Three-dimensional movements of the lumbar spine facet joints and segmental movements: in vivo examinations of normal subjects with a new non-invasive method

Svedmark, Per; Tullberg, Tycho; Noz, Marilyn E.; Maguire, Gerald Q.; Zeleznik, Michael P.; Weidenhielm, Lars; Németh, Gunnar; Olivecrona, Henrik

doi:10.1007/s00586-011-1988-y

Cited by 20 publications

(22 citation statements)

References 22 publications

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“…For more detailed information on this method, please see the previous studies by Svedmark and colleagues. [30][31][32] If no motion between the lower and upper prosthetic component could be detected, the segment was classified as ankylotic. If there was any detectable motion between any of the prosthetic components and the vertebrae to which they were attached, it was classified as an unstable or loose device.…”

Section: Methodsmentioning

confidence: 99%

“…The method has the capability to measure motion both within the implant and relative to the adjacent bone with an accuracy that has been previously established. 30,31 Previous studies on spinal mobility have been performed with varying accuracy, depending on the technique used. 9,12,14,[19][20][21][22][23]28,37,40 Radiostereometric analysis (RSA) has been shown to be the most accurate; 1,26,27 however, the technique always requires implantation of tantalum markers and is therefore an invasive method.…”

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confidence: 99%

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Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data

Skeppholm

Svedmark

Noz

et al. 2015

SPI

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OBJECT Artificial disc replacement (ADR) devices are unlike implants used in cervical fusion in that they are continuously exposed to stress not only within the implant site but also at their site of attachment to the adjacent vertebra. An imaging technique with higher accuracy than plain radiography and with the possibility of 3D visualization would provide more detailed information about the motion quality and stability of the implant in relation to the vertebrae. Such high-accuracy studies have previously been conducted with radiostereometric analysis (RSA), which requires implantation of tantalum markers in the adjacent vertebrae. The aim of this study was to evaluate in vivo motion and stability of implanted artificial discs. A noninvasive analysis was performed with CT, with an accuracy higher than that of plain radiographs and almost as high as RSA in cervical spine. METHODS Twenty-eight patients with ADR were included from a larger cohort of a randomized controlled trial comparing treatment of cervical radiculopathy with ADR or anterior cervical decompression and fusion. Surgical levels included C4–7; 18 patients had 1-level surgery and 10 patients had 2-level surgery. Follow-up time ranged from 19 to 50 months, with an average of 40 months. Two CT volumes of the cervical spine, 1 in flexion and 1 in extension, were obtained in each patient and then spatially registered using a customized imaging tool, previously used and validated for the cervical spine. Motion between the components in the artificial disc, as well as motion between the components and adjacent vertebrae, were calculated in 3 planes. Intraclass correlation (ICC) between independent observers and repeatability of the method were also calculated. RESULTS Intrinsic motion, expressed as degrees in rotation and millimeters in translation, was detectable in a majority of the ADRs. In the sagittal plane, in which the flexion/extension was performed, sagittal rotation ranged between 0.2° and 15.8° and translation between 0.0 and 5.5 mm. Eight percent of the ADRs were classified as unstable, as motion between at least 1 of the components and the adjacent vertebra was detected. Five percent were classified as ankylotic, with no detectable motion, and another 8% showed very limited motion due to heterotopic ossification. Repeatability for the motion in the sagittal plane was calculated to be 1.30° for rotation and 1.29 mm for translation (95% confidence level), ICC 0.99 and 0.84, respectively. All 3 patients with unstable devices had undergone 1-level ADRs at C5–6. They all underwent revision surgery due to increased neck pain, and instability was established during the surgery. CONCLUSIONS The majority of the artificial discs in this study showed intrinsic mobility several years after implantation and were also shown to be properly attached. Implant instability was detected in 8% of patients and, as all of these patients underwent revision surgery due to increasing neck pain, this might be a more serious problem than heterotopic bone formation.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data

