Rotation Of Spine Research Articles

The effectiveness of intramuscular dry needling stimulation in treating trigger points: A case series

Myofascial trigger points are a common presentation in clients with chronic spinal pain. Various techniques are used to manage trigger points and are considered a vital part of chronic spinal pain management. Reducing pain caused by trigger points may be effective in improving function. Case series can provide preliminary evidence and assist in feasibility assessment. The objective of this case series is to document the feasibility of intramuscular dry needling stimulation in managing trigger-point-induced chronic pain. Three individuals aged 35, 33, and 28 years presented to a private clinic with chief complaints of scapular region muscular pain, and their management is reported in this case series. Initial physical examination revealed tenderness over D6 and D8. There was a palpable para spinal muscle hypertonicity and reduced thoracic spine mobility to both sides in all the three clients. The presence of multiple trigger points bilateral to the spine indicated postural dysfunction, which altered pain on changing thoracic posture. Clients were treated with dry needling with intramuscular stimulation over trigger points, paraspinal muscle and inferior to scapula by a therapist trained in the technique. The frequency was kept at 1.5 Hz and intensity was as tolerated by the patient. Outcome measures were taken using VAS, RMDQ and digital inclinometer for thoracic spine rotation. Subject one reported a change of 22 mm in VAS after the first week and 40 mm in the fourth week. It also reported an improvement in mobility to both side rotations by 20 degrees in the first week and full towards the fourth week. Subject two and three improved VAS by 10 mm in week one and 35 mm towards the fourth week. Full mobility was achieved in the fourth week in both cases. RMDQ scores improved significantly in the three cases. The three cases demonstrate significant improvement in both symptoms and function based on outcome measures. This indicates the efficacy of treating thoracic spine myofascial trigger points with dry needling and intramuscular stimulation, but a large-scale study is recommended.

Physiological rotation patterns of the thoracolumbar spine across different ages: A detailed analysis using upright CT

BackgroundThe rotational motion of the spine plays a crucial role in daily activities. Understanding the mechanisms of spinal rotation is essential for evaluating normal spinal function, especially in standing positions due to the influence of gravity. However, previous studies on spinal rotation have been limited. Research QuestionWhat are the differences in thoracolumbar rotation during trunk rotation in a standing position among different age and gender groups? MethodsThis cross-sectional study involved 49 healthy volunteers without back pain, including 24 younger participants (13 males, 11 females) and 25 elderly participants (12 males, 13 females). Upright and trunk-rotated CT (right-rotated standing positions) scans were taken. Vertebral rotation was measured using the femoral head center as an axis. ResultsAnalysis of spinal alignment in the standing position revealed mild rotation from the lumbar to thoracic vertebrae. The lumbar spine exhibited left rotation at apex of L3 (L3: −1.3±3.8°, p=0.01), while the lower thoracic spine showed right rotation at apex of T8 (T8: 1.9±2.4°, p<0.001) and the upper thoracic spine showed left rotation at apex of T3 (T3: −2.6±2.9°, p<0.001). The lumbar spine showed minimal rotation during maximum trunk rotation, with significant rotation noted above T10 (16 % vs 84 %). The total thoracolumbar spinal rotation at T1 showed significant differences by gender and age (male vs. female: 23.9±° vs. 30.3±°, p=0.001; young vs. elderly: 29.2±° vs. 25.0±°, p=0.028; elderly male vs. elderly female: 19.2±° vs. 30.4±°, p<0.001). Younger participants did not show significant gender differences, while elderly females retained more rotation compared to males. SignificanceThis pioneering study provides the first detailed report on the range of spinal rotation in a physiological standing situation, highlighting significant differences by gender and age. These findings offer new insights into the natural patterns of spinal rotation and their potential implications for diagnosing and treating spinal disorders.

Effect of thoracic manipulation on neck pain in the mobility group: A randomized controlled trial.

