Bio- Mechanics of

spine

Presented By-Harsimran kaur

MOT-neurology
Indian spinal injury Centre of
rehabilitation sciences
 Contents
• INTRODUCTION
• STRUCTURE
• ARTICULATIONS
• LIGAMENTS
• MUSCLES
• JOINTS AND MOVEMENTS
• FUNCTIONS OF SPINE-stability
-mobility
• BIOMECHANICS OF SPINE- cervical,
thoracic,lumbar,sacral

• PROBLEMS IN SPINE/BACK
 Introduction
• Spine or Vertebral Column or Backbone
is a complex structure meant for
support and a linking structure between
upper and lower extremities.
• It provides a base of support for the head
and internal organs, a stable base for the
attachment of ligaments, bones and
muscles of the extremities, rib cage and the
pelvis.
• It is a link between the upper and the
lower extremities and provide mobility for
the trunk.
• It protects the Spinal cord.
 Structure
• The Spine comprises of 33 vertebral bones
and 23 Intervertebral disc.
• Cervical (7), Thoracic (12), Lumbar (5),
Sacral (5), Coccygeal (4)
• The vertebrae increase in size from the
cervical to lumbar region and decrease
in size from the sacral to coccygeal
region.
• Primary curve (Kyphotic curve)- Thoracic
and Sacral, they retain the original posterior
convexity throughout life.
• Secondary curve (Lordotic curve)- Cervical
and Lumbar, they develop as anterior
convexity as a result of the accommodation
of the skeleton to the upright posture.
 Articulations
• Two main types of articulations
are found in the vertebral
column:
• The joints between the
vertebral bodies and disks are
referred to as the
Intervertebral joints.
• The joints between the
zygapophyseal facets are
called the Zygapophyseal
(apophyseal or facet) joints.
• All the zygapophyseal joints,
except for the joint between
the first two cervical
vertebrae, are plane synovial
joints.
• The vertebral column
articulates with the ribs, with
the skull and the pelvis at
the sacroiliac joints.
• The motion between any two vertebrae at the intervertebral
joints is extremely limited and consists of a small amount of
gliding (translation) and rotation.
• So Vertebrae has got 3 degree of freedom, permitting
flexion and extension, lateral flexion and rotation.
• However, motions in the vertebral column often are coupled
motions.
• Coupling- the consistent association of one motion about
an axis with another motion around a different axis. Eg. Axial
rotation is coupled with lateral flexion and forward flexion)
Vertebral column structure Functions
Structure Function
Body Resists compressive forces.
Transmits compressive forces to vertebral end plates.
Pedicles Transmit bending forces (exerted by muscles
attached to the spinous and transverse processes)
to the vertebral bodies

Laminae Resist and transmit forces (that are transmitted from

spinous and zygapophyseal articular processes) to
pedicles. Serve as attachment sites for muscles and
ligaments.

Transverse processes Serve as attachment sites for muscles and ligaments.

Spinous processes Resist compression and transmit forces to laminae.
Serve
as attachment sites for ligaments and muscles.
Zygapophyseal facets Resist shear, compression, tensile and torsional
forces. Transmit forces to laminae.
 Intervertebral Disk

• The intervertebral disks make up about 20% to 33% of the length of the
Spine. (approx. 70 cm in male, 60 cm in female)

• The size increases from the cervical to the lumbar region and disk
thickness varies from approx. 3mm in the cervical to about 9 mm in lumbar
region.

• The ratio between disk thickness and vertebral body height is greatest in
the cervical and lumbar regions and least in the thoracic region. The
greater the ratio, the greater the mobility, hence the disks in the cervical
and lumbar regions contribute to the greater mobility in comparison with
the thoracic region.

• The disk is composed of two parts; a central portion called the nucleus
pulposus and a peripheral portion called the annulus fibrosis.
Ligaments and Joint Capsules.

• The ligamentous system of the vertebral

column is extensive and exhibits
considerable regional variability. There are 6
main ligaments associated with the
intervertebral and zygapophyseal joints.
I. Anterior longitudinal ligaments
II. Posterior longitudinal ligaments
III. ligamentum flavum
IV. Interspinous
V. Intertransverse
VI. Supraspinous ligaments
MUSCLES
 JOINTS

• Interbody Joints
• Zygapophyseal Articulations

Kinematics
• Flexion
• Extension
• Lateral flexion
• Rotation.
Contin…
Coupled Motion

Lateral flexion is coupled

with axial rotation
• The addition of an intervertebral disk
allows the vertebra to tilt, which
dramatically increases ROM at the
interbody joint.
• Without an intervertebral disk, only
translatory motions could occur.

