1
|
Evans DW, Wong IT, Leung HK, Yang H, Liew BX. Quantifying lumbar mobility using a single tri-axial accelerometer. Heliyon 2024; 10:e32544. [PMID: 38961956 PMCID: PMC11219489 DOI: 10.1016/j.heliyon.2024.e32544] [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: 07/14/2023] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024] Open
Abstract
Background Lumbar mobility is regarded as important for assessing and managing low back pain (LBP). Inertial Measurement Units (IMUs) are currently the most feasible technology for quantifying lumbar mobility in clinical and research settings. However, their gyroscopes are susceptible to drift errors, limiting their use for long-term remote monitoring. Research question Can a single tri-axial accelerometer provide an accurate and feasible alternative to a multi-sensor IMU for quantifying lumbar flexion mobility and velocity? Methods In this cross-sectional study, 18 healthy adults performed nine repetitions of full spinal flexion movements. Lumbar flexion mobility and velocity were quantified using a multi-sensor IMU and just the tri-axial accelerometer within the IMU. Correlations between the two methods were assessed for each percentile of the lumbar flexion movement cycle, and differences in measurements were modelled using a Generalised Additive Model (GAM). Results Very high correlations (r > 0.90) in flexion angles and velocities were found between the two methods for most of the movement cycle. However, the accelerometer overestimated lumbar flexion angle at the start (-4.7° [95 % CI -7.6° to -1.8°]) and end (-4.8° [95 % CI -7.7° to -1.9°]) of movement cycles, but underestimated angles (maximal difference of 4.3° [95 % CI 1.4° to 7.2°]) between 7 % and 92 % of the movement cycle. For flexion velocity, the accelerometer underestimated at the start (16.6°/s [95%CI 16.0 to 17.2°/s]) and overestimated (-12.3°/s [95%CI -12.9 to -11.7°/s]) at the end of the movement, compared to the IMU. Significance Despite the observed differences, the study suggests that a single tri-axial accelerometer could be a feasible tool for continuous remote monitoring of lumbar mobility and velocity. This finding has potential implications for the management of LBP, enabling more accessible and cost-effective monitoring of lumbar mobility in both clinical and research settings.
Collapse
Affiliation(s)
- David W. Evans
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ian T.Y. Wong
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Hoi Kam Leung
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Hanyun Yang
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Bernard X.W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| |
Collapse
|
2
|
Breen A, Nematimoez M, Branney J, Breen A. Passive intervertebral restraint is different in patients with treatment-resistant chronic nonspecific low back pain: a retrospective cohort study and control comparison. 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 2024; 33:2405-2419. [PMID: 38730057 DOI: 10.1007/s00586-024-08249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE In vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending. METHODS Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables. RESULTS There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient-control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM. CONCLUSION Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.
Collapse
Affiliation(s)
- Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| | - Mehdi Nematimoez
- Department of Sport Biomechanics, University of Bojnord, Bojnurd, Iran
| | - Jonathan Branney
- Faculty of Health and Social Science, Bournemouth University, Poole, BH12 5BB, UK.
| | - Alexander Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| |
Collapse
|
3
|
Liew BXW, Crisafulli O, Evans DW. Quantifying lumbar sagittal plane kinematics using a wrist-worn inertial measurement unit. Front Sports Act Living 2024; 6:1381020. [PMID: 38807615 PMCID: PMC11130507 DOI: 10.3389/fspor.2024.1381020] [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: 02/02/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024] Open
Abstract
Wearable sensors like inertial measurement units (IMUs), and those available as smartphone or smartwatch applications, are increasingly used to quantify lumbar mobility. Currently, wearable sensors have to be placed on the back to measure lumbar mobility, meaning it cannot be used in unsupervised environments. This study aims to compare lumbar sagittal plane angles quantified from a wrist-worn against that of a lumbar-worn sensor. Twenty healthy participants were recruited. An IMU was placed on the right wrist and the L3 spinal level. Participants had to position their right forearm on their abdomen, parallel to the floor. Three sets of three consecutive repetitions of flexion, and extension were formed. Linear mixed models were performed to quantify the effect of region (lumbar vs. wrist) on six outcomes [minimum, maximum, range of motion (ROM) of flexion and extension]. Only flexion ROM was significantly different between the wrist and lumbar sensors, with a mean of 4.54° (95% CI = 1.82°-7.27°). Across all outcomes, the maximal difference between a wrist-worn and lumbar-worn sensor was <8°. A wrist-worn IMU sensor could be used to measure gross lumbar sagittal plane mobility in place of a lumbar-worn IMU. This may be useful for remote monitoring during rehabilitation.
