Intervertebral Motion Research Articles

Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy

PurposeEvidence of intervertebral mechanical markers in chronic, non-specific low back pain (CNSLBP) is lacking. This research used dynamic fluoroscopic studies to compare intervertebral angular motion sharing inequality and variability (MSI and MSV) during continuous lumbar motion in CNSLBP patients and controls. Passive recumbent and active standing protocols were used and the relationships of these variables to age and disc degeneration were assessed.MethodsTwenty patients with CNSLBP and 20 matched controls received quantitative fluoroscopic lumbar spine examinations using a standardised protocol for data collection and image analysis. Composite disc degeneration (CDD) scores comprising the sum of Kellgren and Lawrence grades from L2–S1 were obtained. Indices of intervertebral motion sharing inequality (MSI) and variability (MSV) were derived and expressed in units of proportion of lumbar range of motion from outward and return motion sequences during lying (passive) and standing (active) lumbar bending and compared between patients and controls. Relationships between MSI, MSV, age and CDD were assessed by linear correlation.ResultsMSI was significantly greater in the patients throughout the intervertebral motion sequences of recumbent flexion (0.29 vs. 0.22, p = 0.02) and when flexion, extension, left and right motion were combined to give a composite measure (1.40 vs. 0.92, p = 0.04). MSI correlated substantially with age (R = 0.85, p = 0.004) and CDD (R = 0.70, p = 0.03) in lying passive investigations in patients and not in controls. There were also substantial correlations between MSV and age (R = 0.77, p = 0.01) and CDD (R = 0.85, p = 0.004) in standing flexion in patients and not in controls.ConclusionGreater inequality and variability of motion sharing was found in patients with CNSLBP than in controls, confirming previous studies and suggesting a biomechanical marker for the disorder at intervertebral level. The relationship between disc degeneration and MSI was augmented in patients, but not in controls during passive motion and similarly for MSV during active motion, suggesting links between in vivo disc mechanics and pain generation.

A videofluoroscopy-based tracking algorithm for quantifying the time course of human intervertebral displacements

The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images. To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively. When applied to two patient cases, aberrant intervertebral motions in the cervical spine were typically found to correlate with patient-specific anatomical features such as disc height loss and osteophytes. The case studies suggest that intervertebral kinematic time-course data could have value in clinical assessments, lead to broader understanding of how specific anatomical features influence joint motions, and in due course inform clinical treatments.

Measurement of lumbar spine intervertebral motion in the sagittal plane using videofluoroscopy.

Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. Measurement errors in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column vertebral flexion-extension relative to S1 (L3: max. 5.9°, min. 5.6°), while in others (degenerative disc disease) there was paradoxically a significant variation in this measurement (L3: max. 28.1°, min. 0.7°). By means of a novel vertebral digitisation scheme and customised digitisation/analysis software, sagittal plane intervertebral motion data of the lumbar spine data has been successfully extracted from videofluoroscopic image sequences. Whilst the intervertebral motion signatures of subjects in this study differed significantly, the available sample size precluded the inference of any clinical trends.

Experiences of intervertebral motion palpation in osteopathic practice – A qualitative interview study among Swedish osteopaths

Assessment in manual therapy includes quantitative and qualitative procedures, and intervertebral motion palpation (IMP) is one of the core assessment methods in osteopathic practice. The aim of this study was to explore osteopathic practitioners' experiences of clinical decision-making and IMP as a diagnostic tool for planning and evaluation of osteopathic interventions. The study was conducted with semi-structured interviews that included eight informants. Content analysis was used as the analytical procedure. In total, three categories emerged from the analysis: strategic decision-making, diagnostic usability of IMP, and treatment applicability of IMP. The study indicated that IMP was considered relevant and was given particular importance in cases where IMP findings confirmed clinical information attained from other stages in the diagnostic process as a whole. However, IMP findings were experienced as less important if they were not correlated to other findings.

Intra- and inter-rater reliability of 3D passive intervertebral motion in subjects with nonspecific neck pain assessed by physical therapy students: A pilot study.

Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with nonspecific neck pain. Only very few studies have investigated 3D movements until now. This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with nonspecific neck pain. Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3 to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with nonspecific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.

Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-effect of severe distractive-flexion injury on C3-4 motion.

OBJECTIVE With application of the forces of intubation, injured (unstable) cervical segments may move more than they normally do, which can result in spinal cord injury. The authors tested whether, during endotracheal intubation, intervertebral motion of an injured C3-4 cervical segment 1) is greater than that in the intact (stable) state and 2) differs when a high- or low-force laryngoscope is used. METHODS Fourteen cadavers underwent 3 intubations using force-sensing laryngoscopes while simultaneous cervical spine motion was recorded with lateral fluoroscopy. The first intubation was performed with an intact cervical spine and a conventional high-force line-of-sight Macintosh laryngoscope. After creation of a severe C3-4 distractive-flexion injury, 2 additional intubations were performed, one with the Macintosh laryngoscope and the other with a low-force indirect video laryngoscope (Airtraq), used in random order. RESULTS During Macintosh intubations, between the intact and the injured conditions, C3-4 extension (0.3° ± 3.0° vs 0.4° ± 2.7°, respectively; p = 0.9515) and anterior-posterior subluxation (-0.1 ± 0.4 mm vs -0.3 ± 0.6 mm, respectively; p = 0.2754) did not differ. During Macintosh and Airtraq intubations with an injured C3-4 segment, despite a large difference in applied force between the 2 laryngoscopes, segmental extension (0.4° ± 2.7° vs 0.3° ± 3.3°, respectively; p = 0.8077) and anterior-posterior subluxation (0.3 ± 0.6 mm vs 0.0 ± 0.7 mm, respectively; p = 0.3203) did not differ. CONCLUSIONS The authors' hypotheses regarding the relationship between laryngoscope force and the motion of an injured cervical segment were not confirmed. Motion-force relationships (biomechanics) of injured cervical intervertebral segments during endotracheal intubation in cadavers are not predicted by the in vitro biomechanical behavior of isolated cervical segments. With the limitations inherent to cadaveric studies, the results of this study suggest that not all forms of cervical spine injury are at risk for pathological motion and cervical cord injury during conventional high-force line-of-sight intubation.

The Study of Cobb Angular Velocity in Cervical Spine during Dynamic Extension-Flexion.

A kinematic study of cervical spine. The aim of the study was to confirm the interesting manifestation observed in the dynamic images of the cervical spine movement from full-extension to full-flexion. To further explore the fine motion of total process of cervical spine movement with the new concept of Cobb angular velocity (CAV). Traditionally range of motion (ROM) is used to describe the cervical spine movement from extension to flexion. It is performed with only end position radiographs. However, these radiographs fail to explain how the elaborate movement happens. The dynamic images of the cervical spine movement from full-extension to full-flexion of 12 asymptomatic subjects were collected. After transforming these dynamic images to static lateral radiographs, we overlapped C7 cervical vertebrae of each subject and divided the total process of cervical spine movement into five equal partitions. Finally, CAV values from C2/3 to C6/7 were measured and analyzed. A broken line graph was created based on the data of CAV values. A simple motion process was observed in C2/3 and C3/4 segments. The motion processes of C4/5 and C5/6 segments exhibited a more complex track of "N" and "W" than the other segments. The peak CAV values of C4/5 and C5/6 were significantly greater than the other segments. From C2/3 to C6/7, the peak CAV value appeared in sequence. The intervertebral movements of cervical spine did not take a uniform motion form when the cervical spine moved from full-extension to full-flexion. From C2/3 to C6/7, the peak CAV value appeared in order. The C4/5 and C5/6 segments exhibited more complex kinematic characteristics in sagittal movement. This leads to C4/5 and C5/6 more vulnerable to injury and degeneration. We had a hypothesis that there was a positive correlation between injury/degeneration and complexity of intervertebral movement in the view of CAV. N/A.

