Bio- Mechanics of Spine

Presented By-Debanjan Mondal

MPT(Musculoskeletal), BPT, CMT,
Ergonomist.
 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 33 vertebral bones and 23 Intervertebral
disks.
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.
Vertebral column when viewed from the posterior aspect, all regions
together present a single vertical line that bisects the trunk.
When viewed from the side, a number of curves are seen that vary
with age .
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:
(1)Cartilaginous joints of the symphysis type between the vertebral
bodies and the interposed disks and
(2)Diarthrodial or Synovial joints between the zygopophyseal
facets located on the superior articular processes of one vertebra
and the zygopophyseal facets on the inferior articular processes of
an adjacent vertebra above.
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.
According to White and Punjabi, one vertebra can move in relation
to an adjacent vertebra in six different directions ( 3 translations
and 3 rotations) along and around three axes.
The compound effects of these small amounts of translation and
rotation at a series of vertebrae produce a large range of motion for
the column as a whole.
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)
 A Typical Vertebra.
The structure of a typical vertebra consists of two major parts: an anterior
cylindrically shaped vertebral body and a posterior irregularly shaped vertebral
arch.
Vertebral body- is composed of a block of trabecular or spongy bone, which is
covered by a layer of cortical bone. According to Wu and Chen, the stresses
induced in the cortical bone shell are always much higher than in the
trabecular bone and stresses induced in the vertebral body are always larger at
the anterior side than on the posterior side.
The cortical covering of the superior and inferior surfaces or plateaus is
thickened around the rim where the epiphyseal plates are located and in the
center by a layer of hyaline cartilage called the cartilaginous end-plate.
The vertical, oblique and horizontal trabecular systems correspond to the
stresses placed on the bodies. Vertical system sustain the body weight and
resist compression forces while other trabecular systems help to resist shearing
forces.
Areas of strength are the area where the trabeculae cross each other and the
area of weakness is evident in the anterior portion of the body, which is a
potential site for collapse of the vertebrae resulting compression fracture.
 The vertebral arch is a more complex structure than the body,
because it has many projections, including 3 nonarticular
processes and 4 articular processes.
Nonarticular processes are 2 transverse and 1 spinous process.
They provide sites for the attachment of ligaments and muscles.
The 2 transverse processes divide the arches into anterior and
posterior portions.
The portions of the arch located anterior to the transverse
processes are called Pedicles which attach the arches to the right
and left upper posterior walls of the vertebral body.
The portions of the arches posterior to the transverse processes
constitute the laminae. The posterior portions of the laminae that
are located between the superior and inferior articular processes
on each side are called the pars interarticularis where vertically
oriented lamina and horizontally oriented pedicle meet.
 Summary; Vertebral
Structure
Function.
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 fibrosus.
The composition of the nucleus and annulus are similar in that they both are
composed of water, collagen, and proteoglycans (PGs). However the fluid and PG
concentrations are highest in the nucleus and lowest in the outer annulus.
Conversely collagen concentrations are highest in the outer annulus and lowest in
the nucleus pulposus.
Maturation, aging and disease as well as normal and abnormal stresses on the disk
may affect the distribution and relative proportions of type 1 and type 2 collagen.
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
 Anterior and Posterior Longitudinal
ligaments.
The anterior and posterior longitudinal ligaments are associated with the
intervertebral joints.
The anterior longitudinal ligament runs along the anterior and lateral surfaces
of the vertebral bodies from the sacrum to the second cervical vertebra. An
extension the ligament from C2 to the occiput is called the anterior atlantoaxial
ligament.
It has got two layers that are made up of thick bundles of collagen fibers. The
fibers in the superficial layer are long and bridge several vertebrae, whereas
the deep fibers are short and run between single pairs of vertebrae.
The ligament is well developed in the lordotic sections (cervical, lumbar) but
has little substance in the region of thoracic kyphosis. The anterior longitudinal
ligament increases in thickness and width from the lower thoracic to L5/S1. The
tensile strength of the ligament is greatest at the high cervical, lower thoracic
and lumbar regions. However when tested in axial tension, the ligament
demonstrates its greatest tensile strength (675N) in the lumbar area. The
ligament is compressed in flexion and stretched in extension and slack in the
neutral position. The anterior longitudinal ligament is reported to be twice as
strong as the posterior longitudinal ligament.
 The posterior longitudinal ligament runs within the vertebral canal
along the posterior surfaces of the vertebral bodies from the
second cervical vertebra to the sacrum. It consists of two layers, a
superficial and a deep layer.
