Spine

BIOMECHANICS

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Lumbar Anatomy

5 vertebrae L1-L5

5 intervertebral discs

5 pair of exiting nerve
roots
1

Lumbar lordosis L1-S1
2
ranges from 30°–80°
3

The apex of lumbar
4 lordosis L3-L4
5

Sreeraj S R
 Lumbar Spine Anatomy
Typical lumbar vertebra (L2)

Body

Vertebral foramen/canal

Intervertebral foramen
Superior A Lateral P
Pedicle
Superior

Transverse process
inferior
Lamina

Spinous process
superior Inferior
Facet joints
Anterior (oblique) Posterior (oblique)

Pars interarticularis

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Intervertebral Disc

Soft fibro-cartilaginous
cushions

Between two vertebra

Allows some motion

Serve as shock
absorbers

Total – 23 discs

¼ th of the spinal column's
length

Avascular

Nutrients diffuse through
end plates

Collagen

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Intervertebral Disc
NUCLEUS PULPOSUS

Has more water and PGs

PG are macro-molecules

Attract and retain water

Hydrophilic gel–like
matter

Resists compression

Amount of water

Activity related

Varies throughout the
day
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Intervertebral Disc
NUCLEUS PULPOSUS

Eccentrically positioned posteriorly

Young & healthy, 90% water, bound
to proteoglycans

Aging> desiccation> increase
viscosity> fissuring

Young nucleus> even distribution of
load

Old nucleus> undue concentration
on vertebral body edges

Small displacement w/ ROM, ball-
bearing like

Compressive stress predominates

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Intervertebral Disc
NUCLEUS PULPOSUS

Pascal’s law: Fluid mass within closed
container> local increase in pressure>
transmit around entire side wall
(annulus)

Nucleus pulpous imbibes water

Develops internal pressure

Pressure exerted in all directions

Lateral forces against annulus

Superiorly and inferiorly directed
forces against end plates

Increases stiffness of end plate
and annulus fibrosus

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Intervertebral Disc
ANNULUS FIBROSUS

Strong radial tire–like
structure

Series of lamellae

Concentric sheets of
collagen fibers

Connected to end plates

Orientated at various angles

Under compression

Become horizontal

Encloses nucleus pulposus

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Intradiscal Pressure
INTRADISCAL PRESSURE

Compressive loads in vivo:
500N standing, 700N sitting

Increased to 3000 to 6000N
during lifting of moderate
weights, decreases with load
closer to body

Estimate of P = 1.5X
compressive load divided by
the cross sectional area

Disk pressure is usually
uniform

Pressure lowest in supine
position

Disk usually does not fail,
but end plates fracture
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Spinal Ligaments

Anterior Longitudinal

Posterior Longitudinal

Ligamentum Flavum

Interspinous
Ligaments

Supraspinous
Ligaments

Intertransverse
Ligaments

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Lumbar Spine

Sreeraj S R
Lumbar Spine

Thoraco lumbar fascia

Stabilizing corset

Transmit load
longitudinally to the
spinous process
Ilio lumbar ligament

Stabilize 5th lumbar
vertebrae from ant.
Displacement

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Types of motion
Stress-Strain Curve

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The Motion Segment

Functional Spinal Unit

2 adjacent vertebrae &
intervening soft tissue

Anterior

Vertebral body

Disk

ALL, PLL

Support, absorb impact,
restrict vertical translation

Posterior

Neural arch & its processes

Facet joint

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STABILITY
The vertebral column subject to

Axial compression

Bending

Torsion

Shear

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STABILITY

Primary load-transmitting
element, 80-90%

Bone Mineral Content, Size

Osteoporosis> loss of
horizontal trabeculae

Increasing size from C to L
spine

Compressive load> pressure
higher in center of end plates
than periphery

In vivo, filled with blood>
greater strength, hydraulic
shock absorber

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STABILITY
POSTERIOR ELEMENTS

pedicles, lamina, facet joints,
spinous & transverse processes

Bony processes> lengthen
moment arms of muscles

Forces on processes>
transmitted to Lamina

Forces on posterior elements>
transmitted to vertebral bodies
from Pedicles

Pars Interarticularis

Large bending forces;
excessive extension

Thicker than rest of lamina

Common site of
stress/fatigue fractures>
weakens motion segment>
spondylolithesis
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STABILITY