Collapse
Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Oscar Crisafulli
- Criams-Sport Medicine Centre Voghera, University of Pavia, Pavia, Italy
| | - David W. Evans
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
4
|
Cooper J, Chow JCK, Lichti D. Enhancing Single-Plane Fluoroscopy: A Self-Calibrating Bundle Adjustment for Distortion Modeling. Diagnostics (Basel) 2024; 14:567. [PMID: 38473039 DOI: 10.3390/diagnostics14050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/11/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Single-plane fluoroscopy systems with image intensifiers remain commonly employed in a clinical setting. The imagery they capture is vulnerable to several types of geometric distortions introduced by the system's components and their assembly as well as interactions with the local and global magnetic fields. In this study, the application of a self-calibrating bundle adjustment is investigated as a method to correct geometric distortions in single-plane fluoroscopic imaging systems. The resulting calibrated imagery is then applied in the quantitative analysis of diaphragmatic motion and potential diagnostic applications to hemidiaphragm paralysis. The calibrated imagery is further explored and discussed in its potential impact on areas of surgical navigation. This work was accomplished through the application of a controlled experiment with three separate Philips Easy Diagnost R/F Systems. A highly redundant (~2500 to 3500 degrees-of-freedom) and geometrically strong network of 18 to 22 images of a low-cost target field was collected. The target field comprised 121 pre-surveyed tantalum beads embedded on a 25.4 mm × 25.4 mm acrylic base plate. The modeling process resulted in the estimation of five to eight distortion coefficients, depending on the system. The addition of these terms resulted in 83-85% improvement in terms of image point precision (model fit) and 85-95% improvement in 3D object reconstruction accuracy after calibration. This study demonstrates significant potential in enhancing the accuracy and reliability of fluoroscopic imaging, thereby improving the overall quality and effectiveness of medical diagnostics and treatments.
Collapse
Affiliation(s)
- Jackson Cooper
- Department of Geomatics Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jacky C K Chow
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Derek Lichti
- Department of Geomatics Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| |
Collapse
|
5
|
Meszaros-Beller L, Antico M, Fontanarosa D, Pivonka P. Assessment of thoracic spinal curvatures in static postures using spatially tracked 3D ultrasound volumes: a proof-of-concept study. Phys Eng Sci Med 2023; 46:197-208. [PMID: 36625994 PMCID: PMC10030537 DOI: 10.1007/s13246-022-01210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023]
Abstract
The assessment of spinal posture is a difficult endeavour given the lack of identifiable bony landmarks for placement of skin markers. Moreover, potentially significant soft tissue artefacts along the spine further affect the accuracy of marker-based approaches. The objective of this proof-of-concept study was to develop an experimental framework to assess spinal postures by using three-dimensional (3D) ultrasound (US) imaging. A phantom spine model immersed in water was scanned using 3D US in a neutral and two curved postures mimicking a forward flexion in the sagittal plane while the US probe was localised by three electromagnetic tracking sensors attached to the probe head. The obtained anatomical 'coarse' registrations were further refined using an automatic registration algorithm and validated by an experienced sonographer. Spinal landmarks were selected in the US images and validated against magnetic resonance imaging data of the same phantom through image registration. Their position was then related to the location of the tracking sensors identified in the acquired US volumes, enabling the localisation of landmarks in the global coordinate system of the tracking device. Results of this study show that localised 3D US enables US-based anatomical reconstructions comparable to clinical standards and the identification of spinal landmarks in different postures of the spine. The accuracy in sensor identification was 0.49 mm on average while the intra- and inter-observer reliability in sensor identification was strongly correlated with a maximum deviation of 0.8 mm. Mapping of landmarks had a small relative distance error of 0.21 mm (SD = ± 0.16) on average. This study implies that localised 3D US holds the potential for the assessment of full spinal posture by accurately and non-invasively localising vertebrae in space.
Collapse
Affiliation(s)
- Laura Meszaros-Beller
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia.
