BME 322

Biomechanics of the Spine

 Introduction
• Human spine is a complex structure

• Spine functions:
– Protects the spinal cord
• Three major functions: 1) as a conduit for motor
information, which travels down the spinal cord,
2) as a conduit for sensory information in the
reverse direction, and 3) as a center for
coordinating certain reflexes

– Transfers loads from upper body (head

and trunk) to pelvis

– Provides stability and movement to trunk

 Introduction
• The Motion Segment is the functional
unit of the spine
• Each Motion segment is composed of:
– 2 adjacent vertebrae and intervening
soft tissues
– Anterior portion:
▪ 2 vertebrae, intervertebral disc,
longitudinal ligaments
– Posterior portion:
▪ Vertebral arches, intervertebral
joints, transverse and spinous
processes, various ligaments
 Lumbar Spine: Structure

Anteroposterior (A) and lateral (B) Motion Segment: Transverse Plane

roentgenograms (x-ray image) of the lumbar
spine. One motion segment, the functional
unit of the spine, is indicated
 The Intervertebral Disc
• Intervertebral disc has hydrostatic functions:
– Store energy
– Distribute loads
– Restrain excessive motion

• Well suited for these roles by virtue of its

location and composition

• During daily activities disc is subject to a

combination of :
– Compression
– Bending
– Torsion

• Disc degeneration impairs disc functions

https://www.anatomystandard.com/Columna_Vertebralis/Juncturae/Disci.html
 The Intervertebral Disc
➢ A disc consists of four parts: a nucleus pulposus, an
anulus fibrosus, and two cartilaginous end-plate.

➢ The end-plate provide a pathway for nutrition

➢ The nucleus pulposus has the remarkable property

of absorbing and retaining water against physical and
osmotic pressure. It is fibro cartilaginous and is made up
of crisscrossing concentric lamellae between adjacent
vertebrae. It is also is a water-rich mixture of
proteoglycan gel and a lattice of collagen fibers.

➢ The annulus is reinforced in front and behind

by fibers from the anterior and posterior
longitudinal ligaments.

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 Structure/Function- Intervertebral Disc

➢ The nucleus distributes forces

equally in all directions, with
converting longitudinal to
horizontal forces, and transmits
them to the circumferential
annuli.
➢ The resilient annulus and the
cartilage plate, capping the
upper and lower surfaces of the
vertebrae, absorb shock energy.

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 Structure/Function- Intervertebral Disc
Normal • A. Normal young disc. The gelatinous nucleus pulposus is
80% to 88% water content. Age-related variations in
protein-polysaccharides from human nucleus pulposus,
annulus fibrosus, and costal cartilage are easy to
distinguish from the firmer annulus fibrosus

Mid-age • B. Normal mid-age disc. The nucleus pulposus has lost

water content, a normal degenerative process. The
fibers on the posterior part of the annulus have
sustained excessive stress

Degenerated • C. Severely degenerated disc. The nucleus pulposus has

become dehydrated and has lost its gel-like character. The
boundary between the nucleus and the annulus is difficult
to distinguish because the degree of hydration is now
about the same in both structures.
 Structure/Function-Facets
The posterior portion of the motion segment guides its movement.
The type of motion possible at any level of the spine is determined by the orientation of
the facets of the intervertebral joints to the transverse and frontal planes. This
orientation changes throughout the spine.
 Structure/Function
• Facet joint main function:
– Guides movement of
motion segment

• Orientation of facets
determines type of motion
possible

• Facets sustain compressive

loads
– Particularly during
hyperextension

• With disc degeneration:

– Greater amount of force
transferred to facets
– Redistribution of load
through motion segment
Transverse Plane Frontal Plane

Cervical Spine

Thoracic Spine

60

Lumbar Spine
 Kinematics
• Motion between 2 vertebrae is
small
• Functional motion always
combined action of several
motion segments
• Skeletal structure influencing
trunk motion:
– Rib cage: limits thoracic
motion
– Pelvis: increases trunk
movements by tilting

https://www.spine-health.com/conditions/spine-anatomy/cervical-spine-anatomy
 Kinematics
• Range of motion (ROM) varies at different levels of the spine

• Instantaneous center of motion lies within lumbar disc

• During flexion:
• Instant center moves caudally (towards posterior end)
• Facet forces decrease
• During extension (the opposite happens)
• Instant center moves towards the anterior end
• Facet forces increase
IC and Surface Joint Motion
Kinematics: Muscles and Ligaments
• Trunk muscles provide extrinsic spine stability.
• Ligaments and discs provide intrinsic stability.
• Muscles anterior to spine act as flexors.
• Muscles posterior to spine act as extensors.
– Symmetric contraction induces extension.
– Asymmetric contraction induces lateral bending and twisting.

