Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy

Breen, Alexander

doi:10.1007/s00586-017-5155-y

Cited by 30 publications

(59 citation statements)

References 48 publications

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“…Radiographic techniques (e.g., video fluoroscopy) are advancing in NSCLBP research [25] and are warranted to understand true vertebral movement during functional activity. Analysis of other NSCLBP MCI subgroups, trunk muscle activity, and psychosocial factors is required to better understand underlying pain mechanisms [24] as spinal movement alone appears insufficient to comprehensively explain subjectively reported pain presentations.…”

Section: Limitations and Future Workmentioning

confidence: 99%

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

et al. 2017

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Purpose A multidimensional classification approach suggests that motor control impairment subgroups exist in non-specific chronic low back pain (NSCLBP). Differences in sitting lumbar posture have been identified between two such subgroups [flexion pattern (FP) and active extension pattern (AEP)] and healthy individuals; however, functional spinal movement has not been explored. This study will evaluate whether NSCLBP subgroups exhibit regional spinal kinematic differences, compared to healthy individuals, during functional tasks. Methods Observational, cross-sectional study design. Spinal kinematics of 50 NSCLBP subjects (27 FP, 23 AEP) and 28 healthy individuals were investigated using 3D motion analysis (Vicon TM ) during functional tasks [reaching upwards, step down, step up, lifting, and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor]. Mean sagittal angle for the total thoracic, total lumbar, upper thoracic, lower thoracic, upper lumbar, and lower lumbar regions between groups was compared. Results Significant differences were observed in lower thoracic and upper lumbar regions between NSCLBP subgroups during most tasks. Significant differences were observed between the FP and healthy group in the lower thoracic region during stand-to-sit-to-stand tasks and bending (and returning from) to retrieve a pen from the floor. All significant results demonstrated the FP group to operate in comparatively greater flexion. Conclusions The thoraco-lumbar spine discriminated between FP and AEP, and FP and healthy groups during functional tasks. FP individuals demonstrated more kyphotic thoraco-lumbar postures, which may be pain provocative. No significant differences were observed between AEP and healthy groups, suggesting that alternative mechanisms may occur in AEP.

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Section: Limitations and Future Workmentioning

confidence: 99%

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

et al. 2017

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“…Low back pain is the world's largest cause of years lost to disability, but it usually has no objective diagnosis or known mechanism [1,2]. Aberrant intervertebral motion in the lumbar spine as measured in vivo using standardised quantitative fluoroscopic imaging protocols (QF) has been linked to nonspecific low back pain (NSLBP) as a biomarker [3][4][5], and many interventions exist to influence it [6][7][8]. This holds out the prospect of applying lumbar motion parameters as personalised biomarkers for the diagnosis of otherwise 'nonspecific' low back pain.…”

Section: Introductionmentioning

confidence: 99%

Intrasubject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy

2018

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Purpose In vivo quantification of intervertebral motion through imaging has progressed to a point where biomarkers for low back pain are emerging. This makes possible deeper study of the condition's biometrics. However, the measurement of change over time involves error. The purpose of this prospective investigation is to determine the intrasubject repeatability of six in vivo intervertebral motion parameters using quantitative fluoroscopy. Methods Intrasubject reliability (ICC) and minimal detectable change (MDC) of baseline to 6-week follow-up measurements were calculated for six lumbar spine intervertebral motion parameters in 109 healthy volunteers. A standardised quantitative fluoroscopy (QF) protocol was used to provide measurements in the coronal and sagittal planes using both passive recumbent and active weight-bearing motion. Parameters were: intervertebral range of motion (IV-RoM), laxity, motion sharing inequality (MSI), motion sharing variability (MSV), flexion translation and anterior disc height change during flexion. Results The best overall intrasubject reliability (ICC) and agreement (MDC) were for disc height (ICC 0.89, MDC 43%) and IV-RoM (ICC 0.96, MDC 60%), and the worst for MSV (ICC 0.04, MDC 408%). Laxity, MSI and translation had acceptable reliability (most ICCs > 0.60), but not agreement (MDC > 85%). Conclusion Disc height and IV-RoM measurement using QF could be considered for randomised trials, while laxity, MSI and translation could be considered for moderators, correlates or mediators of patient-reported outcomes. MSV had both poor reliability and agreement over 6 weeks. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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“…QF is an imaging method that allows the motion of the spine to be determined in real time. Motion patterns have been shown to differ between healthy controls and patients with low back pain (Breen and Breen, 2017;Mellor et al, 2014) suggesting that the load distribution within the spine may also vary. Although the current study only assessed the end-points of motion, multiple steps in the modelling procedure would allow continuous motion to be modelled.…”

Section: Discussionmentioning

confidence: 99%

“…Low back pain is the largest single contributor to disability in many countries across the world (Institute for Health Metrics and Evaluation, 2013) and is regarded as being mechanical in nature in many instances (Borenstein, 2013). Movement patterns are shown to differ between healthy individuals and patients with back pain (Breen and Breen, 2017;Mellor et al, 2014), where an inability to maintain normal movement patterns is thought to be linked through abnormal loading (Mulholland, 2008). Relating movement patterns to the magnitude and sharing of the load, however, is challenging as direct measurement of load in the spine is invasive.…”

Section: Introductionmentioning

confidence: 99%

Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models

Zanjani-Pour

Meakin

Breen

et al. 2018

Journal of Biomechanics

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Finite element (FE) models driven by medical image data can be used to estimate subject-specific spinal biomechanics. This study aimed to combine magnetic resonance (MR) imaging and quantitative fluoroscopy (QF) in subject-specific FE models of upright standing, flexion and extension. Supine MR images of the lumbar spine were acquired from healthy participants using a 0.5 T MR scanner. Nine 3D quasi-static linear FE models of L3 to L5 were created with an elastic nucleus and orthotropic annulus. QF data was acquired from the same participants who performed trunk flexion to 60° and trunk extension to 20°. The displacements and rotations of the vertebrae were calculated and applied to the FE model. Stresses were averaged across the nucleus region and transformed to the disc co-ordinate system (S1 = mediolateral, S2 = anteroposterior, S3 = axial). In upright standing S3 was predicted to be -0.7 ± 0.6 MPa (L3L4) and -0.6 ± 0.5 MPa (L4L5). S3 increased to -2.0 ± 1.3 MPa (L3L4) and -1.2 ± 0.6 MPa (L4L5) in full flexion and to -1.1 ± 0.8 MPa (L3L4) and -0.7 ± 0.5 MPa (L4L5) in full extension. S1 and S2 followed similar patterns; shear was small apart from S23. Disc stresses correlated to disc orientation and wedging. The results demonstrate that MR and QF data can be combined in a participant-specific FE model to investigate spinal biomechanics in vivo and that predicted stresses are within ranges reported in the literature.

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Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy

Cited by 30 publications

References 48 publications

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

Intrasubject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy

Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models

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