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Jeffrey C Wang - One of the best experts on this subject based on the ideXlab platform.
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kinetic magnetic resonance imaging analysis of thoracolumbar Segmental mobility in patients without significant spondylosis
Medicine, 2020Co-Authors: Xingwang Yao, Fei Chen, Chuning Dong, Jeffrey C Wang, Yanlin TanAbstract:To observe thoracolumbar Segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular Segmental Motion as well as the relative contribution of each segment to total thoracolumbar Segmental Motion in order to obtain a more complete understanding of this Segmental Motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational Motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational Motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular Motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular Motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental Motion was greatest in the proximal lumbar levels, and angular Motion showed a gradually increasing trend from T10 to L2.
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kinetic magnetic resonance imaging analysis of lumbar Segmental Motion at levels adjacent to disc herniation
European Spine Journal, 2016Co-Authors: Lifeng Lao, Michael D Daubs, Shinji Takahashi, Elizabeth L Lord, Jeremiah R Cohen, Guibin Zhong, Jeffrey C WangAbstract:A retrospective radiographic study was carried out to analyze the effect of lumbar disc herniation on the kinetic Motion of adjacent segments. A total of 162 patients with low back pain or radicular pain in the lower limbs without a prior history of surgery were evaluated using kinetic magnetic resonance imaging. Translational Motion, angular variation, and disc height were measured at each segment from L1–L2 to L5–S1. Other factors including the degree of disc degeneration, age, gender, and vertebral segment location were analyzed to determine any predisposing risk factors for Segmental instability adjacent to disc herniations. Spinal levels above the disc herniation exhibited, on average, a 6.4 % increase in translational Motion per mm of disc herniation (P = 0.496) and a 21.4 % increase in angular Motion per mm herniation (P = 0.447). Levels below the herniation demonstrated a 5.2 % increase in translational Motion per mm of disc herniation (P = 0.428) and a decrease of 10.7 % in angular Motion per mm (P = 0.726). The degree of disc degeneration had no significant correlation with adjacent level Motion. Similarly, disc herniation was not significantly correlated with disc height at adjacent levels, although there was a significant relationship between gender and adjacent segment disc height. Although disc height, translational Motion, and angular variation are significantly affected at the level of a disc herniation, no significant changes are apparent in adjacent segments. Our results indicate that herniated discs have no effect on range of Motion at adjacent levels regardless of the degree of disc degeneration or the size of disc herniation, suggesting that the natural progression of disc degeneration and adjacent segment disease may be separate, unrelated processes within the lumbar spine.
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effect of modic changes on spinal canal stenosis and Segmental Motion in cervical spine
European Spine Journal, 2014Co-Authors: Tetsuo Hayashi, Michael D Daubs, Akinobu Suzuki, Kevin Phan, Keiichiro Shiba, Jeffrey C WangAbstract:Purpose Few studies have reported the characteristics of Modic changes (MCs) in the cervical spine in contrast to the lumbar spine. The purpose of this study was to identify the prevalence of MCs in the cervical spine and to elucidate the relationship of MCs with spinal canal stenosis and angular Motion.
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effect of modic changes on spinal canal stenosis and Segmental Motion in cervical spine
European Spine Journal, 2014Co-Authors: Tetsuo Hayashi, Michael D Daubs, Akinobu Suzuki, Kevin Phan, Keiichiro Shiba, Jeffrey C WangAbstract:Few studies have reported the characteristics of Modic changes (MCs) in the cervical spine in contrast to the lumbar spine. The purpose of this study was to identify the prevalence of MCs in the cervical spine and to elucidate the relationship of MCs with spinal canal stenosis and angular Motion. 437 consecutive, symptomatic patients with neck pain with or without neurogenic symptoms were included in this study. MRI in multiple positions was performed with dynamic Motion of the cervical spine in upright, weight-bearing neutral, flexion and extension positions. Type of MC, intervertebral disc degeneration grade, spinal cord compression grade and sagittal angular Motion between flexion and extension for each segment from C2–3 to C6–7 were evaluated. MCs were observed in 84 out of 437 patients (19.2 %) and in 109 out of 2,185 Motion segments (5.0 %) with type 2 changes predominating. Disc degeneration grades and spinal cord compression grades of segments with MCs were significantly higher than those without MCs. Sagittal angular Motion of segments with MCs were significantly lower than those without MCs. Multiple logistic regression analysis revealed that significantly elevated odds ratios for MCs were observed in segments with severe disc degeneration, severe spinal canal compression and less angular Motion. The cervical segments with MCs were significantly more likely to have disc degeneration and spinal canal stenosis. In addition, the segments with MCs had significantly less angular Motion, which suggests MCs may correlate with loss of mobility.
