A patient with T6 ASIA A paraplegia performs a wheelie for pressure relief. During the wheelie, weight is shifted off the ischial tuberosities. Which anatomical structures primarily bear the load in this position?

A patient with T6 ASIA A paraplegia performs a wheelie for pressure relief. During the wheelie, weight is shifted off the ischial tuberosities. Which anatomical structures primarily bear the load in this position?

• A. Greater trochanters
• B. Sacrum and coccyx
• C. Spinous processes of the vertebral column
• D. Posterior superior iliac spines

Answer: (C)

When weight is taken off the sit bones, the body’s weight must be supported by the trunk and spine. In a wheelie, the backrest and posterior spine become the main load-bearing interface, so the load is transmitted through the posterior elements of the vertebral column. The spinous processes are the key bony structures along the midline that bear and transfer this load, rather than the pelvis or hip prominences like the greater trochanters or PSIS. The sacrum and coccyx would only bear load in a different alignment where the pelvis carries weight, which isn’t the case here.

When weight is taken off the sit bones, the body’s weight must be supported by the trunk and spine. In a wheelie, the backrest and posterior spine become the main load-bearing interface, so the load is transmitted through the posterior elements of the vertebral column. The spinous processes are the key bony structures along the midline that bear and transfer this load, rather than the pelvis or hip prominences like the greater trochanters or PSIS. The sacrum and coccyx would only bear load in a different alignment where the pelvis carries weight, which isn’t the case here.