Mini Anterior Lumbar Interbody Fusion: One Year Follow up for a Novel Device

Introduction This study is a prospective cohort observational trial, to evaluate the ROI-A (Radiolucent Open Implant-ALIF) and VerteBRIDGE plate construct, in the treatment of symptomatic lumbar degenerative disc disease. The principal advantage of anterior approach is that the risks associated with exploration of the spinal canal through a posterior approach can be avoided and damage to the muscles of the back is eliminated. The anterior approach offers superior visualization of the disc space itself, and can be done without disruption of the otherwise healthy posterior elements. The Mini ALIF retroperitoneal approach facilitates rapid patient recovery. Materials and Methods The ROI-A (Radiolucent Open Implant-ALIF) is made from PEEK (Polyetheretherketone), a medical grade plastic, and two metallic anchoring plates, marketed as VerteBridge, which provide both stability at the site of desired bony fusion and fixation of the implant to the vertebrae adjacent to the interbody device. Inclusion Criteria: 18 patients between the ages 31 and 65 years of age; Disc disease between L2-S1; Patients may have up to grade I spondylolisthesis or retrolesthesis at the involved site; Maximum two diseased vertebral motion segments to be instrumented; Has had no more than two previous non-fusion surgeries to the lumbar soine at the same level(s); Has failed to respond to an appropriate attempt at conservative treatment. Exclusion Criteria: More than two vertebral motion segments involved; Prior anterior, retroperitoneal approach; Has had previous anterior instrumented fusion at the proposed operative level; Higher than grade I spondylolisthesis or retrolisthesis at the involved level(s); Has reported active malignancy, localized or systemic infection; Morbid obesity, as defined by NIH Clinical Guidelines Body Mass Index (BMI > 40); Patients with a diagnosis of osteoporosis, osteopenia, Paget's or other metabolic bone disease; Patients who smoke more than 1 pack per day; Has an active workers compensation claim relative to the involved part. Outcome Measures: Subjects are evaluated clinically pre-operatively, 6 weeks and 12 months post op by the pain questionnaire (VAS), and function questionnaire (ODI); The radiological measures included the segmental lordosis, integrity of the construct, and presence of bridging bone; Fusion success is defined as presence of bridging bone, and postoperative intervertebral motion at 12 months which is less than 5 degrees, via manual radiographic angular measurements (Cobb Method) of the implanted level(s) on flexion and extension radiographs at the 12 month follow up visit. Results The VAS has improved from an average of 9 preop to an average of 2 postop. ODI score has reduced an average 30 points from preop measurement. 83% (15 patients) went on bony fusion at the radiological assessment 12 month post op. None of the patients underwent revision, removal of implant, supplemented fixation, or re-operation. One patient developed mechanical ileus for 48 hours postop, resolved with NG tube. Conclusion Mini anterior inter-body fusion is a valid option when treating degenerative/discogenic back pain, the ROI-A implant is a safe and simple, with satisfactory results up to 12 month, according to our pilot study.

Adjacent Segment Degeneration and Adjacent Segment Disease in Patients with Cervical Arthroplasty with 5 Years Follow-Up

Introduction Among the practical advantages of the cervical arthroplasty, the preservation of the movement could reduce the presentation of cases of adjacent segment disease and adjacent segment degeneration compared with anterior cervical fusion. It is estimated that ~90% of patients managed with anterior cervical fusion will present a new onset or progression of a degenerative adjacent levels, exhibiting symptoms during the first 10 years. Currently there are reports of reoperation of cases treated with this technique due to the presence of nonunion, bone collapse, migration of the implants and the development of adjacent segment disease. Material and Methods During the period between January 2005 and July 2010 were included 153 patients with an average age of 47.69 years (range 40–60 years, 56 men), who had a diagnosis of symptomatic cervical disc disease of 1 or 2 levels. All were treated by cervical arthroplasty prosthesis using the Mobi-C, Activ-C and ProDisc-C systems, searching for the presence of adjacent segment disease or degeneration according to the classification of Hillbrand. The monitoring was performed with clinical examination and radiological control in all patients with visits at 15, 30 and 60 days and periodically thereafter 6 months. Results The follow-up time was 60 months and only 11 cases (9.40%) of the 117 patients who were managed with radiculopathy in 1 level showed adjacent segment degeneration during the 5 years of follow up. The average time that the degeneration was observed was 30 months, without observing changes in the first year of follow-up in any of the cases. In patients where 2 levels were handled, we found 3 cases of degeneration (8.33%), drawing attention that these were presented earlier manner (12–18 months) compared with only 1 level affected group. We found 7 cases (5.98%) in which adjacent segment disease was presented in patients with 1 level affected and 4 cases (11.11%) of involvement in patients with 2 levels affected. It was observed that 81.81% occurred in the upper segment and 18.19% in the lower segment. All patients who developed adjacent segment disease required revision surgery (11 cases), showing a positive trend during the monitoring period. No infections, spinal injuries or dural tears occurred. We did not observed the presence of collapse or migration of the implants. No mortality was documented during the study. Conclusion Cervical arthroplasty is an excellent tool for management of cervical radiculopathy, favoring the intervertebral movement and reducing stress, whereby the occurrence of adjacent segment degeneration and adjacent segment disease are diminished compared with anterior cervical fusion according to that reported in the literature.

