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Hartley L, Zappalà M, Ehiogu U, Heneghan NR, Gardner A. What is the most appropriate method for the measurement of the range of motion in the lumbar spine and how does surgical fixation affect the range of movement of the lumbar spine in adolescent idiopathic scoliosis? A systematic review protocol. Syst Rev 2022; 11:208. [PMID: 36180881 PMCID: PMC9523991 DOI: 10.1186/s13643-022-02077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/18/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is a three-dimensional rotational change in the normal shape of the spine which affects children aged 10 to 18 years. Both the condition and its management can have significant impact on functional ability. Currently, expected restriction in spinal motion is experience based, rather than evidence based, and discussions to inform patient expectations pre-operatively can be difficult. The aim of this review is to evaluate the evidence pertaining to measurement of spinal motion and whether this is altered following surgery, dependent on the anatomical level of surgical fixation in AIS. METHODS/ANALYSIS: This protocol is reported in line with both PRISMA-P and informed by the COSMIN methodology. Electronic databases will be searched using a two-stage search strategy. The first stage will identify and evaluate the methods used to assess spinal motion. The second stage aims to evaluate the change in spinal motion using these methods based on anatomical level of fixation following surgery along with the measurement properties of those methods, to include the validity, reliability and responsiveness of the methods. Two reviewers will independently screen the search results against eligibility criteria, extract the data and assess the quality of the included studies. Any disputes between the reviewers will be resolved with a third independent reviewer. Data may be pooled where possible; however, this is not expected. The overall strength of the body of evidence will then be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. PATIENT AND PUBLIC INVOLVEMENT Patients and members of the public will not be consulted in the production of this review, although the review was conceived based on the experiences of the authors when managing this patient population and a need to address patient expectations in pre-operative planning. ETHICS, DISSEMINATION AND DATA AVAILABILITY No ethical approval required. The final review will be submitted to peer-reviewed journals for publication and disseminated publicly. The datasets used and/or analysed in this review will be available from the corresponding author on reasonable request. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number. CRD42021282264.
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Affiliation(s)
- Laura Hartley
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Mattia Zappalà
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Uzo Ehiogu
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, The Woodlands, Bristol Road South, Northfield, Birmingham, B31 2AP, UK. .,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
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Comparison between genders for trunk mobility in normal adults. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: There are multiple factors which can affect spinal range of motion such as medical conditions, pelvic asymmetry age, sex, race and geographical distribution etc. Aim: The present study aims to assess the differences between genders for trunk mobility in normal adults. Material & methods: In this cross sectional study, 137 subjects (71 females and 66 males) were included for 6 months from various institutes of Sumandeep Vidyapeeth and assessed using Tape method and goniometry for trunk mobility in all planes (sagittal, frontal and transverse) for forward flexion with and without stabilization, extension, lateral flexion and rotation to both the sides and their gender specific differences were calculated using students t test. Result: The mean values by tape method and goniometry for all movements (flexion with and without stabilization, extension, lateral flexion to both the sides and rotation to both the sides) have been given in form of descriptive statistics in the table. There was no statistically significant difference for all spinal movements among the genders, except in lateral flexion (p value 0.009 & 0.008) and rotation (p value 0.023 & 0.004) where females had greater mobility than males.
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Cholewicki J, Breen A, Popovich JM, Reeves NP, Sahrmann SA, van Dillen LR, Vleeming A, Hodges PW. Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point-Counterpoint Debate. J Orthop Sports Phys Ther 2019; 49:425-436. [PMID: 31092123 PMCID: PMC7394249 DOI: 10.2519/jospt.2019.8825] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.
