Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine

Background Context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonl...

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Main Authors: Jacob Braunstein, MD, John A. Hipp, PhD, Robert Browning, MD, Trevor F. Grieco, PhD, Charles A. Reitman, MD
Format: Article
Language:English
Published: Elsevier 2020-12-01
Series:North American Spine Society Journal
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S266654842030038X
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spelling doaj-a059ad68aedd43d3b51853c989b871612021-06-08T04:43:59ZengElsevierNorth American Spine Society Journal2666-54842020-12-014100038Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spineJacob Braunstein, MD0John A. Hipp, PhD1Robert Browning, MD2Trevor F. Grieco, PhD3Charles A. Reitman, MD4Medical University of South Carolina Department of Orthopaedics and Physical Medicine. Charleston, SCMedical Metrics Diagnostics, Inc, Houston, TX USA; Corresponding author.Rush University Department of Orthopedic Surgery. Chicago, IL USAMedical Metrics Diagnostics, Inc, Houston, TX USAMedical University of South Carolina Department of Orthopaedics and Physical Medicine. Charleston, SCBackground Context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities. Purpose: Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population. Study Design/Setting: Prospective analysis of images retrospectively collected from routine clinical practices. Methods: After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers. Results: At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions. Conclusions: Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion.http://www.sciencedirect.com/science/article/pii/S266654842030038XBiomechanicsDiagnostic ImagingPatient PositioningIntervertebral MotionSpinal stability
collection DOAJ
language English
format Article
sources DOAJ
author Jacob Braunstein, MD
John A. Hipp, PhD
Robert Browning, MD
Trevor F. Grieco, PhD
Charles A. Reitman, MD
spellingShingle Jacob Braunstein, MD
John A. Hipp, PhD
Robert Browning, MD
Trevor F. Grieco, PhD
Charles A. Reitman, MD
Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
North American Spine Society Journal
Biomechanics
Diagnostic Imaging
Patient Positioning
Intervertebral Motion
Spinal stability
author_facet Jacob Braunstein, MD
John A. Hipp, PhD
Robert Browning, MD
Trevor F. Grieco, PhD
Charles A. Reitman, MD
author_sort Jacob Braunstein, MD
title Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
title_short Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
title_full Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
title_fullStr Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
title_full_unstemmed Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
title_sort analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine
publisher Elsevier
series North American Spine Society Journal
issn 2666-5484
publishDate 2020-12-01
description Background Context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities. Purpose: Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population. Study Design/Setting: Prospective analysis of images retrospectively collected from routine clinical practices. Methods: After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers. Results: At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions. Conclusions: Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion.
topic Biomechanics
Diagnostic Imaging
Patient Positioning
Intervertebral Motion
Spinal stability
url http://www.sciencedirect.com/science/article/pii/S266654842030038X
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