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia.
| | - Maria Antico
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
6
|
Breen A, Carvil P, Green DA, Russomano T, Breen A. Effects of a microgravity SkinSuit on lumbar geometry and kinematics. 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 2023; 32:839-847. [PMID: 36645514 DOI: 10.1007/s00586-022-07454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/12/2022] [Accepted: 11/05/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Astronauts returning from long ISS missions have demonstrated an increased incidence of lumbar disc herniation accompanied by biomechanical and morphological changes associated with spine elongation. This research describes a ground-based study of the effects of an axial compression countermeasure Mk VI SkinSuit designed to reload the spine and reduce these changes before return to terrestrial gravity. METHODS Twenty healthy male volunteers aged 21-36 without back pain participated. Each lay overnight on a Hyper Buoyancy Flotation (HBF) bed for 12 h on two occasions 6 weeks apart. On the second occasion participants donned a Mk VI SkinSuit designed to axially load the spine at 0.2 Gz during the last 4 h of flotation. Immediately after each exposure, participants received recumbent MRI and flexion-extension quantitative fluoroscopy scans of their lumbar spines, measuring differences between spine geometry and intervertebral kinematics with and without the SkinSuit. This was followed by the same procedure whilst weight bearing. Paired comparisons were performed for all measurements. RESULTS Following Mk VI SkinSuit use, participants evidenced more flexion RoM at L3-4 (p = 0.01) and L4-5 (p = 0.003), more translation at L3-4 (p = 0.02), lower dynamic disc height at L5-S1 (p = 0.002), lower lumbar spine length (p = 0.01) and greater lordosis (p = 0.0001) than without the Mk VI SkinSuit. Disc cross-sectional area and volume were not significantly affected. CONCLUSION The MkVI SkinSuit restores lumbar mobility and lordosis following 4 h of wearing during hyper buoyancy flotation in a healthy control population and may be an effective countermeasure for post space flight lumbar disc herniation.
Collapse
Affiliation(s)
- Alexander Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| | - Philip Carvil
- Centre of Human and Applied Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - David Andrew Green
- Centre of Human and Applied Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK.,Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany.,KBRwyle, Cologne, Germany
| | - Thais Russomano
- CEMA, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz (Edifício Comum ao Hospital de Santa Maria), 1649-028, Lisbon, Portugal
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
| |
Collapse
|
7
|
Daniel ES, Lee RYW, Williams JM. The reliability of video fluoroscopy, ultrasound imaging, magnetic resonance imaging and radiography for measurements of lumbar spine segmental range of motion in-vivo: A review. J Back Musculoskelet Rehabil 2023; 36:117-135. [PMID: 35988213 DOI: 10.3233/bmr-210285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge. OBJECTIVE To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo. METHODS The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised. RESULTS The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen. CONCLUSIONS Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.
Collapse
Affiliation(s)
| | - Raymond Y W Lee
- Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | | |
Collapse
|
8
|
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.
Collapse
|
9
|
Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation. Spine J 2022; 22:197-206. [PMID: 34343665 DOI: 10.1016/j.spinee.2021.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight. PURPOSE To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6 months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology. STUDY DESIGN This is a prospective longitudinal study. PATIENT SAMPLE Our sample included a cohort of twelve astronaut crewmembers. OUTCOME MEASURES From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral endplate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm2), multifidus lean muscle cross-sectional area (cm2), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (°), maximum lateral bending ROM (°), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI. METHODS Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending six months in space: (1) within a year before launch ("pre-flight"), (2) within a week after return to Earth ("post-flight"), and (3) between 1 and 2 months after return to Earth ("recovery"). Fluoroscopy of segmental kinematics was collected at preflight and postflight timepoints. We assessed the effect of spaceflight and postflight recovery on longitudinal changes in spinal structure and function, as well as differences between crew members who did and did not present a symptomatic disc herniation following spaceflight. RESULTS Half of our astronauts (n=6) experienced new symptoms associated with a new or previously asymptomatic lumbar disc protrusion or extrusion following spaceflight. We observed decreased multifidus muscle quality following spaceflight in the lower lumbar spine, with a reduced percentage of lean muscle at L4L5 (-6.2%, p=.009) and L5S1 (-7.0%, p=.006) associated with the incidence of new disc herniation. Additionally, we observed reduced lumbar segment flexion-extension ROM for L2L3 (-17.2%, p=.006) and L3L4 (-20.5%, p=.02) following spaceflight, and furthermore that reduced ROM among the upper three lumbar segments (-24.1%, p=.01) associated with the incidence of disc herniation. Existing endplate pathology was most prevalent in the upper lumbar spine and associated with reduced segmental ROM (-20.5%, p=.02). CONCLUSIONS In conclusion from a 10-year study investigating the effects of spaceflight on the lumbar spine and risk for disc herniation, we found the incidence of lumbar disc herniation following spaceflight associates with compromised multifidus muscle quality and spinal segment kinematics, as well as pre-existing spinal endplate irregularities. These findings suggest differential effects of spinal stiffness and muscle loss in the upper versus lower lumbar spine regions that may specifically provoke risk for symptomatic disc herniation in the lower lumbar spine following spaceflight. Results from this study provide a unique longitudinal assessment of mechanisms and possible risk factors for developing disc herniations and related low back pain. Furthermore, these findings will help inform physiologic countermeasures to maintain spinal health in astronauts during long-duration missions in space.