Thoracic spine manipulation (TSM) increases the thoracic spine's range of motion (ROM), effectively reducing pain intensity and disability in patients with mechanical neck pain. We aimed to determine the effect of TSM on neck pain intensity and functional impairment in patients classified under the "mobility" category in Childs' classification. In this randomized controlled trial, patients with mechanical neck pain who met the inclusion criteria were randomly assigned to either the TSM (n = 21) or sham manipulation (n = 20) group. The primary outcomes were pain during neck rotation and subjective improvement assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC), respectively. The secondary outcomes were NPRS at rest, disability (assessed using the Neck Disability Index [NDI]), and ROM of the cervical and thoracic spine rotation. Outcome measurements were performed at baseline, immediately after treatment, 1 week after treatment, and at the 4-week follow-up. Linear mixed models were used to analyze the NPRS, NDI, and ROM. The GROC was analyzed using a chi-square test for the percentage recording ≥+4; the means of each group were compared using an unpaired t-test. The NPRS with neck rotation, neck and thoracic ROM, and NDI showed significant interactions between the groups. The NPRS with neck rotation was significantly lower in the TSM group than in the sham group at all time points after the treatment (p < 0.001). There was no difference between the groups in the proportion showing moderate (≥+4) improvement according to the GROC; however, there was a significant difference in the mean values (p = 0.013). Incorporating TSM into treatment protocols may improve clinical outcomes in patients with neck pain, potentially leading to better pain management and functional recovery. Therefore, physiotherapists should consider TSM as a viable and effective intervention to improve patient outcomes in neck pain rehabilitation.

Clinical history correlates with lateral atlantoaxial (C1-2) joint edema. A pilot study

BackgroundClinical evaluation in the determination of the etiology of axial spine pain is limited. ObjectiveTo determine if a set of three features of the clinical history are indicative of C1-2 joint edema on MRI. MethodsAll patients from one physician's practice who had axial cervical spine pain from 2021 to 2023 were evaluated. Cases were defined as those with all 3 of the ASL criteria, defined as Age >65, Superior cervical/suboccipital pain, and exacerbation of pain primarily by Lateral cervical spine rotation. Age-matched controls had axial cervical spine pain without meeting the ASL criteria. Edema around the atlantoaxial joint and/or odontoid was evaluated by STIR MR sequences. ResultsThe ASL criteria had a sensitivity of 82 % [95 % CI: 64–100 %], specificity of 79 %, [95 % CI: 63–95 %], positive predictive value of 74 % [95 % CI: 54–94 %], and negative predictive value of 86 % [95 % CI: 72–100 %] in diagnosing C1-2 joint edema. ConclusionA positive ASL criteria is sensitive and specific in the diagnosis of C1-2 joint edema, which may have clinical implications.

Anterior percutaneous full-endoscopic transcorporeal decompression for cervical disc herniation: a finite element analysis and long-term follow-up study

ObjectiveThe purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint.MethodsA three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery.ResultsThe long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments.ConclusionsLong-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.

Differences in spinal axial rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups: A cross-sectional study.

Trunk rotation is important in many sporting activities The thoracic spine has reciprocal relationships with the lumbar and pelvic spines, such that reduced flexibility in the lumbar or thoracic spine can lead to abnormal patterns of trunk movement and pain. However, few studies have investigated the relative trunk rotation mobilities of the thorax, lumbar, and pelvis. To compare thoracic, lumbar, and pelvic rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups. Thirty-two young, active participants were enrolled in this study. After the attachment of inertial measurement units at the T1, T7, T12, L3, and S2 levels, the participants were required to stand in a comfortable upright posture for 5s to allow postural measurements before performing the lumbar-locked rotation test. The participants were then divided into hyper thoracic rotation and normal thoracic rotation groups based on T1 angle measurements obtained during the lumbar-locked rotation test. The hyper thoracic rotation group had significantly higher thoracic rotation angles on both the right (p< 0.05) and left (p< 0.05) sides compared with the normal thoracic rotation group. Furthermore, we observed flat lumbar lordosis in the hyper thoracic rotation group compared with the normal thoracic rotation group, particularly in the lower lumbar region in standing posture. Our data suggest that evaluations of thoracic mobility should consider relative thoracic, lumbar, and pelvic motions, rather than the T1 angle alone. This study provides a basis for health professionals to evaluate movement dysfunctions associated with thoracic hypermobility.

