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Como CJ, LeVasseur CM, Oyekan A, Padmanabhan A, Makowicz N, Chen S, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. Dynamic in vivo 3D atlantooccipital kinematics during multiplanar physiologic motions. J Biomech 2024; 173:112236. [PMID: 39084063 DOI: 10.1016/j.jbiomech.2024.112236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
Normal biomechanics of the upper cervical spine, particularly at the atlantooccipital joint, remain poorly characterized. The purpose of this study was to determine the intervertebral kinematics of the atlantooccipital joint (occiput-C1) during three-dimensional in vivo physiologic movements. Twenty healthy young adults performed dynamic flexion/extension, axial rotation, and lateral bending while biplane radiographs were collected at 30 images per second. Motion at occiput-C1 was tracked using a validated volumetric model-based tracking process that matched subject-specific CT-based bone models to the radiographs. The occiput-C1 total range of motion (ROM) and helical axis of motion (HAM) was calculated for each movement. During flexion/extension, the occiput-C1 moved almost exclusively in-plane (ROM: 17.9 ± 6.9°) with high variability in kinematic waveforms (6.3°) compared to the in-plane variability during axial rotation (1.4°) and lateral bending (0.9°) movements. During axial rotation, there was small in-plane motion (ROM: 4.2 ± 2.5°) compared to out-of-plane flexion/extension (ROM: 12.7 ± 5.4°). During lateral bending, motion occurred in-plane (ROM: 9.0 ± 3.1°) and in the plane of flexion/extension (ROM: 7.3 ± 2.7°). The average occiput-C1 axis of rotation intersected the sagittal and coronal planes 7 mm to 18 mm superior to the occipital condyles. The occiput-C1 axis of rotation pointed 60° from the sagittal plane during axial rotation but only 10° from the sagittal plane during head lateral bending. These novel results are foundational for future work on upper cervical spine kinematics.
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Affiliation(s)
- Christopher J Como
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States.
| | - Clarissa M LeVasseur
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Anthony Oyekan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Aditya Padmanabhan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Noah Makowicz
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Stephen Chen
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William F Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Joon Y Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Jeremy D Shaw
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William J Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
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Luo Y, Huang X, Yue Y, Lin X, Chen G, Wang K, Luo Y. In vivo cervical vertebrae kinematic studies based on dual fluoroscopic imaging system measurement: A narrative review. Heliyon 2024; 10:e30904. [PMID: 38765031 PMCID: PMC11097065 DOI: 10.1016/j.heliyon.2024.e30904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024] Open
Abstract
Understanding the motion characteristics of cervical spine through biomechanical analysis aids in the identification of abnormal joint movements. This knowledge is essential for the prevention, diagnosis, and treatment of related disorders. However, the anatomical structure of the cervical spine is complex, and traditional medical imaging techniques have certain limitations. Capturing the movement characteristics of various parts of the cervical spine in vivo during motion is challenging. The dual fluoroscopic imaging system (DFIS) is able to quantify the motion and motion patterns of individual segments. In recent years, DFIS has achieved accurate non-invasive measurements of dynamic joint movements in humans. This review assesses the research findings of DFIS about the cervical spine in healthy and pathological individuals. Relevant study search was conducted up to October 2023 in Web of Science, PubMed, and EBSCO databases. After the search, a total of 30 studies were ultimately included. Among them, 13 studies focused on healthy cervical spines, while 17 studies focused on pathological cervical spines. These studies mainly centered on exploring the vertebral bodies and associated structures of the cervical spine, including intervertebral discs, intervertebral foramina, and zygapophyseal joints. Further research could utilize DFIS to investigate cervical spine motion in different populations and under pathological conditions.
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Affiliation(s)
- Yuanbiao Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xinwei Huang
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Yongda Yue
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xiande Lin
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Guoxian Chen
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Kun Wang
- Department of Rehabilitation Therapy, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Ye Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Nalley TK, Scott JE, McGechie F, Grider-Potter N. Comparative ontogeny of functional aspects of human cervical vertebrae. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24788. [PMID: 37283367 DOI: 10.1002/ajpa.24788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Differences between adult humans and great apes in cervical vertebral morphology are well documented, but the ontogeny of this variation is still largely unexplored. This study examines patterns of growth in functionally relevant features of C1, C2, C4, and C6 in extant humans and apes to understand the development of their disparate morphologies. MATERIALS AND METHODS Linear and angular measurements were taken from 530 cervical vertebrae representing 146 individual humans, chimpanzees, gorillas, and orangutans. Specimens were divided into three age-categories based on dental eruption: juvenile, adolescent, and adult. Inter- and intraspecific comparisons were evaluated using resampling methods. RESULTS Of the eighteen variables examined here, seven distinguish humans from apes at the adult stage. Human-ape differences in features related to atlantoaxial joint function tend to be established by the juvenile stage, whereas differences in features related to the nuchal musculature and movement of the subaxial elements do not fully emerge until adolescence or later. The orientation of the odontoid process-often cited as a feature that distinguishes humans from apes-is similar in adult humans and adult chimpanzees, but the developmental patterns are distinct, with human adultlike morphology being achieved much earlier. DISCUSSION The biomechanical consequences of the variation observed here is poorly understood. Whether the differences in growth patterns represent functional links to cranial development or postural changes, or both, requires additional investigation. Determining when humanlike ontogenetic patterns evolved in hominins may provide insight into the functional basis driving the morphological divergence between extant humans and apes.