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Wang L, Zhang Y, Lin X, Yan Z. Study of lumbar spine activity regularity based on Kanade-Lucas-Tomasi algorithm. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mahato NK, Montuelle S, Clark BC. Assessment of In Vivo Lumbar Inter-Vertebral Motion: Reliability of a Novel Dynamic Weight-Bearing Magnetic Resonance Imaging Technique Using a Side-Bending Task. Asian Spine J 2019; 13:377-385. [PMID: 30691259 PMCID: PMC6547391 DOI: 10.31616/asj.2018.0219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/06/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Between-session reliability of a magnetic resonance imaging (MRI) based experimental technique to quantify lumbar inter-vertebral motion in humans. Purpose We have developed a novel, dynamic, MRI-based approach for quantifying in vivo lumbar inter-vertebral motion. In this study, we present the protocol’s reliability results to quantify inter-vertebral spine motion. Overview of Literature Morphometric studies on intervertebral displacements using static, supine MRI and quantification of dynamic spine motion using different X-ray based radiography techniques are commonly found in the literature. However, reliability testing of techniques assessing real-time lumbar intervertebral motion using weight-bearing MRI has rarely been reported. Methods Ten adults without a history of back pain performed a side-bending task on two separate occasions, inside an open-MRI, in a weight-bearing, upright position. The images were acquired during the task using a dynamic magnetic resonance (MR) sequence. The MRI imaging space was externally calibrated before the study to recreate the imaging volume for subsequent use in an animation software. The dynamic MR images were processed to create side-bending movement animations in the virtual environment. Participant-specific three-dimensional models were manually superimposed over vertebral image silhouettes in a sequence of image frames, representing the motion trials. Inter-vertebral axes and translation and rotational displacements of vertebrae were quantified using the animation software. Results Quantification of inter-vertebral rotations and translations shows high reliability. Between-session reliability results yielded high values for the intra-class correlation coefficient (0.86–0.93), coefficient of variation (13.3%–16.04%), and Pearson’s correlation coefficients (0.89–0.98). Conclusions This technique may be developed further to improve its speed and accuracy for diagnostic applications, to study in vivo spine stability, and to assess outcomes of surgical and non-surgical interventions applied to manage pathological spine motion.
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Affiliation(s)
- Niladri Kumar Mahato
- The University of The West Indies, St. Augustine, Trinidad and Tobago.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | | | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA.,Department of Geriatric Medicine, Ohio University, Athens, OH, USA
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Breen A, Hemming R, Mellor F, Breen A. Intrasubject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:450-460. [PMID: 30535658 DOI: 10.1007/s00586-018-5849-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE In vivo quantification of intervertebral motion through imaging has progressed to a point where biomarkers for low back pain are emerging. This makes possible deeper study of the condition's biometrics. However, the measurement of change over time involves error. The purpose of this prospective investigation is to determine the intrasubject repeatability of six in vivo intervertebral motion parameters using quantitative fluoroscopy. METHODS Intrasubject reliability (ICC) and minimal detectable change (MDC) of baseline to 6-week follow-up measurements were calculated for six lumbar spine intervertebral motion parameters in 109 healthy volunteers. A standardised quantitative fluoroscopy (QF) protocol was used to provide measurements in the coronal and sagittal planes using both passive recumbent and active weight-bearing motion. Parameters were: intervertebral range of motion (IV-RoM), laxity, motion sharing inequality (MSI), motion sharing variability (MSV), flexion translation and anterior disc height change during flexion. RESULTS The best overall intrasubject reliability (ICC) and agreement (MDC) were for disc height (ICC 0.89, MDC 43%) and IV-RoM (ICC 0.96, MDC 60%), and the worst for MSV (ICC 0.04, MDC 408%). Laxity, MSI and translation had acceptable reliability (most ICCs > 0.60), but not agreement (MDC > 85%). CONCLUSION Disc height and IV-RoM measurement using QF could be considered for randomised trials, while laxity, MSI and translation could be considered for moderators, correlates or mediators of patient-reported outcomes. MSV had both poor reliability and agreement over 6 weeks. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | - Rebecca Hemming
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Fiona Mellor
- Centre for Biomechanics Research, AECC University College, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK.
