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Muriuki MG, Havey RM, Blank KR, Patwardhan AG. Coupled rotation patterns in cervical spine axial rotation can change when the head is kept level. J Biomech 2024; 163:111924. [PMID: 38237496 DOI: 10.1016/j.jbiomech.2024.111924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/01/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
The biomechanical literature describes axial rotation occurring coupled with lateral bending and flexion in the cervical spine. Since the head is kept level during some activities of daily living, we set out to investigate the changes in total and segmental motion that occur when a level gaze constraint is applied to cadaveric cervical spine specimens during axial rotation. 1.5Nm of left and right axial rotation moment was applied to sixteen C2-T1 cadaveric specimens with C2 unconstrained and C2 constrained to simulate level gaze. Overall and segmental motions were determined using optoelectronic motion measurement and specimen-specific kinematic modeling. Without a kinematic constraint on C2, motions were as described in the literature; namely, flexion and lateral bending to the same side as axial rotation. Keeping C2 level reduced that total axial rotation range of motion of the specimens. Changes were also produced in segmental coupled rotation in all specimens. The observed changes included completely opposite coupled motion than in the uncoupled specimens, and traditional coupled behavior at one load extreme and the opposite at the other extreme. Constraining C2 during axial rotation to simulate level gaze can produce coupled motion that differs from the classically described flexion and lateral bending to the same side as axial rotation. Statement of Clinical Significance: Activities of daily living that require the head to be kept level during axial rotation of the cervical spine may produce segmental motions that are quite different from the classically described motions with implications for biomechanical experiments and implant designers.
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Affiliation(s)
- Muturi G Muriuki
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | - Robert M Havey
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Kenneth R Blank
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA; Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA
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Dahdaleh NS, El-Tecle N, Cloney MB, Shlobin NA, Koski TR, Wolinsky JP. Functional Anatomy and Biomechanics of the Craniovertebral Junction. World Neurosurg 2023; 175:165-171. [PMID: 37365762 DOI: 10.1016/j.wneu.2023.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 06/28/2023]
Abstract
The craniovertebral junction (CVJ) involves the atlas, axis, and occiput along with the atlanto-occipital and atlantoaxial joints. The anatomy and neural and vascular anatomy of the junction render the CVJ unique. Specialists treating disorders that affect the CVJ must appreciate its intricate anatomy and should be well versed in its biomechanics. This first article in a three-article series provides an overview of the functional anatomy and biomechanics of the CVJ.
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Affiliation(s)
- Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Najib El-Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael B Cloney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jean Paul Wolinsky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Hage R, Buisseret F, Houry M, Dierick F. Head Pitch Angular Velocity Discriminates (Sub-)Acute Neck Pain Patients and Controls Assessed with the DidRen Laser Test. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22072805. [PMID: 35408420 PMCID: PMC9002899 DOI: 10.3390/s22072805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 06/01/2023]
Abstract
Understanding neck pain is an important societal issue. Kinematic data from sensors may help to gain insight into the pathophysiological mechanisms associated with neck pain through a quantitative sensorimotor assessment of one patient. The objective of this study was to evaluate the potential usefulness of artificial intelligence with several machine learning (ML) algorithms in assessing neck sensorimotor performance. Angular velocity and acceleration measured by an inertial sensor placed on the forehead during the DidRen laser test in thirty-eight acute and subacute non-specific neck pain (ANSP) patients were compared to forty-two healthy control participants (HCP). Seven supervised ML algorithms were chosen for the predictions. The most informative kinematic features were computed using Sequential Feature Selection methods. The best performing algorithm is the Linear Support Vector Machine with an accuracy of 82% and Area Under Curve of 84%. The best discriminative kinematic feature between ANSP patients and HCP is the first quartile of head pitch angular velocity. This study has shown that supervised ML algorithms could be used to classify ANSP patients and identify discriminatory kinematic features potentially useful for clinicians in the assessment and monitoring of the neck sensorimotor performance in ANSP patients.
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Affiliation(s)
- Renaud Hage
- CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium; (F.B.); (F.D.)
- Traitement Formation Thérapie Manuelle (TFTM), Private Physiotherapy/Manual Therapy Center, Avenue des Cerisiers 211A, 1200 Brussels, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Place Pierre de Coubertin 1, 1348 Ottignies-Louvain-la-Neuve, Belgium
| | - Fabien Buisseret
- CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium; (F.B.); (F.D.)