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Affiliation(s)
- Thierra K Nalley
- Medical Anatomical Sciences Department, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Jeremiah E Scott
- Medical Anatomical Sciences Department, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Faye McGechie
- Department of Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Neysa Grider-Potter
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
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Lodin J, Terč J, Cihlář F, Sameš M, Cihlář J, Vachata P. Dynamics of atlantoaxial rotation related to age and sex: a cross-sectional study of 308 subjects. Spine J 2023; 23:1276-1286. [PMID: 37182705 DOI: 10.1016/j.spinee.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT Physiological ranges and dynamic changes of atlantoaxial rotation (ROTC1/2), total cervical spine rotation (ROTCs) and the percentage of ROTC1/2 from ROTCs (ROTCperc) for different age groups have not yet been investigated in a sufficiently sized cohort. Furthermore, it is not clear whether demographic variables such a sex, smoking status or diabetes affect ROTC1/2, ROTCs and ROTCperc. PURPOSE Obtain physiological ranges of ROTC1/2, ROTCs and ROTCperc for different age groups and determine their age-based dynamics. Investigate whether ROTC1/2, ROTCs and ROTCperc are affected by sex, smoking status or diabetes. DESIGN Observational cross-sectional study. PATIENT SAMPLE Patients undergoing elective CT examinations of the head and neck region between August 2020 and January 2022. OUTCOME MEASURES Ranges of motion of ROTC1/2, ROTCs and ROTCperc in degrees. METHODS A total of 308 subjects underwent dynamic rotational CT examinations of the upper cervical spine. Patients were divided into three age categories A1 (27-49 years), A2 (50-69 years) and A3 (≥70 years). Category A3 was further divided into B1 (70-79 years) and B2 (≥80 years). Values of ROTC1/2, ROTCs and ROTCperc were compared between all age groups, males and females, smokers and nonsmokers, diabetics a nondiabetics. Dynamics of ROTC1/2, ROTCs related to age and sex were visualized using scatterplot and trendline models. RESULTS ROTC1/2 significantly decreased from group A1 (64.4°) to B2 (46.7°) as did ROTCs from A1 (131.2°) to B2 (97.6°). No significant differences of ROTperc were found between groups A1-B2 with values oscillating between 49% and 51%. Smoking and diabetes did not significantly affect ROTC1/2, ROTCs and ROTCperc, females had significantly higher ROTCs than males. Males and females demonstrated a different dynamic of ROTC1/2 and ROTCs demonstrated by out scatterplot and trendline models. CONCLUSIONS Both ROTC1/2 and ROTCs significantly decrease with age, whereas ROTCperc remains stable. Females demonstrated higher ROTCs and their decrease of ROTC1/2 and ROTCs occurred in higher age groups compared to males. The functional repercussions atlantoaxial fusion are variable based on patient age and sex and should be taken into account prior to surgery.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic.
| | - Jan Terč
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Filip Cihlář
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Jiří Cihlář
- J. E. Purkyně University, Pasteurova 3544/1, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic
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Bleton JP, Portero R, Zuber K, Sangla S, Brandel JP, Vidailhet M, Mesure S, Williams M, Savatovsky J. Assessment of axial rotation movement in cervical dystonia using cone-beam computed tomography. Clin Biomech (Bristol, Avon) 2023; 107:106037. [PMID: 37429102 DOI: 10.1016/j.clinbiomech.2023.106037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Cervical dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal postures of the head and neck. Botulinum neurotoxin injection is the first-line treatment. Imaging determination of the cervical segments involved (lower or upper according to the torticollis-torticaput [COL-CAP] Classification) is an aid in determining the muscles to be injected. We aimed to clarify the impact of dystonia on posture and rotational movement of cervical vertebrae in the transverse plane. METHODS A comparative study was conducted in a movement disorders department. Ten people with cervical dystonia and 10 matched healthy subjects (without cervical dystonia) were recruited. 3-D images of posture and cervical range of motion in axial rotation in the sitting position were recorded by using a cone-beam CT scanner. Range of rotational motion of the upper cervical spine from the occipital bone to fourth cervical vertebra was measured and compared between the two groups. FINDINGS The head posture analysis showed that the total cervical spine position was more significantly distant from the neutral position for people with dystonia than healthy subjects (p = 0.007). The rotational range of motion of the cervical spine was significantly lower in cervical dystonia participants than in healthy subjects for the total (p = 0.026) and for upper cervical spine (p = 0.004). INTERPRETATION We demonstrated, by means of cone-beam CT, that the disorganization of movements due to cervical dystonia affected the upper cervical spine and mostly the atlantoaxial joint. The involvement of rotator muscles at this cervical level should be considered more in treatments.
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Affiliation(s)
- Jean-Pierre Bleton
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France; Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France.
| | - Raphaël Portero
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Zuber
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Sophie Sangla
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Marie Vidailhet
- Sorbonne Université, F-75005 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, F-75013 Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM, F-75013 Paris, France
| | - Serge Mesure
- Aix-Marseille University, CNRS, ISM UMR 7287, F-13288 Marseille, France
| | - Marc Williams
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Julien Savatovsky
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
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Oyekan AA, LeVasseur CM, Shaw JD, Donaldson WF, Lee JY, Anderst WJ. Changes in intervertebral sagittal alignment of the cervical spine from supine to upright. J Orthop Res 2023; 41:1538-1545. [PMID: 36484123 PMCID: PMC10250559 DOI: 10.1002/jor.25500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Cervical sagittal alignment is a critical component of successful surgical outcomes. Unrecognized differences in intervertebral alignment between supine and upright positions may affect clinical outcomes; however, these differences have not been quantified. Sixty-four patients scheduled to undergo one or two-level cervical arthrodesis for symptomatic pathology from C4-C5 to C6-C7, and forty-seven controls were recruited. Upright sagittal alignment was obtained through biplane radiographic imaging and measured using a validated process with accuracy better than 1° in rotation. Supine alignment was obtained from computed tomography scans. Coordinate systems used to measure supine and upright alignment were identical. Distances between adjacent bony endplates were measured to calculate disc height in each position. For both patients and controls, the C1-C2, C2-C3, and C3-C4 motion segments were in more lordosis when upright as compared with supine (all p < 0.001). However, the C4-C5, C5-C6, and C6-C7 motion segments were in less lordosis when upright as compared with supine (all p ≤ 0.004). There was an interaction between group and position at the C1-C2 (p = 0.002) and C2-C3 (p = 0.001) motion segments, with the controls demonstrating a greater increase in lordosis at both motion segments when moving from supine to upright. The results indicate that cervical motion segment alignment changes between supine and upright positioning, those changes differ among motion segments, and cervical pathology affects the magnitude of these changes. Clinical Significance: Surgeons should be mindful of the differences in alignment between supine and upright imaging and the implications they may have on clinical outcomes.