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du Rose A, Breen A, Breen A. Relationships between muscle electrical activity and the control of inter-vertebral motion during a forward bending task. J Electromyogr Kinesiol 2018; 43:48-54. [PMID: 30237131 DOI: 10.1016/j.jelekin.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022] Open
Abstract
Muscle strengthening exercises are commonly used in primary care for the treatment of chronic, non-specific low back pain (CNSLBP) as it has been theorised that increased muscle activity contributes to the stabilisation of inter-vertebral motion segments during bending and other spinal movements, however this has never been demonstrated in vivo. This study used contemporaneous quantitative fluoroscopy (QF) and surface electromyography (sEMG) to investigate relationships between continuous inter-vertebral motion variables and muscle electrical activity in the lumbar multifidus (LMU), lumbar and thoracic erector spinae (LES and TES) during standardised lumbar flexion and return in 18 healthy male human subjects. Our results demonstrated that the variability in the sharing of angular motion (i.e. Motion Share Variability MSV) and motion segment laxity during a bending task were significantly (p < 0.05) negatively correlated (Spearman) with muscle electrical activity throughout the participant bend for both locally and globally acting muscle groups. MSV was also strongly correlated with L2-3 laxity. The former suggests a damping mechanism reducing irregular displacements (i.e. less variability in the sharing of segmental motion) during bending and an action of spinal stabilisation by muscles at segmental levels, and the latter a synergy between laxity at L2-3 and MSV. While this has previously been theorised, it has never been shown in vivo at the inter-vertebral level. These assessments may be considered for use in validation studies of exercise programs for CNSLBP, however further replication is required.
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Affiliation(s)
- Alister du Rose
- University of South Wales, Treforest, Pontypridd, Wales CF37 1DL, UK.
| | - Alex Breen
- AECC University College, Bournemouth, Dorset, England BH52DF, UK
| | - Alan Breen
- AECC University College, Bournemouth, Dorset, England BH52DF, UK
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Plocharski M, Lindstroem R, Lindstroem CF, Østergaard LR. Motion analysis of the cervical spine during extension and flexion: Reliability of the vertebral marking procedure. Med Eng Phys 2018; 61:81-86. [PMID: 30172653 DOI: 10.1016/j.medengphy.2018.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Cervical spine motion analysis using videofluoroscopy is currently a technique without a gold standard. We demonstrate the reliability of a rigid and reliable analysis methodology for cervical motion using videofluoroscopic images, representing the entire range of motion during flexion and extension, from the neutral position to the end-range in the sagittal plane. Two researchers with radiography and vertebral marking expertise, and two inexperienced researchers with 10 hours of training manually marked anatomical structures on fluoroscopic images in a procedure designed to control for vertebral rotation around the mid-plane axis. The average marking error across examiners and images was -0.12∘ (standard deviation: 0.88°), and the intraexaminer error ranged from -1.00∘ to 1.61° (standard deviation range: 0.27°-1.19°). Our method demonstrated lower errors compared to the higher resolution X-ray studies, and proved that vertebral marking can be performed by persons with no experience in radiographic image analysis.