OVERVIEW OF ANEMIA AFTER SCOLIOSIS SURGERY IN THE INTENSIVE CARE UNIT (ICU) SOEHARSO ORTHOPEDIC HOSPITALINDONESIA

Anemia is a condition where the hemoglobin concentration is lower than normal. This condition reflects the lack of the normal number of erythrocytes in the body's circulation and consequently the amount of oxygen delivered to the body's tissues is also reduced. Miller &amp; Thompson (2019) scoliosis comes from the Greek word "scoliosis" which means crooked. Scoliosis is a complex three-dimensional deformity of the spine characterized by a lateral deviation of at least 10 degrees with spinal rotation and is usually associated with a reduction in the normal kyphotic curvature of the spine / hypokyphosis. The cause of bleeding in spinal surgery usually occurs more in cases of rigid scoliosis, pedicle subtraction osteotomy and vertebral column resection often referred to as triple column osteotomy and is considered a procedure with a high risk of complications with massive blood loss, reaching more than 10 liters (Jun. 2019). Based on its classification, this type of research is retrospective descriptive research. studies that discuss one or more variables separately, one-by-one, but do not examine the relationship between these variables, using the observation method with the subject being observed by looking at past conditions (Harlan &amp;Sutjiati, 2022). Using total sampling technique in sampling, the population is the medical records of patients admitted to the ICU, postoperative diagnosis of scoliosis with anemia, the sample size is 58 patient medical records. The variables observed were: indications for ICU admission and postoperative scoliosis, the inclusion criteria were medical record data for postoperative scoliosis patients with anemia admitted to the ICU for the period January 1 - December 31, 2022 and patients with the first scoliosis surgery. Based on this study, the following results were obtained: Most respondents were female (81%), the average age of respondents was 17 years. The most common type of scoliosis is adolescence idiopathic scoliosis (89.7%). The most Lenke classification is Lenke 3 (44.8%), the most types of surgery are stabilization, fusion, discectomy, laminectomy and osteotomy (56.9%). The duration of surgery was mostly 180-240 minutes (46.6%) with an average duration of surgery of 257 minutes, the average amount of bleeding was 884.5 ml, the average preoperative Hb was 13.3g/dL, the average postoperative Hb was 8.8 g/dL. The average postoperative Hemoglobin decrease was 5.3 g/dL, patients who were given blood transfusions (87.9%) with an average of 2.9 bags per patient, the most common type of transfused blood was PRC (90.2%).

Effects of Multimodal Physical Therapy on Pain, Disability, H-reflex, and Diffusion Tensor Imaging Parameters in Patients With Lumbosacral Radiculopathy Due to Lumbar Disc Herniation: A Preliminary Trial.

Background Lumbosacral radiculopathy (LSR) due to lumbar disc herniation (LDH) is a condition caused by mechanical compression of nerve roots. Various physical therapy interventions have been proposed for the conservative management of LSR due to LDH. However, the study of physical therapy interventions in a multimodal form is lacking. Additionally, the effect of physical therapy on diffusion tensor imaging (DTI) parameters of the compressed nerve root has not been studied. This study aimed to investigate the effects of multimodal physical therapy (MPT) on pain, disability, soleus H-reflex, and DTI parameters of the compressed nerve root in patients with chronic unilateral LSR due to LDH. Methods A prospective preliminary pre-postclinical trial with a convenience sample was conducted. A total of 14 patients with chronic unilateral LSR due to paracentral L4-L5 or L5-S1 LDH were recruited for the study. Participants received a total of 18 sessions of a six-weekMPT program that consisted of electrophysical agents, manual therapy interventions, and core stability exercises. Electrophysical agents involved interferential current and hot pack. Manual therapy interventions included myofascial release, side posture positional distraction, passive spinal rotation mobilization, and high-velocity low-amplitude manipulation. Visual analog scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), soleus H-reflex amplitude, side-to-side amplitude (H/H) ratio, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the compressed nerve root were measured at baseline and post-intervention. Results There were significant improvements in VAS, RMDQ, H/H ratio, FA, and ADC of the compressed nerve root. Furthermore,significant improvement was found in the affected side compared with the contralateral side in H-reflex amplitude. Conclusions The observations of this preliminary trial suggest that MPT is a successful intervention in patients with chronic unilateral LSR due to LDH. Regarding DTI parameters of the compressed nerve root, FA increased and ADC decreased. Future studies with a control group, large sample sizes, and longer follow-up periods are needed.

