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Hemming R, du Rose A, Sheeran L, van Deursen R, Sparkes V. Relationships between trunk muscle activation and thoraco-lumbar kinematics in non-specific chronic low back pain subgroups during a forward bending task. Gait Posture 2024; 107:96-103. [PMID: 37797443 DOI: 10.1016/j.gaitpost.2023.09.018] [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: 10/11/2022] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Trunk muscle activity and thoraco-lumbar kinematics can discriminate between non-specific chronic low back pain (NSCLBP) subgroups and healthy controls. However, research commonly focuses on lumbar kinematics, with limited understanding of relationships between kinematics and muscle activity across clinical subgroups. Similarly, the thoracic spine, whilst intuitively associated with NSCLBP, has received less attention and potential relationships between spinal regions and muscle activity requires exploration. RESEARCH QUESTION Is there a relationship between trunk muscle activation and regional thoracic and lumbar kinematics in NSCLBP subgroups during a forward bending task? METHODS Observational, case-control study. Fifty subgrouped NSCLBP motor control impairment participants (27 Flexion Pattern (FP-MCI), 23 Active Extension Pattern (AEP-MCI)) and 28 pain-free controls were evaluated using 3D motion analysis (Vicon™) and surface electromyography during a forward bending and return to upright task. Mean sagittal angles for the upper-thoracic (UTx), lower-thoracic (LTx), upper-lumbar (ULx) and lower-lumbar (LLx) regions were compared with normalised (% sub-maximal voluntary contraction) mean amplitude electromyography of bilateral transversus abdominis/internal oblique, external oblique, superficial lumbar multifidus and erector spinae (longissimus thoracis) muscles between groups. Pearson correlations were computed to assess relationships (significance p < 0.01). RESULTS AEP-MCI individuals demonstrated statistically significant relationships between superficial lumbar multifidus and ULx and LLx kinematics (-.812 to.659). FP-MCI individuals exhibited statistically significant relationships between erector spinae and superficial lumbar multifidus and LLx and LTx kinematics (-.686 to.664) in both task phases, and between external oblique and LTx during forward bending) (-.459 to.572). Correlations were moderate to strong for all significant relationships (-.812 to .664). SIGNIFICANCE Relationships between muscle activity and regional spinal kinematics varied between NSCLBP subgroups, suggesting that those with flexion- or extension-related LBP adopt different motor control strategies when performing a bending task. As effectively mechanical biomarkers, these findings may inform treatment by improving understanding of varied motor strategies in subgroups.
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Affiliation(s)
- Rebecca Hemming
- Biomechanics and Bioengineering Research Centre Versus Arthritis, School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales, UK.
| | | | - Liba Sheeran
- Biomechanics and Bioengineering Research Centre Versus Arthritis, School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales, UK.
| | - Robert van Deursen
- Biomechanics and Bioengineering Research Centre Versus Arthritis, School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales, UK.
| | - Valerie Sparkes
- Biomechanics and Bioengineering Research Centre Versus Arthritis, School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales, UK.
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Systematic analysis of different low-pass filter cut-off frequencies on lumbar spine kinematics data and the impact on the agreement between accelerometers and an optoelectronic system. J Biomech 2022; 145:111395. [PMID: 36442430 DOI: 10.1016/j.jbiomech.2022.111395] [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: 05/25/2022] [Revised: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
A necessary step in the validation of accelerometers for the measurement of spine angles is to determine the levels of agreement with current gold standard methods. However, agreement may be a function of filtering parameters. We aimed to (1) systematically determine the effect of different filter frequency cut-offs on the peak range of motion (ROM) during forward bending as measured by accelerometers and an optoelectronic (OE) system, (2) explore the influence of filtering on agreement between systems, and (3) determine the difference in peak ROM measurement between these systems. Accelerometers and OE sensors were attached at L2, L4, and S1 of 20 asymptomatic female participants for a guided flexion trial. Signals were then iteratively low-pass filtered with cut-off frequencies ranging from 14 Hz to 1 Hz and peak range of motion outcome measures were compared between systems. Peak ROM was minimally affected by filter cut-off frequency for both accelerometer and OE system. The difference in peak ROM between difference cut-off frequencies were maximum 0.66°, median 0.18° and minimum 0.06° for accelerometer derived values and maximum 0.23°, median 0.08° and minimum 0.03° for the OE system. The maximum difference across the filtering frequencies was 0.62° and the largest difference between the two systems (with outliers removed) was 0.82°. Cut-off frequencies ranging from 14 to 1 Hz had little effect of peak lumbar spine ROM during low velocity (6°/s) forward bending, regardless of motion capture method. Filtering cut-off frequency had little effect on the differences between the accelerometer and OE system and similar measurements can be achieved using accelerometers compared to OE systems.