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Affiliation(s)
- Maciej Plocharski
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Rene Lindstroem
- SMI (Sensory-Motor Interaction), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Lasse Riis Østergaard
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Breen A. Anti-directional cervical intervertebral motion: could it have gone any other way? JOURNAL OF SPINE SURGERY (HONG KONG) 2018; 4:461-464. [PMID: 30069544 PMCID: PMC6046349 DOI: 10.21037/jss.2018.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Alan Breen
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
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10
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Breen A, Breen A. Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:145-153. [PMID: 28555313 DOI: 10.1007/s00586-017-5155-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/03/2017] [Accepted: 05/24/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Evidence of intervertebral mechanical markers in chronic, non-specific low back pain (CNSLBP) is lacking. This research used dynamic fluoroscopic studies to compare intervertebral angular motion sharing inequality and variability (MSI and MSV) during continuous lumbar motion in CNSLBP patients and controls. Passive recumbent and active standing protocols were used and the relationships of these variables to age and disc degeneration were assessed. METHODS Twenty patients with CNSLBP and 20 matched controls received quantitative fluoroscopic lumbar spine examinations using a standardised protocol for data collection and image analysis. Composite disc degeneration (CDD) scores comprising the sum of Kellgren and Lawrence grades from L2-S1 were obtained. Indices of intervertebral motion sharing inequality (MSI) and variability (MSV) were derived and expressed in units of proportion of lumbar range of motion from outward and return motion sequences during lying (passive) and standing (active) lumbar bending and compared between patients and controls. Relationships between MSI, MSV, age and CDD were assessed by linear correlation. RESULTS MSI was significantly greater in the patients throughout the intervertebral motion sequences of recumbent flexion (0.29 vs. 0.22, p = 0.02) and when flexion, extension, left and right motion were combined to give a composite measure (1.40 vs. 0.92, p = 0.04). MSI correlated substantially with age (R = 0.85, p = 0.004) and CDD (R = 0.70, p = 0.03) in lying passive investigations in patients and not in controls. There were also substantial correlations between MSV and age (R = 0.77, p = 0.01) and CDD (R = 0.85, p = 0.004) in standing flexion in patients and not in controls. CONCLUSION Greater inequality and variability of motion sharing was found in patients with CNSLBP than in controls, confirming previous studies and suggesting a biomechanical marker for the disorder at intervertebral level. The relationship between disc degeneration and MSI was augmented in patients, but not in controls during passive motion and similarly for MSV during active motion, suggesting links between in vivo disc mechanics and pain generation.
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Affiliation(s)
- Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
| | - Alexander Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Bournemouth, BH5 2DF, UK
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Balkovec C, Veldhuis JH, Baird JW, Brodland GW, McGill SM. A videofluoroscopy-based tracking algorithm for quantifying the time course of human intervertebral displacements. Comput Methods Biomech Biomed Engin 2017; 20:794-802. [PMID: 28294643 DOI: 10.1080/10255842.2017.1302435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images. To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively. When applied to two patient cases, aberrant intervertebral motions in the cervical spine were typically found to correlate with patient-specific anatomical features such as disc height loss and osteophytes. The case studies suggest that intervertebral kinematic time-course data could have value in clinical assessments, lead to broader understanding of how specific anatomical features influence joint motions, and in due course inform clinical treatments.
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Affiliation(s)
- Christian Balkovec
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Jim H Veldhuis
- b Department of Civil and Environmental Engineering , University of Waterloo , Waterloo , Canada
| | - John W Baird
- c Markham Chiropractic Centre , Markham , Canada
| | - G Wayne Brodland
- b Department of Civil and Environmental Engineering , University of Waterloo , Waterloo , Canada.,d Centre for Bioengineering and Biotechnology , University of Waterloo , Waterloo , Canada
| | - Stuart M McGill
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
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du Rose A, Breen A. Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study. BMC Musculoskelet Disord 2016; 17:121. [PMID: 26964535 PMCID: PMC4785734 DOI: 10.1186/s12891-016-0975-1] [Citation(s) in RCA: 15] [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: 11/05/2015] [Accepted: 03/04/2016] [Indexed: 12/26/2022] Open
Abstract
Background Intervertebral motion impairment is widely thought to be related to chronic back disability, however, the movements of inter-vertebral pairs are not independent of each other and motion may also be related to morphology. Furthermore, maximum intervertebral range of motion (IV-RoMmax) is difficult to measure accurately in living subjects. The purpose of this study was to explore possible relationships between (IV-RoMmax) and lordosis, initial attainment rate and IV-RoMmax at other levels during weight-bearing flexion using quantitative fluoroscopy (QF). Methods Continuous QF motion sequences were recorded during controlled active sagittal flexion of 60° in 18 males (mean age 27.6 SD 4.4) with no history of low back pain in the previous year. IV-RoMmax, lordotic angle, and initial attainment rate at all inter-vertebral levels from L2-S1 were extracted. Relationships between IV-RoMmax and the other variables were explored using correlation coefficients, and simple linear regression was used to determine the effects of any significant relationships. Within and between observer repeatability of IV-RoMmax and initial attainment rate measurements were assessed in a sub-set of ten participants, using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM). Results QF measurements were highly repeatable, the lowest ICC for IV-RoMmax, being 0.94 (0.80–0.99) and highest SEM (0.76°). For initial attainment rate the lowest ICC was 0.84 (0.49–0.96) and the highest SEM (0.036). The results also demonstrated significant positive and negative correlations between IV-RoMmax and IV-RoMmax at other lumbar levels (r = −0.64–0.65), lordosis (r = −0.52–0.54), and initial attainment rate (r = −0.64–0.73). Simple linear regression analysis of all significant relationships showed that these predict between 28 and 42 % of the variance in IV-RoMmax. Conclusions This study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. These effects, when combined, may be important when such levels are being considered by healthcare professionals as potential sources of pain generation. Multivariate investigations in larger samples are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0975-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alister du Rose
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth, BH5 2DF, UK. .,Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK.