Comparative Analysis of Thoracic Rotation Exercises: Range of Motion Improvement in Standing and Quadruped Variants.

There have been few investigations into the effectiveness of thoracic spine exercises for improving thoracic range of motion (ROM) in any plane. This study assessed the effectiveness of two thoracic spine exercises: one in the quadruped position and one in the thoracic standing position. We determined how these exercises affect thoracic spine mobility ROM over a 2-week intervention period. Thirty-nine healthy participants were enrolled and assigned to a Quadruped Thoracic Rotation group (n=17 participants: 9 females and 8 males) or Flamenco Thoracic Spine Rotation group (n=22: 14 females and 8 males). All participants were administered a KOJI AWARENESSTM screening test, and the initial thoracic spine ROM before intervention exercise was measured in a laboratory setting. Quadruped Thoracic Rotation was performed as the quadruped exercise and Flamenco Thoracic Spine Rotation as the standing exercise. The KOJI AWARENESSTM thoracic spine test and ROM were evaluated on the day after the first exercise session and again after the program. Despite their different approaches to thoracic mobility, the quadruped exercise and standing exercise achieved equivalent improvement in thoracic ROM after 2 weeks. Practitioners have a range of exercise options for enhancing thoracic mobility based on their environmental or task-specific needs.

On growth and scoliosis

PurposeTo describe the physiology of spinal growth in patients with adolescent idiopathic scoliosis (AIS).MethodsNarrative review of the literature with a focus on mechanisms of growth.ResultsIn his landmark publication On Growth and Form, D’Arcy Thompson wrote that the anatomy of an organism reflects the forces it is subjected to. This means that mechanical forces underlie the shape of tissues, organs and organisms, whether healthy or diseased. AIS is called idiopathic because the underlying cause of the deformation is unknown, although many factors are associated. Eventually, however, any deformity is due to mechanical forces. It has long been shown that the typical curvature and rotation of the scoliotic spine could result from vertebrae and intervertebral discs growing faster than the ligaments attached to them. This raises the question why in AIS the ligaments do not keep up with the speed of spinal growth. The spine of an AIS patient deviates from healthy spines in various ways. Growth is later but faster, resulting in higher vertebrae and intervertebral discs. Vertebral bone density is lower, which suggests less spinal compression. This also preserves the notochordal cells and the swelling pressure in the nucleus pulposus. Less spinal compression is due to limited muscular activity, and low muscle mass indeed underlies the lower body mass index (BMI) in AIS patients. Thus, AIS spines grow faster because there is less spinal compression that counteracts the force of growth (Hueter–Volkmann Law). Ligaments consist of collagen fibres that grow by tension, fibrillar sliding and the remodelling of cross-links. Growth and remodelling are enhanced by dynamic loading and by hormones like estrogen. However, they are opposed by static loading.ConclusionIncreased spinal elongation and reduced ligamental growth result in differential strain and a vicious circle of scoliotic deformation. Recognising the physical and biological cues that contribute to differential growth allows earlier diagnosis of AIS and prevention in children at risk.

Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation.

Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation.

Relationship between the shoulder, trunk, and pelvis kinematics during the deceleration phase of throwing

BackgroundThe shoulder motion during pitching is influenced by the trunk and pelvis motions, but their relationship during the deceleration phase of throwing on flat ground has not yet been clarified. This study aimed to investigate the relationship between shoulder, trunk, and pelvis kinematics at the maximum internal rotation (MIR) of the shoulder during the deceleration phase of throwing on flat ground. MethodsThe study participants included 17 male baseball players over 20 years old and at the recreational playing level. The recreational level was illustrated by players who did not practice at high intensity and had played only 1–2 competitions per week. Reflective markers were applied to the subject, and throwing motion was assessed using a three-dimensional motion capture system. Data were captured at 1,000 Hz. We assessed the angle of the shoulder, spine, and pelvis at the MIR on flat ground. Internal shoulder rotation velocity and spinal and pelvic angular velocities were also assessed. The relationship between the shoulder, spine, and pelvis kinematics at the MIR were examined using simple linear regression analysis. ResultsThe internal shoulder rotation angle at the MIR was negatively associated with only the spinal flexion and rotation angle at the MIR (p = 0.006 and p = 0.010, respectively). No other significant associations between shoulder, spine, and pelvis kinematics were detected at the MIR. ConclusionFor throwing on flat ground, the internal shoulder rotation motion may be suppressed by producing trunk flexion and rotation motion at the MIR.

