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PII: S0021-9290(17)30361-5

DOI: http://dx.doi.org/10.1016/j.jbiomech.2017.07.002

Reference: BM 8290

Please cite this article as: D.J. Coombs, P.J. Rullkoetter, P.J. Laz, Efficient Probabilistic Finite Element Analysis

of a Lumbar Motion Segment, Journal of Biomechanics (2017), doi: http://dx.doi.org/10.1016/j.jbiomech.

2017.07.002

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers

we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and

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An original article

Lumbar Motion Segment

Corresponding Author:

Coombs, Dana J.

DePuy Synthes

1301 Goshen Parkway

West Chester, PA 19380, USA

610-719-6919

dcoombs3@its.jnj.com

Rullkoetter, Paul J.

Center for Orthopaedic Biomechanics

University of Denver

2390 South York Street

Denver, CO 80208

303-871-3512

paul.rullkoetter@du.edu

Laz, Peter J.

Center for Orthopaedic Biomechanics

University of Denver

2390 South York Street

Denver, CO 80208

303-871-3614

peter.laz@du.edu

Keywords: finite element analysis, lumbar, disc, nucleus pulposis, annulus fibrosis,

Holzapfel, Gasser, Ogden, Mooney Rivlin, spinal ligament, calibration, probabilistic,

Monte Carlo, Descriptive sampling, Sobol sampling, functional spinal unit

Word Count (Introduction-Discussion): 3,498

Page 1 of 30

ABSTRACT

Finite element models of the lumbar spine are useful in assessing biomechanics

and performance of implants. Models are often developed using the anatomy of an

individual subject. Average mechanical property values for the annulus and other soft

tissue structures are typically utilized from the literature, as data for the same subject

are not available. However, these properties can have significant variability. While

probabilistic methods enable the impact of soft tissue property variability on spine

the objective of this study was to develop efficient methods to perform Monte Carlo

variability in the properties of the soft tissue structures. Distributions for the soft tissue

methods, including the Sobol and Descriptive sampling techniques, were assessed for

Comparisons were based on output torque-rotation curves at the 10th and 90th

percentile for flexion, extension, axial rotation, and lateral bending. The Descriptive

sampling technique best matched the random sampling technique, at the extremes of

rotation, with a 3.6% mean difference. This was achieved with a 10X reduction in the

Page 2 of 30

1. INTRODUCTION

repaired spines. Experimental tests provide direct measurements, but are expensive

mechanics (Ayturk et al., 2011; de Visser et al., 2007; Eberlein et al, 2004; Ezquerro et

al., 2004; Ezquerro et al., 2011; Guan et al, 2006; Lu et al., 1996; Schmidt et al., 2007;

Wong et al., 2003). For example, a subject-specific model provides a consistent method

to compare implant performance (Bono et al., 2007; Bowden et al., 2008; Chiang et al.,

2006; Dooris et al., 2001; Goel et al., 2005; Polikeit et al., 2003; Rohlmann et al., 2005;

Tsuang et al., 2009; Vadapalli et al., 2006; Xiao et al., 2012; Zhong et al., 2009). While

both models and experiments assess torque-rotation behavior, some measures can be

extracted from a model that cannot be easily measured experimentally including bone

strain, facet contact force, disc pressure, and annulus fibrosis (AF) strain. Deterministic

models are typically based on anatomy generated from medical image data. In some

cases, the soft tissue representation is based on tissue tests from the same specimen,

but in most cases, the ligaments are defined as the average values reported in the

as distributions and predict output distributions and bounds of performance, while also

Page 3 of 30

parameters, are most influential. Previous studies have applied Monte Carlo (MC)

the soft tissue properties and anatomy (Lee et al., 2005; Barnes et al., 2011). Modeling

has also considered the failure of a vertebral body based on the variability of stress

measures in the bone (Ahman et al., 2010; Rohlmann et al., 2010). In addition,

probabilistic studies have assessed the mechanics associated with total disc

replacement (TDR) with variability in implant alignment in the disc space and key

(Isight Component Guide, Saliby 1990) and Sobol Sampling (Burhenne et al., 2011, Isight

Component Guide) can predict output distributions with similar accuracy in fewer

2001).

input parameters, and can extend the findings for a few subjects to better represent the

experimental literature and calibrated the material properties for models of tissue-level

ligaments. The objective of this study was to demonstrate efficient methods to perform

Page 4 of 30

probabilistic predictions of spine mechanics considering variability in the properties of

soft tissue structures using Monte Carlo simulations of a finite element model of the L4

