Biomechanics

of the Spine

By: Vahideh Moradi

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Spinal Orthoses

– Spinal orthoses are recommended for four

basic reasons:

– Motion control
– Positional control
– Pain management
– Trunk support
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Spine
Functional Spinal Unit (FSU)

A three-joint complex:
oAnteriorly vertebral bodies articulate with an
intervertebral disc (a fibro-cartilaginous joint)
oposteriorly two facet joints (synovial joints) articulate
on either side of the spinal canal
othe smallest functional unit of the
osteoligamentous spine
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Functional Spinal Unit (FSU)

o The three-joint complex moves in three planes:

o Sagittal: flexion and extension (F/E)
o Frontal: Lateral bending (LB)
o Transverse: Axial rotation (AR)
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Motion in spine
Sagittal motion in the thoracic spine
increases in a cranial to caudal direction.
Axial rotation is greatest in the upper
thoracic spine and gradually decreases
caudally.

Different levels of the spine vary in their contribution to overall spine

range of motion
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Alignment of spine

• The normal spine is essentially vertical in the coronal

plane but exhibits four curves in the sagittal plane.

• The normal amount of thoracic kyphosis ranges from

20 to 50 degrees.
• The mean lordosis in the cervical spine is 35 to 40
degrees.
• The normal range of lordosis in the lumbar spine is
from 20 to 60 degrees.
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Loading Forces

o Axial compressive loads are produced by:

1. gravitational forces due to the mass of body segments
2. external forces and moments generated by a physical activity
3. muscle tension
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A:Direct axial compression

causes the disc fibers to bulge radially, generating even tension that restrains the nucleus pulposus (NP) centrally and
maintains even load transmission (thick arrows)from one vertebral body (VB) to the next.
B: Under unbalanced axial loading
The NP flows from the compression side to the stretch side, balancing the pressure throughout the disc and across
inferior endplate.
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Strain

Within the initial part of ROM, a neutral zone exists where motion encounters minimal
resistance because joint capsules, ligaments, fascias, and tendons remain slack. With further
deviation from neutral in all planes of F/E, LB, and AR, the joint restraints become
strained by tension, creating an elastic zone.
A key elastic restraint to spinal motion is the annulus fibrosus.
A combination of lateral bending and flexion generates maximal shear and strain forces
on the posterior inferior vertebral endplate and posterolateral discs, respectively.

The posterolateral disc and inferior vertebral endplate are the most common sites of
disc injury.
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Spinal instability

Injuries, degeneration, and surgical procedures alter normal load

sharing between the components of an FSU and cause an abnormal
motion response to physiologic loads.
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Spinal instability

• Microinstability
Microinstability refers to degenerative changes that compromise
spinal stability.

Chronic overcompression of the anterior side can cause endplate

fractures, whereas strain on the posterior endplate is associated with
osteophyte formation.

Initial degenerative changes in the disc expand the neutral zone and
decrease the stiffness of the elastic zone, resulting in increased
segmental motion.
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Microinstability

Disc degeneration decreases

elastic resistance and allows
segments to move unstably.
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Microinstability

– Facet joint degeneration follows degenerative changes

in the disc.
– At terminal flexion the facet joint gaps, placing tension
on the capsule, whereas in terminal extension the
lower edge of the inferior articular process opposes
the superior edge of the superior articular processes.

– Increased gapping of the facets in flexion places

severe strain on the capsular ligament.
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Macroinstability

– Macroinstability implies gross disruption related to

fracture or dislocation of the spinal column causing a
severely unstable spine.
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The three-column concept
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Fusion is a time-dependent process that requires bony healing; thus fused vertebrae are unstable in th
perioperative period. Perioperative instability thus may be managed with bracing and/or hardware t
compensate. Bracing can reduce segmental loading and shearing from F/E or bending and preven
strain from axial rotation. Spinal instrumentation increases the rigidity of segments at the fusion sit
reducing the relative motion between the vertebrae during the biologic healing process.
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