Kinetics

• Axial Compression
• Bending
• Torsion
• Shear
 Contin…..
• Side-to-side translation (gliding)
occurs in the frontal plane.
• Superior and inferior translation (axial
distraction and compression) occur
vertically.
• Anteroposterior translation occurs in
the sagittal plane.
• Side-to-side rotation (tilting) in a
frontal plane occurs around an
anteroposterior axis.
• Rotation occurs in the transverse
plane around a vertical axis.
• Anteroposterior rotation (tilting)
occurs in the sagittal plane around a
frontal axis.
 Functions of Spine
Stability:
• The stiffness of the vertebral column is the column’s
ability to resist an applied load. Stiffness can be
represented graphically by the slope of the stress-
strain curve. The steeper the slope of the curve, the
stiffer the structure.
• The neutral zone is the ROM through which the spine
can be displaced from a neutral position to the point at
which elastic deformation begins when a small load is
applied. In a stress-strain curve the neutral zone would
be represented by the toe region of the curve.
• The spine is subjected to axial compression, tension,
bending, torsion and shear stress not only during
normal functional activities, at rest also it depends
upon the type, duration and rate of loading; the
person’s age and posture; the condition and properties
of the various elements.
Stress-Strain Curve
 Axial Compression
• Axial compression (force acting through the long axis at an 90*
degree) occurs due to the force of gravity, ground reaction forces
and forces produced by the ligaments and muscular contractions.
• Most compressive force is resisted by the disks and vertebral bodies,
but the arches and zygapophyseal joints share some of the load in
certain postures and during specific motions.
• Compressive load> pressure higher in center of end plates than
periphery.
 Bending
• Bending causes both compression and tension on the structures of
the spine.
• In forward flexion the anterior structures are subjected to
compression; the posterior structures are subjected to tension. The
resistance offered to the tensile forces by collagen fibers in the
posterior outer annulus fibrosus, zygapophyseal joint capsules, and
posterior ligaments help to limit extremes of motion and hence
provide stability in flexion.

• In extension the posterior structures generally are either unloaded

or subjected to compression, whereas the anterior structures are
subjected to tension. Resistance to extension is provided by the
anterior outer fibers of the annulus vibrosus, zygapophyseal joint
capsules, passive tension in the anterior longitudinal ligament and
by contact of the spinous processes.

• In lateral bending, the ipsilateral side of the disk is compressed;

that is, in right lateral bending the right side of the disk is
compressed while the outer fibers of the left side of the disk are
stretched so the contralateral fibers and ligaments help to provide
stability.
 Torsion
• Torsional forces are created during axial rotation that
occurs as a part of the coupled motions that take place
in the spine. The torsional stiffness in flexion and lateral
bending of the upper thoracic region from T1 to T6 is
similar, but torsional stiffness increases from T7/T8 to
L3/L4.

• Tortional stiffness is provided by the outer layers of

both the vertebral bodies and intervertebral disks.

• The risk of rupture of the disk fibers is increased when

torsion, heavy axial compression and bending are
combined.
 Shear

• Shear forces act on the mid plane of the disk

and tend to cause each vertebra to undergo
translation (move anteriorly, posteriorly or
from side to side in relation to the inferior
vertebra).
• In the lumbar spine the zygapophyseal joints
resist some of the shear force and the disks
resist the remainder. When the load is
sustained, the disks exhibit creep and the
zygapophyseal joints may have to resist all of
the shear force.
 Mobility
• Motions at the intervertebral and zygapophyseal joints are
interdependent. The motion that occurs between the vertebral
bodies at the intervertebral joints is similar to what occurs when a
rubbing ball is placed between two blocks of wood. The blocks may
be tilted or rotated in any direction and may glide if the ball rolls.

• The motions of flexion and extension occur as a result of the tilting

and gliding of a superior vertebra over the inferior vertebra.

• The nucleus pulposus acts like a pivot but unlike a ball is able to
undergo greater distortion because it behaves as a fluid.

• The magnitude of motion created by the ratio of disk height to width,

a gliding motion occurs at the zygapophyseal joints as the vertebral
body tilts over the disk at the intervertebral joint.

• If the superior and inferior zygapophyseal facet surfaces of three

adjacent vertebrae lie in the sagittal plane, the motions of flexion
and extension are facilitated. If the zygapophyseal facet surfaces
are placed in the frontal plane the predominant motion that is
allowed is that of lateral flexion.
 Biomechanics of spine

• Cervical Region
Structure
Two distinct regions:
• The upper cervical , or
craniovertebral region and
• The lower cervical region

Cervical Region
 Craniovertebral Region

ATLAS

• The atlas is a markedly atypical vertebra.

• It lacks a body and a spinous process.
 AXIS
• The dens (odontoid process) is a
protuberance that arises from
the anterior portion of the body
of the axis(2nd cervical vertebra).
• The superior zygapophyseal
facets are located on either side
of the dens.

LIGAMENTS
• Atlantal cruciform ligament

• Alar ligaments
 Kinematics
 Nodding motions of the
atlanto-occipital joints.

A. Flexion-Flexion of the lower

cervical spine combines anterior
translation and sagittal plane
rotation of the superior vertebra.
B. Extension-Extension combines
posterior translation with sagittal
plane rotation.
 Superior view of rotation at the
atlantoaxial joints: The occiput
and atlas pivot as one unit
around the dens of axis.
 Kinetics
• cervical region bears less weight and is
generally more mobile.

