Thoracolumbar Joint Research Articles

Relationship Between Thoracolumbar Joint Position Sense And Range Of Motion Among Collegiate Baseball Players

Relationship Between Thoracolumbar Joint Position Sense And Range Of Motion Among Collegiate Baseball Players

Radiographic Outcomes Following Various Treatment Options of Thoracolumbar Burst Fractures.

Thoracolumbar burst fractures include a spectrum of treatment options ranging from conservative management to multilevel fusion with or without corpectomy. Given the variability of treatment options, consideration of radiographic outcomes with different treatment modalities should be a critical consideration in management. A retrospective review was conducted evaluating all patients presenting with spine fractures over a 7-year period. Inclusion criteria were limited to adults with acute, traumatic burst fractures of the thoracolumbar joint levels T11-L2. Patients were categorized by nonoperative management, short-segment fusion, multilevel fusion without anterior column reconstruction, and corpectomy. Radiographic information collected included kyphotic angle (KA), Cobb angle (CA), and Gardner angle (GA). In total, 117 patients (70.5%) were successfully treated nonoperatively, 4 (2.4%) underwent short-segment fusion, 28 (16.9%) underwent multilevel fusion, and 12 (7.2%) underwent corpectomy. All nonoperative patients demonstrated significantly worse kyphosis at 1-year follow-up as measured by KA, CA, and GA (P < 0.001). Patients undergoing corpectomy had the largest improvement in kyphosis with an average improvement of 14.1° on KA, 8.1° on CA, and 11.0° on GA (P < 0.001, P = 0.098, and P = 0.004, respectively). In comparison, patients undergoing multilevel fusion showed an average improvement of 2.6°, 2.7°, and 3.3° of correction on GA, CA, and KA, respectively (P > 0.05). Nonoperative and short-segment fusion burst fracture patients demonstrated significantly worse kyphosis at 1-year follow-up. Patients undergoing corpectomy demonstrated a superior improvement in kyphotic correction compared with those undergoing multilevel fusion and short-segment fusion.

Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain.

The study was aimed at examining the reliability of the Double Inclinometer (DI) method for the assessment of thoracolumbar Range of Movement (ROM) and Joint Position Sense (JPS) in patients with a recent history of Low Back Pain (LBP). Twenty patients with a history of LBP in the last three months participated. The thoracolumbar ROM and JPS were examined from a standing position by using both the DI and the tape measure method. The DI method was found to have moderate to good intra-rater (ICC = 0.68-0.79, SEM = 2.20-2.77°, SDD = 6.09-7.67°), moderate inter-rater (ICC = 0.59-0.62, SEM = 2.96-3.35°, SDD = 8.19-9.27°) and poor test-retest reliability (ICC = 0.13-0.17, SEM = 3.98-4.32°, SDD = 11.02-11.96°) for the assessment of thoracolumbar JPS. For the assessment of thoracolumbar ROM, the DI method was found to have good to excellent intra-rater (ICC = 0.88-0.94, SEM = 4.25-6.20°, SDD = 11.77-17.17°), excellent inter-rater (ICC = 0.90-0.91, SEM = 7.26-7.74°, SDD = 20.11-21.43°) and excellent test-retest reliability (ICC = 0.91-0.93, SEM = 6.03-6.87°, SDD = 16.70-19.02°). The concurrent validity of the DI method with the tape measure method was found to be very weak for the assessment of thoracolumbar JPS (r = 0.02, p = 0.93) and strong for the assessment of thoracolumbar ROM (r = 0.66, p = 0.001). The DI method seems to be a very reliable method for the assessment of thoracolumbar ROM in individuals with a recent history of LBP.

Lumbar Bone Mineral Adaptation: The Effect of Fast Bowling Technique in Adolescent Cricketers.