• Example of electromyographic activity of the erector spinae

muscles collected with surface electrodes during side-bending
of the trunk. The figure illustrates trunk bending to the right
and muscle activity at the L1, L3, and L5 levels of the lumbar
spine.
• Substantial contralateral muscle activity (left) of the erector
spinae muscles is recorded when bending to the right to
maintain equilibrium.
 Kinetics
• The spine can be considered as
a modified elastic rod because of
the flexibility of the spinal
column, the shock absorbing
behavior of the discs and
vertebrae, the stabilizing function
of the longitudinal ligaments and
the elasticity of the ligamentum
flavum

• The two curvatures of the spine

in the sagittal plane (kyphosis
and lordosis) also contribute to
its spring-like capacity
 Kinetics: Standing
• When a person stands the
postural muscles are constantly
active
• This activity is minimized when
the body is well aligned
• The line of gravity of the trunk
usually passes ventral (anterior)
to the transverse axis of motion
• Thus, the motion segments are
subjected to a constant forward
bending moment, which must be
balanced by ligament and
muscle forces.
 Kinetics: Role of the Pelvis
• Effect of pelvic tilting on the inclination of the base of the sacrum to the transverse plane
(sacral angle) during upright standing

A. Tilting the pelvis B. During C. Tilting the pelvis

backward reduces relaxed forward increases
the sacral angle standing, the the sacral angle and
and flattens the sacral angle is accentuates the
lumbar spine. approx. 30. lumbar lordosis.
Kinetics: Daily Activities
• Data from two studies
(Nachemson and Wilke)
using intradiscal pressure
measurements.

• The relative loads on the

third and fourth lumbar
discs measured in vivo in
various body positions are
compared with the load
during upright standing,
depicted as 100%.
Kinetics: Sitting
Kinetics: Supine Position
A. When a person assumes a supine
position with legs straight, the
pull of the vertebral portion of the psoas
muscle produces some
loads on the lumbar spine.

B. When the hips and knees are bent

and supported, the psoas muscle relaxes
and the loads on the
lumbar spine decrease.
Kinetics: abdominal training
• Performing a curl to the point where only the shoulder
blades clear the table minimizes the lumbar motion
and hence the load on the lumbar spine is less than
when a full sit-up is performed.

• A greater moment is produced if the arms are raised

above the head or the hands are clasped behind the
neck, as the center of gravity of the upper body then
shifts farther away from the center of motion in the
spine.

• A reverse curl, isometrically performed, provides

efficient training of the abdominal muscles and
produces moderate stresses on the lumbar discs. The
relative loads on the third lumbar disc during a full
sit-up and an isometric curl are compared with the
load during upright standing, depicted as 100%.
 Kinetics: Lifting
• The highest loads on the spine are generally produced by
external loads, such as lifting a heavy object
• Several factors influence spinal loading during lifting:
– Position of the object relative to the center of motion
of the spine
– Size, shape, weight and density of the lifted object
– The rate or frequency of loading
Kinetics: Walking
 The Cervical Spine
➢ The intricate and elegant design
of the cervical spine contributes
to the structure of the human
body and profoundly enhances its
function

➢ Two principal functions: support

and conduit

➢ The cervical spine supports the

skull, acts as a shock absorber for
the brain and protects the
brainstem, spinal cord as well as
various neurovascular structure as
they enter and exit the skull

https://www.anatomystandard.com/ossa-et-juncturae/columna-vertebralis/c1-c7.html 26
 The Cervical Spine
➢ Biomechanically, it partially facilitates the transfer of weight and
bending moments of the head

➢ The vertebral column also provides a multitude of muscle and

ligamentous attachments for complex movement and stability.

➢ The neuromuscular control afforded by the muscle attachments,

when combined with the numerous articulations of the cervical
spine, allows for a wide range of physiologic motion that maximizes
the range of motion of the head and neck and serves to integrate
the head with the rest of the body and the environment.

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 The Upper Cervical Spine -Functional Anatomy
➢ The upper cervical spine includes OC1 and
C1/2 (and sometimes C2/3)
• The Atlas (the most cranial vertebra in the
vertebral column supporting the skull via
condylar surface) has two arches and two
lateral masses.
➢ The Axis forms a pivot (dens) for the atlas to
rotate on.

Atlas. The top aspect. Axis

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 The Typical Cervical Vertebrae (C3-6)
➢ Small oval bodies, large vertebral canal, long laminae, a broad transverse process and
with a foramen transversarium

➢ The vertebral arches arise from the posterolateral aspect of the bodies, giving rise to the
pedicles.