L5 functional spinal unit. Variance reduction sampling methods, including the Sobol and

output torque-rotation curves at the 10th and 90th percentile for flexion, extension,

2. METHODS

Dassault Systemes, Johnston, RI), using an implicit solver, for the L4-L5 FSU from a

healthy 33 year old male with no evidence of disc degeneration (Fig. 1) (Rao, 2012,

Coombs et al., 2013). The vertebral geometry was segmented from a CT scan using

ScanIP (Simpleware, Exeter, UK) and bones were represented by 3-noded triangular

rigid elements (Element type=R3D3). The AF was meshed with 8-noded hexahedral

elements (Element type=C3D8R) and the nucleus pulposis (NP) was represented with an

8-noded fluid-filled membrane (Element type= SFM3D4R). The AF was modeled using

constitutive model. This constitutive model was chosen because the embedded fibers

direction and dispersion, to be modified. The AF was divided into four quadrants

Page 5 of 30

representing an anterior, posterior, and right and left lateral quadrants due to the

variation in material properties in the AF (Kurtz et al., 2006). The orientation of the

elements in the AF was defined with the normal direction of the outer surface of the

disc as the radial direction, the anatomical inferior/superior axis, and the remaining

tangential direction derived via cross-product. The superior and inferior surfaces of the

disc were kinematically coupled to a reference point at the center of the L4 and L5

vertebral bodies, respectively. Because the vertebrae were defined as rigid, this results

in the same behavior as a tied constraint between the disc surface and the vertebral

endplates. The articulating facet surfaces were rigid and represented by 8-noded

hexahedral elements (Element type=C3D8R) using linear pressure over closure contact

(Rao et al., 2009). Seven passive ligaments were defined in the model using non-linear

tension only connector elements. The ligaments included the anterior longitudinal

intraspinous ligament (ISL), intertransverse ligament (ITL), facet capsular ligament (FCL)

and ligamentum flavum (LFL). The ligament attachment sites were based on dissection

performed after testing and agreed with literature-based descriptions (Panjabi et al.,

1991).

The test frame applied pure moments of 10Nm at the L4 vertebrae while

allowing passive translation at the L5 vertebrae. Rotation was measured using a Vicon

motion capture system (Vicon, Denver, CO). The resulting measurements were 5.92 of

extension, 8.66 of flexion, 6.01 of lateral bending, and 1.75 of axial rotation (Rao,

Page 6 of 30

2012; Coombs et al., 2013). These rotations were applied to the model and the reaction

comprehensive summary of direct mechanical test data; distributions of stiffness for the

7 spinal ligaments were defined with mean and standard deviation and used as input in

the current study (Table 1). The data compiled were focused at the L4 L5 level;

however, data from other levels were used in cases when the L4 L5 data were not

single stiffness parameter was defined for the stiffness of the linear load displacement

behavior for each ligament. Two inflection points were defined to represent the toe in

region based on the mechanical test data found in literature. The location of the points

Properties for the AF were defined for the four quadrants; anterior, posterior,

and left and right lateral. The left and right lateral quadrants were assumed to be

constitutive model (Holzapfel et al., 2000) to match the distribution found in the

Page 7 of 30

literature summary. The Holzapfel-Gasser-Ogden model is defined by five parameters

C10 affects the stiffness of the ground substance. k1 affects the stiffness of the fibers in

the material. k2 determines the nonlinearity of the fiber stiffness (Abaqus Theory Guide

Chapter 4.6.3, release 6.12). This is a phenomenological constitutive model and the

fiber stiffness values do not represent individual fibers or indicate the number of

discrete fibers. The compressibility parameter, D, was defined as 1/(20*C 10), which is

equivalent to defining the initial bulk modulus as twenty times the initial shear modulus.

Poissons ratio of 0.475 (Abaqus Users Guide Chapter 22.5.1, release 6.12). The fiber

dispersion parameter, , was set to 0 assuming the fibers are perfectly aligned to the

fiber direction. As a result, three input parameters (C10, k1, k2) defined the Holzapfel-

Gasser-Ogden relationship for each quadrant. The best agreement to literature data

parameters. Mean and standard deviations for the parameters are reported for each

An initial assessment of the FE model was performed using mean values of the

soft tissue parameters and compared the torque rotation behavior and range of motion

