BIOMECHANICS

OF SPINE
By
Dr. Faizan Siddiqui (PT)
(Lecturer)
School of Physiotherapy,
IPM&R, Dow University of
Health Sciences, Karachi
 Anatomy of
spine

• Spine has 33
vertebrae;
• 7 Cervical
• 12 Thoracic
• 5 Lumbar
• 5 SACRAL
• 4 Coccygeal
 Curves of spine
o The normal spine has an "S"- like
curve when looking at it from the
side
o It has 4 curves
o Thoracic & sacral curves concave
anteriorly
o Cervical & lumbar curves
concave posteriorly
 Curves of spine
• Cervical Lordosis
– Maintained predominantly by slightly wedged
shaped intervertebral dics
– Intervertebral discs are larger anteriorly than
posteriorly
• Thoracic Kyphosis
– Maintained largely by vertebral bodies
themselves
– Posterior portion of vertebrae lareger than
anterior portion
 MOTION SEGMENT

• The functional unit of spine is called motion

segment of the spine
• It consists of 2 adjacent vertebrae & associated
soft tissues (IVD & ligaments b/w the vertebrae)
• Ligaments
– Anterior and posterior longitudinal ligaments,
intertransvers, interpinous, supraspinous and
the facet capsular ligaments
 Anatomy of the cervical
spine
• First two vertebrae (C1 and C2)
– Atypical
– C1 Vertebra …… Atlas
– C2 Vertebra ….. Axis
• Other five vertebrae (C3 to C7)
– Typical vertebrae
– Similar in structure
– Similar in function
• Smaller Bodies
• Larger Arches
• Transverse Process, transverse foramina pierced by vertebral artery / vein
• C7 - very prominent spinous process, reduced transverse foramina
 UNCOVERTEBRAL JOINTS
(LUSCHKA'S JOINTS)

• These are the anterior joint surfaces in the Cervical motion segment. They
lie parallel to one another, at the lateral edges of the cervical disc. They
serve as important landmarks during surgery. The paired vertebral arteries
lie just lateral to the uncovertebral joints.
 O-C1 - C2 Complex

• Comprises of upper cervical spine

• Responsible of approx. 40 % of cervical flexion
& 60 % of cervical rotation
• Atlanto – Occipital Joint (O-C1 Joint)
– Permits primarily flexion and extension
• Atlanto – Axial joint ( C1-C2 Joint)
– Primarily responsible for rotation in the cervical
spine
 First Cervical vertebra
• A bony ring
• Consists of an anterior & posterior arches
and 2 lateral masses
• Anterior Arch
– Anterior tubercle for attachment of Longus colli
muscle
• Posterior Arch
– Grooves for passage of vertebral arteries on
superior surface
 First Cervical vertebra
• 2 Lateral masses
• Face cranially & inward
• Forms articulation with occipital condyles called
Occipito-cervical Joint (OC1 Joint)
• Occipital condyles face caudally & outward
• OC1 Joint permits primarily flexion & extension
• Extension is limited by bony anatomy & Flexion is
limited by ligaments & not by tectoral membrane
• No intervertebral disc at OC1 Junction
• Stability by intact bones & ligamentous
 2nd cervical vertebra
• Odontoid Process
– Projects from superior surface of the body
– Restrain in a socket formed by transverse ligament
& anterior arch of C1
– Prevent anterior translation of C1 on C2
– Forms C1-C2 joint which is primarily specialized for
Rotation
– Other ligaments at C1-C2 joint are Alar and Apical
ligaments
 Alar and Apical Ligaments

• Alar ligaments
– Symmetrically attach the dens to the occiput
– Prevent excessive Rotation (Right & left Rotation)
– To some extent act to limit side bending as well
• Apical ligament
– Also connects dense to occiput
 3 to 6 cervical vertebrae
rd th

