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Lumbar Intervertebral Motion Analysis During Flexion and Extension Cinematographic Recordings in Healthy Male Participants: Protocol.

ABSTRACT: BACKGROUND:Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. OBJECTIVE:This study aims to define the lumbar spines' physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. METHODS:Cinematographic recordings will be performed in 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. RESULTS:The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of applied sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. CONCLUSIONS:If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. TRIAL REGISTRATION:ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14741.

SUBMITTER: Caelers IJ

PROVIDER: S-EPMC7078620 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Lumbar Intervertebral Motion Analysis During Flexion and Extension Cinematographic Recordings in Healthy Male Participants: Protocol.

Caelers Inge Jmh IJ Boselie Toon Fm TF Rijkers Kim K Van Hemert Wouter Lw WL De Bie Rob A RA Van Santbrink Henk H

JMIR research protocols 20200224 2

<h4>Background</h4>Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. Howeve ...[more]

PMID: 32130199

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Project description:BackgroundThe analysis of sagittal intervertebral rotational motion (SIRM) can provide important information for the evaluation of cervical diseases. Deep learning has been widely used in spinal parameter measurements, however, there are few investigations on spinal motion analysis. The purpose of this study is to develop a deep learning-based model for fully automated measurement of SIRM based on flexion-neutral-extension cervical lateral radiographs and to evaluate its applicability for the flexion-extension (F/E), flexion-neutral (F/N), and neutral-extension (N/E) motion analysis.MethodsA total of 2796 flexion, neutral, and extension cervical lateral radiographs from 932 patients were analyzed. Radiographs from 100 patients were randomly selected as the test set, and those from the remaining 832 patients were used for training and validation. Landmarks were annotated for measuring SIRM at five segments from C2/3 to C6/7 on F/E, F/N, and N/E motion. High-Resolution Net (HRNet) was used as the main structure to train the landmark detection network. Landmark performance was assessed according to the percentage of correct key points (PCK) and mean of the percentage of correct key points (MPCK). Measurement performance was evaluated by intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots.ResultsAt a 2-mm distance threshold, the PCK for the model ranged from 94 to 100%. Compared with the reference standards, the model showed high accuracy for SIRM measurements for all segments on F/E and F/N motion. On N/E motion, the model provided reliable measurements from C3/4 to C6/7, but not C2/3. Compared with the radiologists' measurements, the model showed similar performance to the radiologists.ConclusionsThe developed model can automatically measure SIRM on flexion-neutral-extension cervical lateral radiographs and showed comparable performance with radiologists. It may provide rapid, accurate, and comprehensive information for cervical motion analysis.

Project description:BackgroundMeasurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions.PurposeThe main purpose was to investigate the reliability and validity of an iPhone(®) app (TiltMeter(©) -advanced level and inclinometer) for measuring standing lumbar spine flexion-extension ROM in asymptomatic subjects.DesignA cross-sectional study was carried out.SettingThis study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran.SubjectsA convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18-55 years) was recruited between August 2015 and December 2015.MethodsFollowing a 2-minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12-L1 and S1-S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone (®) app to measure lumbar spine flexion-extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion-extension ROM, the measurement from S1-S2 was subtracted from T12-L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone(®) app. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × [Formula: see text].ResultsGood to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ?0.84 and ?0.77 and the iPhone(®) app with ICC values of ?0.85 and ?0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively.ConclusionsThe iPhone(®)app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone(®) app can be used for the measurement of lumbar spine flexion-extension ROM.Level of evidenceIIb.

Project description:Study designIn vivo patient biomechanical study.ObjectiveTo investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body.Summary of background dataLIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown.MethodsNine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was magnetic resonance imaging scanned for construction of three-dimensional lumbar vertebral models, and fluoroscopically imaged when the body extended from 45 flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segments L4/5 and L5/S1 were compared with a normal control group at 45 flexion, upright, and full extension of the body.ResultsThe mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (P <0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (P <0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (P >0.05).ConclusionSimilar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment.Level of evidenceN/A.

Project description:BackgroundThe quality of flexion-extension motion after cervical disc arthroplasty has been a subject of interest due to the number of available devices with different designs and kinematics. Previous studies of motion quality have been limited to measuring the range of motion using two radiographs taken at the extremes of flexion and extension. This is the first study evaluating the in vivo quality of index segment motion using fluoroscopic images collected over the arc of flexion-extension after M6-C cervical disc arthroplasty surgery.MethodsEligible participants had previously undergone a single-level cervical disc arthroplasty surgery for degenerative cervical spine disease performed by the senior author. Study participants underwent dynamic lateral fluoroscopic imaging to capture the C2-C7 motion between maximal flexion and extension. The amount of motion contribution by individual segments to the C2-C7 motion (termed segmental motion fraction) and its variation throughout the arc of flexion-extension were compared between the index and adjacent segments. The shift of centre of rotation during the arc of motion was also assessed.ResultsTen subjects with a mean age of 43.8 years old were recruited, with an average follow-up of 16.2 months at the time of fluoroscopy. The C2-C7 cervical spine had an average flexion-extension range of 66.7 degrees. The contribution of the index segment averaged over the flexion-extension arc of motion was 18.9% (peak contribution 24.4%) for the C5-C6 group; and 15.5% (peak contribution 25.5%) for the C6-C7 group. The mean cranial-caudal location of the centre of rotation progressively shifted in the cranial direction from C2-C3 to C6-C7 motion segment.ConclusionsOur results demonstrated physiologic quality of motion at the index segment and harmony among its neighbouring segments following cervical disc arthroplasty, without gearshift-like intermittent locking of the prosthesis during the arc of flexion-extension motion. This pilot study provides a basis for the design of future long-term studies with larger sample size to compare the quality of motion between different cervical disc prostheses using the concept of segmental motion fraction as a motion-quality metric.