Page 8 of 30

2.3 Probabilistic Methods

Systemes, Johnston, RI) to determine the uncertainty of the torque-rotation curves for

flexion, extension, axial rotation, and lateral bending based on the uncertainty of the

soft tissue parameters. The random sampling technique with 500 iterations established

the baseline. Sampling error and convergence were calculated to assess the quality of

the predictions. To assess the number of trials required to achieve convergence, the

Monte Carlo simulation was evaluated by calculating the cumulative 10th and 90th

percentile of the reaction moment at the end of the applied rotation and then

calculating the percent error between the current iteration cumulative percentile and

The Descriptive and Sobol variance reduction techniques were evaluated. The

the space defined by each random input parameter is divided into subsets of equal

probability and the analysis is performed with the value for each subset of each random

parameter selected only once. The Sobol sampling technique uses a quasi-random

sequence to generate samples of input parameters more uniformly than random and

Descriptive Sampling while considering previously sampled points to avoid clusters and

gaps (Burhenne et al., 2011). The Sobol sequence generates numbers as binary

fractions of appropriate length from a set of special binary fractions. The Descriptive

Sampling and Sobol Sampling techniques were used with 50 and 25 iterations and

Page 9 of 30

performed for the 10th percentile and 90th percentile torque rotation curves. Error was

computed as the sum of the squared differences in reaction moment between the

efficient prediction and the baseline results established with 500 iterations of random

sampling. The error was calculated using 20 evenly distributed points along the torque-

A sensitivity study was also performed to identify which input parameters most

affected the reaction torque. Initially, the Parameter Study functionality in Isight was

assess its impact on the output. Further, correlations, a measure of sensitivity, were

calculated for the 500 random sampling data points using the Pearson Product-Moment

Correlation Coefficient. Visualizing the sampling data also identified that some of the

relationships between the input parameters and the reaction torques were nonlinear.

3. RESULTS

The FE model with ligament and disc parameters defined at their mean values fit

well within the ranges of motion reported in the literature. Guan et al. (2006) reported

torque rotation curves and their statistics for 10 L4-L5 FSUs (50.6 +/- 13.2 years old,

max 68, min 27) loaded with a pure moment in flexion, extension, lateral bending and

axial rotation. Campbell et al. (2011) reported similar data with 9 L4-L5 FSUs (mean

Page 10 of 30

65.5 years old, max 75, min 48). Qualitatively, the model falls between the

experimental ranges of +/- 1 standard deviation for all degrees of freedom with the

exception of extension. This is also true for the subject specific test data measured from

the specimen that was used to define the anatomy of the FE model (Fig. 2). Symmetric

Total range of motion was also compared at specified moments. Campbell et al.

(2011) also reported range of motion at 10Nm for flexion, extension, lateral bending,

and axial rotation. Yamamoto et al. (1989) reported similar data based on 10 L4-L5

FSUs (25 to 63 years). Panjabi et al. (1994) reported range of motion at 4Nm for

flexion, extension, and lateral bending based on 9 FSUs (35 to 62 years) and Guan et al.

(2006) reported similar data based on 10 L4-L5 FSUs (mean 50.6 +/- 13.2 years). The FE

data was within 1 standard deviation of a literature source for each motion except for

flexion-extension at 10Nm, which was between the mean valued reported by Campbell

et al. (2011) and Yamamoto et al. (1989) (Fig. 3). There was not a literature source to

For all degrees of freedom (flexion, extension, axial rotation, and lateral bend),

torque-rotation curves for the FSU at the 10th and 90th percentiles showed that Monte

Carlo simulations with the Descriptive and Sobol sampling methods compared well with

the baseline random sampling method with 500 iterations (Fig. 4). Results for the

Page 11 of 30

iterations. The sum of the squared error (SSE) quantified differences between the

torque-rotation curves for the various methods (Fig. 4, Table 3). The SSE was lower for

certain methods in specific degrees of freedom (e.g. Sobol with 50 iterations for lateral

bending). The Descriptive sampling technique with 50 iterations had the smallest mean

SSE across all degrees of freedoms (2.74 (Nm)2) and for flexion-extension (1.10 (Nm)2)

Computation time for each iteration was approximately 70 minutes for all

simulation with 500 iterations took 24 days, underscoring the need for more efficient

approaches. The 25 and 50 iteration methods took approximately 1.2 days and 2.4

days, respectively. In Monte Carlo simulation with random sampling, the number of

trials and the location (mean or tail) in the distribution influenced the accuracy of the

results. For 500 iterations, confidence intervals bounding the predictions were

computed for the 10th and 90th percentile torque-rotation curves at the maximum

applied rotation (Table 4) and provide a context for error comparison with the variance

reduction methods (Haldar et al., 2000). The convergence error for flexion, extension,

axial rotation, and lateral bending was less than 0.5% at 500 iterations, which supported

the us the results as the baseline for comparison with the variance reduction sampling

techniques.