• Consist of a body, 2 transverse processes, 2 pedicles, 2

lateral masses, 2 laminae and a spinous process
• Body
– Oval-shaped
– Wider Medio-lateral than Antero-posterior
• Transverse Processes
– Foramen for vertebral artery
– Anterior & Post. tubercles for muscles attachment
– Groove for nerve root on Superior surface
 3rd to 6th cervical vertebrae
• Pedicles connects vertebral body to lateral mass
• Laminae connect spinous process to lateral masses
• Lateral Masses have Inf. & Sup. facets which form
Facet joints
– Cervical Facet Joints play a critical role in spinal
stability
• Oriented approx. 45˚ to the transverse plane
• Located in the sagittal plane
• Resists most shear forces & approximately 16% of
compressive forces acting on the spine
 Intervertebral discs
• Contribute up to 1/3 of the height of vertebral
column
• Withstand greater than normal loads when
compressive forces are applied
– Short-duration/High-amplitude loads by activities
such as running & jumping
– Long-duration/ Low-amplitude Loads by normal
physical activities and upright stance
• Disc consists of nucleus pulposus & annulus
fibrosus
 Intervertebral discs
• Nucleus Pulposus
– Central part of disc
– Comprises of water, proteoglycan & type II collagen
– Water (90% in young individuals & decreases 70% as
the disc degenerates with age)
– Proteoglycan decreases with aging & disc
degeneration
– Type-II collagen fibers absorb more compressive
forces than Type-I collagen fibers
 Intervertebral discs
• Annulus Fibrosus
– Outer portion of the disc
– Consists of collagen with water content
– Water (approx. 78% in young individuals &
decreases 70% with age in older persons)
– Collagen fibers
• Arrange in approx. 90 concentric lamellar bands
• Having Considerable strength & some flexibility
• 60% Type-II Collagen & 40% Type-I collagen
• With age Type-II Collagen are replaced by Type-I
 Mechanical properties
of vertebrae
• Vertebrae
– Strength and stiffness, stress & strain relationship
– Cancellous bone withstands greater stress before
fracture than cortical bone
– Vertebral compression strength increases from the
upper cervical to the lower lumber levels
– Bone strength decreases with age because of constant
decrease in mineral contents
– Cortical shell is responsible for only 10% of its
strength during compressive loading
 Mechanical properties
of Vertebrae
• Contraction of attached Muscles can alter the
stress distribution in the vertebrae
• During flexion of spine, tensile stresses are
applied to the post. Cortex & compressive
stresses to the ant. cortex of the vertebral body
• As bone is weaker, it fails earlier in tension than
compression
• Bone failure is first than disc damage during
compressive loading
 Mechanical properties
of IV Discs
• Viscoelastic properties
(Creep & relaxation) and hysteresis
• Creep occur more slowly in healthy discs than
in degenerated or herniated discs
 Mechanical properties
of Ligaments
• Spinal stability is primarily maintained by
ligaments strength & limited extensibility
especially at OC1 junction
• Spinal ligaments are functional mainly during
distraction
• Alar ligament strength = 200N, Transverse
ligament strength = 350 N (Dvorak et al., 1988a)
•
 Mechanical properties
of Ligaments
• All ligaments have high collagen contents
except ligamentum flavum
• Ligamentum flavum is under tension even in a
neutral position or somewhat extended
position
• Thus, Pre-stress the disc and provide intrinsic
stability to the spine
 Mechanical properties
of spinal muscles
• Muscle strength & control
– Maintain head / neck balance
– Reduce stresses on bones
• During Cervical flexion
– Tensile stresses on posterior cortex
– Compressive stresses on anterior cortex
– Considerable load on vertebral bodies
especially in the lower cervical spine
 Mechanical properties
of spinal muscles
• Load on OC1 Junction (Harms-Ringdahl, 1986)
– Lowest during extreme neck extension
– Highest during extreme neck flexion
– Slight increase with neck in neutral position
• Load on C7-T1 motion segment
– Low with the neck in neutral position
– Lower with the head in upright/chin tucked
– Increased/greatest during extreme extension
– Considerable during slight flexion
 Mechanical properties
of spinal muscles
• Activity of erector spinae muscles of cervical
spine
– Very low level of activity during full flexion,
slight flexion, neutral, head up-right with
the chin tucked in and full extension
– Flexion relaxation phenomenon
 Neural Elements
• Cx shows significant changes in length during
flexion-extension
• Poorly tolerates axial translation
• Compressive tolerance is b/w 2.75 KN to 3.44 KN
• Neurogenic injuries may result from antero-posterior
compression commonly in stenotic regions
• Spinal cord injuries without radiographic
abnormalities are common in children
 Kinematics
• In spine, kinematic is studied
through motion segment
• Each motion segment is having six
degree of freedom
• Movement is either rotational or
translational
• Coupled motion:
• Rotation on one axis combined
with translation on another
axis and vice versa
 Range of Motion
(Angular motion)
• Rotation -each side (50% on C1-2)
– Active 39⁰
– Passive 41⁰
• Lateral flexion ----98⁰---49 each side
• Flexion-extension
– C1-2 ---12-15⁰
– C3-7--- 64⁰ ( 40 flex 24 extension)
 ROM-Translation

• Subaxial motion segments A-P

translation=3.5mm (unequally)
– 1.9mm ant: 1.6mm post shear
• Lateral translation: 3mm equally on both sides
• Tension results in1.1 mm distraction
• Compression results in 0.7 mm loss of height
 Surface joint motion

• Flexion: The superior articular facets slide superior and

anteriorly
• Extension: glides inferior and posterior
• Side bending: right, the left superior facet moves superiorly
and anterior while the right superior facet moves inferior and
posterior.
• Change in size of foramina
• Use of cervical collar
 Coupled Motion
• Atlanto-axial segment:
– COR is located at dens
– C1-2 rotation is coupled with ipsilateral
vertical translation and A-P displacement
• Sub-axial spine:
– Lateral bending to left is coupled with right
motion of spinous process (ipsilateral rot of
v. body) and vice versa
– During flexion v. body shifts forward and
facets glides up and over
• Facet configuration and Lushka joints are
responsible for coupling motion
• Degeneration leads to abnormal coupling
motions
 Instability of O-C1-C2-
complex
• Transverse lig; stabilizes dens
• Permits only 2 to 3 mm ant subluxation
• Displacement of 3-5 indicates lig;
rupture
• Of 5—10 accessory lig damage
• > 10 all lig; damaged
• RA destroys these articulations and
transverse lig:
• Steel’s rule of thirds is a guide for A-A
displacement
 Applied Biomechanics

• Decompression
• Laminectomy…..
– Dvelopment of kyphosis or hyperlordosis
• Facetectomy
– Loss of facet joints alone causes a dec; in coupled motion
from lateral bending
• Laminectomy e more than 25% of facet resection result in
significant instability in all motions
• Arthrodesis
• Anterior & posterior approaches
• Subsequent motion segment/s degeneration
• Total disc arthroplasty to preserve motion of
spine
 Biomechanics of cervical
trauma
• Airbag injuries
• Back facing children…… massive skull injuries
• Front facing children……cervical injuries
• NHTSA… Safety guidelines for infants and children
 Whiplash syndrome

• Hyper-extension cervical injury resulted from rear end

automobile collision
• Secondary hyper-flexion injury may occurs
• Includes
– Neck & shoulder pain
– Dizziness
– Headache
– Blurring of vision
– Often show normal radiographs
• Injuries include
– Interspinous lig tear
– Spinous process fracture
– Disc
– Lig flavum rupture
– Facet disruption
– Ant muscle strain
– TMJ injury
• Correct positioning and headrest is important