The instant axis of rotation influences facet forces at L5/S1 during flexion/extension and lateral bending

Abstract

Because the disc and facets work together to constrain spinal kinematics, changes in the instant axis of rotation associated with disc degeneration or disc replacement may adversely influence risk for facet overloading and arthritis. The relationships between L5/S1 segmental kinematics and facet forces are not well defined, since previous studies have separated investigations of spinal motion and facet force. The goal of this cadaveric biomechanical study was to report and correlate a measure of intervertebral kinematics (the centrode, or the path of the instant axis of rotation) and the facet forces at the L5/S1 motion segment while under a physiologic combination of compression and anterior shear loading. Twelve fresh-frozen human cadaveric L5/S1 joints (age range 50-64 years) were tested biomechanically under semi-constrained conditions by applying compression plus shear forces in several postures: neutral, and 3 degrees and 6 degrees of flexion, extension and lateral bending. The experimental boundary conditions imposed compression and shear representative of in vivo conditions during upright stance. The 3-D instantaneous axis of rotation (IAR) was calculated between two consecutive postures. The facet joint force was simultaneously measured using thin-film sensors placed between both facet surfaces. Variations of IAR location and facet force during motion were analyzed. During flexion and extension, the IAR was oriented laterally. The IAR intersection with the mid-sagittal plane moved cephalad relative to S1 endplate during flexion (P=0.010), and posterior during extension (P=0.001). The facet force did not correlate with posture (P=0.844). However, changes in the facet force between postures did correlate with IAR position: higher IAR's during flexion correlated with lower facet forces and vice versa (P=0.04). During lateral bending, the IAR was oblique relative to the main plane of motion and translated parallel to S1 endplate, toward the side of the bending. Overall, the facet force was increased on the ipsilateral side of bending (P=0.002). The IAR positions demonstrate that the L5 vertebral body primarily rotates forward during flexion (IAR close to vertebral body center) and rotates/translates backward during extension (IAR at or below the L5/S1 intervertebral disc). In lateral bending, the IAR obliquity demonstrated coupling with axial torsion due to resistance of the ipsilateral facet.

Fig. 1

Schematic diagram of L5/ S1: 40° sacral slope and 850 N load in standing position (a). Testing device constrained L5 posture in flexion, extension, and bending for investigating L5/S1 kinematics (b). Load is uniformly distributed and applies both shear and compression. Axial torsion was unconstrained

Fig. 2

Schematic of a lateral view of L5/S1 facets. Facet force variation (δF) in the facet joints in flexion/extension is related to height (h) of the IAR assuming that L5/S1 facets are perpendicular to S1 endplate (a). Facets open into flexion when the IAR is above the facet level. Facets close into flexion when the IAR is below the facet level (b)

Fig. 3

Example of IAR data. Three-dimensional representation of the IAR in flexion/extension (a) and lateral bending (b). Intersections of the IAR and the sagittal and the coronal plane through the center of the disc are represented on a lateral and an AP radiograph respectively. The diameter of the circles corresponds to the average error in position (4 mm). The circle color code (red/yellow/green/blue) represents differing positions from extension to flexion and from left to right lateral bending (see legend)

Fig. 4

IAR distance to S1 endplate (z_i: mm) plotted against facet force variation (N) for each 3° rotation into flexion. The “gray zone” corresponds to the facet height and hence force sensor location. The average facet force variation between two consecutive postures during flexion was −4.8 N when the IAR was located above the force sensor, and +7.2 N when the IAR was located below the force sensor (P=0.040). The IAR height is related to the facet force variation in flexion/ extension