Localized bone mineral density (BMD) adaptation of the lumbar spine, particularly on the contralateral side to the bowling arm, has been observed in elite male cricket fast bowlers. No study has investigated this in adolescents, or the role of fast bowling technique on lumbar BMD adaptation. This study aims to investigate lumbar BMD adaptation in adolescent cricket fast bowlers, and its relationship with fast bowling technique. Thirty-nine adolescent fast bowlers underwent anteroposterior dual x-ray absorptiometry scan of their lumbar spine. Hip, lumbopelvic and thoracolumbar joint kinematics, and vertical ground reaction kinetics were determined using three-dimensional motion capture and force plates. Significant partial (covariate: fat-free mass) and bivariate correlations of the technique parameters with whole lumbar (L1-L4) BMD and BMD asymmetry (L3 and L4) were advanced as candidate variables for multiple stepwise linear regression. Adolescent fast bowlers demonstrated high lumbar Z-Scores (+1.0; 95% confidence interval [CI], 0.7-1.4) and significantly greater BMD on the contralateral side of L3 (9.0%; 95% CI, 5.8%-12.1%) and L4 (8.2%; 95% CI, 4.9%-11.5%). Maximum contralateral thoracolumbar rotation and maximum ipsilateral lumbopelvic rotation in the period between back foot contact and ball release (BR), as well as contralateral pelvic drop at front foot contact, were identified as predictors of L1 to L4 BMD, explaining 65% of the variation. Maximum ipsilateral lumbopelvic rotation between back foot contact and BR, as well as ipsilateral lumbopelvic rotation and contralateral thoracolumbar side flexion at BR, were predictors of lumbar asymmetry within L3 and L4. Thoracolumbar and lumbopelvic motion are implicated in the etiology of the unique lumbar bone adaptation observed in fast bowlers whereas vertical ground reaction force, independent of body mass, was not. This may further implicate the osteogenic potential of torsional rather than impact loading in exercise-induced adaptation.

A kinematic comparison of on-ergometer and on-water kayaking

The aim of this study was to compare the kinematic profile of on-water and on-ergometer kayaking during maximal paddling. Eleven elite junior female kayak athletes (Mean SD, age: 16.8 ± 1.2 years; body mass: 64.1 ± 8.1 kg) performed a 2-minute maximal kayaking exercise with their competition equipment on water, and a 2-minute maximal kayaking exercise on a standard ergometer. Kinematic data was recorded with an inertial motion capture system. Elbow, shoulder and knee angles and their respective angular velocities were extracted and normalised with respect to the stroke cycle. Statistical Parametric Mapping (SPM) was used to identify statistically significant differences between the two conditions. The stroke rate was significantly higher on ergometer (122.1 ± 6.8 strokes per minute) compared to on water (107.1 ± 4.6 strokes per minute, p < 0.05), with a difference of 8.4 ± 5.9 strokes per minute. Elite kayak female athletes exhibited differences in elbow, shoulder and knee kinematics when comparing on-ergometer to on-water performance. Moreover, the results demonstrated an increased range of motion in lateral bending in the thoracolumbar joint (p < 0.001). The current results support recent findings that a kayak ergometer may not replicate on-water kinematics.

Clinical assessment and grading of back pain in horses.

BackgroundThe clinical presentation of horses with back pain (BP) vary considerably with most horse's willingness to take part in athletic or riding purpose becoming impossible. However, there are some clinical features that are directly responsible for the loss or failure of performance.ObjectivesTo investigate the clinical features of the thoracolumbar region associated with BP in horses and to use some of the clinical features to classify equine BP.MethodsTwenty-four horses comprised of 14 with BP and 10 apparently healthy horses were assessed for clinical abnormality that best differentiate BP from normal horses. The horses were then graded (0–5) using the degree of pain response, muscular hypertonicity, thoracolumbar joint stiffness and overall physical dysfunction of the horse.ResultsThe common clinical features that significantly differentiate horses with BP from non-BP were longissimus dorsi spasm at palpation (78.6%), paravertebral muscle stiffness (64.3%), resist lateral bending (64.3%), and poor hindlimb impulsion (85.7%). There were significantly (p < 0.05) higher scores for pain response to palpation, muscular hypertonicity, thoracolumbar joint stiffness and physical dysfunction among horses with BP in relation to non-BP. A significant relationship exists between all the graded abnormalities. Based on the cumulative score, horses with BP were categorized into mild, mild-moderate, moderate and severe cases.ConclusionsBP in horse can be differentiated by severity of pain response to back palpation, back muscle hypertonicity, thoracolumbar joint stiffness, physical dysfunctions and their cumulative grading score is useful in the assessment and categorization of BP in horses.

Relationship between the thoracolumbar flexion angle and pelvic posterior movement during trunk flexion.

[Purpose] The purpose of this study was to investigate the linear relationship between the thoracolumbar flexion angle and hip posterior displacement. [Subjects and Methods] This study was performed on 15 subjects. The subjects performed three trials of a lumbar flexion–extension task. To quantify the statistical linear relationship between the thoracolumbar flexion angle and hip posterior displacement, Spearman’s rank correlation coefficient was used. [Results] The thoracolumbar flexion angle was significantly correlated with the degree of hip posterior displacement. [Conclusion] According to the results of this study, movement of the thoracolumbar joint and posterior movement of the pelvis must be considered for accurate analysis of the lumbopelvic rhythm.

