In Vivo Measurements of Lumbar Segmental Motion During Axial Rotation in Asymptomatic and Chronic Low Back Pain Male Subjects

Ochia, Ruth S.; Inoue, Nozomu; Takatori, Ryota; Andersson, Gunnar; An, Howard S.

doi:10.1097/brs.0b013e318060122b

Cited by 43 publications

(42 citation statements)

References 19 publications

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“…Although cross-sectional studies have been carried out across the generations, the relationship between disc degeneration and lumbar symptoms remains controversial. Some studies have reported an intimate relation [4,19], while others have contradicted this finding [15,17]. Kirkaldy-Willis and Farfan [11] reported that the stages of spondylolisthesis were related to treatment selection, and the unstable stage possibly changed to the re-stabilization stage with the progression of disc degeneration and age as a result of a decrease in disc height and the development of osteophytes around the segment.…”

Section: Introductionmentioning

confidence: 99%

Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

et al. 2012

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Introduction Little is known about when and how progressive spondylolisthesis occurs. In this report segmental motion related to age and disc degeneration at L4/5 disc was investigated. Materials and methods 637 patients with low back and/or leg pain underwent radiologic and MRI examinations simultaneously. Because 190 patients with conditions which might impede accurate measurement were excluded, 447 patients, comprising 268 men and 179 women, were included; age range, was 10-86 (mean: 53) years. Three radiologic parameters slip in neutral position (mm), sagittal translation (mm), and segmental angulation (degrees) were examined at the L4/5 segment. On T2-weighted MRI, severity of disc degeneration at L4/5 was classified by Pfirrmann's criteria, grade 1-5. Results Results showed stage of disc degeneration that progressed according to aging with significant differences except for between grades 4 and 5. Amount of anterior slip was small among grades 1 to 3; however, it greatly increased between grades 3 and 4 and between grades 4 and 5, suggesting that grade 3 disc degeneration has a potential risk of future progression of anterior slip. This finding may also suggest that once significant slip occurs, it will progress to the final grade. Furthermore, the grade 3 degeneration group exhibited large amounts of motion in both angulation and translation, suggesting it was the most unstable group. Conclusion Our results with radiography and MRI indicate that grade 3 disc degeneration is a critical stage for the progression of lumbar spondylolisthesis at L4/5 segment.

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Section: Introductionmentioning

confidence: 99%

Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

et al. 2012

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“…It is clear that implementation of a high accuracy measurement method will increase the validity of conclusions stemming from a study on kinematics changes at the adjacent level, as pointed out by other authors [34]. There was no disc height loss associated with disc degeneration during a 1-year period following ACDF in the Table 4 In vivo kinematic studies on flexion/extension angles during flexion/extension at adjacent levels to ACDF or cervical disc arthroplasty (CDA) preoperatively and postoperatively CDA cervical disc arthroplasty, Diff difference between pre-OP and post-OP, n sample size, NA data not available, NS not significant, P p value of comparison between Pre-OP and Post-OP a Calculated from reference [35] b Calculated from reference [27] c Calculated from reference [9] current study. As with the case of the anterior-posterior translation measurement, there is limited information in the literature about the changes in disc height at the adjacent levels following ACDF (Table 6).…”

Section: Discussionmentioning

confidence: 99%

“…This study introduced a high-accuracy method for measuring disc height. While conventional methods based on 2D radiographic images typically use four corner CDA cervical disc arthroplasty, CaA caudal anterior, CaP caudal posterior, CrA cranial anterior, CrP cranial posterior, Diff difference between pre-OP and Post-OP, n sample size, NA data not available, P p value of comparison between Pre-OP and Post-OP a Calculated from reference [27] points from the involved vertebral bodies to calculate the disc height, the method presented here measured disc heights at all endplate surface data points in 3D allowing disc height measurement independent of each vertebral body's 3D orientation, which causes errors in the 2D measurement. It should be noted that the disc height values presented in the current study were smaller than the disc heights measured by conventional methods using 2D radiographic images because our method measures the disc height including Luschka joints, which lowered the mean disc height.…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report

et al. 2011

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Purpose Development of adjacent segment degeneration following anterior cervical decompression and fusion (ACDF) is still controversial, as adjacent-level kinematics is poorly understood. This study reports preliminary data from a high-accuracy 3D analysis technique developed for in vivo cervical kinematics. Methods From nine cervical spondylosis patients, four underwent single-level ACDF, and five underwent two-level ACDF using cylindrical titanium cage implant(s). Pre-and post-surgical CT scans were taken in flexion, neutral and extended positions, allowing us to compute segmental ranges of motion for rotation and translation, and 3D disc-height distributions. Differences in segmental motions and disc-height between fused and adjacent levels were analyzed with a Wilcoxon signed-rank test. Results are presented as mean ± SEM. Results The flexion/extension angular-ROM at the fusion level decreased after surgery (7.46 ± 1.17°vs. 3.14 ± 0.56°, p \ 0.003). The flexion/extension angular-ROM at one caudal adjacent level to the fusion level (3.97 ± 1.29°) tended to be greater post-operatively (6.11 ± 1.44°, p = 0.074). Translation in the anterior-posterior direction during flexion/ extension at the fusion level decreased after surgery (1.22 ± 0.20 mm vs. 0.32 ± 0.11 mm, p \ 0.01). No differences were found in adjacent-level disc heights between both study time-points. Conclusions This study showed increased segmental motion in flexion/extension angular-ROM at one level adjacent to ACDF. However, increases in the rotational angular-ROM were not statistically significant when cranial/caudal adjacent levels were analyzed separately. This preliminary study highlighted the capabilities of a 3D-kinematic analysis method to detect subtle changes in kinematics and disc height at the adjacent levels to ACDF. Thus, reliable evidence related to ACDF's influence on adjacent-level cervical kinematics can be collected.

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“…8.8°± 1.8°** 3.4°± 0.9°\0.01 *, **P \ 0.05 degeneration was also occurring in the control group due to age, which then increased the rotational angle compared with data in previous reports. The role of degenerated intervertebral discs in degenerative spinal instability has previously been clarified by means of biomechanical cadaver studies [5,11,14,16,17]. In one study on flexion-extension and axial rotation, the flexibility parameters increased with disc degeneration [11].…”

Section: Discussionmentioning

confidence: 99%

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

et al. 2010

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The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4-L5 disc wedging but without antero-or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior-posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4-L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mobility was measured using the spinal transverse processes of L4 and L5. The relationship between these factors was statistically evaluated using multivariate analysis and Spearman's correlation test. There was a significant increase in the average rotational mobility of the L4-L5 disc-wedging group. In the L4-L5 disc-wedging group, the increased angle of disc wedging and change in the angle between left and right bending correlated with increased rotational mobility. The degree of disc degeneration did not affect rotational mobility. However, existence of vacuum phenomena increased the rotational mobility of the L4-L5 disc-wedging group. This is the first study to evaluate the rotational hypermobility of L4-L5 disc wedging in patients without antero-or retrospondylolisthesis using kinematic CT. Increases in the wedging angle and abnormal instability of lateral bending correlated with increased rotational mobility. For surgical planning of degenerative L4-L5 disc wedging, it is important to consider rotational hypermobility using kinematic CT or X-ray imaging findings of lateral bending.

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In Vivo Measurements of Lumbar Segmental Motion During Axial Rotation in Asymptomatic and Chronic Low Back Pain Male Subjects

Abstract: Current noninvasive CT-based method is feasible for use in healthy and low back pain subjects. Measured segmental motions were similar to other studies in torsion; however, other motions have not been measured previously.

Cited by 43 publications

References 19 publications

Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

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