Page 12 of 30

The sensitivity analysis identified the key input parameters, and was influenced

by the degree of freedom for the applied rotation (flexion, extension, axial rotation, and

lateral bending) and the relative location/contribution of the soft tissue structures (Fig.

5a). For example, the torque-rotation behavior during flexion was most sensitive to the

stiffness of the SSL and ISL. During extension, the torque-rotation behavior was most

sensitive to the stiffness of the ALL and the C 10 parameter of the anterior disc quadrant.

During lateral bending, the torque-rotation behavior was most sensitive to the stiffness

of the ITL and C10 parameter of the lateral disc quadrant. Input parameters identified

based on correlations from the Monte Carlo simulation generally matched the

parameters from the perturbation study (Fig. 5). However, the fiber angle parameter

had the greatest impact on the torque-rotation behavior for the extension, axial

rotation, and lateral bending rotations. To investigate further, correlations in the input

and output data from the baseline random sampling analysis (500 trials) were computed

and relationships between fiber angle and the reaction torque were investigated. By

plotting the reaction moments as a function of fiber angle (Fig. 6), the point clouds

exhibited trends for extension and axial rotation. For these degrees of freedom, the

moment and a resulting greater sensitivity. The correlations and relationships between

fiber angle and reaction moment were less strong for lateral bending and flexion.

4. DISCUSSION

Page 13 of 30

The aim of this study was to assess whether variance reduction techniques, like

the Descriptive or Sobol sampling, could accurately and more efficiently predict the

Monte Carlo simulation with random sampling. This study focused on the variability in

torque rotation behavior due to variability in the soft tissue representations of the AF

and ligaments. A probabilistic representation from Coombs et al. (2016) established the

distributions from a literature review of direct mechanical test data and FE analyses of

spine uses average values for soft tissue properties. The use of the probabilistic

representation to represent the soft tissue properties in the predictions of the current

study are particularly relevant as they enable consideration of the impact of intersubject

variability.

Baseline in the current study was established with a traditional Monte Carlo

simulation using random sampling with 500 iterations and required approximately 4

days of computation time. Descriptive sampling and Sobol sampling techniques were

shown to reduce the computation time with similar levels of accuracy. The Descriptive

sampling technique with 50 iterations was recommended as the results compared well

to the baseline Monte Carlo simulation (500 trials); the total SSE error was 21.88 (Nm) 2

and required 1.2 days or about a 90% reduction in computation time. A deformable

representation of this model was also run and increased the computation time by 10.

This further demonstrates the need for an efficient sampling method if using a

deformable model.

Page 14 of 30

The probabilistic FE modeling approach uniquely allows investigators to assess

how the experimental variability in small tissue specimens propagates to influence the

mechanics of an FSU or the entire spine. Leveraging the efficient methods, the ability to

motions, can be useful in establishing ranges for healthy normal populations, assessing

pathologies (e.g. disc degeneration) and informing implant design and surgical

other output measures of interest, such as disc pressure, facet contact or annulus strain,

can be similarly assessed. These measures would need to also be compared to physical

biomechanics data.

Using a sensitivity analysis, the most important variables influencing the specific

outputs were identified for each applied rotation. As expected, the reaction moment

was generally most sensitive to ligaments that had the greatest moment arms

considering the direction of the applied motion. This observation was also true for the

quadrants of the AF. Surprisingly, the reaction moments were most sensitive to the AF

fiber angle in the extension and axial rotation degrees of freedom. The distribution for

fiber angle was derived from Guerin et al. (2006) from direct experimental

measurement. This variability was determined from outer anterior annulus specimens

from 8 discs. The reaction moments were not as sensitive at lower values of fiber angles

because the component of the force generated by the fiber angle resisting the rotation

is smaller. This finding underscores the importance of accurately measuring the fiber

angle when performing tests. Further biomechanical studies to better characterize the

Page 15 of 30

variation present in fiber angle and understand the relationship between AF fiber angle

and the torque rotation response are recommended. Further studies should also be

conducted to understand the sensitivity of fiber angle and fiber stiffness in degenerated

and the parameter values reported in this study reproduce the torque-rotation curves.