The associations of physical parameters with the Closed Kinetic Chain Upper Extremity Stability Test, the Upper Quarter Y Balance Test, and the Upper Limb Rotation Test in professional overhead athletes

ObjectiveTo investigate the associations of glenohumeral internal (IR) and external rotation (ER), horizontal adduction (HA), and thoracic spine rotation ranges of motion (ROM), isometric muscle strength of the shoulder rotators, and trunk muscle endurance with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Quarter Y Balance Test (YBT-UQ), and the Upper Limb Rotation Test (ULRT) in overhead athletes. DesignCross-sectional study. SettingsLaboratory. ParticipantsOne hundred twenty-one athletes were enrolled. Main outcome measuresIndependent variables were: IR, ER, HA, and thoracic spine rotation ROMs, isometric muscle strength of glenohumeral IR and ER muscles, and trunk muscle endurance. Dependent variables were: CKCUEST, YBT-UQ, ULRT. ResultsIR ROM of the nondominant side was associated with the CKCUEST, the YBT-UQ, and the ULRT. IR muscle strength of the dominant side was associated with the CKCUEST and the ULRT. Trunk flexor and lateral endurance of the dominant side were associated with the CKCUEST and the YBT-UQ, respectively. ConclusionsMany of the physical parameters influencing scores on the CKCUEST and the YBT-UQ are different. Common parameters influence the CKCUEST and ULRT scores, yet more parameters influence the CKCUEST score. We suggest the combined use of the CKCUEST and the YBT-UQ in overhead athletes.

Intra- and Inter-rater Reliability of the Lumbar-Locked Thoracic Rotation Test in Patients With Neck Pain.

Neck pain is a common musculoskeletal disorder. Therefore, establishing effective physical therapy for neck pain is one of the most important issues. In addition, in physical therapy for neck pain, it is important to evaluate the thoracic spine, which is an adjacent region of the neck. The lumbar-locked rotation test is designed to evaluate the rotational range of the thoracic spine. However, the reliability of the test when performed on patients with neck pain has not been confirmed. We aimed to determine the intra- and inter-rater reliability of the lumbar-locked rotation test in patients with neck pain. In this study involving 43 patients, two separate examiners measured thoracic spine rotation. Both examiners conducted three measurements for each side, before and after a five-minute interval. Reliability was assessed using various intra-class correlation coefficient (ICC) models. The intra-rater reliability showed ICC values of 0.99 for both examiners. The inter-rater reliability showed ICC values of 0.98 for both right and left thoracic rotations. The findings strongly suggest that the lumbar-locked rotation test has high within-session intra- and inter-rater reliability for patients with neck pain. This test can be considered a reliable method of measuring the thoracic spine rotational range of motion in patients with neck pain in clinical practice.

Finite element analysis of different pedicle screw internal fixations for first lumbar vertebral fracture in different sports conditions.

Lumbar fractures are the most common spinal injuries, and surgery is required for severe fracture. This study aimed to investigate the variations in motion and stress in varying states of activity after minimally invasive and traditional open pedicle screw placement for L1 vertebral fracture stabilization. We studied a male volunteer (26 years old) with no history of chronic back pain or lumbar spine trauma. We used the finite element method for this investigation. Using finite element software, we created a three-dimensional model of L1 vertebral compression fracture. We also constructed models for four percutaneous pedicle screws spanning the fractured vertebra and four screws traversing the damaged vertebra with transverse fixation. In all three-dimensional movement directions, the open pedicle fixation system experienced maximum stress higher than its percutaneous counterpart. With axial spinal rotation, von Mises stress on the traditional open pedicle screw was considerably lower than that with percutaneous pedicle fixation, but peak stress was elevated at the transverse connection. Traditional open pedicle fixation displayed less maximum displacement than percutaneous pedicle internal fixation. During axial spinal movements, high peak stress is observed at the transverse connection. Patients should avoid excessive axial rotation of the spine during recovery.