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Liu D, Shi B, Li Y, Liu Z, Sun X, Zhu Z, Qiu Y. Failure of Posterior Lower Lumbar/Lumbosacral Hemi-Vertebra Resection: An Analysis of Reasons and Revision Strategies. Orthop Surg 2022; 14:1413-1419. [PMID: 35678133 PMCID: PMC9251278 DOI: 10.1111/os.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the causes of failed primary surgery and the revision strategies for congenital scoliosis (CS) patients with lower lumbar/lumbosacral (LL/LS) hemi-vertebra (HV). METHODS Fifteen CS patients with LL/LS HV (seven females and eight males) with a mean age of 20.4 ± 10.4 years undergoing revision surgery in our center were retrospectively reviewed. The radiographic parameters including Cobb angle, distance between C7 plumb line and center sacral vertical line (C7 PL-CSVL), thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA) were assessed at pre-revision, post-revision and the last follow-up. The causes of failure in primary operation, and radiographic and clinical outcomes of revision procedures were analyzed. RESULTS The revision rate of patients undergoing LL/LS HV resection and correction surgery was 11.4%. The average time interval between primary surgery and revision surgery was 18.2 ± 10.6 months. The operation duration and estimated blood loss of revision surgery were 194 ± 56 min and 326 ± 74 ml, respectively. Reasons for failed primary operations were as follows: internal fixation fracture in 10 cases, curve progression in two cases, implant loose in two cases and post-operative coronal imbalance in one case. The post-revision Cobb angle was significantly improved from 29.9° ± 8.3° to 18.7° ± 6.7° (P < 0.001) with a correction rate of 37.5% ± 12.6%. At the final follow-up, the average Cobb angle was 18.9° ± 6.2° and the correction was well maintained (P = 0.788). The C7 PL-CSVL at pre-revision, post-revision and at last follow-up were 23.2 ± 9.3 mm, 14.8 ± 4.8 mm and 14.9 ± 5.4 mm, respectively. Significant improvements (P = 0.004) were observed after revision surgery and there was no evident loss of correction (P = 0.703). There was no significant difference in TK, LL and SVA before and after revision surgery (all P > 0.05). At the last follow-up, no significant correction loss of above coronal and sagittal parameters were observed (all P > 0.05). The revision methods were individualized according to the primary surgical procedures and the reasons for revision. The recommended revision strategies include incision of pseudarthrosis with sufficient bone graft, fixation of satellite rods, thorough residual HV excision, prolonged fusion to S2 and transforaminal lumbar interbody fusion at lumbosacral region. Solid bony fusion and no implant-related complication were detected during the follow-up. CONCLUSIONS The causes of revision surgery for patients with congenital scoliosis (CS) due to lumbosacral HV were verified and implant failure with pseudarthrosis was the main reason for failed primary operation.