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Affiliation(s)
- Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clarissa M LeVasseur
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William F Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
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Hidalgo-García C, Lorente AI, López-de-Celis C, Lucha-López MO, Rodríguez-Sanz J, Maza-Frechín M, Tricás-Moreno JM, Krauss J, Pérez-Bellmunt A. Effects of occipital-atlas stabilization on the upper cervical spine rotation combinations: an in vitro study. Sci Rep 2023; 13:3578. [PMID: 36864117 PMCID: PMC9981738 DOI: 10.1038/s41598-023-30512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
The purpose of this study is to compare axial rotation range of motion for the upper cervical spine during three movements: axial rotation, rotation + flexion + ipsilateral lateral bending and rotation + extension + contralateral lateral bending before and after occiput-atlas (C0-C1) stabilization. Ten cryopreserved C0-C2 specimens (mean age 74 years, range 63-85 years) were manually mobilized in 1. axial rotation, 2. rotation + flexion + ipsilateral lateral bending and 3. rotation + extension + contralateral lateral bending without and with a screw stabilization of C0-C1. Upper cervical range of motion and the force used to generate the motion were measured using an optical motion system and a load cell respectively. The range of motion (ROM) without C0-C1 stabilization was 9.8° ± 3.9° in right rotation + flexion + ipsilateral lateral bending and 15.5° ± 5.9° in left rotation + flexion + ipsilateral lateral bending. With stabilization, the ROM was 6.7° ± 4.3° and 13.6° ± 5.3°, respectively. The ROM without C0-C1 stabilization was 35.1° ± 6.0° in right rotation + extension + contralateral lateral bending and 29.0° ± 6.5° in left rotation + extension + contralateral lateral bending. With stabilization, the ROM was 25.7° ± 6.4° (p = 0.007) and 25.3° ± 7.1°, respectively. Neither rotation + flexion + ipsilateral lateral bending (left or right) or left rotation + extension + contralateral lateral bending reached statistical significance. ROM without C0-C1 stabilization was 33.9° ± 6.7° in right rotation and 28.0° ± 6.9° in left rotation. With stabilization, the ROM was 28.5° ± 7.0° (p = 0.005) and 23.7° ± 8.5° (p = 0.013) respectively. The stabilization of C0-C1 reduced the upper cervical axial rotation in right rotation + extension + contralateral lateral bending and right and left axial rotations; however, this reduction was not present in left rotation + extension + contralateral lateral bending or both combinations of rotation + flexion + ipsilateral lateral bending.
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Affiliation(s)
- César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, C/ Domingo Miral S/N, 50009, Zaragoza, Spain.
| | - Ana I Lorente
- Impact Laboratory, Aragon Institute of Engineering Research, Universidad de Zaragoza, Alcañiz, Spain
| | - Carlos López-de-Celis
- ACTIUM Anatomy Group, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primaria de Salut Jordi Gol i, Barcelona, Spain
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, C/ Domingo Miral S/N, 50009, Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- ACTIUM Anatomy Group, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Mario Maza-Frechín
- Impact Laboratory, Aragon Institute of Engineering Research, Universidad de Zaragoza, Alcañiz, Spain
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, C/ Domingo Miral S/N, 50009, Zaragoza, Spain
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Albert Pérez-Bellmunt
- ACTIUM Anatomy Group, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
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8
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Chu ECP, Trager RJ, Tao C. Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report. Cureus 2023; 15:e34630. [PMID: 36891015 PMCID: PMC9988189 DOI: 10.7759/cureus.34630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient's pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.
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Affiliation(s)
- Eric Chun-Pu Chu
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Cliff Tao
- Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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Zárate-Tejero C, Hidalgo-García C, Lucha-López O, Hernández-Secorún M, Krauss J, Rodríguez-Rubio P. Association between age, sex and cervical and upper cervical rotation tests. Descriptive and correlational study in healthy volunteers. Ther Adv Chronic Dis 2023; 14:20406223231170158. [PMID: 37152351 PMCID: PMC10155033 DOI: 10.1177/20406223231170158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Active cervical spine rotation (ACROM Rot) shows cervical rotation and flexion rotation test (FRT); side-bending rotation test (SBRT) and upper cervical axial rotation test (C0-C2ART) are described to measure upper cervical rotation. The objectives of this study are (1) to describe the normal range of motion (ROM) of ACROM Rot, and the ROM in FRT, SBRT and C0-C2ART tests; (2) to explore the correlation among the four tests and (3) to investigate the influence of age and sex in their ROM. Methods A cross-sectional study was carried out with healthy volunteers from 18 to 75 years of age. Tests were measured using a CROM device and a bubble inclinometer. Descriptive analysis was performed to establish normative data for the ROM tests. Correlation analysis was conducted to understand the relation between upper and global cervical rotation ROM and among the three upper cervical rotation tests. Linear regression models were developed to understand the influence of age and sex in the ROM of all tests. Results Normative values were obtained from 122 healthy volunteers (50% male), by sex and age strata. The degree of correlation ranged between 0.582 (p < 0.01) for FRT and ACROM Rot left and 0.217 (p < 0.05) for SBRT and C0-C2ART left. Linear regression models showed the influence of sex for ACROM Rot right (men -4.64° less than women), SBRT (men -4.1° less than women) left and C0-C2ART right and left (men -2.24° and -1.78° less than women). The age influenced rotation ROM with a decrease for every 10 years of -2.11° and -1.96° for ACROM Rot right and left, of -1.72° and -1.26° for FRT right and left and -0.58° and -0.41° for C0-C2ART right and left in the linear regression models. No association was found between age and SBRT (p = 0.63 for right SBRT and p = 0.49 for left SBRT). Conclusion Weak-to-moderate correlation was found between the upper cervical spine rotation tests and with the ACROM. Women had a larger ROM in ACROM Rot right, SBRT left and C0-C2ART. Decreases in ROM related with age were observed for ACROM Rot, FRT and C0-C2ART but not for SBRT.
