle force. In contrast to the abdominal muscle, effect of abdominal pressure was not clear that was partly depending on the assumption of constant abdominal pressure.

For stability analysis of the lumbar spine, the hypothesis presented is that the disc has stress sensors driving feedback mechanism, which could react to the imposed loads by adjusting the contraction of the muscles. Fusion in the motion segment of the lumbar spinal column is believed to alter the stability of the spinal column. To identify this effect finite element (FE) models combined with optimization technique was applied and quantify the role of each muscle and reaction forces in the spinal column with respect to the fusion level. The musculoskeletal FE model was consisted with detailed whole lumbar spine, pelvis, sacrum, coccyx and simplified trunk model. Vertebral body and pelvis were modeled as a rigid body and the rib cage was constructed with rigid truss element for the computational efficiency. Spinal fusion model was applied to L3-L4, L4-L5, L5-S1 (single level) and L3-L5 (two levels) segments. Muscle architecture with 46 local muscles was used as acting directions. Minimization of the nucleus pressure deviation and annulus fiber average axial stress deviation was selected for cost function. As a result, spinal fusion produced reaction changes at each motion segment as well as contribution of each muscle. Longissimus thoracis and psoas major muscle showed dramatic changes for the cases of L5-S1 and L3-L5 level fusion. Muscle force change at each muscle also generated relatively high nucleus pressure not only at the adjacent level but at another level, which can explain disc degeneration pattern observed in clinical study.