This material model was defined with initially nearly incompressible behavior. It is

possible that another set of parameter values with a purely incompressible material

would provide similar load displacement behavior, which could decrease the sensitivity

The finite element model utilized in the study was based on the anatomy of a

single specimen (33 years, male, 59 kg). The specimens anatomy was compared to

anatomy data derived from 157 healthy spines with a mean age of 26.8 years (Gilad et

al., 1986). In general, the specimens L4-L5 anatomy was slightly smaller than the

average reported by Gilad et al. (1986). The majority of the measurements were within

1 standard deviation of the mean (Table 5), with the exception of the anterior/posterior

(A/P) width of the superior L5 endplate. The anterior and posterior FE model disc height

was greater than the mean disc height. Therefore, the disc in the FE model was taller

and narrower than the literature means, causing the disc to be more flexible in flexion

and extension. This observation could explain why the model is less stiff with mean

parameter values than the typical torque rotation curves. Furthermore, the donor used

to define the FE model was 177.8cm tall compared to the mean height of 174.7cm from

Page 16 of 30

In this study, the bony anatomy was approximated as a rigid body. As the model

outputs are focused on kinematics and torque-rotation behavior, they should not be

have made similar assumptions (Thacker et al., 2001; Coombs et al. 2013). While

variability in the soft tissue properties was considered, future work could include

variability in the bony anatomy, facet cartilage geometry, and even loading conditions.

population and efficiently generating virtual subjects for finite element analysis

(Hollenbeck et al., 2013). The bony anatomy could also be treated as deformable and

the variability in bone stiffness could be included. This would require significant effort

because the modulus of bone spatially varies and needs to be accurately correlated to

were based on data from a healthy normal population. Further work could be

which may be useful when assessing pathology or developing spinal implants. Studies

have shown that disc degeneration influenced the torque-rotation behavior of the FSU;

range of motion generally decreased with more severe degeneration (Rohlmann et al.,

2006).

probabilistic analyses to be completed in 10% of the time required for the traditional

Page 17 of 30

efficiency enables consideration of the uncertainty present in the population and can be

employed for timely design phase assessments of spinal implant designs and

ACKNOWLEDGEMENT

This study was supported in part by DePuy Synthes. The authors gratefully acknowledge

the model development work performed by Dr. Milind Rao and experimental testing

Page 18 of 30

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Page 23 of 30

CAPTIONS

Figure 1. Finite element model of L4 L5 FSU model with detailed representation of the

disc showing anterior, posterior, and lateral regions of the annulus fibrosis, and a

representative load vs. displacement graph of the ALL with mean and +/- 1 standard

deviation of stiffness.

parameter values to the literature (Guan et al., 2006; Campbell et al., 2011).

Figure 3. Total range of motion compared to available literature data at 4Nm and 10Nm

for flexion-extension (FE), lateral bending (LB) and axial rotation (AR) degrees of

freedom. Model predictions are based on average parameter values.

Figure 4. Comparison of torque-rotation behavior for Monte Carlo results at 10th and

90th percentile, using random, Descriptive and Sobol sampling.

Figure 5. Parameter sensitivity assessed via parameter perturbation in Isight (a) and

correlations based on Monte Carlo simulation data (b). Results shown for flexion,

extension, axial rotation and lateral bending reaction moments at the maximum range

of motion.

Figure 6. Scatter plots of annulus fiber angle vs. reaction moments for flexion, extension,

axial rotation and lateral bending with Pearson Correlation Coefficients. Each data point

represents one of the 500 Monte Carlo iterations.

(Coombs et al., 2016)

Table 2. Equations for Ligament Load vs. Displacement Behavior, Npar = number of

elements in parallel, Nser = number of elements in series, K = stiffness

Table 3. Sum of squared error (Nm)2 comparison of Descriptive and Sobol sampling to

baseline random sampling (500 trials) for flexion-extension, axial rotation, and lateral

bending degrees of freedom

Table 4. Confidence interval (alpha = 0.95) bounds for the reaction moment (Nm) at the

maximum applied rotation. Calculation is based on traditional random Monte Carlo

sampling with 500 trials.

Page 24 of 30

Table 5. Comparison of FSU anatomic measurements between specimen/model and

statistical measurements from Gilad et al. (1986).