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does lumbar disk degeneration increase Segmental mobility in vivo Segmental Motion analysis of the whole lumbar spine using kinetic mri
Journal of Spinal Disorders & Techniques, 2014Co-Authors: Scott D Daffner, Jeffrey C WangAbstract:Abstract This is a retrospective analysis of lumbar Segmental Motion using Kinetic magnetic resonance imaging(KMRI). The aim of the study was to investigate lumbar Segmental Motion in functional (ie, standing weight-bearing flexion and extension) positions and examine the effects of lumbar disk degeneration on lumbar Segmental Motion. Various biomechanical studies using cadaveric specimens have demonstrated the effects of disk degeneration on lumbar Motion. However, the studies did not determine the effect of disk degeneration on Segmental Motion in the functional, living spine. Segmental range of Motion (ROM) was calculated and disk degeneration was graded in patients who had undergone KMRI in weight-bearing neutral, 60 degrees of flexion, and 20 degrees of extension. Patients (n=262) were categorized as having normal disks (n=94), single-level degeneration at L4–L5 (n=28) or L5–S1 (N=71), or double-level degeneration at L4–L5–S1 (N=69). Angular ROM, contribution (%)of each segment to total lumbar Motion, and contribution of Motion from upper (L1–L3) and lower (L4–S1) lumbar levels were compared. Mean ROMo f the lumbar spine in the normal group was 41.3±13.3 degrees. The L4–L5 degeneration group (36.1±12.4 degrees) and the L4–L5–S1 degeneration group (37.1±12.5 degrees) showed significantly decreased total lumbar ROM compared with the normal group. The ROM in upper lumbar segments was significantly larger than that in the lower segments in the normal group and similar in the degeneration groups. The contribution of L5–S1 to total lumbar Motion was the smallest of all segments, and no significant difference was found between all groups. In functional positions assessed utilizing weight bearing KMRI, Segmental Motion at levels with degenerated disks was decreased. The contribution of upper lumbar segments to the total lumbar Motion was not smaller than that of the lower segments. The L5–S1 level showed the smallest ROM in lumbar Motion.
Scott D Daffner - One of the best experts on this subject based on the ideXlab platform.
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does lumbar disk degeneration increase Segmental mobility in vivo Segmental Motion analysis of the whole lumbar spine using kinetic mri
Journal of Spinal Disorders & Techniques, 2014Co-Authors: Scott D Daffner, Jeffrey C WangAbstract:Abstract This is a retrospective analysis of lumbar Segmental Motion using Kinetic magnetic resonance imaging(KMRI). The aim of the study was to investigate lumbar Segmental Motion in functional (ie, standing weight-bearing flexion and extension) positions and examine the effects of lumbar disk degeneration on lumbar Segmental Motion. Various biomechanical studies using cadaveric specimens have demonstrated the effects of disk degeneration on lumbar Motion. However, the studies did not determine the effect of disk degeneration on Segmental Motion in the functional, living spine. Segmental range of Motion (ROM) was calculated and disk degeneration was graded in patients who had undergone KMRI in weight-bearing neutral, 60 degrees of flexion, and 20 degrees of extension. Patients (n=262) were categorized as having normal disks (n=94), single-level degeneration at L4–L5 (n=28) or L5–S1 (N=71), or double-level degeneration at L4–L5–S1 (N=69). Angular ROM, contribution (%)of each segment to total lumbar Motion, and contribution of Motion from upper (L1–L3) and lower (L4–S1) lumbar levels were compared. Mean ROMo f the lumbar spine in the normal group was 41.3±13.3 degrees. The L4–L5 degeneration group (36.1±12.4 degrees) and the L4–L5–S1 degeneration group (37.1±12.5 degrees) showed significantly decreased total lumbar ROM compared with the normal group. The ROM in upper lumbar segments was significantly larger than that in the lower segments in the normal group and similar in the degeneration groups. The contribution of L5–S1 to total lumbar Motion was the smallest of all segments, and no significant difference was found between all groups. In functional positions assessed utilizing weight bearing KMRI, Segmental Motion at levels with degenerated disks was decreased. The contribution of upper lumbar segments to the total lumbar Motion was not smaller than that of the lower segments. The L5–S1 level showed the smallest ROM in lumbar Motion.