Effect of Off-Axis Fluoroscopy Imaging on Two-Dimensional Kinematics in the Lumbar Spine: A Dynamic In Vitro Validation Study.

Spine intersegmental motion parameters and the resultant regional patterns may be useful for biomechanical classification of low back pain (LBP) as well as assessing the appropriate intervention strategy. Because of its availability and reasonable cost, two-dimensional (2D) fluoroscopy has great potential as a diagnostic and evaluative tool. However, the technique of quantifying intervertebral motion in the lumbar spine must be validated, and the sensitivity assessed. The purpose of this investigation was to (1) compare synchronous fluoroscopic and optoelectronic measures of intervertebral rotations during dynamic flexion-extension movements in vitro and (2) assess the effect of C-arm rotation to simulate off-axis patient alignment on intervertebral kinematics measures. Six cadaveric lumbar-sacrum specimens were dissected, and active marker optoelectronic sensors were rigidly attached to the bodies of L2-S1. Fluoroscopic sequences and optoelectronic kinematic data (0.15-mm linear, 0.17-0.20 deg rotational, accuracy) were obtained simultaneously. After images were obtained in a true sagittal plane, the image receptor was rotated in 5 deg increments (posterior oblique angulations) from 5 deg to 15 deg. Quantitative motion analysis (qma) software was used to determine the intersegmental rotations from the fluoroscopic images. The mean absolute rotation differences between optoelectronic values and dynamic fluoroscopic values were less than 0.5 deg for all the motion segments at each off-axis fluoroscopic rotation and were not significantly different (P > 0.05) for any of the off-axis rotations of the fluoroscope. Small misalignments of the lumbar spine relative to the fluoroscope did not introduce measurement variation in relative segmental rotations greater than that observed when the spine and fluoroscope were perpendicular to each other, suggesting that fluoroscopic measures of relative segmental rotation during flexion-extension are likely robust, even when patient alignment is not perfect.

Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study.

BackgroundIntervertebral motion impairment is widely thought to be related to chronic back disability, however, the movements of inter-vertebral pairs are not independent of each other and motion may also be related to morphology. Furthermore, maximum intervertebral range of motion (IV-RoMmax) is difficult to measure accurately in living subjects. The purpose of this study was to explore possible relationships between (IV-RoMmax) and lordosis, initial attainment rate and IV-RoMmax at other levels during weight-bearing flexion using quantitative fluoroscopy (QF).MethodsContinuous QF motion sequences were recorded during controlled active sagittal flexion of 60° in 18 males (mean age 27.6 SD 4.4) with no history of low back pain in the previous year. IV-RoMmax, lordotic angle, and initial attainment rate at all inter-vertebral levels from L2-S1 were extracted. Relationships between IV-RoMmax and the other variables were explored using correlation coefficients, and simple linear regression was used to determine the effects of any significant relationships. Within and between observer repeatability of IV-RoMmax and initial attainment rate measurements were assessed in a sub-set of ten participants, using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM).ResultsQF measurements were highly repeatable, the lowest ICC for IV-RoMmax, being 0.94 (0.80–0.99) and highest SEM (0.76°). For initial attainment rate the lowest ICC was 0.84 (0.49–0.96) and the highest SEM (0.036). The results also demonstrated significant positive and negative correlations between IV-RoMmax and IV-RoMmax at other lumbar levels (r = −0.64–0.65), lordosis (r = −0.52–0.54), and initial attainment rate (r = −0.64–0.73). Simple linear regression analysis of all significant relationships showed that these predict between 28 and 42 % of the variance in IV-RoMmax.ConclusionsThis study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. These effects, when combined, may be important when such levels are being considered by healthcare professionals as potential sources of pain generation. Multivariate investigations in larger samples are warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0975-1) contains supplementary material, which is available to authorized users.

