Serge Gracovetsky

The optimum spine.

System theory is used to describe the mechanism of the lumbar spine. The role of the spine in vertebrate evolution is presented. The importance of the intervertebral joint for the survival of the species is shown to be crucial. The mechanical behavior of the joint is derived, and from this the corresponding spinal motion and muscular responses is calculated. It is shown that physiologic behavior implies that the stress at the intervertebral joints is equalized and minimized. From this simple condition, the motion of the spine in the sagittal plane is calculated. From the analysis of sagittal plane motion together with a knowledge of the energy transfer through the intervertebral joint, a new theory of locomotion is derived. This theory of locomotion differs in important respects from current theories, but nevertheless explains available experimental data. This unified theory of the function of the human spine permits the determination of the level of safe loads that can be lifted and transported. It predicts the conditions of load transfer through a joint. It proposes a new approach to the mechanism of arthritis and to the repair of fractures.

The abdominal mechanism

The abdominal mechanism, utilizing intraabdominal pressure, has been described and numericized. Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint. The musculature of the lumbar spine is of primary importance in the control of the efficiency of the spinal mechanism. The system of loading, which results in observable physiologic response, maintains the compressive load at virtually 90° at the bisector of the disc for all weights and all angles of forward flexion.

A database for estimating normal spinal motion derived from noninvasive measurements

Study Design. A database for estimated normal spinal motion was derived using a noninvasive, high-resolution, computer-aided system, which tracks the motion of skin markers strategically placed on the spine. Forty normal subjects, selected from hundreds of possible subjects according to rigorous inclusion/exclusion criteria, were tested on the system. Objectives. Patterns of estimated spinal motion were analyzed as a function of load, age, and sex, confirming a correlation between the movement of spinal segments and the motion of skin markers. Summary of Background Data. The Workers Compensation Board of Quebec funded and supervised the experiments necessary to establish a normative reference database for a high-resolution motion analysis system that permits a noninvasive assessment of spinal function. A previous study examined the correlation between the movements of the skin markers and the underlying bony structures for trunk flexion. Skin movement cannot be random and contains information characterizing both the spine and its surrounding soft tissues. Methods. A noninvasive dynamic imaging system was used to measure normal spinal function under free movement. A high-resolution three-dimensional camera system collected basic kinematic data from strategically placed skin markers over the lumbar spine while the activity of paraspinal muscles was being recorded with surface electromyography. The measurements were analyzed for consistent, specific patterns recognizable as normal lumbar spine skin motion and reflecting normal lumbar spine function. A comparison was made with previous radiographic studies to confirm the correlation between the motion of skin markers and lumbar spine function. Results. Lumbar skin marker motion patterns in normal subjects were consistent and varied little with load; gender had no effect except in the initial phase of a movement. There was less mobility but similar coordination in older subjects. No inconsistencies with previous radiologic investigations were found for sagittal and lateral plane movement. Conclusions. Consistent patterns were found and measurements compare favorably with previous radiographic data. Results show that it is possible to estimate spinal function from the data collected from the motion of skin markers.

An hypothesis for the role of the spine in human locomotion: A challenge to current thinking

Locomotion was first achieved by the motion of the spine. The limbs came after, as an improvement, not as a substitute; and yet, analysis of bipedal gait concentrates almost exclusively on the motion of the limbs. The requirements for land locomotion are examined from a general point of view and the evolution of the vertebrate spine is presented as a mechanism designed to move the animal. The necessary spinal movements are also analysed; the role of the musculoskeletal system is discussed and it is shown that the lumbar spine is a key structure in land locomotion, the pelvis being driven by the spine. The optimum control of motion demands that the stress at all the intervertebral joints should be minimized and equalized. This theory of locomotion requires the central nervous system to control the torque at those intervertebral joints and suggests that a breakdown of the control system would result in torsional failure of the spine. The theory is supported by EMG, force and torque data collected from several sources.

The biomechanics of the thoracolumbar fascia

The back muscles alone are unable to provide the extensor moment required to lift large weights, and must be aided by another source of anti-flexion moments. It has been postulated that contraction of the abdominal muscles can provide an extension moment by developing tension in the thoracolumbar fascia (TLF). Anatomical studies and a biomechanical analysis, however, reveal that the anti-flexion moment generated in this way is only very small. Too little of the abdominal musculature attaches to the TLF to generate a significant tension in it. Previous calculations of the forces in the TLF have overestimated the tension developed in it because of erroneous assumptions and interpretations of the relevant anatomy. Whatever the role played by the TLF in lifting it must be essentially independent of abdominal mechanisms.

Relationship between functional evaluation measures and self-assessment in nonacute low back pain.