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 The Typical Cervical Vertebrae (C3-6)
➢ The laminae arise from the pedicles and
arch backward to meet in the midline,
forming the bifid spinous processes.
➢ The intervertebral foramen for nerve
root
➢ The foramen transversarium for
vertebral artery except C7
➢ The spinal canal for spinal cord.

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https://www.anatomystandard.com/Columna_Vertebralis/Vertebrae_Cervicales/Typical_Cervical.html
5th cervical vertebra 7th cervical vertebra 31
 MECHANICAL PROPERTIES
➢ Recall: Cortical bone is stiffer than cancellous bone and can withstand greater
stresses before failure. When the strain in vivo exceeds 2% of the original length,
cortical bone fractures; cancellous bone can withstand somewhat greater
strains before fracturing.

➢ The greater ability to withstand strain

is because of the structure of
cancellous bone: Its porosity varies
from 30% to 90% compared with
cortical bone, which has values of 5%
to 30%

➢ Vertebral compression strength

increases from the upper cervical to
the lower lumbar levels.

➢ The mineral content of vertebrae decreases with increasing age at a relatively

constant rate
 Kinematics
➢ Measurements of cervical range of motion are based on radiographic
studies or postmortem investigations

➢ The established range of active axial rotation to one side at C1-2 is 27°
to 49° (mean = 39°); passive rotation is 29° to 46° (mean = 41°)

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 IC and Surface Joint Motion

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 Abnormal Kinematics
➢ Abnormal kinematics generally refers to excessive motion within functional
spinal units; however, abnormal kinematics may also refer to atypical
patterns of motion, such as abnormal coupling or paradoxical motion.
➢ Paradoxical motion is seen when the overall pattern of motion of one aspect
of the spine is in one direction and the local pattern is in the opposite. For
instance, paradoxical flexion is seen when flexion occurs at a single functional
spinal unit although the spine as a whole is extended. These types of
abnormal motions describe a pattern of movement known as instability.
➢ Kinematic instability refers to the quantity of motion (too much or too little)
or the quality of motion present (alterations in the normal pattern), or both.
Clinical instability addresses the clinical biomechanical role of the various
anatomic structures of the functional spinal unit.

A thorough understanding of biomechanical principles is an

important base aspect of the treating physician’s knowledge
because the normal structure and function of the spinal
column is frequently altered during surgery
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 The Upper Cervical Spine
➢ ROM of the OC1: FL-EXT (about 16 ° to 20°), Side
Bending (SB) (about 5 °), and axial ROT (about 8 °).
➢ ROM of the C1/2: FL-EXT (about 10 °), SB (about 3 °)
and axial ROT (about 40 °)
➢ Selective motion can occur between the OC1 and
between the C1/2 without motion below the axis.

Atlas. The top aspect. Axis. The isometric aspect.

https://www.anatomystandard.com/Columna_Vertebralis/Vertebrae_Cervicales/C1.html
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 Biomechanics of The Upper Cervical Spine
Atlanto-Occipital joint
➢ The atlas has no body. It is a solid ring
of bone with two pillars. It has no
intervertebral foramen.
➢ The attachment of the posterior atlanto-
occipital membrane arches over the
artery at the posterior arch of the atlas.

https://www.anatomystandard.com/Columna_Vertebralis/Juncturae/Artt_C0-C2.html
 Biomechanics of The Upper Cervical Spine
Atlanto-Occipital joint

➢ Occipital condyles (bony structure connecting the

cranium and the vertebral column) are in convex
surfaces and the superior facets of the atlas are in
concave surfaces.

➢ In flexion, the occipital condyles roll forward and

glide backwards.

➢ In extension, the occipital condyles roll

backwards and glide forwards.

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 Ligaments of The Upper Cervical Spine
➢ Transverse ligament: holds the dens tightly to the
anterior arch of the atlas to prevent subluxation
(partial desclocation).
➢ Alar ligaments: (occipital portion) run on either
side from the tip of the dens to the margins of the
foramen magnum; (atlantal portion) run on either
side from the tip of the dens to the posterior
arches of the atlas.
➢ Tectorial membrane is a fan-shaped continuation
of the posterior longitudinal ligament.

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https://www.anatomystandard.com/Columna_Vertebralis/Juncturae/Artt_C0-C2.html
Homework:

1- Revise the topics taught in the class, and highlight the subjects that were
unclear

2- Survey those topics online, and present the list of sources that helped you
clear the subjects.

3- Answer the question:

Considering the Biomedical Engineering career, in which scenario do you
foresee the use of the subjects learned? Highlight its importance.