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Affiliation(s)
- Carlos Zárate-Tejero
- Physiotherapy Department, Faculty of Medicine
and Health Sciences, Universitat Internacional de Catalunya, Barcelona,
Spain
| | | | | | - Mar Hernández-Secorún
- Unidad de Investigación en Fisioterapia,
Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza,
Spain
| | - John Krauss
- School of Health Sciences, Oakland University,
Rochester, MI, USA
| | - Pere Rodríguez-Rubio
- Physiotherapy Department, Faculty of Medicine
and Health Sciences, Universitat Internacional de Catalunya, Barcelona,
Spain
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Atlantoaxial Non-Fusion Using Biomimetic Artificial Atlanto-Odontoid Joint: Technical Innovation and Initial Biomechanical Study. Spine (Phila Pa 1976) 2022; 47:825-832. [PMID: 34618789 DOI: 10.1097/brs.0000000000004259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro investigation. OBJECTIVE To evaluate the function and stability of self-designed biomimetic artificial atlanto-odontoid joint (BAAOJ) replacement on the atlantoaxial joint. SUMMARY OF BACKGROUND DATA Upper cervical fusion surgery is a common treatment for various atlantoaxial disorders, and favorable clinical outcome has been achieved. However, the fusion surgery results in loss of atlantoaxial motion as well as adjacent segments degeneration, reducing the quality of life of patients and might produce severe neurological symptoms. Non-fusion technology is expected to solve the above problems, but various designed devices have certain defects and are still in the exploratory phase. MATERIALS AND METHODS Biomechanical tests were conducted on 10 fresh human cadaveric craniocervical specimens in the following sequence: 1) intact condition, 2) after the BAAOJ arthroplasty, 3) after BAAOJ fatigue test, 4) after odontoidect-omy, and 5) after anterior rigid plate fixation. Three-dimensional movements of the C1-C2 segment were evaluated to investigate the function and stability of BAAOJ arthroplasty compared with the intact condition after the BAAOJ fatigue test, odontoidect-omy, and rigid plate fixation. RESULTS Comparing the BAAOJ implantation to the intact state, the range of motion and neutral zone were slightly reduced in all directions (P > 0.05). Compared with the rigid plate fixation, the BAAOJ implantation significantly increased the range of motion and neutral zone in all directions, especially in the axial rotation (P < 0.05). CONCLUSION We designed a BAAOJ for correcting atlantoaxial disorders arising from atlantoaxial instability. As a non-fusion device, the most critical feature of BAAOJ replacement is the retention of flexion-extension, lateral bending, and axial rotation range of motion similar to the normal state. It can also stabilize the atlantoaxial complex, and the BAAOJ itself has a good initial stability.Level of Evidence: 4.
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11
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Odontoid Fractures: A Standard Review of Current Concepts and Treatment Recommendations. J Am Acad Orthop Surg 2022; 30:e561-e572. [PMID: 35266921 DOI: 10.5435/jaaos-d-21-00165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
Odontoid fractures represent the most common fractures involving C2 and the most common cervical spine fractures in patients older than 65 years. Despite their increasing frequency, optimal management of these injuries remain a subject to debate. Although types I and III injuries have relatively good healing potential with nonsurgical treatment, type II fractures carry a higher risk for nonunion. In particular, elderly patients are at risk for nonunion or fibrous malunion after nonsurgical treatment; however, increased medical comorbidities and poor bone quality also increase the risks of surgery in this cohort. The high morbidity and mortality associated with these injuries has made it an area of particular interest among spine surgeons. The purpose of this review was to summarize the pathophysiology, evaluation, and diagnosis of these injuries and to review controversies in management and considerations for treatment based on the most recent available literature.
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12
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Lindenmann S, Tsagkaris C, Farshad M, Widmer J. Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2022; 50:1705-1733. [PMID: 36496482 PMCID: PMC9794546 DOI: 10.1007/s10439-022-03088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns can help diagnose these diseases, plan surgical interventions and improve relevant tools and software. During the last decades, numerous studies based on diverse methodologies attempted to elucidate spinal mobility in different planes of motion. The authors aimed to summarize and compare the evidence about cervical spine kinematics under healthy and degenerative conditions. This includes an illustrated description of the spectrum of physiological cervical spine kinematics, followed by a comparable presentation of kinematics of the degenerative cervical spine. Data was obtained through a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As far as the degenerative conditions are concerned, kinematic data regarding disc degeneration and spondylolisthesis were available. Although the majority of the studies identified repeating motion patterns for most motion planes, discrepancies associated with limited sample sizes and different imaging techniques and/or spine configurations, were noted. Among healthy/asymptomatic individuals, flexion extension (FE) and lateral bending (LB) are mainly facilitated by the subaxial cervical spine. C4-C5 and C5-C6 were the major FE contributors in the reported studies, exceeding the motion contribution of sub-adjacent segments. Axial rotation (AR) greatly depends on C1-C2. FE range of motion (ROM) is distributed between the atlantoaxial and subaxial segments, while AR ROM stems mainly from the former and LB ROM from the latter. In coupled motion rotation is quantitatively predominant over translation. Motion migrates caudally from C1-C2 and the center of rotation (COR) translocates anteriorly and superiorly for each successive subaxial segment. In degenerative settings, concurrent or subsequent lesions render the association between diseases and mobility alterations challenging. The affected segments seem to maintain translational and angular motion in early and moderate degeneration. However, the progression of degeneration restrains mobility, which seems to be maintained or compensated by adjacent non-affected segments. While the kinematics of the healthy cervical spine have been addressed by multiple studies, the entire nosological and kinematic spectrum of cervical spine degeneration is partially addressed. Large-scale in vivo studies can complement the existing evidence, cover the gaps and pave the way to technological and clinical breakthroughs.
