{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:30:36Z","timestamp":1768217436528,"version":"3.49.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/V029452\/1"],"award-info":[{"award-number":["EP\/V029452\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Excessive intervertebral disc (IVD) strains and vertebral body motions are associated with lower back pain (LBP). Quantifying these strains and motions may aid in predicting the success of candidate LBP treatments and enable better prediction of pre-operative instability and post-operative implant failure, but cannot currently be obtained in routine clinical assessment. Thus, the aim of this study was to evaluate the feasibility of utilising clinical measures of spinal alignment, IVD geometry, and disc degeneration to predict\n                      <jats:italic>in vivo<\/jats:italic>\n                      IVD strains and vertebral translations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifteen participants presenting no LBP were subjected to one unloaded and one supine extension-loaded MRI scan. MRI-based digital volume correlation (DVC) was used to quantify the principal and shear strains of lumbar IVDs and anterior-posterior, cranial-caudal, and total translation of the vertebral bodies (L1-S1). IVD height, anterior-posterior IVD height ratio, segmental lordosis, lumbar lordosis, lumbar height, sacral angle, and Pfirrmann grade were evaluated using the reference MR images. Multivariate linear regression was used to predict level-wise strains and translations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>IVD strains and vertebral translations were successfully predicted from clinical measures of spinal alignment and disc degeneration, but only at the L4-L5 and L5-S1 levels. Specifically, greater minimum principal IVD strains and vertebral anterolisthesis were associated with a reduced anterior-posterior IVD height ratio at L4-L5 (p &amp;lt; 0.01). Greater peak minimum principal strains and anterolisthesis were associated with taller IVDs in the L5-S1 segment (p &amp;lt; 0.05). In the same segment, increased sacral angle was associated with greater peak minimum principal strains (p &amp;lt; 0.05) but lower anterolisthesis (p &amp;lt; 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study demonstrates the potential of utilising radiographic variables to predict the biomechanical behaviour at the segmental level, giving rise to future exploration of complex loading patterns in patient cohorts with specific spinal pathologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2025.1730260","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:17Z","timestamp":1768205957000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["In vivo prediction of intervertebral disc strains and segmental kinematics from clinical MRI during lumbar extension"],"prefix":"10.3389","volume":"13","author":[{"given":"Kay Ann","family":"Raftery","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saman","family":"Tavana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Becky","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Leong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett Arthur","family":"Freedman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Newell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1007\/s00586-016-4673-3","article-title":"A morphometric analysis of all lumbar intervertebral discs and vertebral bodies in degenerative spondylolisthesis","volume":"25","author":"Abu-Leil","year":"2016","journal-title":"Eur. Spine J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"F1000 Faculty Rev-1530","DOI":"10.12688\/f1000research.8105.2","article-title":"Mechanisms of low back pain: a guide for diagnosis and therapy","volume":"5","author":"Allegri","year":"2016","journal-title":"F1000Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1227\/01.neu.0000303194.02921.30","article-title":"Spinopelvic alignment of patients with degenerative spondylolisthesis","volume":"61","author":"Barrey","year":"2007","journal-title":"Neurosurgery"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1097\/00007632-199409150-00017","article-title":"Effect of lordosis on the position of the nucleus pulposus in supine subjects: a study using magnetic resonance imaging","volume":"19","author":"Beattie","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/00002517-199902000-00011","article-title":"The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis","volume":"12","author":"Berlemann","year":"1999","journal-title":"J. Spinal Disord."},{"key":"B6","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1097\/00007632-199006000-00026","article-title":"Lumbosacral segmental motion in normal individuals: have we been measuring instability properly?","volume":"15","author":"Boden","year":"1990","journal-title":"Spine (Phila Pa 1976)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1097\/BRS.0b013e31817b8fbd","article-title":"Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain","volume":"34","author":"Chen","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3389\/fmats.2017.00031","article-title":"Precision of digital volume correlation approaches for strain analysis in bone imaged with micro-computed tomography at different dimensional levels","volume":"4","author":"Dall\u2019Ara","year":"2017","journal-title":"Front. Mater"},{"key":"B9","doi-asserted-by":"publisher","first-page":"109900","DOI":"10.1016\/j.mehy.2020.109900","article-title":"A new approach to the treatment of spinal instability: fusion or structural reinforcement without surgery?","volume":"144","author":"Dang","year":"2020","journal-title":"Med. Hypotheses"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0140315","DOI":"10.1371\/journal.pone.0140315","article-title":"CT and MRI determination of intermuscular space within lumbar paraspinal muscles at different intervertebral disc levels","volume":"10","author":"Deng","year":"2015","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/S0268-0033(02)00032-3","article-title":"Relationship between pain and vertebral motion in chronic low-back pain subjects","volume":"17","author":"Dickey","year":"2002","journal-title":"Clin. Biomech."