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Lodin J, Terč J, Cihlář F, Sameš M, Cihlář J, Vachata P. Dynamics of atlantoaxial rotation related to age and sex: a cross-sectional study of 308 subjects. Spine J 2023; 23:1276-1286. [PMID: 37182705 DOI: 10.1016/j.spinee.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT Physiological ranges and dynamic changes of atlantoaxial rotation (ROTC1/2), total cervical spine rotation (ROTCs) and the percentage of ROTC1/2 from ROTCs (ROTCperc) for different age groups have not yet been investigated in a sufficiently sized cohort. Furthermore, it is not clear whether demographic variables such a sex, smoking status or diabetes affect ROTC1/2, ROTCs and ROTCperc. PURPOSE Obtain physiological ranges of ROTC1/2, ROTCs and ROTCperc for different age groups and determine their age-based dynamics. Investigate whether ROTC1/2, ROTCs and ROTCperc are affected by sex, smoking status or diabetes. DESIGN Observational cross-sectional study. PATIENT SAMPLE Patients undergoing elective CT examinations of the head and neck region between August 2020 and January 2022. OUTCOME MEASURES Ranges of motion of ROTC1/2, ROTCs and ROTCperc in degrees. METHODS A total of 308 subjects underwent dynamic rotational CT examinations of the upper cervical spine. Patients were divided into three age categories A1 (27-49 years), A2 (50-69 years) and A3 (≥70 years). Category A3 was further divided into B1 (70-79 years) and B2 (≥80 years). Values of ROTC1/2, ROTCs and ROTCperc were compared between all age groups, males and females, smokers and nonsmokers, diabetics a nondiabetics. Dynamics of ROTC1/2, ROTCs related to age and sex were visualized using scatterplot and trendline models. RESULTS ROTC1/2 significantly decreased from group A1 (64.4°) to B2 (46.7°) as did ROTCs from A1 (131.2°) to B2 (97.6°). No significant differences of ROTperc were found between groups A1-B2 with values oscillating between 49% and 51%. Smoking and diabetes did not significantly affect ROTC1/2, ROTCs and ROTCperc, females had significantly higher ROTCs than males. Males and females demonstrated a different dynamic of ROTC1/2 and ROTCs demonstrated by out scatterplot and trendline models. CONCLUSIONS Both ROTC1/2 and ROTCs significantly decrease with age, whereas ROTCperc remains stable. Females demonstrated higher ROTCs and their decrease of ROTC1/2 and ROTCs occurred in higher age groups compared to males. The functional repercussions atlantoaxial fusion are variable based on patient age and sex and should be taken into account prior to surgery.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic.
| | - Jan Terč
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Filip Cihlář
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Jiří Cihlář
- J. E. Purkyně University, Pasteurova 3544/1, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic
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Wan Z, Wang W, Li C, Li J, Lin J, Tian F, Zhu T, Wu D, Guo L, Wang S. Validation and application of a novel in vivo cervical spine kinematics analysis technique. Sci Rep 2021; 11:24266. [PMID: 34930931 PMCID: PMC8688511 DOI: 10.1038/s41598-021-01319-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
To validate the accuracy of Cone beam computed tomography (CBCT) cervical spine modeling with three dimensional (3D)-3D registration for in vivo measurements of cervical spine kinematics. CBCT model accuracy was validated by superimposition with computed tomography (CT) models in 10 healthy young adults, and then cervical vertebrae were registered in six end positions of functional movements, versus a neutral position, in 5 healthy young adults. Registration errors and six degrees of freedom (6-DOF) kinematics were calculated and reported. Relative to CT models, mean deviations of the CBCT models were < 0.6 mm. Mean registration errors between end positions and the reference neutral position were < 0.7 mm. During flexion–extension (F–E), the translation in the three directions was small, mostly < 1 mm, with coupled LB and AR both < 1°. During lateral bending (LB), the bending was distributed roughly evenly, with coupled axial rotation (AR) opposite to the LB at C1–C2, and minimal coupled F–E. During AR, most of the rotation occurred in the C1–C2 segment (29.93 ± 7.19° in left twist and 31.38 ± 8.49° in right twist) and coupled LB was observed in the direction opposite to that of the AR. Model matching demonstrated submillimeter accuracy in cervical spine kinematics data. The presently evaluated low-radiation-dose CBCT technique can be used to measure 3D spine kinematics in vivo across functional F–E, AR, and LB positions, which has been especially challenging for the upper cervical spine.