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Affiliation(s)
- Sara Lindenmann
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Christos Tsagkaris
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland ,Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Intersegmental Kinematics of the Upper Cervical Spine: Normal Range of Motion and Its Alteration After Alar Ligament Transection. Spine (Phila Pa 1976) 2021; 46:E1320-E1326. [PMID: 34269757 DOI: 10.1097/brs.0000000000004167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical study using cadaveric cervical spines. OBJECTIVE To evaluate joint mobility and stiffness at the craniovertebral junction. SUMMARY OF BACKGROUND DATA Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation. METHODS Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment-rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side. RESULTS The intersegmental (C0-C1/C1-C2) moment-rotation response was continuously quantified in full flexion (7.2 ± 6.6°/12.1 ± 5.8°), extension (11.1 ± 6.4°/3.0 ± 2.8°), lateral bending to the right (3.1 ± 2.2°/1.6 ± 1.2°) and left sides (3.3 ± 1.6°/2.1 ± 1.5°), and axial rotation to the right (1.2 ± 3.5°/32.3 ± 9.3°) and left sides (2.7 ± 2.6°/25.3 ± 8.3°). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed. CONCLUSION Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.Level of Evidence: N/A.
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14
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Lorente AI, Hidalgo-García C, Fanlo-Mazas P, Rodríguez-Sanz J, López-de-Celis C, Krauss J, Maza-Frechín M, Tricás-Moreno JM, Pérez-Bellmunt A. In vitro upper cervical spine kinematics: Rotation with combined movements and its variation after alar ligament transection. J Biomech 2021; 130:110872. [PMID: 34839151 DOI: 10.1016/j.jbiomech.2021.110872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/11/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Previous studies indicate that maximum upper cervical axial rotation occurs only through a combination of transverse, frontal, and sagittal plane motions. This study explores the relationship between transection of the alar ligament and combined upper cervical axial rotation movements. Ten cryopreserved upper cervical spines were manually mobilized in bilateral axial rotation and two different motion combinations with simultaneous motion in the three anatomical planes: rotation in extension (extension + axial rotation + contralateral lateral bending) and rotation in flexion (flexion + axial rotation + ipsilateral lateral bending). These three motions were performed before and after right alar ligament transection. The occiput-axis axial rotation was measured using an optical motion capture system while measuring the applied load. With intact alar ligament, the axial rotation in flexion showed the lowest range of motion (right, R: 9.81 ± 3.89°; left, L: 15.54 ± 5.89°). Similar results were found between the other two mobilizations: axial rotation (R: 33.87 ± 6.64°; L: 27.99 ± 6.90°) and rotation in extension (R: 35.15 ± 5.97°; L: 28.96 ± 6.47°). After right alar ligament transection, rotation in flexion (particularly in left rotation) showed the largest increase in motion: rotation in flexion (R: 13.78 ± 9.63°; L: 23.04 ± 5.59°), rotation in extension (R: 36.39 ± 7.10°; L: 31.71 ± 7.67°), and axial rotation (R: 38.50 ± 9.47°; L: 31.59 ± 6.55°). Different combinations of movements should be evaluated when analyzing the maximum axial rotation of the upper cervical spine, as axial rotation alone and rotation in extension showed a larger range of motion than rotation in flexion. After unilateral alar ligament injury, rotation to the non-injured side in flexion demonstrates the most movement increase.
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Affiliation(s)
- Ana I Lorente
- Impact Laboratory - Aragón Institute of Engineering Research (I3A), Parque Tecnológico TechnoPark (MotorLand) - Edificio Joaquín Repolles, Ctra. Te-V-7033 km 1, Alcañiz (Teruel) 44600, Spain.
| | - César Hidalgo-García
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Unidad de Investigación en Fisioterapia, c/Domingo Miral s/n, 50009 Zaragoza, Spain.
| | - Pablo Fanlo-Mazas
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Unidad de Investigación en Fisioterapia, c/Domingo Miral s/n, 50009 Zaragoza, Spain.
| | - Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n (Hospital Universitari General de Catalunya), Sant Cugat del Valles (Barcelona) 08195, Spain.
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n (Hospital Universitari General de Catalunya), Sant Cugat del Valles (Barcelona) 08195, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain.
| | - John Krauss
- School of Health Sciences, Oakland University, HHB- Room 3085, 433 Meadowbrook Rd, Rochester (MI) 48309, USA.
| | - Mario Maza-Frechín
- Impact Laboratory - Aragón Institute of Engineering Research (I3A), Parque Tecnológico TechnoPark (MotorLand) - Edificio Joaquín Repolles, Ctra. Te-V-7033 km 1, Alcañiz (Teruel) 44600, Spain.
| | - José Miguel Tricás-Moreno
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Unidad de Investigación en Fisioterapia, c/Domingo Miral s/n, 50009 Zaragoza, Spain.
