Three-Dimensional In Vivo Measurement of Lumbar Spine Segmental Motion

Ochia, Ruth S.; Inoue, Nozomu; Renner, Susan M.; Lorenz, Eric; Lim, Tae-Hong; Andersson, Gunnar; An, Howard S.

doi:10.1097/01.brs.0000231435.55842.9e

Cited by 149 publications

(123 citation statements)

References 20 publications

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“…In vitro and in vivo studies on axial rotation in normal discs have been reported. The in vitro data have suggested that the L4-L5 disc had 1.6°of axial rotation [15], while studies of in vivo data have reported 1.74° [6], 1.5° [19], and less than 1°for normal L4-L5 discs [13]. In the current study, the average rotational mobility determined by kinematic CT was 3.2°± 0.8°in the control group.…”

Section: Discussioncontrasting

confidence: 39%

“…However, this report was not a kinematic study and did not evaluate the dynamic instability of the axial plane. To study axial rotation of the lumbar spine, a variety of methods have been used to determine instability by measuring segmental motion, including flexion-extension and bilateral radiographs, surgical implantation of wires, magnetic resonance imaging (MRI), and CT [4,6,13,18]. However, the rotational instability of lumbar disc wedging associated with lumbar scoliosis has not been reported.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 39%

Section: Introductionmentioning

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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“…Igunuchi et al [15] examined flexion and extension movement in symptomatic patients, and found that whereas flexion and extension films were not of value, if translation occurred, then it was greater in the more symptomatic, if 3 mm or more. However the paper by Ochia et al [39] examined asymptomatic subjects, and showed that translation movement was often greater than had been shown to be present in the symptomatic patients reported by Iguchi, or by Fujiwara, being up to 5.4 mm.…”

Section: Instability and The Basic Scientistsmentioning

confidence: 94%

The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain

Mulholland¹

2008

Eur Spine J

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“…This procedure provides rotation angles and translations during flexion/ extension with an accuracy of 1.0°and 1.0 mm [31]. A validated Volume-Merge method was further used to increase accuracy of the 3D-3D registration of the vertebra [26]. In the Volume-Merge method, a vertebral body in a flexed or extended position (the moving vertebra) was virtually rotated and translated towards the same body in a neutral position (the stationary target).…”

Section: Three-dimensional Segmental Motion Analysismentioning

confidence: 99%

“…In this preliminary study, we report the initial results from a high accuracy in vivo 3D kinematic analysis system developed to measure lumbar and cervical spine kinematics [26][27][28][29][30][31]. This method measures lumbar or cervical spine kinematics in a 3D space to allow for true characterization of spinal motion in vivo.…”

Section: Introductionmentioning

confidence: 99%

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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Three-Dimensional In Vivo Measurement of Lumbar Spine Segmental Motion

Abstract: Complex coupled motions were measured due to external torsion and could be indicative of instability chronic patients with low back pain. The presented data provide baseline segmental motions for future comparisons to symptomatic subjects.

Cited by 149 publications

References 20 publications

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

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

The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain

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

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