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does lumbar disk degeneration increase Segmental mobility in vivo Segmental Motion analysis of the whole lumbar spine using kinetic mri
Journal of Spinal Disorders & Techniques, 2014Co-Authors: Sang Hun Lee, Scott D Daffner, Jeffrey C WangAbstract:STUDY DESIGN This is a retrospective analysis of lumbar Segmental Motion using Kinetic magnetic resonance imaging(KMRI). OBJECTIVE The aim of the study was to investigate lumbar Segmental Motion in functional (ie, standing weight-bearing flexion and extension) positions and examine the effects of lumbar disk degeneration on lumbar Segmental Motion. SUMMARY OF BACKGROUND DATA Various biomechanical studies using cadaveric specimens have demonstrated the effects of disk degeneration on lumbar Motion. However, the studies did not determine the effect of disk degeneration on Segmental Motion in the functional, living spine. METHODS Segmental range of Motion (ROM) was calculated and disk degeneration was graded in patients who had undergone KMRI in weight-bearing neutral, 60 degrees of flexion, and 20 degrees of extension. Patients (n=262) were categorized as having normal disks (n=94), single-level degeneration at L4–L5 (n=28) or L5–S1 (N=71), or double-level degeneration at L4–L5–S1 (N=69). Angular ROM, contribution (%)of each segment to total lumbar Motion, and contribution of Motion from upper (L1–L3) and lower (L4–S1) lumbar levels were compared. RESULTS Mean ROMo f the lumbar spine in the normal group was 41.3±13.3 degrees. The L4–L5 degeneration group (36.1±12.4 degrees) and the L4–L5–S1 degeneration group (37.1±12.5 degrees) showed significantly decreased total lumbar ROM compared with the normal group. The ROM in upper lumbar segments was significantly larger than that in the lower segments in the normal group and similar in the degeneration groups. The contribution of L5–S1 to total lumbar Motion was the smallest of all segments, and no significant difference was found between all groups. CONCLUSIONS In functional positions assessed utilizing weight bearing KMRI, Segmental Motion at levels with degenerated disks was decreased. The contribution of upper lumbar segments to the total lumbar Motion was not smaller than that of the lower segments. The L5–S1 level showed the smallest ROM in lumbar Motion.
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cervical Segmental Motion at levels adjacent to disc herniation as determined with kinetic magnetic resonance imaging
Spine, 2009Co-Authors: Scott D Daffner, Henry J Hymanson, Cyrus E Taghavi, Jiang Xin, Chethan Mudiyam, Wei Hongyu, Jeffrey C WangAbstract:Study design. Retrospective radiographic review. Objective. To investigate the effects of cervical disc herniation on kinematics at adjacent vertebral Motion segments. Summary of Background Data. Kinetic magnetic resonance imaging (KMRI) is an alternative method to conventional MRI, which allows evaluation of the cervical spine in a more physiologic, weight-bearing position, and acquisition of images in flexion, extension, and neutral alignment. kMRI has previously been used to evaluate the effects of disc degeneration on cervical kinematics. Methods. A total of 407 patients with neck pain without prior history of surgery were evaluated using KMRI. Translational Motion, angular variation, and disc height were measured at each segment from C2-C3 through C7-T1. Other factors including the degree of disc degeneration, age, gender, and vertebral segment location were analyzed in order to determine any predisposing risk factors for Segmental instability adjacent to disc herniations. Results. Spinal levels above the disc herniation exhibited, on average, a 7.2% decrease in translational Motion per mm of disc herniation (P = 0.0113), without significant change in angular Motion. Levels below the herniation demonstrated a 5.2% decrease in angular Motion per mm of disc herniation (P = 0.0236) without significant change in translational Motion. The degree of disc degeneration had no significant effect on adjacent level Motion. Disc herniation had no significant impact on disc height at adjacent levels, although disc degeneration correlated with decreased disc height above and increased disc height below. Conclusion. Although disc height, translational Motion, and angular variation are significantly affected at the level of a disc herniation, no significant changes are apparent in adjacent segments. Our results indicate that herniated discs have no effect on ROM at adjacent levels regardless of the degree of disc degeneration or the size of disc herniation, suggesting that the natural progression of disc degeneration and adjacent segment disease may be separate, unrelated processes within the cervical soine.
Gunnar Leivseth - One of the best experts on this subject based on the ideXlab platform.