| | - Alan Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth, BH5 2DF, UK.,Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK
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Breen AC, Dupac M, Osborne N. Attainment rate as a surrogate indicator of the intervertebral neutral zone length in lateral bending: an in vitro proof of concept study. Chiropr Man Therap 2015; 23:28. [PMID: 26430509 PMCID: PMC4589909 DOI: 10.1186/s12998-015-0073-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Lumbar segmental instability is often considered to be a cause of chronic low back pain. However, defining its measurement has been largely limited to laboratory studies. These have characterised segmental stability as the intrinsic resistance of spine specimens to initial bending moments by quantifying the dynamic neutral zone. However these measurements have been impossible to obtain in vivo without invasive procedures, preventing the assessment of intervertebral stability in patients. Quantitative fluoroscopy (QF), measures the initial velocity of the attainment of intervertebral rotational motion in patients, which may to some extent be representative of the dynamic neutral zone. This study sought to explore the possible relationship between the dynamic neutral zone and intervertebral rotational attainment rate as measured with (QF) in an in vitro preparation. The purpose was to find out if further work into this concept is worth pursuing. Method This study used passive recumbent QF in a multi-segmental porcine model. This assessed the intrinsic intervertebral responses to a minimal coronal plane bending moment as measured with a digital force guage. Bending moments about each intervertebral joint were calculated and correlated with the rate at which global motion was attained at each intervertebral segment in the first 10° of global motion where the intervertebral joint was rotating. Results Unlike previous studies of single segment specimens, a neutral zone was found to exist during lateral bending. The initial attainment rates for left and right lateral flexion were comparable to previously published in vivo values for healthy controls. Substantial and highly significant levels of correlation between initial attainment rate and neutral zone were found for left (Rho = 0.75, P = 0.0002) and combined left-right bending (Rho = 0.72, P = 0.0001) and moderate ones for right alone (Rho = 0.55, P = 0.0012). Conclusions This study found good correlation between the initial intervertebral attainment rate and the dynamic neutral zone, thereby opening the possibility to detect segmental instability from clinical studies. However the results must be treated with caution. Further studies with multiple specimens and adding sagittal plane motion are warranted.