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Affiliation(s)
- Dun Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Shin SS, Yoo WG. Differences in regional and global lumbar angle during slumped sitting and upright sitting among global three subgroups. J Back Musculoskelet Rehabil 2021; 34:877-885. [PMID: 34057131 DOI: 10.3233/bmr-200087] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in regional lumbar lordosis (RLL) and global lumbar lordosis (GLL) angle during slumped sitting and upright sitting among three global subgroups. METHODS A total of 48 young asymptomatic volunteers stood in a comfortable posture, sat upright, and sat in a slumped position for 5 seconds, with inertial measurement units attached to the T10, L3, and S2 vertebrae. According to standing measurement, the participants were categorized into flat-back (GLL < 20∘), normal lordosis (20∘⩽ GLL < 30∘), and hyper-lordosis (30∘⩽ GLL < 40∘) groups. RESULTS Both the GLL and RLL in the flat-back group were reduced lumbar lordosis in the upright sitting posture and increased lumbar kyphosis in the slumped sitting postures compared to the other groups (p< 0.05), but the range of motion during the transition from upright sitting to slumped sitting was lower than that of the normal and hyper-lordosis groups (p< 0.05). GLL in standing was a moderate correlation with GLL and RLL during upright sitting (p< 0.05). However, there was a strong correlation between GLL and RLL kinematics during upright and slumped sitting (p< 0.05). CONCLUSIONS Flat-back posture is a potential source of low back pain during both upright and slumped sitting compared to the normal and hyper-lordosis groups. Posture measurements in a standing and sitting position conducted to assess lordosis should consider the relationship between GLL and RLL.
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Sarcevic ZZ, Tepavcevic A. Association Among Dyskinesia of the Lumbar Spine Segment, Inclination Angle of the Lumbosacral Spine, and Low Back Pain in Young Athletes: A Predictive Correlational Study. J Manipulative Physiol Ther 2020; 43:646-654. [PMID: 32861522 DOI: 10.1016/j.jmpt.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/28/2019] [Accepted: 12/05/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine. METHODS The study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2). The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression. RESULTS There was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra. CONCLUSION There was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.
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Senington B, Lee RY, Williams JM. Biomechanical risk factors of lower back pain in cricket fast bowlers using inertial measurement units: a prospective and retrospective investigation. BMJ Open Sport Exerc Med 2020; 6:e000818. [PMID: 32843992 PMCID: PMC7430332 DOI: 10.1136/bmjsem-2020-000818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives To investigate spinal kinematics, tibial and sacral impacts during fast bowling, among bowlers with a history of low back pain (LBP) (retrospective) and bowlers who developed LBP in the follow-up season (prospective). Methods 35 elite male fast bowlers; senior (n=14; age=24.1±4.3 years; height=1.89±0.05 m; weight=89.2±4.6 kg) and junior (n=21; age=16.9±0.7; height=1.81±0.05; weight=73.0±9.2 kg) were recruited from professional county cricket clubs. LBP history was gathered by questionnaire and development of LBP was monitored for the follow-up season. Spinal kinematics, tibial and sacral impacts were captured using inertial measurement units placed over S1, L1, T1 and anteromedial tibia. Bonferroni corrected pairwise comparisons and effect sizes were calculated to investigate differences in retrospective and prospective LBP groups. Results Approximately 38% of juniors (n=8) and 57% of seniors (n=8) reported a history of LBP. No differences were evident in spinal kinematics or impacts between those with LBP history and those without for seniors and juniors. Large effect sizes suggest greater rotation during wind-up (d=1.3) and faster time-to-peak tibial impacts (d=1.5) in those with no history of LBP. One junior (5%) and four (29%) seniors developed LBP. No differences were evident in spinal kinematics or impacts between those who developed LBP and those who did not for seniors. In seniors, those who developed LBP had lower tibial impacts (d=1.3) and greater lumbar extension (d=1.9) during delivery. Conclusion Retrospective analysis displayed non-significant differences in kinematics and impacts. It is unclear if these are adaptive or impairments. Prospective analysis demonstrated large effect sizes for lumbar extension during bowling suggesting a target for future coaching interventions.