• No disks are present at either the atlanto-

occipital or atlantoaxial articulations;

• The trabeculae show that the laminae of both

the axis and C7 are heavily loaded
 Thoracic Region
Structure
• The 1st and 12th are transitional
vertebrae
• 1st, 9th, 10th, 11th, 12th are atypical
vertebrae
Articulations
• Interbody Joints-The interbody joints of the
lumbar region are capable of translations and
tilts in all directions.
• Zygapophyseal Joints - In a newborn, the
zygapophyseal joints in the lumbar region lie
predominantly in the frontal plane in the
presence of lumbar kyphosis.
 The adult lumbar zygapophyseal joints display
great variability both between individuals and
within individuals; however, the majority of them
have a curved structure that is biplanar in
orientation.
 Kinematics
• the range of flexion and extension is
extremely limited

• Rotation of a thoracic vertebral body to

the left produces a distortion of the
associated rib pair that is convex
posteriorly on the left and convex
anteriorly on the right.

Kinetics
• The thoracic region is subjected to
increased compression forces in
comparison with the cervical region,
because of the greater amount of body
weight that needs to be supported and
the region’s kyphotic shape.
 Lumbral region

Lumbar Anatomy
• 5 vertebraes- L1-L5
• 5 intervertebral discs
• 5 pair of exiting nerve roots
• Lumbar lordosis L1-S1 ranges
from 30°–80°.
• The apex of lumbar lordosis is
L3-L4.
Types of motion
 Lumbo sacral angle

Ferguson’s angle

• Is formed by the fifth

lumbar vertebra and first
sacral segment
• The first sacral segment ,
which inclined anteriorly
and inferiorly forms an
angle with the horizontal
35-40⁰ considered normal.
 Lumbo pelvic rhythm
• Coordinated simultaneous activity of lumbar
flexion and tilting of pelvis
• LPR can increase the range of forward flexion,
anterior pelvic tilt and flexion of lumbar spine
The process of degeneration of the lumbar spine has been
described in 3 phases:
•Stage 1: “Early degeneration” it involves increased laxity of the facet joints,
fibrillation of the articular cartilage and intervertebral discs display grade 1-2
degenerative changes.

•Stage 2: “Lumbar instability” at the effected level(s) develops due to laxity of the
facet capsules, cartilage degeneration and grade 2-3 degenerative disc disease.
Segmental Instability: may be defined as loss of motion and segmental stiffness
such that force application to that motion segment will produce greater
displacements than would occur in a normal structure. Mechanical testing suggests
the intervertebral disc is most susceptible to herniation at this stage.

•Stage 3: “Fixed deformity” results from repair processes such as facet and
peridiscal osteophytes effectively stabilising the motion segment. There is advanced
facet joint degeneration (or “facet joint syndrome”) and grade 3-4 disc degeneration
of clinical importance is altered spinal canal dimensions due to fixed deformity and
osteophyte formation
 Sacral region
 Five sacral vertebrae are fused to form
the triangular or wedge-shaped structure
that is called the sacrum.
• The base of the triangle, which is formed
by the first sacral vertebra, supports two
articular facets that face posteriorly for
articulation with the inferior facets of the
fifth lumbar vertebra.
• The apex of the triangle, formed by the
fifth sacral vertebra, articulates with the
coccyx.
SACROILIAC JOINT
• A joint that connects the spinal
column with the pelvis. The V-
shaped sacrum near the base of
the spine fits like a wedge
between the wide wings of the
ilium (hipbone).
 Disorders Of The Back/Spine

● Back Strain/Sprain
● Ankylosing Spondylitis
● Cauda Equina
● Herniated Nucleus Pulposus
(HNP)
● Spinal Stenosis
● Kyphosis/Scoliosis
● Low Back Pain (LBP):
Spondylolysis
 Back Strain/Sprain
● LBP is the most frequentcause of lost
work time and disability in adults
<45 years
● Most symptoms of limited
duration
● 85% of patients improve
and returning to work
within 1month

Ankylosing Spondylitis
● Progressive spinal flexion
deformities (mayprogress to a chin-
on-chest deformity)
Cauda Equina symdrome
Herniated Nucleus Pulposus (HNP) of the Lumbar Spine

● Displacement of the central

area of the disc (nucleus)
resulting in impingement on a
nerve root

Kyphosis
● Defined: abnormally
increased convexity in the
curvature of the thoracic
spine asviewed from side
● Scheuermann’s Disease
● Hyperkyphosis that
does not reverse on
attempts at
hyperextension
 Scoliosis
● Lateral curvature of thespine greater than
10 degrees, usually thoracic or lumbar,
associated with rotation of the vertebrae
and sometimes excessive kyphosis or
lordosis
● Idiopathic scoliosis
● Lateral deviation and rotation of the
spinewithout an identifiable cause
Low Back Pain
● Spondylolysis
● Unilateral Pars defect is the
result of a fatigue/fracture
from repetitive
hyperextension