Superiorly the ligament continues to the occiput becoming the
tectorial membrane at C2. in the lumbar region, the ligament
narrows to a thin ribbon that continues into the sacral canal. The
ligament provides little support for the intervertebral joints in the
lumbar region.
The posterior longitudinal ligaments resistance to axial tension in
the lumbar area is only one sixth of that of the anterior
longitudinal ligament ( 160N only).
It is stretched in flexion where maximal strain in the ligament
occur s when it is slack in extension. However if the axis of motion
moves posteriorly, as it does when the nucleus pulposus is
destroyed either experimentally or by degenerative processes, the
ligament may be stretched in extension.
 Ligamentum Flavum
The ligamentum flavem is a thick, elastic ligament, which is located on
the posterior surface of the vertebral canal. The fibers of the ligament
run within the canal from the second cervical vertebra to the sacrum,
connecting laminae of adjacent vertebrae.
In the lumbar region the ligament is composed of superficial and deep
components. It attaches to adjacent laminae and contributes to the
formation of the smooth dorsal wall of the spinal canal that abuts the
dura. Most of the anterior surface of the lumbar laminae is covered by
the ligamentum flavum.
It is the strongest in the lower thoracic and weakest in the midcervical
region. Although the highest strain in this ligament occurs during flexion
when the ligament is stretched, this ligament is under constant tension
even when the spine is in a neutral position. The ligamentous tension
creates a continuous compressive force on the disks, which causes the
intradiskal pressure to remain high. The raised pressure in the disks
makes the disks stiffer and thus more able to provide support for the
spine in the neutral position.
 Interspinous Ligaments
The interspinous ligaments vary from region to region. In the
cervical and upper two thirds of the thoracic region, the
ligaments connect and cover the margins of adjacent spinous
processes. The parallel fibers of the ligaments run diagonally
and fill up the space between the spinous processes.
In the lumbar region the ligaments are particularly well
developed and attach to both the thoracolumbar fascia and
the caudal fibers of the joint capsules.
The ligaments are slack in extension and stretched in forward
flexion when they resist the separation of the spinous
processes that accompanies flexion. The ligaments have a
tensile strength of only 24 to 185 N and thus are potentially
weaker in tensile strength than the anterior and posterior
longitudinal ligaments and the ligamentum flavum.
 Supraspinous Ligament
The supraspinous ligament is a strong cordlike structure
that connects the tips of the spinous processes from the
seventh cervical vertebra to L3 or L4. the fibers of the
ligament become indistinct in the lumbar area where
they merge with the thoracolumbar fascia and
insertions of the lumbar muscles.
In the cervical region the ligament beccomes the
ligamentum nuchae. The supraspinous ligament like the
interspinous ligament is stretched in flexion and its
fibers resist separation of the spinous processes during
forward flexion. During hyperflexion the supraspinous
and the interspinous are maximally stretched and are
the first of the posterior ligaments to fail.
 Intertransverse Ligaments
The ligaments pass between the transverse
processes and attach to the deep muscles of the
back. In the cervical region only a few fivers of the
ligaments are found.
The membranous fibers of the ligament form part
of the thoracoluumbar fascia.
The ligaments are alternatively stretched and
compressed during lateral bending. The ligaments
on the right side are stretched and offer resistance
during lateral bending to the left while the
ligaments on the left side are slack and
compressed during this motion and vice versa.
 Zygapophyseal Joint
Capsule
The zygapophyseal joint capsules assist the ligaments
in providing limitation to motion and stability for the
spine. The capsule s are strongest in the thoracolumbar
region and at he cervicothoracic junction sites where
the spinal configuration changes from a kyphotic to
lordotic curve and from a lordotic to kyphotic curve,
respectively.
The joint capsules, like the supraspinous and
interspinous ligaments, are vulnerable to hyperflexion,
especially in the lumbar region. It provide more
restraint to forward flexion than any of the posterior
ligaments because they fail after the supraspinous and
interspinous ligaments when the spine is hyperflexed.
 Functions of Spine.
Stability:
The stiffness of the vertebral column is the columns 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.
By applying a specified load to a motion segment (two adjacent vertebrae and the
intervening soft tissues) stiffness of that particular segment can be determined.
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.
Punjabi has suggested that the existence of a large neutral zone indicates
instability. Instability of the vertebral column can be considered as a lack of
stiffness and an unstable structure is one that is not in an optimal state of
equilibrium.
The spine is subjected to axial compression, tension, bending, torsion and shear
stress not only during normal functional activities but also at rest which depend
upon the type, duration and rate of loading; the persons age and posture; the
condition and properties of the various elements.