Assessment of the stiffness of the upper trapezius muscle in a group of asymptomatic people with cervical spine rotation asymmetry.

This study investigated the relationship between the stiffness of the upper trapezius muscle and the range of rotational movement of the cervical spine. A total of 60 right-handed asymptomatic students participated in the study. Participants (N = 22) characterised by asymmetry in rotational movements were selected for the experimental group. A difference of ≥10° between right and left rotation of the cervical spine was considered asymmetrical. The control group (N = 38) included participants whose rotation difference was < 10°. Belonging to the experimental or control group did not significantly differentiate trapezius muscle stiffness. The rotation side differentiated the stiffness of the right and left trapezius muscles only in the group of people with rotational movement asymmetry. There were high correlation coefficients between right cervical rotation and the stiffness of the muscle on the right side, and between rotation to the left and the stiffness of the muscle on the left side. There is a relationship between the stiffness of the right and left upper trapezius muscles and the range of right and left rotational motion of the cervical spine. Stiffness of the upper trapezius correlates more strongly with rotation to the side on which the muscle lies than to the opposite side. Increased stiffness of the upper trapezius muscle on the side of limited cervical spine rotation is likely to be determined by the muscle fibre stretching mechanism.

An in Vivo, Three-Dimensional (3D), Functional Centers of Rotation of the Healthy Cervical Spine

ObjectiveThis study examined cervical center of rotation (COR) positions in seven postures using validated cone beam computed tomography (CBCT) combined with 3D-3D registration in healthy volunteers. MethodsCBCT scans were performed on twenty healthy volunteers in seven functional positions, constructing a three-dimensional model. Images were registered to the neutral position using 3D-3D registration, allowing analysis of kinematic differences and rotational axes. COR measurements were obtained for each segment (C2/3 to C6/7) in each posture. ResultsThe CORs of C2/3 to C6/7 were predominantly posterior (-5.3±3.8 ∼ -0.6±1.2mm) and superior (16.5±6.0 ∼ 23.6±3.2 mm) to the intervertebral disc's geometric center (GC) in flexion and extension. However, the C4/5 segment's COR was anterior to the GC (2.0±9.8 mm) during flexion and close to it in the right-left direction. During left-right twisting, the CORs of C2/3-C6/7 were posterior (-21.8±10.5 ∼-0.9±0.8 mm) and superior (3.1±7.5 ∼23.2±3.6 mm) to the GCs in anterior-posterior and superior-inferior directions, without consistent right-left directionality. During left-right bending, each segment's COR was predominantly posterior (-25.2±13.1 ∼-6.5±9.9 mm) and superior (0.3±12.5 ∼12.1±5.1 mm) to the GC in anterior-posterior and superior-inferior directions, except for the C2/3 segment, located inferiorly (-5.9 ±4.1 mm) in left bending. The right-left COR position varied across segments. ConclusionsOur findings reveal segment-specific and posture-dependent COR variations. Notably, the CORs of C3/4, C4/5, and C5/6 consistently align near the intervertebral disc's GC at different postures, supporting their suitability for total disc replacement surgery within the C3/4 to C5/6 segments.

Efficacy and safety of the orthopaedic manipulation techniques of the Lin School of Lingnan Region in the treatment of adolescent idiopathic scoliosis: protocol of a participant-and-assessor-blinded randomized controlled study