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Affiliation(s)
- Billy Senington
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Raymond Y Lee
- Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | - Jonathan M Williams
- Department of Rehabilitation and Sport Sciences, Bournemouth University, Bournemouth, UK
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Digo E, Pierro G, Pastorelli S, Gastaldi L. Evaluation of spinal posture during gait with inertial measurement units. Proc Inst Mech Eng H 2020; 234:1094-1105. [PMID: 32633209 DOI: 10.1177/0954411920940830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing number of postural disorders emphasizes the central role of the vertebral spine during gait. Indeed, clinicians need an accurate and non-invasive method to evaluate the effectiveness of a rehabilitation program on spinal kinematics. Accordingly, the aim of this work was the use of inertial sensors for the assessment of angles among vertebral segments during gait. The spine was partitioned into five segments and correspondingly five inertial measurement units were positioned. Articulations between two adjacent spine segments were modeled with spherical joints, and the tilt-twist method was adopted to evaluate flexion-extension, lateral bending and axial rotation. In total, 18 young healthy subjects (9 males and 9 females) walked barefoot in three different conditions. The spinal posture during gait was efficiently evaluated considering the patterns of planar angles of each spine segment. Some statistically significant differences highlighted the influence of gender, speed and imposed cadence. The proposed methodology proved the usability of inertial sensors for the assessment of spinal posture and it is expected to efficiently point out trunk compensatory pattern during gait in a clinical context.
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Affiliation(s)
- Elisa Digo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Giuseppina Pierro
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Stefano Pastorelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Laura Gastaldi
- Department of Mathematical Sciences "G.L. Lagrange," Politecnico di Torino, Torino, Italy
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Seerden SF, Dankaerts W, Swinnen TW, Westhovens R, de Vlam K, Vanwanseele B. Multi-segment spine and hip kinematics in asymptomatic individuals during standardized return from forward bending versus functional box lifting. J Electromyogr Kinesiol 2019; 49:102352. [DOI: 10.1016/j.jelekin.2019.102352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/03/2023] Open
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Ike H, Dorr LD, Trasolini N, Stefl M, McKnight B, Heckmann N. Spine-Pelvis-Hip Relationship in the Functioning of a Total Hip Replacement. J Bone Joint Surg Am 2018; 100:1606-1615. [PMID: 30234627 DOI: 10.2106/jbjs.17.00403] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hiroyuki Ike
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lawrence D Dorr
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nicholas Trasolini
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael Stefl
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Braden McKnight
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Kuai S, Zhou W, Liao Z, Ji R, Guo D, Zhang R, Liu W. Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living. BMC Musculoskelet Disord 2017; 18:216. [PMID: 28545560 PMCID: PMC5445463 DOI: 10.1186/s12891-017-1572-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Low back pain (LBP) is a common problem that can contribute to motor dysfunction. Previous studies reporting the changes in kinematic characteristics caused by LBP present conflicting results. This study aimed to apply the multisegmental spinal model to investigate the kinematic changes in patients with lumbar disc herniation (LDH) during five activities of daily living (ADLs). Methods Twenty-six healthy subjects and 7 LDH patients participated in this study and performed level walking, stair climbing, trunk flexion, and ipsilateral and contralateral pickups. The angular displacement of the thorax, upper lumbar (ULx), lower lumbar (LLx), pelvis, hip, and knee was calculated using a modified full-gait-model in the AnyBody modeling system. Results In the patient group, the ULx almost showed no sagittal angular displacement while the LLx remained part of the sagittal angular displacement during trunk flexion and the two pickups. In the two pickups, pelvic tilt and lower extremities’ flexion increased to compensate for the deficiency in lumbar motion. LDH patients exhibited significantly less pelvic rotation during stair climbing and greater pelvic rotation in other ADLs, except in contralateral pickup. In addition, LDH patients demonstrated more antiphase movement in the transverse plane between ULx and LLx, during level walking and stair climbing, between thorax and pelvis in the two pickups. Conclusions LDH patients mainly restrict the motion of LLx and ULx in the spinal region during the five ADLs. Pelvic rotation is an important method to compensate for the limited lumbar motion. Furthermore, pelvic tilt and lower extremities’ flexion increased when ADLs were quite difficult for LDH patients.
