PDF | On Jan 1, , G. Plaugher and others published Clinical anatomy and biomechanics of the spine. Request PDF on ResearchGate | Clinical Biomechanics of the Spine | Combining orthopedic surgery with biomechanical engineering, this reference and. A clear understanding of biomechanical principles is essential in the treatment of orthopedic and spinal disorders. Charnley designed a smaller.
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You can finely include the soft file Clinical Biomechanics Of The Spine By Augustus A. White,. Manohar M. Panjabi PhD DTech to the gizmo or every computer. clinical biomechanics of spine - dokument [*.pdf] Clinical Biomechanics geSpine Second Edition ~,.B. LIPPINCarr COMPA Y Clinical. Spondylolopsis of lumbar L4 vertebra. Person was neurologically intact. Radiograph from White & Panjabi Clinical Biomechanics of the Spine. The cervical.
Understanding the biomechanical consequences of degeneration is imperative for the treatment of spinal disorders, regardless of etiology. In this review, we discuss key concepts of spinal anatomy and degenerative processes of the spine.
Anatomy Thirty-three vertebrae comprise the spinal column: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal bones. Functionally, the spinal column transmits loads, permits limited motion, and protects the spinal cord. The range of normal spinal alignment is dependent upon the region of the spine. In the coronal plane, the normal spine has a neutral curvature. In the sagittal plane, the cervical and lumbar segments are lordotic whereas the thoracic and sacral regions are kyphotic.
Regional kyphosis or lordosis are evolutionary responses to an upright stance in the bipedal human and serve to balance the occiput over the pelvis in an energy efficient manner [ 3 , 4 ]. However, vertebral bodies within a spinal segment do not evenly distribute alignment.
Clinical Biomechanics of the Spine
Similarly, L4—5 and L5—S1 provide about two-thirds of lumbar lordosis [ 6 ]. Sagittal alignment can be measured by dropping a plumb line from the C7 vertebral body to the lumbosacral junction and, when within normal limits, permits balanced posture, minimal energy expenditure, and appropriate tension of perispinal ligaments [ 7 ].
The intimate relationships between global balance and both clinical outcomes [ 8 , 9 ] and biomechanics [ 10 ] have been reported. As sagittal imbalance increases, defined as a plumb line that fails to fall between the sacrum and femoral heads, the pelvis undergoes retroversion in relation to the feet.
The change in pelvic positioning maintains a fixed gravity line-heel offset, which preserves a center of force near the feet and permits standing balance [ 10 ]. The functional spinal unit FSU or spinal motion segment is the smallest segment that represents the characteristics of the entire spinal column.
It consists of two vertebrae, the intervertebral disc, zygaphophyseal facet joints, and supporting ligaments ligamentum flavum, supraspinous, interspinous, anterior longitudinal, and posterior longitudinal. The disc and paired facet joints at each level therefore form a three-joint complex between which loads are transmitted [ 11 ]. The intervertebral disc functions to transmit loads between adjacent vertebrae and permit motion.
As such, it carries and distributes forces to which the trunk is subjected [ 12 ]. Each motion segment has an IAR, which is a dynamic point about which the FSU rotates and is dependent upon spinal alignment and forces acting on the spine. There are 12 potential movements about the IAR due to rotation around the three axes x, y, and z that pass through the center of rotation. The IAR is not constant; for example, during flexion-extension at C0-C1 the IAR passes through the center of the mastoid processes whereas during lateral bending the IAR is located 2 cm above the dens [ 13 ].
The IAR in the lumbar spine is similarly dependent upon position. The IAR is located in the anterior disc in flexion, lateral aspect of the disc with contralateral side-bending, and in the posterior annulus during axial rotation [ 14 , 15 ]. Surgical intervention, trauma, and degenerative processes affect the position of the IAR. Soft tissues about the spine also play a tremendous role in flexibility and mobility.
The Biomechanics of Back Pain
Below the subaxial spine, there are seven ligaments that play a paramount role in maintaining physiologic motion. Ligaments, composed of elastin and collagen [ 16 ], and joint capsules restrict motion to within normal limits. The ligaments have variable strengths, but weaker ligaments such as the interspinous and supraspinous contribute greatly to spinal stability by providing resistance to flexion via a long moment arm from the spinous process to the IAR [ 17 ]. The ligamentum flavum, in contrast, is a pair of broad ligaments that provides compression at the disc space by maintaining resting tension as it courses along the ventral laminae [ 18 ].