Facet Joints

Major role in controlling motion

Resist torsion & shear, role in compression

Lumbar FSU – facets 40% torque resistance, 40% disk,
20% ligaments

Load sharing varies with flexion & extension

Seated position> decreased lumbar lordosis> increased
intradiscal pressure & decreased load-bearing of the facets

Orientation of facets

C spine - 45º transverse, parallel frontal

T spine - 60º transverse, 20º frontal

L spine - 90º transverse, 45º frontal

Capsules lax> allow gliding

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MOBILITY

Flexion-Extension

large, due to sizable
disks & lack of facet
restraint

posterior half of
disk, moves w/ flex-
ext

Lateral bending

Axial rotation

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MOBILITY

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

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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
Sreeraj S R
Sacral Anatomy

The sacrum is a series of
3, 4, or 5 fused coccygeal
vertebrae

The coccyx articulates
with the inferior aspect
1 of the sacrum
2
3
4
C

Sreeraj S R
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).

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SACROILIAC JOINT

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MOBILITY AND STABILITY

Poorly understood

Permits a small amount of motion

Stiff, coarse interdigitating articular surfaces

Complete ankylosis in up to 76% over age of 50

Nutation, as described by Kapandji, is the anterior inferior
motion of the sacral base.

counter- nutation as the movement of the sacral base
posteriorly and superiorly.

This nutation and counter- nutation motion of the sacrum
is a pivoting type of motion, so that when the base moves
forward, the sacral apex (inferior part of the sacrum) moves
posteriorly.
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Muscles

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Iliocostalis Lumborum

O

Common tendon origin in
sacrum, iliac crest, lumber
vertebrae

I

Lower borders ribs 6-12

N

Dorsal rami of spinal nerves

F

Bilateral

Spinal extension

Maintenance of erect posture

Stabilization of spine during
flexion

Unilateral

Lateral flexion

Ipsilateral rotation

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 Longissimus Thoracis

O

Common tendon origin
in sacrum, iliac crest,
lumber vertebrae

I

T1-12 transverse
processes

N

Dorsal rami of spinal
nerves

F

Same as above

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Spinalis Thoracis

O

Common tendon origin
in sacrum, iliac crest,
lumber vertebrae

I

T3-8 spinous processes

N

Dorsal rami of spinal
nerves

F

Same as above

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Multifidus

O

Transverse processes C4-L5

Sacrum

PSIS

I

Spinous process of vert above
origin

N

Spinal nerve roots

F

Extend and lateral flexion of
vertebral column

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Quadratus Lumborum

O

Iliolumbar Ligament

Iliac crest

I

Lower border 12th rib

L1-L4 transverse processes

N

ventral branches of T12 and L1 to
L4.

F

Pelvis elevation

Trunk extension

Trunk lateral flexion

Pulls down rib 12 to fix origin of
diaphragm

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Rotatores

O

Transverse processes from
axis to sacrum

I

Laminae of vert above

N

Direct branches over spinal
nerve roots

F

Spine extension

Rotation to opposite side

Sreeraj S R
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, Spondylolisthesis

Sreeraj S R
 Back Strain/Sprain

LBP is the most frequent cause of
lost work time and disability in
adults <45 years

Most symptoms of limited
duration

85% of patients
improve and returning
to work within 1 month

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Ankylosing Spondylitis

Progressive spinal flexion

deformities (may progress
to a chin-on-chest
deformity)

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Cauda Equina symdrome

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Herniated Nucleus Pulposus (HNP) of the
Lumbar Spine

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

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Kyphosis

Defined: abnormally
increased convexity in
the curvature of the
thoracic spine as viewed
from side

Scheuermann’s Disease

Hyperkyphosis that
does not reverse on
attempts at
hyperextension

Sreeraj S R
 Scoliosis

Lateral curvature of the spine
of 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 spine without
an identifiable cause

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Low Back Pain

Spondylolysis

Unilateral Pars defect is
the result of a fatigue
fracture from
repetitive
hyperextension

Sreeraj S R
 Low Back Pain

Spondylolisthesis

Bilateral Pars Interarticularis
defect

Forward slippage of one
vertebra on another

Usually L5-S1

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