Collapse
|
10
|
Breen A, De Carvalho D, Funabashi M, Kawchuk G, Pagé I, Wong AYL, Breen A. A Reference Database of Standardised Continuous Lumbar Intervertebral Motion Analysis for Conducting Patient-Specific Comparisons. Front Bioeng Biotechnol 2021; 9:745837. [PMID: 34646820 PMCID: PMC8503612 DOI: 10.3389/fbioe.2021.745837] [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: 07/22/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Lumbar instability has long been thought of as the failure of lumbar vertebrae to maintain their normal patterns of displacement. However, it is unknown what these patterns consist of. Research using quantitative fluoroscopy (QF) has shown that continuous lumbar intervertebral patterns of rotational displacement can be reliably measured during standing flexion and return motion using standardised protocols and can be used to assess patients with suspected lumbar spine motion disorders. However, normative values are needed to make individualised comparisons. One hundred and thirty-one healthy asymptomatic participants were recruited and performed guided flexion and return motion by following the rotating arm of an upright motion frame. Fluoroscopic image acquisition at 15fps was performed and individual intervertebral levels from L2-3 to L5-S1 were tracked and analysed during separate outward flexion and return phases. Results were presented as proportional intervertebral motion representing these phases using continuous means and 95%CIs, followed by verification of the differences between levels using Statistical Parametric Mapping (SPM). A secondary analysis of 8 control participants matched to 8 patients with chronic, non-specific low back pain (CNSLBP) was performed for comparison. One hundred and twenty-seven asymptomatic participants’ data were analysed. Their ages ranged from 18 to 70 years (mean 38.6) with mean body mass index 23.8 kg/m2 48.8% were female. Both the flexion and return phases for each level evidenced continuous change in mean proportional motion share, with narrow confidence intervals, highly significant differences and discrete motion paths between levels as confirmed by SPM. Patients in the secondary analysis evidenced significantly less L5-S1 motion than controls (p < 0.05). A reference database of spinal displacement patterns during lumbar (L2-S1) intersegmental flexion and return motion using a standardised motion protocol using fluoroscopy is presented. Spinal displacement patterns in asymptomatic individuals were found to be distinctive and consistent for each intervertebral level, and to continuously change during bending and return. This database may be used to allow continuous intervertebral kinematics to drive dynamic models of joint and muscular forces as well as reference values against which to make patient-specific comparisons in suspected cases of lumbar spine motion disorders.
Collapse
Affiliation(s)
| | - Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Département de chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Isabelle Pagé
- Département de chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Alan Breen
- AECC University College, Bournemouth, United Kingdom.,Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| |
Collapse
|
11
|
Errors in Measuring Glenohumeral Arthrokinematics With 2-Dimensional Fluoroscopy. J Appl Biomech 2021; 37:282-287. [PMID: 33485271 DOI: 10.1123/jab.2020-0098] [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: 04/08/2020] [Revised: 09/26/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Two-dimensional fluoroscopic imaging allows measurement of small magnitude humeral head translations that are prone to errors due to optical distortion, out-of-plane imaging, repeated manual identification of landmarks, and magnification. This article presents results from in vivo and in vitro fluoroscopy-based experiments that measure the errors and variability in estimating the humeral head translated position in true scapular plane and axillary views. The errors were expressed as bias and accuracy. The variability with repeated digitization was calculated using the intraclass correlation coefficient (ICC) and the standard error of measurement. Optical distortion caused underestimation of linear distances. The accuracy was 0.11 and 0.43 mm for in vitro and in vivo experiments, respectively, for optical distortion. The intrarater reliability was excellent for both views (ICC = .94 and .93), and interrater reliability was excellent (ICC = .95) for true scapular view but moderate (ICC = .74) for axillary views. The standard error of measurement ranged from 0.27 to 0.58 mm. The accuracy for the humeral head position in 10° out of true scapular plane images ranged from 0.80 to 0.87 mm. The current study quantifies the magnitude of error. The results suggest that suitable measures could be incorporated to minimize errors and variability for the measurement of glenohumeral parameters.
