In vivo range of motion of the lumbar spinous processes

Abstract

The study design included an in vivo laboratory study. The objective of the study is to quantify the kinematics of the lumbar spinous processes in asymptomatic patients during un-restricted functional body movements with physiological weight bearing. Limited data has been reported on the motion patterns of the posterior spine elements. This information is necessary for the evaluation of traumatic injuries and degenerative changes in the posterior elements, as well as for improving the surgical treatment of spinal diseases using posterior procedures. Eight asymptomatic subjects with an age ranging from 50 to 60 years underwent MRI scans of their lumbar segments in a supine position and 3D models of L2-5 were constructed. Next, each subject was asked to stand and was positioned in the following sequence: standing, 45 degrees flexion, maximal extension, maximal left and right twisting, while two orthogonal fluoroscopic images were taken simultaneously at each of the positions. The MRI models were matched to the osseous outlines of the images from the two orthogonal views to quantify the position of the vertebrae in 3D at each position. The data revealed that interspinous process (ISP) distance decreased from L2 to L3 to L4 to L5 when measured in the supine position; with significantly higher values at L2-3 and L3-4 compared with L4-5. These differences were not seen with weight-bearing conditions. During the maximal extension, the ISP distance at the L2-3 motion segment was significantly reduced, but no significant changes were detected at L3-4 and L4-5. During flexion the ISP distances were not significantly different than those measured in the MRI position at all segments. Going from the left to right twist positions, the L4-5 segment had greater amounts of ISP rotation, while all segments had similar ranges of translation in the transverse plane. The interspinous process distances were dependent on body posture and vertebral level.