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study

BackgroundA wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. ObjectivesTo identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. Design/methodsDelphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. ResultsSeventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. ConclusionsEleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.

Factors affecting confidence and knowledge in spinal palpation among International Manual Physical Therapists

Objectives: We sought to find if there was a relationship between the confidence in use of static palpation, passive physiological intervertebral motion (PPIVM) and passive accessory intervertebral motion (PAIVM) and the manual therapist’s (MTs) knowledge of the literature on these topics. Methods: We designed an international survey to achieve our objectives. Each skill was surveyed for the cervical, thoracic and lumbar spines. We also included several other factors that we believed might influence the use of these skills. Results: We concluded that familiarity of the literature was significantly associated with a MTs’ confidence in the use of static palpation, PPIVM and PAIVM techniques. We also found a relationship with the country of practice of the MT and their confidence using these techniques. Discussion: Spinal palpation is an integral part of the MT’s evaluation and treatment abilities. The vast majority of MTs use spinal palpation and nearly all entry-level education programmes include it in their training. Knowing what factors influence MTs’ confidence assessing and treating the spine may allow for more effective teaching and training, as well as improved patient outcomes.

Functional cervicothoracic boundary modified by anatomical shifts in the neck of giraffes.

Here we examined the kinematic function of the morpho- logically unique first thoracic vertebra in giraffes. The first thoracic vertebra of the giraffe displayed similar shape to the seventh cervical vertebra in general ruminants. The flexion experiment using giraffe carcasses demonstrated that the first thoracic vertebra exhibited a higher dorsoventral mobility than other thoracic vertebrae. Despite the presence of costovertebral joints, restriction in the intervertebral movement imposed by ribs is minimized around the first thoracic vertebra by subtle changes of the articular system between the vertebra and ribs. The attachment area of musculus longus colli, mainly responsible for ventral flexion of the neck, is partly shifted posteriorly in the giraffe so that the force generated by muscles is exerted on the cervical vertebrae and on the first thoracic vertebra. These anatomical modifications allow the first thoracic vertebra to adopt the kinematic function of a cervical vertebra in giraffes. The novel movable articulation in the thorax functions as a fulcrum of neck movement and results in a large displacement of reachable space in the cranial end of the neck. The unique first thoracic vertebra in giraffes provides higher flexibility to the neck and may provide advantages for high browsing and/or male competition behaviours specific to giraffes.

Three-dimensional movements of the pelvis and the lumbar intervertebral joints in walking and trotting dogs

Current knowledge of the physiological range of motion (ROM) in the canine axial system during locomotion is relatively limited. This is particularly problematic because dogs with back-related dysfunction frequently present for routine consultations. To collect detailed kinematic information and describe the three-dimensional motions of the pelvis and the lumbar spine (i.e. intervertebral joints S1/L7–L2/L1), we recorded ventro-dorsal and latero-lateral X-ray videos of three walking and trotting dogs and reconstructed their pelvic and intervertebral motions using X-ray reconstruction of moving morphology and scientific rotoscoping.Pelvic roll displayed a monophasic motion pattern and the largest ROM with on average 13° and 11° during walking and trotting, respectively. Pelvic yaw had the smallest ROM with on average 5° (walk) and 6° (trot). A biphasic pattern was observed for pelvic pitch with a mean ROM of 8°. At both gaits, the greatest intervertebral motions occurred either in S1/L7 or L7/L6. The intervertebral motions were mono- or biphasic in the horizontal and the transverse body planes and biphasic in the sagittal plane. Cranial to L6/5, the ROM tended to decrease from 3° to <1.5° in all three planes. Our results confirm that pelvic displacement and intervertebral joint movements are tightly linked with pelvic limb action at symmetrical gaits. The overall small movements, particularly cranial to L5, are consistent with the epaxial musculature globally stabilising the spine against the external and internal limb forces acting on the pelvis and the trunk during walking and trotting.