 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 resested by the disks and vertebral bodies, but the arches and
zygapophyseal joints share some of the load in certain postures and
during specific motions. The compressive load is transmitted from the
superior end plate to the inferior end plate through the trabecular bone of
the vertebral body and the cortical shell.
The cancellous body contributes 25%-55% of the strengthof a lumbar
vertebra under the age of 40yrs and the cortical bone carries the
remainder.
Depending on the posture and region of the spine, the zygapophyseal
joints carry from 0%-33% of the compression load. The spinous processes
also may share some of the load when the spine is in hyperextension.
The nucleus pulposus acts as a ball of fluid that can be deformed by a
compression force. The pressure created in the nucleus actually is greater
than the force of the applied load.
 When a weight is applied to the nucleus pulposus from above, the nucleus loses
height as it exhibits a swelling pressure and tries to expand outward toward the
annulus and the end plates. As the nucleus attempts to distribute the pressure in
all directions, stress is created in the annulus and central compressive loading
occurs on the vertebral end plates.
The forces of the nucleus on the annulus and the annulus on the nucleus form an
interaction pair which provide sufficient resistance to the swelling pressure in the
nucleus to reach an maintain a state of equilibrium.
The pressure exerted on the end plates is transmitted to the superior and inferior
vertebral bodies. The annulus fibrosus is under tensile stress and thus is able to
better resist he compressive load. The disks and trabecular bone are able to
undergo a greater amount of deformation without failure than the cartilaginous end
plates or cortical bone when subjected to axial compression. The end plates are
able to undergo the least deformation and therefore will be the first to fail/ failure
under high compressive loading. The disks will be the last to fail.
The disks are subjected to a constant load by forces that are not large enough to
cause permanent damage, the disks exhibit creep. The recovery of fluid that
returns the disk to its original state explains why a person getting up from bed is
taller in the morning than in the evening and why an astronaut returning from
weight weightlessness of space is taller on his return than on his departure.
Running is a form of dynamic loading that decreases disk height more rapidly than
static loading. The loss of height that occurs as people grow older is due to the fact
that the nucleus loses a large proportion of its fluid-imbibing capacity with aging.
 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.
The resulting deformation of supporting structures such as ligaments, joint
capsules, and intervertebral disks leads to an increase in the ROM beyond
normal limits and places the vertebral structures at risk of injury.
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 in stiffness, 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 and by the orientation of the facets.
The outer shell of cortical bone reinforces the trabecular bone and
provides resistance to torsion.
When the disk is subjected to torsion, one half of the annulus fibers
resist clockwise rotations, whereas fibers oriented in the opposite
direction resist counter clockwise rotations. It has been suggested that
the annulus fibrosus may be the most effective structure in the lumbar
region for resisting torsion.
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 amount of motion available is determined primarily by the orientation of
the facets. 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 ma 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 underfo
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 he 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 later flexion.
 Flexion
In vertebral flexion the anterior tilting and gliding of the superior vertebra
causes a widening of the intervertebral foramen and a separation of the
spinous processes.
The amount of tilting is partly dependent on the size of the disks, tensionin
the supraspinous and interspinous ligaments resists separation of the
spinous processes and thus limits tje extent of flexion. Passive tension tn
the zygaapophyseal joint capsules, ligamentum flavum, posterior
longitudinal ligament, posterior annulus, and the back extensors also
imposes controls on excessive flexion. Tension in the posterior ligaments
can be produced by contractions of the hip extensors pulling downward on
the pelvis when a person is in the standing position.
Tension in the thoracolumbar fascia produced by contractions of the
transversus abdominis also can limit flexion by the pull of the fascia on the
spinous processes in the lumbar area.
The disks influence flexion because the anterior portion of the annulus
fibrosus is compressed and bulges anteriorly during flexion while the
posterior portion is stretched and resists separation of the vertebral bodies.
 Extension
In extension, the intervertebral foramen is narrowed and the
spinous processes move closer together. The amoutnt of motion
available in extension, in addition to being limited by the size of
the disks, is limited by bony contact of the spinous processes,
passive tension in the zygapophyseal joint capsules, anterior
fibers of the annulus, anterior trunk muscles, and the anterior
longitudinal ligament.
There are many more ligaments that limit flexion than there are
ligaments that limit extension.
The only ligament that limits extension is the anterior longitudinal
ligament. The numerous checks to flexion follow the pattern of
finding ligamentous checks to motion where bony limits are
minimal.
Few ligamentous checks to extension are necessary given the
presence of numerous bony checks.
