Thesis (Ph.D.) - Cairo University - Faculty of Physical Therapy - Department ofPhysical Therapy for Neuromuscular and Neurosurgery

Background: Despite the clinical importance of lumbar intervertebral foramen (IVF) dimensions, there was little in vivo data on the degree of changes in dimensions of IVF with different spinal positions. Purpose: The purposes of this study were to measure and analyze the geometry of lumbar IVF changes and amount of disc bulge at different loading trunk positions, to validate finite element model, to match the results with kinesiological H-reflex findings and to determine the optimal spinal position used in treatment. Methods: Twenty male patients had L4-L5 disc prolapse and ten normal subjects matched patients represented the sample of this study. The study was conducted to three equal groups. First group (G1) represented healthy asymptomatic subjects, second group (G2) patients with L4-5 posterior disc bulge and third group (G3) patients with L4-5 posterolateral disc bulge. Three dimensional finite element models (FEM) were created based on radiological imaging (micro MRI, micro CT, 3D CT, DXA, and X-ray). The construction and analysis of FEM was done by using simpleware (Scan IP, Scan FE, and Scan CAD) and Ansys11.0. Dimensions of IVF (height, width, and cross sectional area) and amount of disc bulge were measured at different loading positions: axial compression, flexion, extension, axial rotation, lateral bending, and coupled movement. Model was validated in vitro studies

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