Collapse
|
12
|
To D, Breen A, Breen A, Mior S, Howarth SJ. Investigator analytic repeatability of two new intervertebral motion biomarkers for chronic, nonspecific low back pain in a cohort of healthy controls. Chiropr Man Therap 2020; 28:62. [PMID: 33228737 PMCID: PMC7685540 DOI: 10.1186/s12998-020-00350-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background Understanding the mechanisms underlying chronic, nonspecific low back pain (CNSLBP) is essential to advance personalized care and identify the most appropriate intervention. Recently, two intervertebral motion biomarkers termed “Motion Sharing Inequality” (MSI) and “Motion Sharing Variability” (MSV) have been identified for CNSLBP using quantitative fluoroscopy (QF). The aim of this study was to conduct intra- and inter-investigator analytic repeatability studies to determine the extent to which investigator error affects their measurement in clinical studies. Methods A cross-sectional cohort study was conducted using the image sequences of 30 healthy controls who received QF screening during passive recumbent flexion motion. Two independent investigators analysed the image sequences for MSI and MSV from October to November 2018. Intra and inter- investigator repeatability studies were performed using intraclass correlations (ICC), standard errors of measurement (SEM) and minimal differences (MD). Results Intra-investigator ICCs were 0.90 (0.81,0.95) (SEM 0.029) and 0.78 (0.59,0.89) (SEM 0.020) for MSI and MSV, respectively. Inter-investigator ICCs 0.93 (0.86,0.97) (SEM 0.024) and 0.55 (0.24,0.75) (SEM 0.024). SEMs for MSI and MSV were approximately 10 and 30% of their group means respectively. The MDs for MSI for intra- and inter-investigator repeatability were 0.079 and 0.067, respectively and for MSV 0.055 and 0.067. Conclusions MSI demonstrated substantial intra- and inter-investigator repeatability, suggesting that investigator input has a minimal influence on its measurement. MSV demonstrated moderate intra-investigator reliability and fair inter-investigator repeatability. Confirmation in patients with CNSLBP is now required.
Collapse
Affiliation(s)
- Daphne To
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | - Alan Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | - Silvano Mior
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Samuel J Howarth
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.
| |
Collapse
|
13
|
Brownhill K, Mellor F, Breen A, Breen A. Passive intervertebral motion characteristics in chronic mid to low back pain: A multivariate analysis. Med Eng Phys 2020; 84:115-125. [PMID: 32977908 DOI: 10.1016/j.medengphy.2020.08.006] [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: 03/23/2020] [Revised: 07/02/2020] [Accepted: 08/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Studies comparing back pain patients and controls on continuous intervertebral kinematics have shown differences using univariate parameters. Hitherto, multivariate approaches have not been applied to this high dimensional data, risking clinically relevant features being undetected. A multivariate re-analysis was carried out to estimate main modes of variation, and explore group differences. METHODS 40 participants with mechanical back pain and 40 matched controls underwent passive recumbent quantitative videofluoroscopy. Intervertebral angles of L2/3 to L4/5 were obtained for right and left side-bending, extension, and flexion. Principal components analysis (PCA) was used to identify the main modes of variation, and to obtain a lower dimensional representation for comparing groups. Linear discriminant analysis (LDA) was used to identify how groups differed. RESULTS PCA identified three main modes of variation, all relating to range of motion (ROM) and its distribution between joints. Significant differences were found for coronal plane motions only (right: p = 0.02, left: p = 0.03) . LDA identified a shift in ROM to more cranial joints in the back pain group. CONCLUSION The results confirm altered motion sharing between intervertebral joints in back pain, and provides more details about this. Further work is required to establish how these findings lead to pain, and so strengthen the theoretical basis for treatment and management of this condition.
Collapse
Affiliation(s)
- Kevin Brownhill
- University College of Osteopathy, 275 Borough High Street, London SE1 1JE, United Kingdom.
| | - Fiona Mellor
- Centre for Biomechanics Research, AECC University College, Bournemouth, United Kingdom.
| | - Alex Breen
- Centre for Biomechanics Research, AECC University College, Bournemouth, United Kingdom.
| | - Alan Breen
- Centre for Biomechanics Research, AECC University College, Bournemouth, United Kingdom.
