3. CONTENTS:
īąBasic of human spine
īąSpinal curves
īąFeatures of the vertebrae
īąFeatures of the intervertebral disks
īąArticulations
īąSpinal ligaments
īąKinetics of spine
īąKinematics of spine
4. HUMAN SPINE:
īą A curved stack of 33 vertebrae structurally
divided into five regions:
ī§ cervical region - 7 vertebrae
ī§ thoracic region - 12 vertebrae
ī§ lumbar region - 5 vertebrae
ī§ sacrum - 5 fused vertebrae
ī§ coccyx - 4 fused vertebrae
7. CURVES
īąKyphotic Curves
âĸ Curves that have a posterior
convexity (anterior concavity)
īąLordotic Curves
âĸ Curves that have an anterior
convexity (posterior
concavity)
8. PRIMARY AND SECONDARY
CURVES:
īąPRIMARY CURVES
īąTwo curves
īąThoracic and Sacral
īą Are present at birth
īąSECONDARY CURVES
īąTwo curves
īąCervical and Lumbar
īą Develop from supporting the body in an upright
position after young children begin to sit and stand
9. ABNORMAL CURVES:
ī§ Scoliosis-abnormal lateral curve of more than
10°
ī§ âtwisted diseaseâ
ī§ Kyphosis-exaggerated thoracic curve
ī§ âhumped diseaseâ
ī§ Lordosis-accentuated lumbar curve
ī§ âbent-backward diseaseâ
10.
11. TYPICAL VERTEBRA
âĸ Consists of two major parts:
âĸ Anterior
âĸ Cylindrically shaped vertebral
body
âĸ Posterior
âĸ Irregularly shaped vertebral or
neural arch
âĸ Pedicles
âĸ Posterior elements
12.
13.
14.
15. TYPICAL VERTEBRA
īąArticular processes:
âĸ Consist of two superior and two inferior facets for
articulation with facets from the cranial and caudal
vertebrae, respectively.
īąIn the sagittal plane, these articular processes form a
supportive column, frequently referred to as the
articular pillar.
16. INTER VERTEBRAL DISK
âĸ Function:
âĸ It separate two vertebral bodies, so increasing
available motion,
âĸ It transmit load from one vertebral body to the next.
âĸ Size of the inter vertebral disk is related to both:
âĸ Amount of motion
âĸ Magnitude of the loads that must be transmitted.
17. ī§ Absent between
ī§ C1 and C2
ī§ Sacrum and coccyx
ī§ Annulus Fibrosus
ī§ Outer collar of concentric rings
ī§ Outer rings = ligaments
ī§ Inner rings = fibrocartilage
ī§ Supportive/Structural
ī§ Nucleus Pulposus
ī§ Inner disc, cushiony pad
ī§ Remnants of notocord
ī§ Shock Absorber
18. INTER VERTEBRAL DISK
ī§ The inter vertebral disks:
ī§ Make up about 20% to 33% (1/3) of the length of the vertebral
column
ī§ Increase in size from the cervical to the lumbar regions.
ī§ Disk thickness varies:
ī§ Approxi.3 mm in the cervical region,
ī§ where the weight-bearing loads are the lowest
ī§ About 9 mm in the lumbar region,
ī§ where the weight-bearing loads are the greatest
21. ARTICULATIONS
Interbody Joints
ī§ Available movements at the interbody joints
ī§ gliding, distraction and compression, and rotation (also called tilt or rocking in
the spine)
ī§ Gliding motions can occur in the following directions:
ī§ anterior to posterior, medial to lateral, and torsional.
ī§ Tilt motions can occur in
ī§ anterior to posterior and in lateral directions.
ī§ These motions, together with the distraction and compression,
constitute six degrees of freedom
22. Interbody Joints
Translations and rotations of one vertebra in
relation to an adjacent vertebra.
A. Side-to-side translation (gliding) occurs in the
frontal plane.
B. Superior and inferior translation (axial distraction
and compression) occur vertically.
C. Anteroposterior translation occurs in the sagittal
plane.
D. Side-to-side rotation (tilting) in a frontal plane
occurs around an anteroposterior axis.
E. Rotation occurs in the transverse plane around
a vertical axis.
F. Anteroposterior rotation (tilting) occurs in the
sagittal plane around a frontal axis.
23. LIGAMENTS AND JOINT
CAPSULES
âĸ The ligamentous system of the vertebral column is extensive
and exhibits considerable regional variability.
âĸ Six main ligaments are associated with the intervertebral and
zygapophyseal joints.
1. Anterior longitudinal ligament
2. posterior longitudinal ligament
3. Ligamentum flavum
4. Interspinous ligament
5. Supraspinous ligament
6. Intertransverse ligaments
24.
25. LIGAMENTS AND JOINT
CAPSULES
Anterior Longitudinal Ligaments
ī§ Well developed in the lordotic sections (cervical and
lumbar)
ī§ The tensile strength of the ligament is greatest at the
high cervical, lower thoracic, and lumbar regions, with
the greatest strength being in the lumbar region.
26. LIGAMENTS AND JOINT
CAPSULES
ī§ Anterior Longitudinal Ligaments
ī§ It is compressed in flexion and stretched in extension
ī§ It may become slack in the neutral position of the spine when the
normal height of the disks is reduced,
ī§ such as might occur when the nucleus pulposus is destroyed or degenerated.
ī§ It is reported to be twice as strong as the PLL.
A. Slack and compressed in
forward flexion of the vertebral
column.