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Affiliation(s)
- Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, 50933, Cologne, Germany
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Junjie Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China
| | - Jinpeng Lin
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China
| | - Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China.,Department of Rehabilitation Medicine, Heping Hospital Affiliated To Changzhi Medical College, Shanxi, 046000, China
| | - Ting Zhu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China
| | - Danni Wu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China
| | - Luqi Guo
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China. .,School of Kinesiology, Shanghai University of Sport, Research Building 412, 200 Hengren Road, Shanghai, 200438, China.
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Kashii M, Masuhara K, Kaito T, Iwasaki M. Rotatory Subluxation and Facet Deformity in the Atlanto-occipital Joint in Patients with Chronic Atlantoaxial Rotatory Fixation: Two Case Reports. J Orthop Case Rep 2018; 7:59-63. [PMID: 29600213 PMCID: PMC5868886 DOI: 10.13107/jocr.2250-0685.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The relationship between the morphometry of atlantoaxial joint and chronic atlantoaxial rotatory fixation (AARF) is well known, but disorders in the atlanto-occipital joint in chronic AARF are not fully elucidated. The authors report two rare cases of secondary deformities in the atlanto-occipital joint in chronic AARF. Case Reports: Two patients with chronic AARF were treated with closed manipulation, skull traction and halo-vest immobilization. Clinical outcomes and radiographs were reviewed retrospectively, focusing on pathological changes in the atlanto-occipital joint using multiplanar reconstruction computed tomography and three-dimensional computed tomography images. Case 1 (12-year-old girl) had rotatory subluxation with a superior facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. After a series of conservative treatments, both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced, and both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed. She was monitored without surgery because the disorder progressed to the spontaneous fusion of the occipital bone to the axis. Case 2 (13-year-old boy) had rotatory subluxation without facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. However, both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed over time, and both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced after a series of conservative treatments. He still had severe neck pain and severely restricted neck mobility and underwent spinal fusion. Conclusion: Atlanto-occipital rotatory subluxation and facet deformity in the atlanto-occipital joint may occur after prolonged AARF. It is necessary to pay attention to pathological changes not only in the atlantoaxial joint but also in the atlanto-occipital joint, when orthopedic surgeons treat patients with AARF.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, Japan.,Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kenta Masuhara
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Anderst W, Rynearson B, West T, Donaldson W, Lee J. Dynamic in vivo 3D atlantoaxial spine kinematics during upright rotation. J Biomech 2017; 60:110-115. [PMID: 28662932 DOI: 10.1016/j.jbiomech.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
Abstract
Diagnosing dysfunctional atlantoaxial motion is challenging given limitations of current diagnostic imaging techniques. Three-dimensional imaging during upright functional motion may be useful in identifying dynamic instability not apparent on static imaging. Abnormal atlantoaxial motion has been linked to numerous pathologies including whiplash, cervicogenic headaches, C2 fractures, and rheumatoid arthritis. However, normal C1/C2 rotational kinematics under dynamic physiologic loading have not been previously reported owing to imaging difficulties. The objective of this study was to determine dynamic three-dimensional in vivo C1/C2 kinematics during upright axial rotation. Twenty young healthy adults performed full head rotation while seated within a biplane X-ray system while radiographs were collected at 30 images per second. Six degree-of-freedom kinematics were determined for C1 and C2 via a validated volumetric model-based tracking process. The maximum global head rotation (to one side) was 73.6±8.3°, whereas maximum C1 rotation relative to C2 was 36.8±6.7°. The relationship between C1/C2 rotation and head rotation was linear through midrange motion (±20° head rotation from neutral) in a nearly 1:1 ratio. Coupled rotation between C1 and C2 included 4.5±3.1° of flexion and 6.4±8.2° of extension, and 9.8±3.8° of contralateral bending. Translational motion of C1 relative to C2 was 7.8±1.5mm ipsilaterally, 2.2±1.2mm inferiorly, and 3.3±1.0mm posteriorly. We believe this is the first study describing 3D dynamic atlantoaxial kinematics under true physiologic conditions in healthy subjects. C1/C2 rotation accounts for approximately half of total head axial rotation. Additionally, C1 undergoes coupled flexion/extension and contralateral bending, in addition to inferior, lateral and posterior translation.