Study Design. The correlations between objective biomechanical indicators of function and self-assessment scores were examined retrospectively for 91 subjects with nonacute low back pain. Objectives. To examine the correlation between self-assessment, trunk range of motion (ROM), velocity, and complex mechanical coordination patterns of the spine in nonacute low back pain. Summary of Background Data. In low back pain, there is often little concordance between pain, physical impairment, and disability. Use of range of motion and velocity to enhance objectivity in impairment evaluations has been ineffectual. In this study, two hypotheses were examined: range of motion and velocity are controllable and inherently correlated with self-assessment; complex spinal coordination patterns such as range of lordosis cannot be controlled and are independent of self-assessment. Methods. Self-assessment questionnaires were administered, and indexes of spinal motion and coordination were measured through skin marker kinematics. The correlation between self-assessments and biomechanical measures was determined. Results. Self-assessments of function were significantly correlated with parameters prone to regulation: range of motion, velocity, and load lifted. In contrast, little correlation was found with measures of complex spinal coordination less susceptible to conscious or affective regulation, namely, range of lordosis and estimated segmental mobility. This effect was magnified with increased load. Self-assessment scores were significantly poorer among insurance referrals, regardless of functional status. Conclusions. Simple parameters of the functional examination, such as range of motion and velocity, are strongly correlated with cognitive state, and thus the information they supply is less than ideal. Complex spinal coordination is a better indicator of the degree of spinal dysfunction and enhances the process of differentiating between pain, disability, and functional impairment.

Energy transfers in the spinal engine

Locomotion is generally perceived as being the function of the legs. The trunk is considered to be carried along in a more or less passive way. This popular hypothesis appears to have been accepted with little substantiation. In light of the numerous observations contradicting this view, we have proposed an alternative hypothesis in which the spine and its surrounding tissues comprise the basic engine of locomotion. This theory is consistent with available experimental data which suggest that the motion of the spine precedes that of the legs. Indeed, the variations in the power delivered to the pelvis by the spine are strikingly similar to, but slightly ahead of, the variation in power at the hip.

Examining motion in the cervical spine I: imaging systems and measurement techniques

Instruments for measuring mobility in the cervical spine range from plumb-lines and inclinometers to sophisticated optoelectronic systems. In order to investigate the need and possible uses for an enhancement to a new diagnostic instrument, we examine some of the available diagnostic systems suitable for cervical motion analysis. These should be of practical use in a clinical setting for the diagnosis of soft tissue injuries. We begin by evaluating the respective roles of plain radiographs, cineradiography, computer tomography, and magnetic resonance imaging in examining the cervical spine. Then we consider Moiré photography, inclinometers, and some opto-electronic scanners, as well as the mathematical techniques needed to correlate skin and spine motion with these devices. We find that there does not appear to be an effective non-invasive tool for comprehensive clinical cervical motion analysis; in particular, coupled joint motion is inadequately quantified. Improperly diagnosed cervical spine injuries, such as hyperextension and hyperflexion, may result in chronic long-term effects. Therefore, instrumentation that would permit objective, routine clinical evaluation of patients could help to avoid such situations.

Coordination between the lumbar spine lordosis and trunk angle during weight lifting

OBJECTIVE: To analyze the coordination of the lumbo-sacral angle (lumbar spine lordosis) and the trunk inclination during lifting of different loads. STUDY DESIGN: Kinematic data of spine motion were analyzed. The parameters characterizing the relationships between the lordosis and the trunk inclination angle were estimated. BACKGROUND: The shape of the spine has been analyzed mostly for static or quasi-static conditions. The parameters relating the lumbar spine lordosis and trunk inclination in dynamics have not been analyzed. METHODS: Healthy subjects performed unconstrained weight lifts from ground to mid-thigh level. Kinematic data were derived from the tracking of markers (light-emitted diodes) placed over the spine and pelvis using an OPTPTRAK system. The relationship between lordosis and trunk inclination was analyzed. RESULTS: The relationship between lumbar spine curvature (lumbo-sacral angle or lordosis) and trunk inclination during weight lifting was described by an exponential function with three parameters. These were the lordosis extremes associated with the horizontal and vertical positions of the trunk and the trunk inclination when lordosis equals zero. The absolute value of the lordosis angle decreases at the onset of the extension phase of lifting when the load increases, implying active reaction of musculosceletal system to increasing load. CONCLUSIONS: The changes in the lordosis and trunk inclination are strictly correlated implying that the nervous system actively coordinates the degrees of freedom of the spine, providing an inter-joint synergy.

Examining motion in the cervical spine. II: Characterization of coupled joint motion using an opto-electronic device to track skin markers.

Analysis of coupled motion in the cervical spine may be useful in helping to identify injuries. In order to investigate this possibility, the nature of coupled motion in the spine and previous investigations on this subject are reviewed here. An enhanced set of displays are developed for an existing opto-electronic device employed for the non-invasive measurement of movement in the upper spine. This instrument consists of a high resolution motion analysis system which tracks small infrared emitting diodes (IREDs). Kinematic data for the motion of the markers is processed and absolute coordinates for the location of each IRED at any time are tabulated; coupled motion with respect to a fixed calibration frame, as well as for vertebrae relative to each other, is deduced from these. Overall analysis provided by the original device includes assessment of cervical lordosis, thoracic kyphosis, and inter-segmental mobility. Characterization of coupled motion, in particular, involves a series of plots showing principal versus secondary motion. Principal movements include flexion-extension, lateral bending, and axial rotation, corresponding to motion in the sagittal, transverse, and horizontal planes, respectively. Mobility is represented in terms of the direction angles made by virtual vectors orthogonal to the planes made by markers on the head, neck, and shoulders. Development of the enhanced displays and the required refinements are described. Precision of the deduced angles is found to be approximately 1 degree. This representation of coupled motion is expected to be valuable in improving the accuracy of attempts to identify normal versus pathological motion in the cervical spine.