| |
Collapse
|
14
|
Breen A, Claerbout E, Hemming R, Ayer R, Breen A. Comparison of intra subject repeatability of quantitative fluoroscopy and static radiography in the measurement of lumbar intervertebral flexion translation. Sci Rep 2019; 9:19253. [PMID: 31848427 PMCID: PMC6917745 DOI: 10.1038/s41598-019-55905-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
Low back pain patients are sometimes offered fusion surgery if intervertebral translation, measured from static, end of range radiographs exceeds 3 mm. However, it is essential to know the measurement error of such methods, if selection for back surgery is going to be informed by them. Fifty-five healthy male (34) and female (21) pain free participants aged 21-80 years received quantitative fluoroscopic (QF) imaging both actively during standing and passively in the lateral decubitus position. The following five imaging protocols were extracted from 2 motion examinations, which were repeated 6 weeks apart: 1. Static during upright free bending. 2. Maximum during controlled upright bending, 3. At the end of controlled upright bending, 4. Maximum during controlled recumbent bending, 5. At the end of controlled recumbent bending. Intervertebral flexion translations from L2-S1 were determined for each protocol and their measurement errors (intra subject repeatability) calculated. Estimations using static, free bending radiographic images gave measurement errors of up to 4 mm, which was approximately twice that of the QF protocols. Significantly higher ranges at L4-5 and L5-S1 were obtained from the static protocol compared with the QF protocols. Weight bearing ranges at these levels were also significantly higher in males regardless of the protocol. Clinical decisions based on sagittal translations of less than 4 mm would therefore require QF imaging.
Collapse
Affiliation(s)
- Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Emilie Claerbout
- Centre for Biomechanics Research, AECC University College, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Rebecca Hemming
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, Eastgate House 35 - 43 Newport Road, Cardiff, CF24 0AB, UK
| | - Ravi Ayer
- Radiology Department, Poole General Hospital NHS Foundation Trust, Longfleet Rd, Poole, BH15 2JB, UK
| | - Alan Breen
- Faculty of Science and Technology Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK.
| |
Collapse
|
15
|
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.
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
du Rose A. Have Studies that Measure Lumbar Kinematics and Muscle Activity Concurrently during Sagittal Bending Improved Understanding of Spinal Stability and Sub-System Interactions? A Systematic Review. Healthcare (Basel) 2018; 6:healthcare6030112. [PMID: 30205578 PMCID: PMC6163188 DOI: 10.3390/healthcare6030112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022] Open
Abstract
In order to improve understanding of the complex interactions between spinal sub-systems (i.e., the passive (ligaments, discs, fascia and bones), the active (muscles and tendons) and the neural control systems), it is necessary to take a dynamic approach that incorporates the measurement of multiple systems concurrently. There are currently no reviews of studies that have investigated dynamic sagittal bending movements using a combination of electromyography (EMG) and lumbar kinematic measurements. As such it is not clear how understanding of spinal stability concepts has advanced with regards to this functional movement of the spine. The primary aim of this review was therefore to evaluate how such studies have contributed to improved understanding of lumbar spinal stability mechanisms. PubMed and Cochrane databases were searched using combinations of the keywords related to spinal stability and sagittal bending tasks, using strict inclusion and exclusion criteria and adhering to PRISMA guidelines. Whilst examples of the interactions between the passive and active sub-systems were shown, typically small sample sizes meant that results were not generalizable. The majority of studies used regional kinematic measurements, and whilst this was appropriate in terms of individual study aims, the studies could not provide insight into sub-system interaction at the level of the spinal motion segment. In addition, the heterogeneity in methodologies made comparison between studies difficult. The review suggests that since Panjabi’s seminal spinal control papers, only limited advancement in the understanding of these theories has been provided by the studies under review, particularly at an inter-segmental level. This lack of progression indicates a requirement for new research approaches that incorporate multiple system measurements at a motion segment level.
Collapse
Affiliation(s)
- Alister du Rose
- Faculty of Life Sciences and Education, University of South Wales, Treforest, Pontypridd, Wales CF37 1DL, UK.