Page 25 of 30

Table 1. Summary of input parameters representing ligaments and annulus fibrosis

(Coombs et al., 2016)

Deviation

Ligaments

Neumann et al (1992)

ALL Stiffness (N/mm) Normal 55.39 17.87 Pintar et al. (1992)

Chazal et al. (1985)

Pintar et al. (1992)

PLL Stiffness (N/mm) Normal 31.30 22.48

Chazal et al. (1985)

Pintar et al. (1992)

LFL Stiffness (N/mm) Normal 23.23 8.67

Chazal et al. (1985)

FCL Stiffness (N/mm) Normal 30.60 1.50 Pintar et al. (1992)

ITL Stiffness (N/mm) Normal 35.35 7.20 Chazal et al. (1985)

Pintar et al. (1992)

ISL Stiffness (N/mm) Normal 24.68 15.75 Chazal et al. (1985)

Iida et al. (2002)

Pintar et al. (1992)

Chazal et al. (1985)

SSL Stiffness (N/mm) Normal 20.55 9.96

Iida et al. (2002)

Robertson et al. (2013)

Anterior Annulus Fibrosis Holzapfel-Gasser-Ogden parameters

Guerin et al. (2006)

C10 (MPa) Lognormal 0.0670 0.050

Wagner et al. (2004)

k1 (MPa) Normal 1000.0 500.0 Fujita et al. (1997)

Holzapfel et al. (2005)

OConnell et al. (2009)

k2 Normal 4809.5 2113.9

Ebara et al. (1996)

Posterior Annulus Fibrosis Holzapfel-Gasser-Ogden parameters

C10 (MPa) Lognormal 0.134 0.100 Fujita et al. (1997)

k1 (MPa) Normal 2000.0 1000.0 Holzapfel et al. (2005)

k2 Normal 5296.3 3208.7 Ebara et al. (1996)

Lateral Annulus Fibrosis Holzapfel-Gasser-Ogden parameters

C10 (MPa) Lognormal 0.130 0.100 Fujita et al. (1997)

k1 (MPa) Normal 1500.0 750.0 Holzapfel et al. (2005)

k2 Normal 5849.2 3119.7 Ebara et al. (1996)

Annulus Fibrosis Fiber angle from transverse plane

Normal 25.44 4.22 Guerin et al.(2006)

Page 26 of 30

Table 2. Equations for Ligament Load vs. Displacement Behavior, Npar = number of

elements in parallel, Nser = number of elements in series, K = stiffness

ALL

PLL

SLL

LFL

ITL

ISL

FCL

Page 27 of 30

Table 3. Sum of squared error (Nm)2 comparison of Descriptive and Sobol sampling to

baseline random sampling (500 trials) for flexion-extension, axial rotation, and lateral

bending degrees of freedom.

Axial Lateral

Extension Extension

Rotation Bending Mean

Sampling Percentile Percentile

Percentile Percentile Error

Technique (Nm)2 (Nm)2

(Nm)2 (Nm)2 (Nm)2

10th 90th 10th 90th 10th 90th 10th 90th

Descriptive 2.78

0.09 3.22 0.38 4.81 0.58 10.95 1.93 0.25

25 Iterations

Descriptive 2.74

0.15 1.31 1.88 1.04 4.28 7.98 0.33 4.91

50 Iterations

Sobol 10.10

0.06 6.78 20.07 25.33 2.67 23.48 0.62 1.82

25 Iterations

Sobol 4.77

0.04 8.46 9.18 5.15 0.04 14.16 0.56 0.53

50 Iterations

Page 28 of 30

Table 4. Confidence interval (alpha = 0.95) bounds for the reaction moment (Nm) at the

maximum applied rotation. Calculation is based on traditional random Monte Carlo

sampling with 500 trials.

Applied Motion

Upper Bound Lower Bound Upper Bound Lower Bound

Extension 3.31 3.14 9.73 9.22

Flexion -35.39 -37.34 -20.54 -21.67

Axial Rotation 4.13 3.91 22.16 21.00

Lateral Bending 7.10 7.49 11.72 12.37

Page 29 of 30

Table 5. Comparison of FSU anatomic measurements between specimen/model and

statistical measurements from Gilad et al. (1986).

Measurement (mm)

L4 L5 Disc L4 L5 Disc

Inferior A/P width of

32.7 30.5 NA 34.9 2.8 33.9 2.7 NA

endplate

Anterior height of vertebral

28.9 26.2 NA 27.4 2.2 28.3 2.1 NA

body

Superior A/P width of

31.5 32.4 NA 34.3 2.7 34.2 2.7 NA

endplate

Posterior height of vertebral

27.3 24.0 NA 27.1 2.3 25.7 2.5 NA

body

Anterior disc height NA NA 14.1 NA NA 12.0 1.8

Posterior disc height NA NA 8.23 NA NA 7.7 1.5

Page 30 of 30

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