Generalized Joint Hypermobility in Healthy Female Koreans: Prevalence and Age-Related Differences

ObjectiveObjective To evaluate the prevalence of generalized joint hypermobility (GJH) in healthy female Koreans and to determine whether the degree of GJH differs between children and adults.MethodsTwo groups of females were enrolled, a group of girls from an elementary school (n=404) and women from a call center (n=266). GJH was diagnosed using the Beighton score, which is composed of an evaluation of bilateral knees, elbows, thumbs, and fifth fingers as well as thoracolumbar joint. The GJH and localized hypermobility of each joint was compared between the two groups, and the pattern of hypermobility according to age and dominant hand was investigated.ResultsTotal prevalence of GJH was 50.0% (335/750), and it was more frequently observed in the group of girls (58.9%, 238/404) than women (36.5%, 97/266). The degree of GJH expressed in terms of Beighton score was inversely correlated with age (p<0.05). Significant differences in localized hypermobility of the thumb and fifth finger were found between the two groups and were postulated as the cause for the decline in GJH with age. The pattern of decreased mobility proportional to aging differed between the two joints. Decreased mobility occurred equally on both sides of the thumb but was biased toward the fifth finger of the dominant side (mostly the right).ConclusionThe female Koreans appeared to have a high prevalence of GJH. The incidence of GJH decreased as age increased as a result of decreased mobility of the fifth finger on the dominant side.

일상 생활 중의 나쁜 자세에 따른 흉·요추 관절의 기구학 해석

The spine is one of the most important skeletal joints, and it strongly affects the health of the musculoskeletal system. A normal spine has an S-shape, and it is very important to maintain this shape. Recently, spinal diseases such as low back pain have increased rapidly, especially among the elderly. Some of these diseases are caused by congenital spinal disorders and sporting and accident injuries as well as by bad postures. Improper spinal postures could generate excessive disc pressure, which is related to degeneration and pain. Therefore, in this study, we investigated the three-dimensional kinematic parameters of the thoraco-lumbar joint in several bad postures using a motion capture analysis technique. Different bad postures created a significant amount of flexion/extension, side bending, and axial rotation angle compared with neutral postures. Further study is necessary to investigate the disc pressure and ligament force due to the increase in joint rotation from the bad postures.

A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment

Study designA prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis.Summary of background dataConservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention). Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis.MethodsA consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve <25 degrees in the coronal plane. Standing radiographs were made i) at start, ii) in brace at beginning and iii) after one year treatment without brace.ResultsBefore treatment start ‘in brace’ radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p < 0.001, pelvic obliquity p < 0.001). After one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in 3 Cobb angles each.ConclusionConservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques.

Brace treatment with progressive lordotic forces at the thoracolumbar junction in adolescent scoliosis and hyperkyphosis

Conclusion This study supports an alternative brace technique for treatment of scoliosis and kyphosis with pure lordosis at the thoracolumbar joint, including periodical adjustments combining passive and active components in redressing tensions. Significant reduction of scoliotic and kyphotic curves is possible during growth. By stepwise restoration of thoracolumbar lordosis and preventing overload in compression during sitting creates improved conditions. Good compliance and satisfaction seems part of the process.

An In Vivo Study of the Axial Rotation of the Human Thoracolumbar Spine

Measurements of axial rotation of the thoracolumbar spine during conditions of standing, sitting, lateral bending, and level walking were made in living subjects; Steinmann pins were inserted in various thoracolumbar spinous processes of seven male subjects, between twenty and twenty-six years old, and direct measurements were made of the angular displacement of the pins during rotation. The subjects (standing erect, then sitting, with rotation measured relative to the fixed pelvis) turned from side to side as far as possible. In one subject, 9 degrees of rotation occurred between the first and the fifth lumbar vertebrae during standing and 8 degrees during sitting; additional rotation of approximately 10 degrees was observed at the thoracolumbar joint. An average of approximately 6 degrees was measured at each of the remaining thoracic levels. Some individual variation in the amount of axial rotation was observed in the subjects tested. In one half of a walking cycle during normal level walking on a treadmill, 5 degrees of rotation occurred at the first thoracic vertebra and, in the opposite direction, 6 degrees at the fifth lumbar vertebra. There appeared to be a transition point (displacement node) in the sixth to eighth thoracic vertebral region above which rotation was in the direction opposite to that below. In an additional study, axial rotation was found to occur with motion of the spine in the coronal plane, an observation that supports the concept that axial rotation is an integral motion of the thoracolumbar spine during lateral bending.