B. Stretched in extension of the
vertebral column
27. LIGAMENTS AND JOINT
CAPSULES
Posterior Longitudinal Ligaments
âĸ PLLâs resistance to axial tension in the lumbar area is only
one sixth of that of the anterior longitudinal ligament.
âĸ It is stretched in flexion and is slack in extension
A. Stretched during forward
flexion of the vertebral
column.
B. Slack and compressed
during extension.
28. LIGAMENTS AND JOINT
CAPSULES
Ligamentum Flavum
ī§ Thick, elastic ligament
ī§ Strongest in the lower thoracic region
and weakest in the midcervical region.
ī§ Highest strain in this ligament occurs
during flexion when the ligament is
stretched
29. LIGAMENTS AND JOINT
CAPSULES
Interspinous Ligaments
ī§ The interspinous ligament, along with the supraspinous
ligament, is the first to be damaged with excessive
flexion
ī§ Contribute to lumbar spine stability
ī§ Degenerate with aging
30. LIGAMENTS AND JOINT
CAPSULES
Supraspinous Ligament
ī§ The supraspinous ligament, like the interspinous
ligament, is stretched in flexion, and its fibers resist
separation of the spinous processes during forward
flexion.
ī§ During hyperflexion, the supraspinous ligament, along
with the interspinous ligament, is the first to fail
31. LIGAMENTS AND JOINT
CAPSULES
Intertransverse Ligaments
ī§ The ligaments are alternately stretched and compressed
during lateral bending.
ī§ During lateral bending to the left
ī§ The ligaments on the right side are stretched and offer resistance
ī§ The ligaments on the left side are slack and compressed during this
motion.
ī§ During lateral bending to the right
ī§ The ligaments on the left side are stretched and offer resistance to this
motion
32. KINETICS
ī§ Vertebral column is subjected to
ī§ Axial compression, tension, bending,
torsion, and shear stress
ī§ During normal functional activities & also
at rest
33. KINETICS
âĸ Vertebral columnâs ability to resist these loads
ī§ Varies among spinal regions and
ī§ Depends on the
ī§ Type, duration, and rate of loading
ī§ Personâs age and posture
ī§ Condition and properties of the various structural
elements
ī§ Vertebral bodies, joints, disks, muscles, joint
capsules & ligaments
34. AXIAL COMPRESSION
ī§ Force acting through the long axis of the spine at right angles to
the disks
ī§ Occurs as a result of the
ī§ Force of gravity
ī§ Ground reaction forces
ī§ Forces produced by the ligaments and muscular contractions
ī§ The disks and vertebral bodies resist most of the compressive
force.
35. BENDING
ī§ Bending causes both compression and tension on the structures of the
spine.
ī§ In forward flexion:
ī§ the anterior structures (anterior portion of the disk, anterior ligaments, and muscles)
are subjected to compression;
ī§ the posterior structures are subjected to tension.
ī§ The resistance offered to the tensile forces
By:
ī§ collagen fibers in the posterior outer anulus fibrosus, zygapophyseal joint
capsules, and posterior ligaments
ī§ help to limit extremes of motion
ī§ hence provide stability in flexion
36. TORSION
īąTorsional forces are created during axial rotation that
occurs as a part of the coupled motions that take place in
the spine.
īąThis kind of force tries to twist the bone along its long
axis
īąTorsional forces generally result in short or long spiral
fractures
37. SHEAR
ī§ Shear forces act on the mid plane of the disk and tend to cause each
vertebra to undergo translation
ī§ move anteriorly, posteriorly, or from side to side in relation to the
inferior vertebra
ī§ In the lumbar spine,
ī§ Zygapophyseal joints resist some of the shear force, and the
ī§ Disks resist the remainder.
ī§ When the load is sustained,
ī§ disks exhibit creep
ī§ zygapophyseal joints may have to resist all of the shear force.
38.
39. KINEMATICS
ī§ The motions available to the column as a whole are
flexion and extension, lateral flexion, and rotation.
ī§ These motions appear to occur independently of each
other
ī§ At the level of the individual motion segment,
ī§ these motions are often coupled motions.
40.
41. COUPLED MOTION
ī§ Coupling is defined as the consistent association of one motion
about an axis with another motion around a different axis.
ī§ The most predominant motions that exhibit coupled behaviors
are
ī§ lateral flexion and rotation.
ī§ Pure lateral flexion and pure rotation do not occur in any region
of the spine.
ī§ In order for either motion to occur, at least some of the other must
occur as well
42.
43. KINEMATICS
ī§ Coupling patterns, as well as the types and amounts of motion
that are available
ī§ are complex,
ī§ differ from region to region
ī§ depend on the
ī§ spinal posture, curves,
ī§ orientation of the articulating facets,
ī§ fluidity, elasticity, and thickness of the inter-vertebral disks
ī§ extensibility of the muscles, ligaments, and joint capsules
44. KINEMATICS
A. The superior vertebra tilts and glides
anteriorly over the adjacent vertebra below
during flexion. The anterior tilti ng and
gliding cause compression and bulging of
the anterior anulus fibrosus and stretching
of the posterior anulus fibrosus.
B. In extension, the superior
vertebra tilts and glides posteriorly
over the vertebra below. The
anterior anulus fibers are
stretched, and the posterior
portion of the disk bulges
posteriorly.
Extension
Flexion
45. KINEMATICS
A. The superior vertebra tilts
laterally and rotates over the
adjacent vertebra below during
lateral flexion.
B. Lateral flexion and rotation
of the vertebra are limited by
tension in the
intertransverse ligament on
the convexity of the curve.
Lateral Flexion