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n (Hospital Universitari General de Catalunya), Sant Cugat del Valles (Barcelona) 08195, Spain.
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15
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Zhou C, Guo R, Wang C, Tsai TY, Yu Y, Wang W, Li G, Cha T. Ligament deformation patterns of the craniocervical junction during head axial rotation tracked by biplane fluoroscopes. Clin Biomech (Bristol, Avon) 2021; 88:105442. [PMID: 34390949 PMCID: PMC8490296 DOI: 10.1016/j.clinbiomech.2021.105442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frequently, treatment decisions for craniocervical injuries and instability are based on imaging findings, but in vivo ligament kinematics were poorly understood. This study was to determine in vivo deformation patterns of primary ligaments in the craniocervical junction (i.e., C0-2), including the cruciform ligament, alar ligaments, and accessory ligaments, during dynamic head axial rotation. METHODS The skulls and cervical spines of eight asymptomatic female subjects were dynamically imaged using a biplane fluoroscopic imaging system, when they performed left and right head axial rotations. Using a 3D-to-2D registration technique, the in vivo positions and orientations of cervical segments were determined. An optimization algorithm was implemented to determine ligament wrapping paths, and the resulting ligament deformations were represented by percent elongations. Using paired t-tests, ligament deformations in the end-range position were compared to those in the neutral position. FINDINGS No significant differences were observed in segmental motions during left and right head rotations (p > 0.05). In general, slight deformations occurred in each component of the cruciform ligament. For the alar ligaments, the ipsilateral ligament was lengthened from -0.7 ± 13.8% to 16.6 ± 15.7% (p < 0.001*). For the accessory ligaments, the contralateral ligament was lengthened from -2.9 ± 7.5% to 10.1 ± 6.2% (p < 0.001*). INTERPRETATION This study reveals that there are distinct deformation patterns in craniocervical junction ligaments during dynamic axial head rotation. These ligament deformation data can enhance our understanding of the synergic function of craniocervical junction ligaments, and guide the treatment of craniocervical instability.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Runsheng Guo
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA,Corresponding author at: Orthopaedic Bioengineering Research Center Department of Orthopaedic Surgery Newton-Wellesley Hospital 159 Wells Avenue, Newton, MA, 02459, USA,
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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Hidalgo-García C, Lorente AI, López-de-Celis C, Lucha-López O, Malo-Urriés M, Rodríguez-Sanz J, Maza-Frechín M, Tricás-Moreno JM, Krauss J, Pérez-Bellmunt A. Effects of occipital-atlas stabilization in the upper cervical spine kinematics: an in vitro study. Sci Rep 2021; 11:10853. [PMID: 34035331 PMCID: PMC8149863 DOI: 10.1038/s41598-021-90052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
This study compares upper cervical spine range of motion (ROM) in the three cardinal planes before and after occiput-atlas (C0–C1) stabilization. After the dissection of the superficial structures to the alar ligament and the fixation of C2, ten cryopreserved upper cervical columns were manually mobilized in the three cardinal planes of movement without and with a screw stabilization of C0–C1. Upper cervical ROM and mobilization force were measured using the Vicon motion capture system and a load cell respectively. The ROM without C0–C1 stabilization was 19.8° ± 5.2° in flexion and 14.3° ± 7.7° in extension. With stabilization, the ROM was 11.5° ± 4.3° and 6.6° ± 3.5°, respectively. The ROM without C0–C1 stabilization was 4.7° ± 2.3° in right lateral flexion and 5.6° ± 3.2° in left lateral flexion. With stabilization, the ROM was 2.3° ± 1.4° and 2.3° ± 1.2°, respectively. The ROM without C0–C1 stabilization was 33.9° ± 6.7° in right rotation and 28.0° ± 6.9° in left rotation. With stabilization, the ROM was 28.5° ± 7.0° and 23.7° ± 8.5° respectively. Stabilization of C0–C1 reduced the upper cervical ROM by 46.9% in the sagittal plane, 55.3% in the frontal plane, and 15.6% in the transverse plane. Also, the resistance to movement during upper cervical mobilization increased following C0–C1 stabilization.
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Affiliation(s)
- César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain.
| | - Ana I Lorente
- Impact Laboratory, Aragon Institute of Engineering Research, Universidad de Zaragoza, Alcañiz, Spain
| | - Carlos López-de-Celis
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain
| | - Miguel Malo-Urriés
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mario Maza-Frechín
- Impact Laboratory, Aragon Institute of Engineering Research, Universidad de Zaragoza, Alcañiz, Spain
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud de la Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Albert Pérez-Bellmunt
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Barcelona, Spain
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Guo R, Zhou C, Wang C, Tsai TY, Yu Y, Wang W, Li G, Cha T. In vivo primary and coupled segmental motions of the healthy female head-neck complex during dynamic head axial rotation. J Biomech 2021; 123:110513. [PMID: 34038861 DOI: 10.1016/j.jbiomech.2021.110513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/04/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022]
Abstract
While previous studies have greatly improved our knowledge on the motion capability of the cervical spine, few reported on the kinematics of the entire head-neck complex (C0-T1) during dynamic activities of the head in the upright posture. This study investigated in vivo kinematics of the entire head-neck complex (C0-T1) of eight female asymptomatic subjects during dynamic left-right head axial rotation using a dual fluoroscopic imaging system and 3D-to-2D registration techniques. During one-sided head rotation (i.e., left or right head rotation), the primary rotation of the overall head-neck complex (C0-T1) reached 55.5 ± 10.8°, the upper cervical spine region (C0-2) had a primary axial rotation of 39.7 ± 9.6° (71.3 ± 8.5% of the overall C0-T1 axial rotation), and the lower cervical spine region (C2-T1) had a primary rotation of 10.0 ± 3.7° (18.6 ± 7.2% of the overall C0-T1 axial rotation). Coupled bending rotations occurred in the upper and lower cervical spine regions in similar magnitude but opposite directions (upper: contralateral bending of 18.2 ± 5.9° versus lower: ipsilateral bending of 21.4 ± 5.1°), resulting in a compensatory cervical lateral curvature that balances the head to rotate horizontally. Furthermore, upper cervical segments (C0-1 or C1-2) provided main mobility in different rotational degrees of freedom needed for head axial rotations. Additionally, we quantitatively described both coupled segmental motions (flexion-extension and lateral bending) by correlation with the overall primary axial rotation of the head-neck complex. This investigation offers comprehensive baseline data regarding primary and coupled motions of craniocervical segments during head axial rotation.