Skeppholm

Svedmark

Noz

et al. 2015

SPI

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“…Few studies have reported on the kinematics of the lumbar facet joints 15, 28 . Svedmark et al assessed the movement of the lumbar facet joint in healthy participants during flexion-extension using CT scanning and the volume registration techniques 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Svedmark et al assessed the movement of the lumbar facet joint in healthy participants during flexion-extension using CT scanning and the volume registration techniques 28 . Kozanek et al described the motion of the facet joints in vivo and found that the motion was different between L4–L5 and the above two levels 20 .…”

Section: Discussionmentioning

confidence: 99%

Lumbar Facet Joint Motion in Patients With Degenerative Spondylolisthesis

Yao

Wang

Shin

et al. 2013

Journal of Spinal Disorders &Amp; Techniques

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Study Design Controlled laboratory study. Objective To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Summary of Background Data Although the morphological changes of the facet joints in patients with DLS have been reported in a few studies, no data has been reported on the kinematics of these facet joints. Methods Ten patients with DLS at L4–L5 were studied. Each patient underwent a magnetic resonance imaging (MRI) scan to obtain three-dimensional (3D) models of the lumbar vertebrae from L2–L5 as well as a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending and left-right torsion. The positions of the vertebrae were reproduced by matching the MRI-based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion (ROMs) were compared with those of healthy subjects and those of patients with degenerative disc diseases (DDD) previously published. Results In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4–L5) than that at the adjacent levels (L2–L3 and L3–L4), while the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared to those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4–L5), while no significant difference was found in the range of translation. The ROM of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2–L3 and L3–L4). Conclusion The range of rotation decreased at the facet joints at the DLS level (L4–L5) in patients compared to those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different surgical techniques for the DLS patients.

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“…Image registration of computed tomography (CT) or MRI can be used to determine joint transformations (Crisco et al 2001;Rogers et al 2002;Gardner et al 2006;Tay et al 2008;Zheng and Zhang 2010;Svedmark et al 2012). Surface registration is often used, but voxel-based image registration has been shown to have a similar/better accuracy [mean translation error of 0.21 mm and rotation error of 1.298 compared with mean translation error of 0.8 mm and rotation error of 1.58 for CT-based surface registration (Moojen et al 2003;Goto et al 2005;Gardner et al 2006)].…”

Section: Introductionmentioning

confidence: 99%

Results of automatic image registration are dependent on initial manual registration

Johnson

Fischer

2014

Computer Methods in Biomechanics and Biomedical Engineering

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Measurement of static alignment of articulating joints is of clinical benefit and can be determined using image-based registration. We propose a method that could potentially improve the outcome of image-based registration by using initial manual registration. Magnetic resonance images of two wrist specimens were acquired in the relaxed position and during simulated grasp. Transformations were determined from voxel-based image registration between the two volumes. The volumes were manually aligned to match as closely as possible before auto-registration, from which standard transformations were obtained. Then, translation/rotation perturbations were applied to the manual registration to obtain altered initial positions, from which altered auto-registration transformations were obtained. Models of the radiolunate joint were also constructed from the images to simulate joint contact mechanics. We compared the sensitivity of transformations (translations and rotations) and contact mechanics to altering the initial registration condition from the defined standard. We observed that with increasing perturbation, transformation errors appeared to increase and values for contact force and contact area appeared to decrease. Based on these preliminary findings, it appears that the final registration outcome is sensitive to the initial registration.

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Three-dimensional movements of the lumbar spine facet joints and segmental movements: in vivo examinations of normal subjects with a new non-invasive method

Abstract: This method to assess movement in the lumbar spine is a truly 3D method with a high precision giving both visual and numerical output. We believe that this method for measuring spine movement is useful both in research and in clinical settings.

Cited by 20 publications

References 22 publications

Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data

Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data

Lumbar Facet Joint Motion in Patients With Degenerative Spondylolisthesis

Results of automatic image registration are dependent on initial manual registration

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