Variability in Flexion Extension Radiographs of the Lumbar Spine: A Comparison of Uncontrolled and Controlled Bending.

While low back pain is one of the most prevalent, if not the most prevalent reasons for visits to physicians, a majority of patients with low back pain cannot be given a definitive diagnosis. While there have been substantial advances in imaging technologies over the past 30 years, relatively little has changed in the methodologies for evaluating functionality of the lumbar spine. The current standard of care for function assessment of the lumbar spine focuses on uncontrolled patient directed motion which results in increased inter-patient variability. Recent advancements in functional lumbar spine testing utilize controlled bending and computerized imaging evaluation. To compare the measurement variability of lumbar spine motion when diagnosed using measurements of intervertebral motion taken from standard bending flexion/extension radiographs (FE) between uncontrolled and controlled motion. One-hundred nine patients (57 asymptomatic, 52 symptomatic) were consented in the prospective investigation. The research was designed to compare studies involving FE to controlled motion bending radiographs using the Vertebral Motion Analysis (VMA), (Ortho Kinematics, Inc) within the same patient. Each patient agreed to undergo fluoroscopic still imaging to capture FE data and to undergo cine fluoroscopic imaging to capture VMA data. Measurement variability was determined by the mean and standard deviation of intervertebral rotation when evaluated by 5 independent observers evaluating each of the 109 patients FE and VMA. The resulting standard deviation of the intervertebral rotation determinations was used as the measure of variability. The VMA measurements for assessing intervertebral motion were characterized by the use of: (1) a handling device that assists patients through a standard arc of lumbar bending in both an upright and recumbent posture (70 degree flexion/extension arcs; 60 degree left/right bending arcs); (2) video fluoroscopy imaging of the lumbar spine during bending (capturing images at 8 frames per second); and (3) image processing software capable of automatic frame-to-frame registration and tracking of vertebral bodies across the sequence of video-fluoroscopic images to derive measurements of intervertebral rotation and translation. The FE data were assessed from voluntary bending by the patient. There was statistical greater measurement variability in intervertebral rotation in FE when compared to VMA (both standing and lying). When comparing measurement variability between FE and VMA, results indicate between a 26% to 46% decrease in measurement variability under VMA compared to FE. These findings are consistent across asymptomatic and symptomatic patients. The current standard of care for functional testing of the lumbar spine utilizes uncontrolled FE with a manual data evaluation process. Recent developments in using computerized imaging processes has improved, however there remains variability in patient bending due to the self-selected rate and position of the bending. VMA results in a significant reduction in measurement variability of intervertebral rotation measurements.

Sagittal plane lumbar intervertebral motion during seated flexion-extension radiographs of 658 asymptomatic nondegenerated levels.

Evaluation of lumbar stability is fundamentally dependent on a clear understanding of normal lumbar motion. There are inconsistencies in reported lumbar motion across previously published studies, and it is unclear which provide the most reliable reference data. New technology now allows valid and reliable determination of normal lumbar intervertebral motion (IVM). The object of this study was to provide normative reference data for lumbar IVM and center of rotation (COR) using validated computer-assisted measurement tools. Sitting flexion-extension radiographs were obtained in 162 asymptomatic volunteers and then analyzed using a previously validated and widely used computerized image analysis method. Each lumbar level was subsequently classified as "degenerated" or "nondegenerated" using the Kellgren-Lawrence classification. Of the 803 levels analyzed, 658 were nondegenerated (Kellgren-Lawrence grade < 2). At each level of the lumbar spine, the magnitude of intervertebral rotation and translation, the ratio of translation per degree of rotation (TPDR), and the position of the COR were calculated in the nondegenerative cohort. Translations were calculated in millimeters and percentage endplate width. All parameters were significantly dependent on the intervertebral level. The upper limit of the 95% CIs for anteroposterior intervertebral translation in this asymptomatic cohort ranged from 2.1 mm (6.2% endplate width) to 4.6 mm (13.3% endplate width). Intervertebral rotation upper limits ranged from 16.3° to 23.5°. The upper limits for TPDR ranged from 0.49% to 0.82% endplate width/degree. The COR coordinates were clustered in level-dependent patterns. New normal values for IVM, COR, and the ratio of TPDR in asymptomatic nondegenerative lumbar levels are proposed, providing a reference for future interpretation of sagittal plane motion in the lumbar spine.