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Affiliation(s)
- Runsheng Guo
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures. Spine (Phila Pa 1976) 2021; 46:E433-E442. [PMID: 33186275 DOI: 10.1097/brs.0000000000003818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Kinematics of the cervical spine was investigated using cone beam computed tomography (CBCT) images combined with three dimensions to three dimensions (3D-3D) registration technology in patients after anterior odontoid screw fixation (AOSF) surgery. OBJECTIVE The aim of this study was to investigate in vivo 3D cervical motion characteristics of patients who had undergone AOSF surgeries. SUMMARY OF BACKGROUND DATA AOSF surgery is a classic surgical method for the treatment of odontoid fracture, but there are few studies that investigated its effect on in vivo biomechanics of the cervical spine. Postoperative biomechanical characters of the atlantoaxial joint (C1-C2) and the caudal adjacent segment (C2-C3) have yet to be clarified. METHODS The study involved 14 patients subjected to a procedure of AOSF with lag screw. Subjects were matched with 14 healthy controls. All subjects underwent CBCT scanning of the cervical spine under seven functional positions. A 3D-3D registration was performed for each vertebra at each functional position to calculate the segmental motion characteristics. The ranges of motion (ROMs) of the C1-C2, C2-C3, and the overall cervical spine (C1-C7) for each of the functional positions were determined. RESULTS The ROMs of the AOSF group were significantly (P < 0.05) smaller than the control group in flexion-extension positions for the C1-C2 (7.0°vs.11.0°), C2-C3 (3.7°vs.6.7°) and C1-C7 (43.3°vs.54.4°). The twisting ROM of the C1-C2 was 39.3° in the AOSF group and 65.7° in the control (P < 0.05), the bending ROM of the C2-C3 was 2.8° in the AOSF group and 8.9° in the control (P < 0.05). The twisting ROM of C1-C7 segment was 63.2° for the AOSF and 98.1° for the healthy control groups (P < 0.05). CONCLUSION Although AOSF surgery reduced the flexion-extension ROMs of all investigated spinal segments, additionally, it reduced twisting ROMs of C1-C2 and C1-C7, but only lateral bending ROM of C2-C3, when compared with the control group. The data implied that the AOSF surgery would result in different biomechanics changes in the atlantoaxial segment and caudal adjacent segment. Longer-term follow-up studies of larger patient cohorts are necessary to evaluate the clinical outcomes of patients after the AOSF surgery.Level of Evidence: 3.
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Schäfer AGM, Schöttker-Königer T, Hall TM, Mavroidis I, Roeben C, Schneider M, Wild Y, Lüdtke K. Upper cervical range of rotation during the flexion-rotation test is age dependent: an observational study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20964139. [PMID: 33193833 PMCID: PMC7607754 DOI: 10.1177/1759720x20964139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The flexion-rotation test (FRT) is widely used to detect movement dysfunction in the spinal segment C1/C2, especially in patients with cervicogenic headache. The current published literature indicates that range recorded during the FRT is not age dependent. This is questionable, considering the well documented relationship between aging and degeneration in the cervical spine and loss of cervical movement in older people. The present study therefore aims to examine the influence of age on FRT mobility, and to provide normative values for different age groups. An additional aim is to examine the influence of age on the ratio between lower and upper cervical rotation mobility. Methods: For this cross-sectional, observational study, healthy subjects aged from 18 to 90 years were recruited. The upper cervical range of rotation during the FRT was measured using a digital goniometer. Personal data including age, weight, height, and lifestyle factors were also assessed. Results: A total of 230 (124 male) healthy, asymptomatic subjects, aged between 18 and 87 years were included. Regression analysis showed that 27.91% (p < 0.0001) of the variance in FRT mobility can be explained by age alone, while 41.28% (p < 0.0001) of the variance in FRT mobility can be explained by age and total cervical range of motion (ROM). Normative values for different age decades were calculated using regression analysis. No significant influence of age on the ratio between ROM of lower and upper cervical rotation was found. There was no relevant impact of personal (gender, height, and weight) and lifestyle (smartphone and PC use) factors on ROM during the FRT. Conclusion: Upper cervical rotation mobility determined by the FRT correlates strongly with age; hence, the results of the FRT have to be interpreted taking into account the individual age of the tested subject. The ratio between lower and upper cervical rotation mobility is maintained in all age groups.