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Affiliation(s)
- William Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, United States.
| | - Bryan Rynearson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Tyler West
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - William Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Joon Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
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Ignasiak D, Rüeger A, Ferguson SJ. Multi-segmental thoracic spine kinematics measured dynamically in the young and elderly during flexion. Hum Mov Sci 2017; 54:230-239. [PMID: 28535435 DOI: 10.1016/j.humov.2017.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
Abstract
In contrast to the cervical and lumbar region, the normal kinematics of the thoracic spine have not been thoroughly investigated. The aim of this study was to characterize normal multi-segmental continuous motion of the whole thoracolumbar spine, during a flexion maneuver, in young and elderly subjects. Forty-two healthy volunteers were analyzed: 21 young (age=27.00±3.96) and 21 elderly (age=70.1±3.85). Spinal motion was recorded with a motion-capture system and analyzed using a 3rd order polynomial function to approximate spinal curvature throughout the motion sequence. The average motion profiles of the two age groups were characterized. Flexion timing of the thoracic region of the spine, as compared to the lumbar spine and hips, was found to be different in the two age groups (p=0.011): a delayed/sequential motion type was observed in most of the young, whereas mostly a simultaneous motion pattern was observed in the elderly subjects. A similar trend was observed in flexion of the lower thoracic segments (p=0.017). Differences between age groups were also found for regional and segmental displacements and velocities. The reported characterization of the thoracic spine kinematics may in the future support identification of abnormal movement or be used to improve biomechanical models of the spine.
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Anderst WJ, Aucie Y. Three-dimensional intervertebral range of motion in the cervical spine: Does the method of calculation matter? Med Eng Phys 2017; 41:109-115. [PMID: 28126422 DOI: 10.1016/j.medengphy.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 09/02/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
Intervertebral range of motion (ROM) is commonly calculated using ordered rotations or projection angles. Ordered rotations are sequence-dependent, and projection angles are dependent upon on which orientation vectors are projected. This study assessed the effect of calculation method on intervertebral ROM in the subaxial cervical spine (C3-C7) during in vivo dynamic, three-dimensional, functional movement. Biplane radiographs were collected at 30 images per second while 29 participants performed full ROM flexion/extension, axial rotation and lateral bending movements of their cervical spine. In vivo bone motion was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking technique. Intervertebral rotations were calculated using six Cardan angle sequences and two projection angle combinations. Within-subject comparisons revealed significant differences in intervertebral ROM among calculation methods (all p<0.002). Group mean ROM differences were small, but significantly different among calculation methods (p<0.001). A resampling technique demonstrated that as group size increases, the differences between calculation methods decreases substantially. It is concluded that the method used to calculate intervertebral rotations of the sub-axial cervical spine can significantly affect within-subject and between group comparisons of intervertebral ROM.
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Affiliation(s)
- William J Anderst
- Department of Orthopaedic Surgery, Biodynamics Lab, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA.
| | - Yashar Aucie
- Department of Bioengineering, University of Pittsburgh, USA
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