Non-uniform Segmental Range of Motion of the Thoracic Spine During Maximal Inspiration and Exhalation in Healthy Subjects

Abstract

Background and Objective: To analyse the range of motion of the thoracic spine by radiographically measuring changes in the sagittal profile of different thoracic segments during maximal inspiration and exhalation. The starting hypothesis was that forced deep breathing requires an active, but non-uniform widening of the lordotic–kyphotic range of motion of the different thoracic segments.Methods: Cross-sectional study. Participants were 40 healthy volunteers aged 21–60. Conventional anteroposterior and functional sagittal chest radiographs were performed during maximal inspiration and exhalation. The range of motion of each spinal thoracic functional segment, global T1–T12 motion, and the sagittal displacement of the thoracic column during breathing were measured. Considering the different type of ribs and their attachment the spine and sternum, thoracic segments were grouped in T1–T7, T7–T10, and T10–T12. The displacement of the thoracic spine with respect to the sternum and manubrium was also recorded.Results: The mean difference from inspiration to exhalation in the T1–T12 physiologic kyphosis was 15.9° ± 4.6°, reflecting the flexibility of the thoracic spine during deep breathing (30.2%). The range of motion was wider in the caudal hemicurve than in the cranial hemicurve, indicating more flexibility of the caudal component of the thoracic kyphosis. A wide range of motion from inspiration to exhalation was found at T7–T10, responsible for 73% of T1–T12 sagittal movement. When the sample was stratified according to age ranges (20–30, 30–45, and 45–60 yr.), none of the measurements for inspiration or exhalation showed statistically significant differences.Only changes at this level showed a positive correlation with changes in the global thoracic kyphosis (r = 0.794, p <0.001).Conclusion: The range of motion of the thoracic spine plays a relevant role in respiration dynamics. Maximal inspiration appears to be highly dependent on the angular movements of the T7–T10 segment.

Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached

“…In addition, these instrumented young patients must live with high-density metallic implants inside their bodies which may condition significant long-term consequences [ 14 , 15 ]. Fusion does not improve preoperative respiratory restriction [ 16 ], and it limits the functionality of the thoracolumbar transition and lumbar spine, as some levels of these segments are frequently involved in fusion surgery [ 17 ].…”

Immediate effects of stretching on trunk functions using a stretch pole half-cut

“…By radiographically measuring changes in the sagittal profile of different thoracic segments during maximal inspiration and expiration, the non-uniform sagittal ROM of the thoracic spine could be related to the different types of anatomic rib connections in the thoracic cage. In nonuniform sagittal ROM, at T1-T7 (the true ribs), the attachment of the ribs to the sternum and spine could greatly limit the mobility of the thoracic spine, and ribs joined to T8-T10 (the false ribs) have longer costal cartilage, which attaches to other cartilage, resulting in greater mobility in this area of the rib cage 5) . Therefore, our intervention with T7-T10 may have resulted in a stretch stimulus to the rib cage, including the diaphragm.…”

“…The pole was placed at the level of the T7-T10 vertebra into the top of the semicircle (Fig. 1) because deep breathing appears to be highly dependent on the angular movements of the T7-T10 segment 5) . The duration of the intervention was set to 4 minutes, as described in a previous study 7) .…”

“…Chest and abdominal wall mobilities are related to lung function, respiratory muscle strength, and postural stability [1][2][3][4][5][6][7][8][9][10] . Wall mobility is associated with forced vital capacity (FVC) and maximal expiratory strength in community-dwelling older men.…”

“…Burgos et al showed that the mean difference from inspiration to expiration in the 1st thoracic vertebra (T1)-T12 physiologic kyphosis was 15.9° ± 4.6°, and the range of motion was wider in the caudal hemicurve than in the cranial hemicurve. Furthermore, a wide range of motion was found at T7-T10, which is responsible for 73% of T1-T12 sagittal movement 5) .…”