Apportionment of lumbar L2–S1 rotation across individual motion segments during a dynamic lifting task

Segmental apportionment of lumbar (L2–S1) rotation is a critical input parameter for musculoskeletal models and a candidate metric for clinical assessment of spinal health, but such data are sparse. This paper aims to quantify the time-variant and load-dependent characteristics of intervertebral contributions to L2–S1 extension during a dynamic lifting task. Eleven healthy participants lifted multiple weights (4.5, 9.1, and 13.6kg) from a trunk-flexed to an upright position while being imaged by a dynamic stereo X-ray system at 30frames/s. Vertebral (L2–S1) motion was tracked using a previously validated volumetric model-based tracking method that employs 3D bone models reconstructed from subject-specific CT images to obtain high-accuracy (≤0.26°, 0.2mm) 3D vertebral kinematics. Individual intervertebral motions as percentages of the total L2–S1 extension were computed at each % increment of the motion to show the segmental apportionment. Results showed L3–L4 (25.8±2.2%) and L4–L5 (31±3.1%) together contributed a larger share (∼60% combined) compared to L2–L3 (21.7±3.7%) and L5–S1 (22.6±4.7%); L4–L5 consistently provided the largest contribution of the measured segments. Relative changes over time in L3–L4 (6±12.5%) and L4–L5 (0.5±10.2%) contribution were minimal; in contrast, L2–L3 (18±20.1%) contribution increased while L5–S1 (−33±22.9%) contribution decreased in a somewhat complementary fashion as motion progressed. No significant effect of the magnitude of load lifted on individual segmental contribution patterns was detected. The current study updated the knowledge regarding apportionment of lumbar (L2–S1) motion among individual segments, serving both as input into musculoskeletal models and as potential biomechanical markers of low back disorders.

Computation of spine intervertebral motions in scoliotic patients: a multibody approach

"Computation of spine intervertebral motions in scoliotic patients: a multibody approach." Computer Methods in Biomechanics and Biomedical Engineering, 18(sup1), pp. 1866–1867

Regional spinal kinematics during static postures and functional tasks in people with non-specific chronic low back pain

International Journal of Therapy and RehabilitationVol. 22, No. Sup8 The 34th Scientific Meeting of the Physiotherapy Research Society Conference abstractsRegional spinal kinematics during static postures and functional tasks in people with non-specific chronic low back painR Hemming, L Sheeran, R van Deursen, V SparkesR HemmingSearch for more papers by this author, L SheeranSearch for more papers by this author, R van DeursenSearch for more papers by this author, V SparkesSearch for more papers by this authorR Hemming; L Sheeran; R van Deursen; V SparkesPublished Online:3 Aug 2015https://doi.org/10.12968/ijtr.2015.22.Sup8.S8bAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetailsCited byComparison of postural control between subgroups of persons with nonspecific chronic low back and healthy controls during the modified Star Excursion Balance TestPhysical Therapy Rehabilitation Science, Vol. 8, No. 3Aberrant intervertebral motion in patients with treatment-resistant nonspecific low back pain: a retrospective cohort study and control comparison20 June 2018 | European Spine Journal, Vol. 27, No. 11Have Studies that Measure Lumbar Kinematics and Muscle Activity Concurrently during Sagittal Bending Improved Understanding of Spinal Stability and Sub-System Interactions? A Systematic Review8 September 2018 | Healthcare, Vol. 6, No. 3Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy29 May 2017 | European Spine Journal, Vol. 27, No. 1 1 August 2015Volume 22Issue Sup8ISSN (online): 1759-779X Metrics History Published online 3 August 2015 Published in print 1 August 2015 Information© MA Healthcare LimitedPDF download