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Affiliation(s)
- Alexander C Breen
- School of Design Engineering and Computing, Bournemouth University, Bournemouth, BH1 5BB UK
| | - Mihai Dupac
- School of Design Engineering and Computing, Bournemouth University, Bournemouth, BH1 5BB UK
| | - Neil Osborne
- Anglo-European College of Chiropractic, Bournemouth, BH5 2DF UK
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Bisschop A, van Engelen SJPM, Kingma I, Holewijn RM, Stadhouder A, van der Veen AJ, van Dieën JH, van Royen BJ. Single level lumbar laminectomy alters segmental biomechanical behavior without affecting adjacent segments. Clin Biomech (Bristol, Avon) 2014; 29:912-7. [PMID: 25028214 DOI: 10.1016/j.clinbiomech.2014.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 05/08/2014] [Accepted: 06/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Degenerative lumbar spinal stenosis causes neurological symptoms due to neural compression. Lumbar laminectomy is a commonly used treatment for symptomatic degenerative spinal stenosis. However, it is unknown if and to what extent single level laminectomy affects the range of motion and stiffness of treated and adjacent segments. An increase in range of motion and a decrease in stiffness are possible predictors of post-operative spondylolisthesis or spinal failure. METHODS Twelve cadaveric human lumbar spines were obtained. After preloading, spines were tested in flexion-extension, lateral bending, and axial rotation. Subsequently, single level lumbar laminectomy analogous to clinical practice was performed at level lumbar 2 or 4. Thereafter, load-deformation tests were repeated. The range of motion and stiffness of treated and adjacent segments were calculated before and after laminectomy. Untreated segments were used as control group. Effects of laminectomy on stiffness and range of motion were tested, separately for treated, adjacent and control segments, using repeated measures analysis of variance. FINDINGS Range of motion at the level of laminectomy increased significantly for flexion and extension (7.3%), lateral bending (7.5%), and axial rotation (12.2%). Range of motion of adjacent segments was only significantly affected in lateral bending (-7.7%). Stiffness was not affected by laminectomy. INTERPRETATION The increase in range of motion of 7-12% does not seem to indicate the use of additional instrumentation to stabilize the lumbar spine. If instrumentation is still considered in a patient, its primary focus should be on re-stabilizing only the treated segment level.
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Affiliation(s)
- Arno Bisschop
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Susanne J P M van Engelen
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Idsart Kingma
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, The Netherlands
| | - Jaap H van Dieën
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands; Department of Biomedical Engineering, King Abdulaziz University, Saudi Arabia
| | - Barend J van Royen
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction. Radiography (Lond) 2014; 20:251-257. [PMID: 26512196 PMCID: PMC4579040 DOI: 10.1016/j.radi.2014.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. METHODS Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). RESULTS AND CONCLUSION The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm2), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm2) is lower than for four view functional radiography (7.34 Gy cm2). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm2) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.
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Branney J, Breen AC. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study. Chiropr Man Therap 2014; 22:24. [PMID: 25035795 PMCID: PMC4102240 DOI: 10.1186/s12998-014-0024-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/18/2014] [Indexed: 01/06/2023] Open
Abstract
Background Spinal manipulation for nonspecific neck pain is thought to work in part by
improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure
this or determine whether it is related to clinical outcomes. Objectives This study undertook to determine whether cervical spine flexion and extension
IV-RoM increases after a course of spinal manipulation, to explore relationships
between any IV-RoM increases and clinical outcomes and to compare palpation with
objective measurement in the detection of hypo-mobile segments. Method Thirty patients with nonspecific neck pain and 30 healthy controls matched for age
and gender received quantitative fluoroscopy (QF) screenings to measure flexion
and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September
2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and
Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up.
IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal
detectable changes (MDC) over 4 weeks were calculated from controls. Patients and
control IV-RoMs were compared at baseline as well as changes in patients over 4
weeks. Correlations between outcomes and the number of manipulations received and
the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments
were calculated. Results QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o,
lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o
to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC
and there was no significant difference between the number of hypo-mobile segments
in patients and controls at baseline or significant increases in IV-RoMs in
patients. However, there was a modest and significant correlation between the
number of manipulations received and the number of levels and directions whose
IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement
between palpation and QF in identifying hypo-mobile segments (Kappa
0.04-0.06). Conclusions This study found no differences in cervical sagittal IV-RoM between patients with
non-specific neck pain and matched controls. There was a modest dose-response
relationship between the number of manipulations given and number of levels
increasing IV-RoM - providing evidence that neck manipulation has a mechanical
effect at segmental levels. However, patient-reported outcomes were not related to
this.