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Breen A, Mellor F, Breen A. Aberrant intervertebral motion in patients with treatment-resistant nonspecific low back pain: a retrospective cohort study and control comparison. 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; 27:2831-2839. [PMID: 29926209 DOI: 10.1007/s00586-018-5666-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Intervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown. METHODS Thirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls. RESULTS Eleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p = 0.010), but not MSV (patients 0.08 vs controls 0.08, p = 0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p = 0.018) or no disruption (0.28, p = 0.0007). Laxity and translation above reference limits were not more prevalent in patients. CONCLUSION Patients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Fiona Mellor
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
| |
Collapse
|
21
|
Zanjani-Pour S, Meakin JR, Breen A, Breen A. Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models. J Biomech 2018; 70:134-139. [DOI: 10.1016/j.jbiomech.2017.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
|
22
|
A model-based approach for estimation of changes in lumbar segmental kinematics associated with alterations in trunk muscle forces. J Biomech 2017; 70:82-87. [PMID: 29029957 DOI: 10.1016/j.jbiomech.2017.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022]
Abstract
The kinematics information from imaging, if combined with optimization-based biomechanical models, may provide a unique platform for personalized assessment of trunk muscle forces (TMFs). Such a method, however, is feasible only if differences in lumbar spine kinematics due to differences in TMFs can be captured by the current imaging techniques. A finite element model of the spine within an optimization procedure was used to estimate segmental kinematics of lumbar spine associated with five different sets of TMFs. Each set of TMFs was associated with a hypothetical trunk neuromuscular strategy that optimized one aspect of lower back biomechanics. For each set of TMFs, the segmental kinematics of lumbar spine was estimated for a single static trunk flexed posture involving, respectively, 40° and 10° of thoracic and pelvic rotations. Minimum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 0° to 0.7° and 0 mm to 0.04 mm, respectively. Maximum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 2.4° to 7.6° and 0.11 mm to 0.39 mm, respectively. The differences in kinematics of lumbar segments between each combination of two sets of TMFs in 97% of cases for angular deformation and 55% of cases for translational deformation were within the reported accuracy of current imaging techniques. Therefore, it might be possible to use image-based kinematics of lumbar segments along with computational modeling for personalized assessment of TMFs.
Collapse
|
23
|
Low back pain: Identifying sub-groups, clinical prediction rules and measuring results. Complement Ther Clin Pract 2017; 31:335-337. [PMID: 28803709 DOI: 10.1016/j.ctcp.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
|
24
|
van den Hoorn W, Coppieters MW, van Dieën JH, Hodges PW. Development and Validation of a Method to Measure Lumbosacral Motion Using Ultrasound Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1221-1229. [PMID: 26895754 DOI: 10.1016/j.ultrasmedbio.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/20/2015] [Accepted: 01/03/2016] [Indexed: 06/05/2023]
Abstract
The study aim was to validate an ultrasound imaging technique to measure sagittal plane lumbosacral motion. Direct and indirect measures of lumbosacral angle change were developed and validated. Lumbosacral angle was estimated by the angle between lines through two landmarks on the sacrum and lowest lumbar vertebrae. Distance measure was made between the sacrum and lumbar vertebrae, and angle was estimated after distance was calibrated to angle. This method was tested in an in vitro spine and an in vivo porcine spine and validated to video and fluoroscopy measures, respectively. R(2), regression coefficients and mean absolute differences between ultrasound measures and validation measures were, respectively: 0.77, 0.982, 0.67° (in vitro, angle); 0.97, 0.992, 0.82° (in vitro, distance); 0.94, 0.995, 2.1° (in vivo, angle); and 0.95, 0.997, 1.7° (in vivo, distance). Lumbosacral motion can be accurately measured with ultrasound. This provides a basis to develop measurements for use in humans.
Collapse
Affiliation(s)
- Wolbert van den Hoorn
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Michel W Coppieters
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul W Hodges
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
25
|
Breen A, Breen A. Accuracy and repeatability of quantitative fluoroscopy for the measurement of sagittal plane translation and finite centre of rotation in the lumbar spine. Med Eng Phys 2016; 38:607-614. [PMID: 27129784 DOI: 10.1016/j.medengphy.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/17/2016] [Accepted: 03/19/2016] [Indexed: 11/17/2022]
Abstract
Quantitative fluoroscopy (QF) was developed to measure intervertebral mechanics in vivo and has been found to have high repeatability and accuracy for the measurement of intervertebral rotations. However, sagittal plane translation and finite centre of rotation (FCR) are potential measures of stability but have not yet been fully validated for current QF. This study investigated the repeatability and accuracy of QF for measuring these variables. Repeatability was assessed from L2-S1 in 20 human volunteers. Accuracy was investigated using 10 consecutive measurements from each of two pairs of linked and instrumented dry human vertebrae as reference; one which tilted without translation and one which translated without tilt. The results found intra- and inter-observer repeatability for translation to be 1.1mm or less (SEM) with fair to substantial reliability (ICC 0.533-0.998). Intra-observer repeatability of FCR location for inter-vertebral rotations of 5° and above ranged from 1.5mm to 1.8mm (SEM) with moderate to substantial reliability (ICC 0.626-0.988). Inter-observer repeatability for FCR ranged from 1.2mm to 5.7mm, also with moderate to substantial reliability (ICC 0.621-0.878). Reliability was substantial (ICC>0.81) for 10/16 measures for translation and 5/8 for FCR location. Accuracy for translation was 0.1mm (fixed centre) and 2.2mm (moveable centre), with an FCR error of 0.3mm(x) and 0.4mm(y) (fixed centre). This technology was found to have a high level of accuracy and with a few exceptions, moderate to substantial repeatability for the measurement of translation and FCR from fluoroscopic motion sequences.