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Affiliation(s)
| | - Thomas Schöttker-Königer
- University of Applied Sciences and Arts Hildesheim/Holzminden/Gottingen, Hildesheim, Niedersachsen, Germany
| | | | - Ilias Mavroidis
- German Association of Manual Therapy (DVMT) e.V., Dresden, Saxony, Germany
| | - Christoph Roeben
- German Association of Manual Therapy (DVMT) e.V., Dresden, Saxony, Germany
| | - Martina Schneider
- German Association of Manual Therapy (DVMT) e.V., Dresden, Saxony, Germany
| | - Yorick Wild
- German Association of Manual Therapy (DVMT) e.V., Dresden, Saxony, Germany
| | - Kerstin Lüdtke
- University of Luebeck Human Medicine, Lubeck, Schleswig-Holstein, Germany
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Zhou C, Wang H, Wang C, Tsai TY, Yu Y, Ostergaard P, Li G, Cha T. Intervertebral range of motion characteristics of normal cervical spinal segments (C0-T1) during in vivo neck motions. J Biomech 2019; 98:109418. [PMID: 31653508 DOI: 10.1016/j.jbiomech.2019.109418] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/24/2019] [Accepted: 10/13/2019] [Indexed: 01/19/2023]
Abstract
The in vivo intervertebral range of motion (ROM) is an important predictor for spinal disorders. While the subaxial cervical spine has been extensively studied, the motion characteristics of the occipito-atlantal (C0-1) and atlanto-axial (C1-2) cervical segments were less reported due to technical difficulties in accurate imaging of these two segments. In this study, we investigated the intervertebral ROMs of the entire cervical spine (C0-T1) during in vivo functional neck motions of asymptomatic human subjects, including maximal flexion-extension, left-right lateral bending, and left-right axial torsion, using previously validated dual fluoroscopic imaging and model registration techniques. During all neck motions, C0-1, similar to C7-T1, was substantially less mobile than other segments and always contributed less than 10% of the cervical rotations. During the axial rotation of the neck, C1-2 contributed 73.2 ± 17.3% of the cervical rotation, but each of other segments contributed less than 10% of the cervical rotation. During both lateral bending and axial torsion neck motions, regardless of primary or coupled motions, the axial torsion ROM of C1-2 was significantly greater than its lateral bending ROM (p < 0.001), whereas the opposite differences were consistently observed at subaxial segments. This study reveals that there are distinct motion patterns at upper and lower cervical segments during in vivo neck motions. The reported data could be useful for the development of new diagnosis methods of cervical pathologies and new surgical techniques that aim to restore normal cervical segmental motion.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haiming Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Yan Yu
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA; Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peter Ostergaard
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA.
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine J 2018; 18:2333-2342. [PMID: 30142458 DOI: 10.1016/j.spinee.2018.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is one of the most commonly reported symptoms in primary care settings, and a major contributor to health-care costs. Cervical manipulation is a common and clinically effective intervention for neck pain. However, the in vivo biomechanics of manipulation are unknown due to previous challenges with accurately measuring intervertebral kinematics in vivo during the manipulation. PURPOSE The objectives were to characterize manual forces and facet joint gapping during cervical spine manipulation and to assess changes in clinical and functional outcomes after manipulation. It was hypothesized that patient-reported pain would decrease and intervertebral range of motion (ROM) would increase after manipulation. STUDY DESIGN/SETTING Laboratory-based prospective observational study. PATIENT SAMPLE 12 patients with acute mechanical neck pain (4 men and 8 women; average age 40 ± 15 years). OUTCOME MEASURES Amount and rate of cervical facet joint gapping during manipulation, amount and rate of force applied during manipulation, change in active intervertebral ROM from before to after manipulation, and numeric pain rating scale (NPRS) to measure change in pain after manipulation. METHODS Initially, all participants completed a NPRS (0-10). Participants then performed full ROM flexion-extension, rotation, and lateral bending while seated within a custom biplane radiography system. Synchronized biplane radiographs were collected at 30 images/s for 3 seconds during each movement trial. Next, synchronized, 2.0-milliseconds duration pulsed biplane radiographs were collected at 160 images/s for 0.8 seconds during the manipulation. The manipulation was performed by a licensed chiropractor using an articular pillar push technique. For the final five participants, two pressure sensors placed on the thumb of the chiropractor (Novel pliance system) recorded pressure at 160 Hz. After manipulation, all participants repeated the full ROM movement testing and once again completed the NPRS. A validated volumetric model-based tracking process that matched subject-specific bone models (from computed tomography) to the biplane radiographs was used to track bone motion with submillimeter accuracy. Facet joint gapping was calculated as the average distance between adjacent articular facet surfaces. Pre- to postmanipulation changes were assessed using the Wilcoxon signed-rank test. RESULTS The facet gap increased 0.9 ± 0.40 mm during manipulation. The average rate of facet gapping was 6.2 ± 3.9 mm/s. The peak force and rate of force application during manipulation were 65 ± 4 N and 440 ± 58 N/s. Pain score improved from 3.7 ± 1.2 before manipulation to 2.0 ± 1.4 after manipulation (p <. 001). Intervertebral ROM increased after manipulation by 1.2° (p = .006), 2.1° (p = .01), and 3.9° (p = .003) at the C4/C5, C5/C6, and C6/C7 motion segments, respectively, during flexion-extension; by 1.5° (p = .028), 1.9° (p = .005), and 1.3° (p = .050) at the C3/C4, C4/C5, and C5/C6 motion segments, respectively, during rotation; and by 1.3° (p = .034) and 1.1° (p = .050) at the C4/C5 and C5/C6 motion segments, respectively, during lateral bending. Global head ROM relative to the torso increased after manipulation by 8º (p = .023), 10º (p = .002), and 13º (p = .019) during lateral bending, axial rotation and flexion-extension, respectively, after manipulation. CONCLUSIONS This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments. This study demonstrates the feasibility of characterizing in real time the manual inputs and biological responses that comprise cervical manipulation, including clinician-applied force, facet gapping, and increased intervertebral ROM. This provides a basis for future clinical trials to identify the mechanisms behind manipulation and to optimize the mechanical factors that reliably and sufficiently impact the key mechanisms behind manipulation.
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Affiliation(s)
- William J Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA.
| | - Tom Gale
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Clarissa LeVasseur
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Sandesh Raj
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Kris Gongaware
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
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