Project description: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.

Project description:A precise and comprehensive definition of "normal" in vivo cervical kinematics does not exist due to high intersubject variability and the absence of midrange kinematic data. In vitro test protocols and finite element models that are validated using only end range of motion data may not accurately reproduce continuous in vivo motion.The primary objective of this study was to precisely quantify cervical spine intervertebral kinematics during continuous, functional flexion-extension in asymptomatic subjects. The advantages of assessing continuous intervertebral kinematics were demonstrated by comparing asymptomatic controls with patients with single-level anterior arthrodesis.Cervical spine kinematics were determined during continuous in vivo flexion-extension in a clinically relevant age group of asymptomatic controls and a group of patients with C5-C6 arthrodesis.The patient sample consisted of 6 patients with single-level (C5-C6) anterior arthrodesis (average age: 48.8±6.9 years; 1 male, 5 female; 7.6±1.2 months postsurgery) and 18 asymptomatic control subjects of similar age (average age: 45.6±5.8 years; 5 male, 13 female).Outcome measures included the physiologic measure of continuous kinematic motion paths at each cervical motion segment (C2-C7) during flexion-extension.Participants performed flexion-extension while biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral positions with submillimeter accuracy. Continuous flexion-extension rotation and anterior-posterior translation motion paths were adjusted for disc height and static orientation of each corresponding motion segment.Intersubject variability in flexion-extension angle was decreased 15% to 46% and intersubject variability in anterior-posterior translation was reduced 14% to 33% after adjusting for disc height and static orientation angle. Average intersubject variability in continuous motion paths was 1.9° in flexion-extension and 0.6 mm in translation. Third-order polynomial equations were determined to precisely describe the continuous flexion-extension and anterior-posterior translation motion path at each motion segment (all R2>0.99).A significant portion of the intersubject variability in cervical kinematics can be explained by the disc height and the static orientation of each motion segment. Clinically relevant information may be gained by assessing intervertebral kinematics during continuous functional movement rather than at static, end range of motion positions. The fidelity of in vitro cervical spine mechanical testing protocols may be evaluated by comparing in vitro kinematics to the continuous motion paths presented.

Project description:BackgroundThe root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from a standing position and task specific spine ranges of motion objectively assess muscle function in healthy young and middle age individuals. However, literature on neuromuscular activation and associated spine and hip kinematics in older individuals is sparse. This cross sectional study sought to examine the sex and age (<40 versus >60 years) related differences in the neuromuscular activation profiles of the lumbar extensors and the related spine and hip kinematics from healthy individuals during a standardized trunk flexion-extension task.MethodsTwenty five older (13 females, 60-90 years) and 24 younger (12 females, 18-40 years) healthy individuals performed trunk flexion-extension testing by holding static positions at half-flexion way and full range of motion between standing and maximum trunk flexion. The associated lumbar extensor muscle activity was derived from measurements at standing, half, and maximum flexion positions. The range of motion at the hip and lumbar spine was recorded using 3d accelerometers attached to the skin overlying the multifidus and semispinalis thoracis muscles lateral to the L5 and T4 spinous processes, respectively. Statistical calculations were performed using a permutation ANOVA with bootstrap confidence intervals.ResultsThe muscle activity in the half related to the maximum flexion position (half flexion relaxation ratio) was significantly smaller in older males when compared with younger males. Moreover, measurements revealed smaller activity changes from standing to the half and from half to the maximum flexion position in older compared to younger individuals. Older males displayed smaller gross trunk range of motion from standing to maximum flexion than any other group.ConclusionsGender and normal aging significantly affect both the activation patterns of the lumbar extensor muscles and the kinematics of the trunk during a standardized trunk flexion-extension task. Measurement results from healthy young and middle age individuals should not be used for the assessment of individuals older than 60 years of age.

Dataset Information

Lumbar Intervertebral Motion Analysis During Flexion and Extension Cinematographic Recordings in Healthy Male Participants: Protocol.

Publications

Lumbar Intervertebral Motion Analysis During Flexion and Extension Cinematographic Recordings in Healthy Male Participants: Protocol.

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