European Journal of Applied Physiology

, Volume 118, Issue 7, pp 1315–1329 | Cite as

Asymmetrical intrapleural pressure distribution: a cause for scoliosis? A computational analysis

  • Benedikt Schlager
  • Frank Niemeyer
  • Fabio Galbusera
  • Hans-Joachim Wilke
Original Article



The mechanical link between the pleural physiology and the development of scoliosis is still unresolved. The intrapleural pressure (IPP) which is distributed across the inner chest wall has yet been widely neglected in etiology debates. With this study, we attempted to investigate the mechanical influence of the IPP distribution on the shape of the spinal curvature.


A finite element model of pleura, chest and spine was created based on CT data of a patient with no visual deformities. Different IPP distributions at a static end of expiration condition were investigated, such as the influence of an asymmetry in the IPP distribution between the left and right hemithorax. The results were then compared to clinical data.


The application of the IPP resulted in a compressive force of 22.3 N and a flexion moment of 2.8 N m at S1. An asymmetrical pressure between the left and right hemithorax resulted in lateral deviation of the spine towards the side of the reduced negative pressure. In particular, the pressure within the dorsal section of the rib cage had a strong influence on the vertebral rotation, while the pressure in medial and ventral region affected the lateral displacement.


An asymmetrical IPP caused spinal deformation patterns which were comparable to deformation patterns seen in scoliotic spines. The calculated reaction forces suggest that the IPP contributes in counterbalancing the weight of the intrathoracic organs. The study confirms the potential relevance of the IPP for spinal biomechanics and pathologies, such as adolescent idiopathic scoliosis.


Intrapleural pressure Scoliosis Finite element simulation Etiology Spine Thorax 



Articulatio capitis costae


Articulatio costotransversalis


Anterior longitudinal


Cardiac border




Computed tomography


Costovertebral joint


Finite element model


Flaval ligament


Intercostal space


Intrapleural pressure


Interspinal ligament


Lig. costotransversarium


Lig. costotransversarium superius


Posterior longitudinal


Range of motion


Supraspinal ligament



We thank many colleagues for their assistance and expertise for this study. Special thanks goes to Joachim Kabitz, David Walker, Gabriel Schlager and Daniel Schlager. This project was supported by the German Research Foundation (DFG), Project WI 1352/20-1.

Author contributions

Conceptualization, BS; Methodology, BS, FN and FG; Investigation, BS; Writing—Original Draft, BS; Writing—Review and Editing, BS, FN, FG and HW; Funding Acquisition, HW; Resources, HW; Supervision, HW.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

421_2018_3864_MOESM1_ESM.eps (109 kb)
Relative displacements and rotations of vertebrae in-between vertebral levels (VL) caused by a constant IPP gradient of 6 (black) and by a stepwise gradient distribution (green) of − 9 Pa/mm below T6 and − 3 Pa/mm above T6 (according to Fig. 5). We adapted the range of the scales in each plot to better visualize and comprehend the data; thus, also the scale of the lateral displacement was reversed that left displacement points to left. The bottom sketch of the vertebra indicates the positive direction of displacement/rotation (EPS 109 KB)
421_2018_3864_MOESM2_ESM.eps (137 kb)
Calculated displacements of the ribs on the left and right hemithorax caused by an asymmetrical IPP distribution, with an IPP gradient of – 6 Pa/mm on the left and an IPP gradient of -5 Pa/mm on the right side. The displacements were obtained on a dorsal, middle and ventral point of each rib, as illustrated in the top left sketch (EPS 137 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Orthopaedic Research and BiomechanicsUlm University Medical CentreUlmGermany
  2. 2.IRCCS Istituto Ortopedico GaleazziMilanItaly

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