Collapse
Affiliation(s)
- Alexander Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, Dorset BH5 2DF, UK
| | - Alan Breen
- School of Design Engineering and Computing, Bournemouth University, Talbot Campus, Poole, Dorset BH12 5BB, UK.
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
du Rose A, Breen A. Relationships between Paraspinal Muscle Activity and Lumbar Inter-Vertebral Range of Motion. Healthcare (Basel) 2016; 4:healthcare4010004. [PMID: 27417592 PMCID: PMC4934538 DOI: 10.3390/healthcare4010004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 11/16/2022] Open
Abstract
Control of the lumbar spine requires contributions from both the active and passive sub-systems. Identifying interactions between these systems may provide insight into the mechanisms of low back pain. However, as a first step it is important to investigate what is normal. The purpose of this study was to explore the relationships between the lumbar inter-vertebral range of motion and paraspinal muscle activity during weight-bearing flexion in healthy controls using quantitative fluoroscopy (QF) and surface electromyography (sEMG). Contemporaneous lumbar sEMG and QF motion sequences were recorded during controlled active flexion of 60° using electrodes placed over Longissimus thoracis pars thoracis (TES), Longissimus thoracis pars lumborum (LES), and Multifidus (LMU). Normalised root mean square (RMS) sEMG amplitude data were averaged over five epochs, and the change in amplitude between epochs was calculated. The sEMG ratios of LMU/LES LMU/TES and LES/TES were also determined. QF was used to measure the maximum inter-vertebral range of motion from L2-S1, and correlation coefficients were calculated between sEMG amplitude variables and these measurements. Intra- and inter-session sEMG amplitude repeatability was also assessed for all three paraspinal muscles. The sEMG amplitude measurements were highly repeatable, and sEMG amplitude changes correlated significantly with L4-5 and L5-S1 IV-RoMmax (r = -0.47 to 0.59). The sEMG amplitude ratio of LES/TES also correlated with L4-L5 IV-RoMmax (r = -0.53). The relationships found may be important when considering rehabilitation for low back pain.
Collapse
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 5B, UK.
| | - Alan Breen
- Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth BH5 2DF, UK.
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
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.
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
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.
Collapse
|
32
|
Vertebra identification using template matching modelmp and $$K$$ K -means clustering. Int J Comput Assist Radiol Surg 2013; 9:177-87. [DOI: 10.1007/s11548-013-0927-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/04/2013] [Indexed: 11/26/2022]
|
33
|
Lecron F, Benjelloun M, Mahmoudi S. Cervical spine mobility analysis on radiographs: a fully automatic approach. Comput Med Imaging Graph 2012; 36:634-42. [PMID: 22981777 DOI: 10.1016/j.compmedimag.2012.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/19/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
Conventional X-ray radiography remains nowadays the most common method to analyze spinal mobility in two dimensions. Therefore, the objective of this paper is to develop a framework dedicated to the fully automatic cervical spine mobility analysis on X-ray images. To this aim, we propose an approach based on three main steps: fully automatic vertebra detection, vertebra segmentation and angular measurement. The accuracy of the method was assessed for a total of 245 vertebræ. For the vertebra detection, we proposed an adapted version of two descriptors, namely Scale-invariant Feature Transform (SIFT) and Speeded-up Robust Features (SURF), coupled with a multi-class Support Vector Machine (SVM) classifier. Vertebræ are successfully detected in 89.8% of cases and it is demonstrated that SURF slightly outperforms SIFT. The Active Shape Model approach was considered as a segmentation procedure. We observed that a statistical shape model specific to the vertebral level improves the results. Angular errors of cervical spine mobility are presented. We showed that these errors remain within the inter-operator variability of the reference method.
Collapse
Affiliation(s)
- Fabian Lecron
- University of Mons, Place du Parc, 20, 7000 Mons, Belgium.
| | | | | |
Collapse
|