- Service de Physique Nucléaire et Subnucléaire, UMONS, Research Institute for Complex Systems, Place du Parc 20, 7000 Mons, Belgium
| | - Martin Houry
- Centre de Recherche FoRS, Haute-Ecole de Namur-Liège-Luxembourg (Henallux), Rue Victor Libert 36H, 6900 Marche-en-Famenne, Belgium;
| | - Frédéric Dierick
- CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium; (F.B.); (F.D.)
- Faculté des Sciences de la Motricité, UCLouvain, Place Pierre de Coubertin 1, 1348 Ottignies-Louvain-la-Neuve, Belgium
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation–Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
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Spontaneous Osseous Fusion after Remodeling Therapy for Chronic Atlantoaxial Rotatory Fixation and Recovery Mechanism of Rotatory Range of Motion of the Cervical Spine. J Clin Med 2022; 11:jcm11061504. [PMID: 35329830 PMCID: PMC8949716 DOI: 10.3390/jcm11061504] [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: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to investigate the risk factors of spontaneous osseous fusion (SOF) of the atlantoaxial joint after closed reduction under general anesthesia followed by halo fixation (remodeling therapy) for chronic atlantoaxial rotatory fixation, and to elucidate the recovery mechanism of the rotatory range of motion (ROM) after halo removal. Twelve patients who underwent remodeling therapy were retrospectively reviewed. Five patients with SOF were categorized as the fusion group and seven patients without SOF as the non-fusion group. Three dimensional CT was used to detect direct osseous contact (DOC) of facet joints before and during halo fixation, while dynamic CT at neutral and maximally rotated head positions was performed to measure rotatory ROM after halo removal. The duration from onset to initial visit was significantly longer (3.2 vs. 5.7 months, p = 0.04), incidence of DOC during halo fixation was higher (0/7 [0%] vs. 4/5 [80%], p = 0.004), and segmental rotatory ROM of Occiput/C1 (Oc/C1) at final follow-up was larger (9.8 vs. 20.1 degrees, p = 0.003) in the fusion group. Long duration from the onset to the initial visit might induce irreversible damage to the articular surface of the affected facet, which was confirmed as DOC during halo fixation and resulted in SOF. Long duration from the onset to the initial visit and DOC during halo fixation could be used to suggest the risk for SOF. Nonetheless, rotatory ROM of Oc/C1 increased to compensate for SOF.
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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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Zhou C, Cha T, Peng Y, Li G. Transfer learning from an artificial radiograph-landmark dataset for registration of the anatomic skull model to dual fluoroscopic X-ray images. Comput Biol Med 2021; 138:104923. [PMID: 34638020 DOI: 10.1016/j.compbiomed.2021.104923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023]
Abstract
Registration of 3D anatomic structures to their 2D dual fluoroscopic X-ray images is a widely used motion tracking technique. However, deep learning implementation is often impeded by a paucity of medical images and ground truths. In this study, we proposed a transfer learning strategy for 3D-to-2D registration using deep neural networks trained from an artificial dataset. Digitally reconstructed radiographs (DRRs) and radiographic skull landmarks were automatically created from craniocervical CT data of a female subject. They were used to train a residual network (ResNet) for landmark detection and a cycle generative adversarial network (GAN) to eliminate the style difference between DRRs and actual X-rays. Landmarks on the X-rays experiencing GAN style translation were detected by the ResNet, and were used in triangulation optimization for 3D-to-2D registration of the skull in actual dual-fluoroscope images (with a non-orthogonal setup, point X-ray sources, image distortions, and partially captured skull regions). The registration accuracy was evaluated in multiple scenarios of craniocervical motions. In walking, learning-based registration for the skull had angular/position errors of 3.9 ± 2.1°/4.6 ± 2.2 mm. However, the accuracy was lower during functional neck activity, due to overly small skull regions imaged on the dual fluoroscopic images at end-range positions. The methodology to strategically augment artificial training data can tackle the complicated skull registration scenario, and has potentials to extend to widespread registration scenarios.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yun Peng
- NuVasive Inc, San Diego, CA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
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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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