BackgroundAdolescent idiopathic scoliosis (AIS) is the most common developmental spine disorder among children. It is characterized by a lateral deviation of the spine that gives rise to the distinctive “S” or “C” shaped bending of the spine. The Lin School of Lingnan Region (LSLR), one of the prominent schools for bare-handed orthopaedic manipulation in southern China, provides preliminary evidences that the orthopaedic manipulation techniques help to correct deviations of the spine. Previous research found that Orthopaedic Manipulation Techniques of LSLR (OMT-LSLR) could reduce the Cobb’s angles in patients with AIS. Therefore, the current study aims to investigate the effectiveness and safety of the OMT-LSLR in treating teenagers with AIS.MethodsIn this participant-and-assessor-blinded randomized controlled clinical trial, 50 participants identified AIS without surgical indications will be recruited and randomized into two groups to receive physiotherapy scoliosis-specific exercises training with either orthopaedic manipulation or sham manipulation treatment for 16 weeks, followed by post-treatment visits at week 24. Primary outcome measure is the change of Scoliosis Research Society-22 (SRS-22) questionnaire score. Secondary outcome measures include Traditional Chinese version of Spinal Appearance Questionnaire (TC-SAQ) score, Italian Spine Youth Quality of Life (ISYQOL) score, the change of Cobb’s angle measured by Xray, and the change of Cobb’s angle, spinal rotation and muscle volume measured by three-dimensional (3D) ultrasound. The trial will be conducted at the Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre in Hong Kong (CUHK-CMSCTRC).DiscussionThe results of this study will establish comprehensive clinical evidence about the efficacy and safety of the Orthopaedic Manipulation Techniques of the Lin School of Lingnan Region in the Treatment of Adolescent Idiopathic Scoliosis. One of the characteristics of this trial is that it is a participant-and-assessor-blinded randomized controlled clinical trial with sham manipulation. The study would also apply three-dimensional (3D) ultrasound technology to investigate the relationship between the change of the muscle volume and the spinal curve.Trial registrationThe trial is registered on ClinicalTrials.gov (Identifier: NCT05639023) on December 6, 2022.

Coupled rotation patterns in cervical spine axial rotation can change when the head is kept level

The biomechanical literature describes axial rotation occurring coupled with lateral bending and flexion in the cervical spine. Since the head is kept level during some activities of daily living, we set out to investigate the changes in total and segmental motion that occur when a level gaze constraint is applied to cadaveric cervical spine specimens during axial rotation. 1.5Nm of left and right axial rotation moment was applied to sixteen C2-T1 cadaveric specimens with C2 unconstrained and C2 constrained to simulate level gaze. Overall and segmental motions were determined using optoelectronic motion measurement and specimen-specific kinematic modeling. Without a kinematic constraint on C2, motions were as described in the literature; namely, flexion and lateral bending to the same side as axial rotation. Keeping C2 level reduced that total axial rotation range of motion of the specimens. Changes were also produced in segmental coupled rotation in all specimens. The observed changes included completely opposite coupled motion than in the uncoupled specimens, and traditional coupled behavior at one load extreme and the opposite at the other extreme. Constraining C2 during axial rotation to simulate level gaze can produce coupled motion that differs from the classically described flexion and lateral bending to the same side as axial rotation.Statement of Clinical Significance: Activities of daily living that require the head to be kept level during axial rotation of the cervical spine may produce segmental motions that are quite different from the classically described motions with implications for biomechanical experiments and implant designers.

Relationship Between Lumbar Locked Rotation, Trunk Rotation During Pitching, and Pitch Velocity in High School Baseball Players.

Trunk rotation during pitching correlates with pitching velocity and load on the joints of the upper limb. Trunk rotation is often focusing on during teaching the pitching motion. Athletes who exhibit early trunk rotation during pitching often have low thoracic spine rotational range of motion. The purpose of this study was to investigate the relationship between the range of thoracic spine rotation measured using the lumbar locked rotation test (LLR-t), hip-shoulder separation (H/S) and thoracic rotation angle at stride foot contact (SFC), and ball velocity. Descriptive laboratory study. Fifteen healthy male high school students belonging to a baseball club were recruited for participation. The throwing side and non-throwing side LLR-t was performed using an inclinometer. Hip-shoulder separation and thoracic rotation angle during SFC were measured using a pitching motion analysis application: Pitch AI. In addition, a tracking device specifically designed for pitching：Pitching2.0 was employed to measure ball velocity. Correlations between LLR angle, H/S, trunk rotation angles at SFC, and ball velocity were examined using Pearson's correlation coefficient. There was a positive correlation（r=0.52，p=0.047） between the LLRt angle and H/S. Additionally, there was a negative correlation（r=-0.62, p =0.01） between the LLRt angle on the throwing side and thoracic rotation angle. There was a positive correlation(r=0.54, p=0.04) between ball velocity and H/S and a negative correlation(r=-0.56, p=0.03) between ball velocity and thoracic rotation angle during SFC. . The LLR-t measures thoracic rotation angle with the pelvis-lumbar spine fixed. The results indicated that throwing side LLR was related to the thoracic angle during SFC and hip-shoulder separation. 3.