Spinal motion is also influenced by intervertebral discs and the synovial facet joints, which consist of sliding cartilaginous surfaces.
III, and Manahar M.
Clinical Biomechanics of the Spine (2nd Edition). Augustus A White, Manohar M Panjabi
Lippincott Company. All rights reserved. Na part of this book may be used or reproduced in any manner whatsoever without permission except for brief quotations embodied in critical articles and reviews. Printed in the United States of America. For information write J.
Clinical biomechanics of the spine I Augustus A. White III.
Manahar M. Includes bibliographical references. ISBN 1. Spine-Wounds and injuries. Pain- Treatment. Spine-Mechanical properties. WE Wc] RD However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy. In the last decade, more papers have been published in this area than ever before. In the foreword to the first edition I wrote, "In my eyes, this book is the most important contribution to the literature on spinal diseases since Schmorl and Junghanns' book, Die Gesunde und die Kranke Wirbelsaule in Riintgenbild und Klinik, which appeared in White and Dr.
Let it be a challenge for all the clinicians who consult the pages of this book, to bring the level of clinical treatment of our patients in the 90s up to the same level of knowledge that biomechanicians reached in the 80s. Alf L.
Some major questions with regard to spinal instability were answered and could for the first time be applied to clinical treatment of patients with spinal disorders.
The last decade of spine surgery has witnessed a rapid evolution of anterior decompression techniques and internal fixation devices that have a myriad of applications in spine surgery.
Clinicians need a scientific and biomechanical basis for our work in orthopedics and spine surgery, and laboratory research provides an indispensable part of our core of knowledge. In this second edition, there are detailed scientific analyses of the various spinal implants and arthrodeses both anterior and posterior.
These analyses are based on a thorough review of the literature and on basic research in the laboratory.
This text is unique because of the special collaborative contribution of superb biomechanical studies from the basic scientist, Dr.
This collaboration has resulted in a much greater understanding of the indications and techniques used in spine surgery. Ultimately, the efficacy and durability of these new techniques must also be judged by the clinical results in the patient, with a careful analysis of long-term results. Philosophically, this magnificent text is a testimony to Dr.
The second edition of Clinical Biomechanics of the Spine will, without a doubt, serve as a major reference and teaching text for those clinicians who treat a wide variety of spinal disorders. Ohio Foreword Biomechanics is a relatively new science. The authors of this book, Professor Augustus A. White and Professor Manohar M. Panjabi, worked with Professor Hirsch: They rapidly gained expertise in their chosen field and are in demand as teachers in the United States and abroad.
Connect Tissue Res 8: — Google Scholar Clin Orthop — Google Scholar Holm S, Nachemson AL Variations in the nutrition of the canine intervertebral disc induced by motion. Viscoelastic Behaviour.
Effect of fluid flow on solute transport. Fast A Low back disorders: Conservative management. Spine 16 7 : — CrossRef Google Scholar Evans JH Biomechanics of lumbar fusion. Spine — Google Scholar Pope MH The biomechanical basis for early care programmes.
Hansson T, Roos B The relation between bone mineral content, experimental compression fractures and disc degeneration in lumbar vertebrae. Hansson T, Roos B Microcalluses of the trabeculae in lumbar vertebrae and their relation to the bone mineral content.The chapters on spinal injuries are particularly clear.
Edinburgh: Churchill Livingstone.
In the foreword to the first edition I wrote, "In my eyes, this book is the most important contribution to the literature on spinal diseases since Schmorl and Junghanns' book, Die Gesunde und die Kranke Wirbelsaule in Riintgenbild und Klinik, which appeared in In: Lin PM ed Posterior lumbar interbody fusion.
Other studies have also reported on differences in the responses of discs to applied loads between spinal segments. Pathology is represented from a mechanistic perspective, as is prevention of injury, placing this in the context of the known epidemiology and treatment approaches for back pain. The functional spinal unit FSU or spinal motion segment is the smallest segment that represents the characteristics of the entire spinal column.
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