Spinal Anatomy and Nerves | Lumbar Spine Anterior and Posterior | Back Range of Motion | Vail | CO

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What does the spine do exactly? The spine supports the body, allows enough motion to position the arms and head for activities of daily living, protects the spinal cord nerve roots, has shock absorbing capacity and it's resistant to motion to prevent injury.

There are 5 lumbar vertebrae in general. The discs are sandwiched in between the vertebral bodies. The alignment is straight on an AP, no scoliosis. The definition of a scoliosis is a curve of 10 degrees or more. The lordosis of the lumbar spine is due not to the shape of the vertebra but to the shape of the discs which are trapezoidal.   

In the lumbar spine of the anterior column which is the vertebral body and discs carry 70% of the normal weight of the spine. The discs absorb shock and allow motion, but have poor resistance to shear forces. The disc is fine for compression, fair for rotation and pretty bad for shear forces. What resists shear forces are the facets which Dr. Corenman calls "the door stops." The lowest two discs have the greatest shear forces, and therefore, the most strain on the facets.

Sacroiliac joints are very strange joints because the both have diarthrodial and fibrous articulations. The aging of joints have less range of motion and normal range of motion is 1-2 degrees.

The posterior elements facets are restraints of motion (railroad tracks). The angles of the facets vary from male to female (female is more sagittal orientation). More sagittally faced facets mean there is less ability to resist shear so women will have problems in the facets greater than men. Spinous processes are flexion restraints thru inter and supraspinous ligaments and are extension "blockers." 

For stabilizing ligaments, the center of rotation for a normal spine is the posterior 1/3 of the disc. What does that mean? The center of everything in front goes in one direction and everything in back goes in the other direction. This is also important for the spinal canal because it is in back of the center of rotation which will change in diameter with different spina positions. Flexion is restricted by the capsules, supraspinous and interspinous ligs and abutment of anterior vertebral bodies. 

What is normal sagittal alignment? Is this important? Yes!
-Lumbar lordosis is 40-60 degrees.
-Thoracic kyphosis is 20-40 degrees
-Cervical lordosis is 30-40 degrees
-Sacral angle is 45 degrees
-Center of C7 should be over the center of the sacrum and head over the pelvis
-All three spine curves with the sacral slope should balance each other because if there is one curve that is less than another or greater than other, the patient will have to compensate. Compensation can create problems. Disc asymmetric shapes are responsible for the lumbar and cervical lordosis and the thoracic kyphosis.The multifidi and rotator muscles act as stabilizers. The action is an extension of the lumbar vertebrae or "resisted flexion."Dr. Corenman will talk at-length about anterior "core" muscles including the rectus and the internal/external obliques. The posterior muscle connections such as the erector spinae group which doesn't do as much as you might think which is important to understand for rehabilitation.

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With more than 30 years of experience, Donald Corenman, MD, DC, is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain.  His training as a Doctor of Chiropractic early in his career did not satisfy his desire for a deep understanding of the mechanics of the spine.  This led him to medical school where he completed his Doctor of Medicine, Orthopedic Surgery Residency and Spine Surgery Fellowship.  His study of spinal disorders and deformities brought him to Vail, Colorado where he joined The Steadman Clinic in 1994.  With personalized clinical care a cornerstone of Dr. Corenman’s practice, he has been awarded the “Top 10 Doctor Award”, “Patient’s Choice Award”, “Compassionate Doctor Recognition” and is consistently recognized by Becker’s Spine Review in “Top Spine Surgeons to Know.”

Dr. Corenman is passionate about educating patients on spine anatomy and disorders, so they have the ability to partner with their physicians in finding the most effective treatment for their back pain and disorders.  His focus on peer education earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles.

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