},{"key":"B12","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1097\/00007632-198504000-00015","article-title":"Radiologic diagnosis of degenerative lumbar spinal instability","volume":"10","author":"Dupuis","year":"1985","journal-title":"Spine (Phila Pa 1976)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1054\/math.2000.0356","article-title":"MRI evaluation of lumbar spine flexion and extension in asymptomatic individuals","volume":"5","author":"Edmondston","year":"2000","journal-title":"Man. Ther."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1093\/ptj\/74.12.1093","article-title":"Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome","volume":"74","author":"Erhard","year":"1994","journal-title":"Phys. Ther."},{"key":"B15","doi-asserted-by":"publisher","first-page":"231","DOI":"10.3171\/2017.11.SPINE17976","article-title":"A call for consistent radiographic definition of lumbar lordosis","volume":"29","author":"Frenkel","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1097\/00007632-199306150-00011","article-title":"A histologic study of lumbar pseudarthrosis","volume":"18","author":"Heggeness","year":"1993","journal-title":"Spine (Phila Pa 1976)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1177\/21925682221134044","article-title":"Prevalence and risk factors of degenerative spondylolisthesis and retrolisthesis in the thoracolumbar and lumbar spine \u2013 an EOS study using updated radiographic parameters","volume":"14","author":"Hey","year":"2024","journal-title":"Glob. Spine J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/01.bsd.0000102473.95064.9d","article-title":"Lumbar instability and clinical symptoms: which is the more critical factor for symptoms: sagittal translation or segment angulation?","volume":"17","author":"Iguchi","year":"2004","journal-title":"J. Spinal Disord. Tech."},{"key":"B19","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1097\/00007632-198906000-00008","article-title":"Preoperative and postoperative instability in lumbar spinal stenosis","volume":"14","author":"Johnsson","year":"1989","journal-title":"Spine (Phila Pa 1976)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.3171\/jns.1994.81.5.0806b","article-title":"Herniated lumbar disc","volume":"2009","author":"Jordan","year":"2009","journal-title":"BMJ Clin. Evid."},{"key":"B21","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"682","DOI":"10.31616\/asj.2020.0472","article-title":"Lumbar spinal stenosis: pathophysiology andTreatment principle: a narrative review","volume":"14","author":"Lee","year":"2020","journal-title":"Asian Spine J."},{"key":"B23","doi-asserted-by":"publisher","first-page":"48","DOI":"10.21037\/jss-20-631","article-title":"Flexion-extension standing radiographs underestimate instability in patients with single-level lumbar spondylolisthesis: comparing flexion-supine imaging may be more appropriate","volume":"7","author":"Lee","year":"2021","journal-title":"J. Spine Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1148\/radiol.2451051359","article-title":"Lumbar intervertebral instability: a review","volume":"245","author":"Leone","year":"2007","journal-title":"Radiology"},{"key":"B25","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1186\/s12891-016-1237-y","article-title":"Comparison of the PEEK cage and an autologous cage made from the lumbar spinous process and laminae in posterior lumbar interbody fusion","volume":"17","author":"Lin","year":"2016","journal-title":"BMC Musculoskelet. Disord."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2571","DOI":"10.1097\/00007632-199711010-00020","article-title":"Lumbar lordosis: effects of sitting and standing","volume":"22","author":"Lord","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/00003086-197606000-00010","article-title":"Standing roentgenograms in spondylolisthesis","volume":"117","author":"Lowe","year":"1976","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.nec.2007.01.007","article-title":"Flatback syndrome","volume":"18","author":"Lu","year":"2007","journal-title":"Neurosurg. Clin. N. Am."},{"key":"B29","article-title":"McKenzie back exercises","author":"Mann","year":"2023"},{"key":"B30","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/j.actamat.2014.08.046","article-title":"Yield behavior beneath hardness indentations in ductile metals, measured by three-dimensional computed X-ray tomography and digital volume correlation","volume":"82","author":"Mostafavi","year":"2015","journal-title":"Acta Mater"},{"key":"B31","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/BF00426175","article-title":"Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain","volume":"113","author":"Murata","year":"1994","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"112815","DOI":"10.1016\/j.jbiomech.2025.112815","article-title":"In vivo measurement of vertebral deformation using digital tomosynthesis based digital volume correlation","volume":"189","author":"Oravec","year":"2025","journal-title":"J. Biomech."},{"key":"B33","volume-title":"Spinal deformity study group radiographic measurement manual","author":"O\u2019Brien","year":"2008"},{"key":"B34","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1002\/jor.21232","article-title":"Human intervertebral disc internal strain in compression: the effect of disc region, loading position, and degeneration","volume":"29","author":"O\u2019Connell","year":"2011","journal-title":"J. Orthop. Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/S1050-6411(03)00044-0","article-title":"Clinical spinal instability and low back pain","volume":"13","author":"Panjabi","year":"2003","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2836","DOI":"10.1097\/01.brs.0000245834.30646.aa","article-title":"The effect of lumbar flexion and extension on disc contour abnormality measured quantitatively on magnetic resonance imaging","volume":"31","author":"Parent","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2714","DOI":"10.1038\/s41598-024-51769-2","article-title":"Long-term effects of lumbar flexion versus extension exercises for chronic axial low back pain: a randomized controlled trial","volume":"14","author":"Park","year":"2024","journal-title":"Sci. Rep."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1097\/00007632-200109010-00011","article-title":"Magnetic resonance classification of lumbar intervertebral disc degeneration","volume":"26","author":"Pfirrmann","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1053\/crad.2001.0899","article-title":"Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography","volume":"57","author":"Pitk\u00e4nen","year":"2002","journal-title":"Clin. Radiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/00007632-198504000-00013","article-title":"Biomechanical definitions of spinal instability","volume":"10","author":"Pope","year":"1985","journal-title":"Spine (Phila Pa 1976)"},{"key":"B41","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1093\/jhps\/hnw008","article-title":"Analysis of spinal alignment and pelvic parameters on upright radiographs: implications for acetabular development","volume":"3","author":"Pytiak","year":"2016","journal-title":"J. Hip Preserv Surg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1097\/01.brs.0000152379.54463.65","article-title":"Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position","volume":"30","author":"Roussouly","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/01.bsd.0000109836.59382.47","article-title":"Segmental lumbar lordosis: manual versus computer-assisted measurement using seven different techniques","volume":"17","author":"Schuler","year":"2004","journal-title":"J. Spinal Disord. Tech."},{"key":"B44","doi-asserted-by":"publisher","first-page":"178","DOI":"10.3171\/2014.11.SPINE1426","article-title":"Defining the inherent stability of degenerative spondylolisthesis: a systematic review","volume":"23","author":"Simmonds","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"B45","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.physio.2018.06.001","article-title":"No increase in 6-week treatment effect of mechanical diagnosis and therapy with the use of the LUMOback in people with non-acute non-specific low back pain and a directional preference of extension: a pilot randomized controlled trial","volume":"104","author":"Takasaki","year":"2018","journal-title":"Physiother. (United Kingdom)"},{"key":"B46","doi-asserted-by":"publisher","first-page":"592","DOI":"10.3171\/2015.6.SPINE15288","article-title":"Preoperative retrolisthesis as a risk factor of postdecompression lumbar disc herniation","volume":"24","author":"Takenaka","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"B47","doi-asserted-by":"publisher","first-page":"610907","DOI":"10.3389\/fbioe.2020.610907","article-title":"The effect of degeneration on internal strains and the mechanism of failure in human intervertebral discs analyzed using digital volume correlation (DVC) and ultra-high field MRI","volume":"8","author":"Tavana","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"105730","DOI":"10.1016\/j.jmbbm.2023.105730","article-title":"A novel tool to quantify in vivo lumbar spine kinematics and 3D intervertebral disc strains using clinical MRI","volume":"140","author":"Tavana","year":"2023","journal-title":"J. Mech. Behav. Biomed. Mater"},{"key":"B49","doi-asserted-by":"publisher","first-page":"124141","DOI":"10.1016\/j.wneu.2025.124141","article-title":"Difference in lumbar lordosis between supine and standing positions: a comprehensive indicator of spinal sagittal imbalance and bone density","volume":"199","author":"Tian","year":"2025","journal-title":"World Neurosurg."},{"key":"B50","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3233\/BMR-130440","article-title":"Pathoanatomical characteristics of clinical lumbar spinal stenosis","volume":"27","author":"Tomkins-Lane","year":"2014","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B51","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1097\/01.brs.0000181052.56604.30","article-title":"Internal strains in healthy and degenerated lumbar intervertebral discs","volume":"30","author":"Tsantrizos","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"B52","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/00002517-200006000-00003","article-title":"The prevalence of low back pain: a systematic review of the literature from 1966 to 1998","volume":"13","author":"Walker","year":"2000","journal-title":"J. Spinal Disord."},{"key":"B53","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/s0030-5898(20)31329-8","article-title":"The pathophysiology of degenerative disease of the lumbar spine","volume":"14","author":"Yong Hing","year":"1983","journal-title":"Orthop. Clin. N. Am."},{"key":"B54","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1177\/20494637231208364","article-title":"Healthcare resource utilisation and economic burden attributable to back pain in primary care: a matched case-control study in the United Kingdom","volume":"18","author":"Zemedikun","year":"2024","journal-title":"Br. J. Pain"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1730260\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:21Z","timestamp":1768205961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1730260\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":54,"alternative-id":["10.3389\/fbioe.2025.1730260"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1730260","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1730260"}}