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Affiliation(s)
- Shengzheng Kuai
- Department of Mechanical Engineering, Tsinghua University, Haidian District, Beijing, 100084, China.,Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Nanshan District, Shenzhen, 518057, China
| | - Wenyu Zhou
- Department of Orthopedics, Shenzhen Second People's Hospital, Futian District, Shenzhen, 518035, China.
| | - Zhenhua Liao
- Department of Mechanical Engineering, Tsinghua University, Haidian District, Beijing, 100084, China.,Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Nanshan District, Shenzhen, 518057, China
| | - Run Ji
- National Research Center for Rehabilitation Technical Aids, DaXing District, Beijing, 100176, China
| | - Daiqi Guo
- Department of Orthopedics, Shenzhen Second People's Hospital, Futian District, Shenzhen, 518035, China
| | - Rui Zhang
- Department of Orthopedics, Shenzhen Second People's Hospital, Futian District, Shenzhen, 518035, China
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Haidian District, Beijing, 100084, China. .,Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Nanshan District, Shenzhen, 518057, China.
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Analysis of 3D multi-segment lumbar spine motion during gait and prone hip extension. J Electromyogr Kinesiol 2017; 33:111-117. [DOI: 10.1016/j.jelekin.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
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Yang G, Battié MC, Boyd SK, Videman T, Wang Y. Cranio-caudal asymmetries in trabecular architecture reflect vertebral fracture patterns. Bone 2017; 95:102-107. [PMID: 27876503 DOI: 10.1016/j.bone.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
Clinically, vertebral fractures often occur in the upper lumbar spine and involve the superior endplate of a vertebra (which is immediately caudal to a disc). Knowledge that the cranial endplate of a disc is thicker and has greater bone mineral density (BMD) than the corresponding caudal endplate helps to explain this phenomenon. In this study, we investigated structural differences in vertebral trabeculae on either side of a lumbar disc to provide further insight into vertebral fracture risk. As the focus is trabecular difference within a spinal motion segment, we define cranial and caudal vertebral trabeculae relative to the disc. Ninety-two spinal motion segments from 46 cadaveric lumbar spines (males, mean age 50years, range 21-63years) were studied. Disc narrowing on radiography and spread of barium sulfate (BaSO4) on discography were measured to indicate disc degeneration. Micro-computed tomography (μCT) images were obtained at a resolution of 82μm for each vertebra and processed to include only vertebral trabeculae. Using image processing, the vertebral trabeculae were divided into superior and inferior halves, and then into central and peripheral regions which were approximately opposite to the disc pulposus and annulus, and further into anterior and posterior sub-regions. Microarchitecture measurements for each vertebral region were obtained to determine the differences between the cranial and caudal trabeculae (relative to disc) and their associations with age and disc degeneration within each spinal motion segment. Data from the upper (L1/2-L3/4) and lower (L4/5) lumbar segments were analyzed separately. In the upper lumbar region, the trabeculae cranial to a disc on average had 5.3% greater BMD and trabecular bone volume, 3.6% greater trabecular number, 9.7% greater connectivity density, and 3.7% less trabecular separation than the corresponding caudal trabeculae (P<0.05 for all). Similar trends were observed in peripheral, anterior and posterior regions, but not in central region. No structural difference was observed in the trabeculae of L4/5 segment. Structural asymmetries of vertebral trabeculae were not associated with age, disc degeneration, or disc narrowing. Vertebral trabecular parameters cranial to the disc were greater than caudally in the upper but not in the lower lumbar region. Findings further explain why vertebral fractures are more common in the upper lumbar region and more frequently involve the endplate caudal to a disc.
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Affiliation(s)
- Ge Yang
- Spine lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Michele C Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Steven K Boyd
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tapio Videman
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Yue Wang
- Spine lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
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