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Affiliation(s)
- Jonathan Branney
- Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK ; The School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK
| | - Alan C Breen
- Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK
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Proportional lumbar spine inter-vertebral motion patterns: a comparison of patients with chronic, non-specific low back pain and healthy controls. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2059-67. [PMID: 24676852 DOI: 10.1007/s00586-014-3273-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Identifying biomechanical subgroups in chronic, non-specific low back pain (CNSLBP) populations from inter-vertebral displacements has proven elusive. Quantitative fluoroscopy (QF) has excellent repeatability and provides continuous standardised inter-vertebral kinematic data from fluoroscopic sequences allowing assessment of mid-range motion. The aim of this study was to determine whether proportional continuous IV rotational patterns were different in patients and controls. A secondary aim was to update the repeatability of QF measurement of range of motion (RoM) for inter-vertebral (IV) rotation. METHODS AND MATERIALS Fluoroscopic sequences were recorded of passive, recumbent coronal and sagittal motion, which was controlled for range and velocity. Segments L2-5 in 40 primary care CNSLBP patients and 40 matched controls were compared. Patients also completed the von Korff Chronic Pain Grade and Roland and Morris Disability Questionnaire. Sequences were processed using automated image tracking algorithms to extract continuous inter-vertebral rotation data. These were converted to continuous proportional ranges of rotation (PR). The continuous proportional range variances were calculated for each direction and combined to produce a single variable representing their fluctuation (CPRV). Inter- and intra-rater repeatability were also calculated for the maximum IV-RoM measurements obtained during controlled trunk motion to provide an updated indication of the reliability and agreement of QF for measuring spine kinematics. RESULTS CPRV was significantly higher in patients (0.011 vs. 0.008, Mann-Whitney two-sided p = 0.008), implying a mechanical subgroup. Receiver operating characteristic curve analysis found its sensitivity and specificity to be 0.78 % (60-90) and 0.55 % (37-73), respectively (area under the curve 0.672). CPRV was not correlated with pain severity or disability. The repeatability of maximum inter-vertebral range was excellent, but range was only significantly greater in patients at L4-5 in right side bending (p = 0.03). CONCLUSION The variation in proportional motion between lumbar vertebrae during passive recumbent trunk motion was greater in patients with CNSLBP than in matched healthy controls, indicating that biomechanical factors in passive structures play a part.
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Breen AC, Teyhen DS, Mellor FE, Breen AC, Wong KWN, Deitz A. Measurement of intervertebral motion using quantitative fluoroscopy: report of an international forum and proposal for use in the assessment of degenerative disc disease in the lumbar spine. Adv Orthop 2012; 2012:802350. [PMID: 22666606 PMCID: PMC3362008 DOI: 10.1155/2012/802350] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/26/2012] [Indexed: 01/03/2023] Open
Abstract
Quantitative fluoroscopy (QF) is an emerging technology for measuring intervertebral motion patterns to investigate problem back pain and degenerative disc disease. This International Forum was a networking event of three research groups (UK, US, Hong Kong), over three days in San Francisco in August 2009. Its aim was to reach a consensus on how best to record, analyse, and communicate QF information for research and clinical purposes. The Forum recommended that images should be acquired during regular trunk motion that is controlled for velocity and range, in order to minimise externally imposed variability as well as to correlate intervertebral motion with trunk motion. This should be done in both the recumbent passive and weight bearing active patient configurations. The main recommended outputs from QF were the true ranges of intervertebral rotation and translation, neutral zone laxity and the consistency of shape of the motion patterns. The main clinical research priority should initially be to investigate the possibility of mechanical subgroups of patients with chronic, nonspecific low back pain by comparing their intervertebral motion patterns with those of matched healthy controls.
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Affiliation(s)
- Alan C. Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK
| | - Deydre S. Teyhen
- Fort Sam Houston, US Army-Baylor University, San Antonio, TX 78234, USA
| | - Fiona E. Mellor
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK
| | - Alexander C. Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK
| | - Kris W. N. Wong
- Faculty of Science & Technology, Technological and Higher Education Institute of Hong Kong, Hong Kong
| | - Adam Deitz
- Ortho Kinematics Inc., 1704 Bee Caves Road, Building 3, Suite 315, Austin, TX 78746, USA
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