 Lateral Flexion
In lateral flexion, the superior vertebra tilts, rotates and
translates over the adjacent vertebra below. The annulus
fibrosus is compressed on the concavity of the curve and
stretched on the convexity of the curve. Passive tension in
the annulus fivers, intertransverse ligaments and anterior
and posterior trunk muscles on the convexity of the curve
limit lateral flexion, the rotation that accompanies lateral
flexion differs slightly from region to region because of the
orientation of the facets.
All intervertebral and zygapophyseal joint motion that occurs
between the vertebrae from L5 to S1 adheres to the general
description that have been presented. Regional variations in
the structure, function and musculature of the column are
different in different region.
 Regional Variations in Vertebral Str.
Part Cervical Vert. Thoracic Vert. Lumbar Vert.
Body The body is small with The transverse The body is
a transverse diameter and anterior massive a
greater than anterior posterior transverse
posterior diameter. diameters of the diameter greater
Anterior surface of the bodies are equal. than the anterior
body is convex; Anterior height posterior
posterior surface is is greater than diameter and
flat. The superior posterior. Two height.
surface of the body is demifacets for
saddle shaped due to articulation with
the presence of the ribs are
uncinate processes on located on the
the lateral aspects of postero lateral
the superior surfaces. corners of the
vertebral
plateaus.
Pedicles Project posterolaterally. Variable in shape Short and thick
and orientation
Spinous Short, slender and T1-T10 slope Broad, thick and
processes extend inferiorly T11 extend
horizantally.have bifid and T12 have a horizantally.
tips. triangular shape.
Vertebral Large and roughly Small and Triangular. It is
foramen triangular. circular larger than the
thoracic but
smaller than the
cervical.
Superior Face superiorly and Thin and flat and Vertical and
zygapophy medeally. face posteriorly, concave and face
seal facets superiorly and posteromedially.
laterally. Support
mamillary
processes on
posterior
borders.
Inferior Face anteriorly and Face anteriorly, Vertical, convex
zygapophy laterally. superiorly and and face
seal facets medially. anterolaterally.
Transverse Prossess foramen for Processes are Processes are
processes vertebral artery, vein large with long, slender and
and venous plexus. thickened ends. extend
Also have agutter for Possess paired horizontally.
 Muscles of the Spine
Flexors:
Muscles that flex the trunk are located anteriorly and laterally with
attachments on the ribs, sternum and pelvis these muscles act indirectly on
the vertebral column by exerting a pull on the adjacent structures.
Contractions of the flexor muscles cause compression forces on the
vertebral column.
When the pelvis and ribs are free to move, a shortening contraction of the
flexors will pull these structures closer together and as a consequence flex
the total spine as in a sit up.
If the ribs are fixed, a shortening contraction of the rectus abdominis muscle
will exert an upward pull on the anterior pelvis. The resulting posterior
rotation of the pelvis in the sagittal plane (posterior pelvic tilt) will flex the
contiguous lumbar spine.
The internal and external oblique abdominal muscles turn and twist the
lumbar spine into axial rotation.
The psoas major muscle has been described as a flexor, as a stabilizer and
as an extensor of the lumbar spine.
 Rotators and Lateral flexors
Rotation of the trunk is usually coupled with some degree of
lateral flexion. Anterior muscles that produce rotation and
lateral flexion are the external and internal oblique abdominals.
Rotation of the trunk to the left requires a simultaneous
contraction of the right external oblique and the left internal
oblique and vice versa.
Rotation and lateral flexion to the same side are a function of
the iliocostalis, longissimus, spinalis muscles, quadratus
lumborum and serratus posterior superior.
Muscles that produce rotation to the opposite side are the
semispinalis thoracis, multifidus, rotatores and intertransversarii
thoracis.
The lateral flexors of the trunk are the quadratus lumborum and
the iliopsoas.
 Extensors
Muscles that extend the vertebral column are located posteriorly.
The sacrospinalis muscles (erector spinae), consist of three
divisions. This group of muscles extends from the sacrum to the
occipital portion of the skull, attaching to the transverse and
spinous processes of all vertebrae and the angles of the ribs by
various divisions.
Lateral division- attaches to the ribs is called the iliocostalis group
and consists of the iliocostalis cervicis, thoracis and lumborum.
Medial division- attaches to the spinous processes and is called
the spinalis group, which includes the spinalis cervicis, capitis and
thoracis.
Intermediate division- attaches to the transverse processes is
called the longissimus, which includes the longissimus capitus,
cervicis and thoracis.
Thank- You