The reproducibility comparison of two intervertebral translation measurements in cervical flexion-extension

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Background To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation. Methods Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients receiving an 8-week cervical therapeutic exercise program were followed up with videofluoroscopic images. The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements. Results The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02–8.67% (p = 0.001 ~ 0.029), and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12–9.18% (p = 0.001 ~ 0.006) compared to the baseline. Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82–8.66% (p = 0.002 ~ 0.036 with exception of C5/6). Active lateral flexion away from the affected side significantly increased the foramen by 3.71–6.78% (p = 0.007 ~ 0.046 with exception of C6/7). Conclusions The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in intervertebral foramen areas of the patients with disc herniation. Trial registration ISRCTN61539024

Section: Discussionmentioning

confidence: 97%

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

Chen

You

et al. 2022

Self Cite

“…The model also achieved satisfactory agreement from C3/4 to C6/7, but the ICCs and rs at C2/3 were not sufficient to guarantee reliable consistency, especially on N/E motion (ICC = 0.60, r = 0.61). This might be due to the extremely small range of motion at C2/3, resulting in even slight differences (MAE = 1.21–1.40) having significant impacts [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…To reduce measurement error, all annotations of landmarks were made as close to the corticomedullary margin of the vertebral body as possible [ 7 ]. The method for measuring SIRM was based on the geometric midplanes method, for which excellent agreement and smaller errors have been demonstrated [ 20 , 21 ]. The vertebral midplane was defined by a line through the two midpoints between the anterior and posterior corners.…”

Section: Methodsmentioning

confidence: 99%

Sagittal intervertebral rotational motion: a deep learning-based measurement on flexion–neutral–extension cervical lateral radiographs

Yan

Zhang

Meng

et al. 2022

Background The analysis of sagittal intervertebral rotational motion (SIRM) can provide important information for the evaluation of cervical diseases. Deep learning has been widely used in spinal parameter measurements, however, there are few investigations on spinal motion analysis. The purpose of this study is to develop a deep learning-based model for fully automated measurement of SIRM based on flexion–neutral–extension cervical lateral radiographs and to evaluate its applicability for the flexion–extension (F/E), flexion–neutral (F/N), and neutral–extension (N/E) motion analysis. Methods A total of 2796 flexion, neutral, and extension cervical lateral radiographs from 932 patients were analyzed. Radiographs from 100 patients were randomly selected as the test set, and those from the remaining 832 patients were used for training and validation. Landmarks were annotated for measuring SIRM at five segments from C2/3 to C6/7 on F/E, F/N, and N/E motion. High-Resolution Net (HRNet) was used as the main structure to train the landmark detection network. Landmark performance was assessed according to the percentage of correct key points (PCK) and mean of the percentage of correct key points (MPCK). Measurement performance was evaluated by intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots. Results At a 2-mm distance threshold, the PCK for the model ranged from 94 to 100%. Compared with the reference standards, the model showed high accuracy for SIRM measurements for all segments on F/E and F/N motion. On N/E motion, the model provided reliable measurements from C3/4 to C6/7, but not C2/3. Compared with the radiologists’ measurements, the model showed similar performance to the radiologists. Conclusions The developed model can automatically measure SIRM on flexion–neutral–extension cervical lateral radiographs and showed comparable performance with radiologists. It may provide rapid, accurate, and comprehensive information for cervical motion analysis.

Intraobserver and interobserver reliability of measures of cervical sagittal rotation

Jiang

Chen

Yang

et al. 2014

BackgroundDiagnosis and treatment decisions of cervical instability are made, in part, based on the clinician’s assessment of sagittal rotation on flexion and extension radiographs. The objective of this study is to evaluate the intraobserver and interobserver reliability of three measurement techniques in assessing cervical sagittal rotation.MethodsFifty lateral radiographs of patients with single-level cervical degenerative disc were selected and measured on two separate occasions by three spine surgeons using three different measurement techniques. Cervical sagittal rotation was measured using three different techniques.ResultsIntraclass correlation coefficients were most consistent for Method 2 (ICC 0.93-0.96) followed by Method 1 (ICC 0.88-0.91) and Method 3 (ICC 0.81-0.87). Intraobserver agreement (% of repeated measures within 0.5° of the original measurement) ranged between 76% and 96% for all techniques, with Method 2 showing the best agreement (92%-96%). Paired comparisons between observers varied considerably with interobserver reliability correlation coefficients ranging from 0.54 to 0.89. Method 2 showed the highest interobserver reliability coefficient (0.82, range 0.73-0.88). Method 2 was also more reliable for the classification of “instability”. Intraobserver percent agreements ranged from 94 to 98% for Method 2 versus 84% to 90% for Method 1 and 78% to 86% for Method 3, while interobserver percent agreements ranged from 90% to 98% for Method 2 versus 86% to 94% for Method 1 and 74% to 84% for Method 3.ConclusionsMethod 2 (measuring the angle from the inferior endplate of the vertebra above the degenerative disc and the inferior endplate of the vertebra below the degenerative disc) showed the best intraobserver and interobserver reliability overall in assessing cervical sagittal rotation.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-332) contains supplementary material, which is available to authorized users.