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Segmental Motion adjacent to anterior cervical arthrodesis a prospective study
Spine, 2007Co-Authors: Frode Kolstad, Oystein P Nygaard, Gunnar LeivsethAbstract:Study Design. Prospective, observational study. Objective. The present study describes in a prospective setting the kinematics changes occurring at segments adjacent to a one-level cervical arthrodesis. Summary of Background Data. The development of adjacent segment disease has been noticed by many clinicians. Whether symptoms develop due to fusion induced accelerated spondylosis or due to a natural development in a predisposed person is currently under debate. The motivation for introducing Motion preservation procedures in the neck is primarily to protect the patients from developing symptomatic adjacent disc disease. To accept this rationale, it has to be demonstrated that a fusion creates an unfavorable biomechanical situation at adjacent levels. Methods. Forty-six patients underwent standard anterior cervical decompression and fusion using a cylindrical cage implant. Lateral radiographic views of the cervical spine in flexion and extension were obtained before surgery, and at 12 months of follow-up. Employing Distortion Compensated Roentgen Analysis, rotational and translational Motion at adjacent levels was quantified prospectively. Results. Rotational and translational Motion at adjacent cranial and caudal levels did not exhibit a significant change between the preoperative state and the state 12 months after the operation. Conclusion. The assumption of an iatrogenically caused increased mobility by a one-level cervical fusion could not be confirmed 12 months after surgery.
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increased sagittal plane Segmental Motion in the lower cervical spine in women with chronic whiplash associated disorders grades i ii a case control study using a new measurement protocol
Spine, 2003Co-Authors: Eythor Kristjansson, Gunnar Leivseth, Paul Brinckmann, Wolfgang FrobinAbstract:STUDY DESIGN: Case-control study comparing sagittal plane Segmental Motion in women (n = 34) with chronic whiplash-associated disorders, Grades I-II, with women (n = 35) with chronic insidious onset neck pain and with a normal database of sagittal plane rotational and translational Motion. OBJECTIVE: To reveal whether women with chronic whiplash-associated disorders, Grades I-II, demonstrate evidence of abnormal Segmental Motions in the cervical spine. SUMMARY OF BACKGROUND DATA: It is hypothesized that unphysiological spinal Motion experienced during an automobile accident may result in a persistent disturbance of Segmental Motion. It is not known whether patients with chronic whiplash-associated disorders differ from patients with chronic insidious onset neck pain with respect to Segmental mobility. METHODS: Lateral radiographic views were taken in assisted maximal flexion and extension. A new measurement protocol determined rotational and translational Motions of segments C3-C4 and C5-C6 with high precision. Segmental Motion was compared with normal data as well as among groups. RESULTS: In the whiplash-associated disorders group, the C3-C4 and C4-C5 segments showed significantly increased rotational Motions. Translational Motions within each segment revealed a significant deviation from normal at the C3-C4 segment in the whiplash-associated disorders and insidious onset neck pain groups and at the C5-C6 segment in the whiplash-associated disorders group. Significantly more women in the whiplash-associated disorders group (35.3%) had abnormal increased Segmental Motions compared to the insidious onset neck pain group (8.6%) when both the rotational and the translational parameters were analyzed. When the translational parameter was analyzed separately, no significant difference was found between groups, or 17.6% (whiplash-associated disorders group) and 8.6% (insidious onset neck pain group), respectively. CONCLUSION: Hypermobility in the lower cervical spine segments in 12 out of 34 patients with chronic whiplash-associated disorders in this study point to injury caused by the accident. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.
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sagittal plane Segmental Motion of the cervical spine a new precision measurement protocol and normal Motion data of healthy adults
Clinical Biomechanics, 2002Co-Authors: Wolfgang Frobin, Gunnar Leivseth, M Biggemann, Paul BrinckmannAbstract:Abstract Objective. (1) Precise documentation of sagittal plane Segmental rotational and posteroanterior translational Motion of segments C0/C1–C6/C7 of the human cervical spine from lateral radiographic views. (2) Compilation of a database describing normal Motion. (3) Comparison of individual Motion patterns with the normal database. Design. Descriptive study based on computer-aided measurements from lateral radiographic views taken in flexion and extension. Background. Previous studies concentrated on Segmental rotational Motion of the cervical spine. Normal data for translational Motion were not available. Description of cervical spine Motion patterns thus remained incomplete. Methods. Based on computer-aided measurements from lateral radiographic views taken in flexion and extension, a new protocol determines rotational and translational Motion for all segments (C0/C1–C6/C7) imaged on the radiographic views. Measured results are corrected for radiographic magnification and variation in stature; they are virtually uninfluenced by radiographic distortion and patient alignment errors. A database describing normal Motion was compiled from 137 sets of lateral views of healthy adults taken in active flexion and extension. A specimen study as well as inter- and intra-observer studies quantify measurement errors. Results. The error study demonstrated the error (SD) of a rotational Motion measurement to amount to slightly less than 2°. The error (SD) of a translational Motion measurement amounts to less than 5% of vertebral depth; for a vertebra of 15 mm depth this corresponds to 0.7 mm. A normal database for rotational and translational Motion was compiled. There was a linear relation between rotational and translational Motion. This finding agrees qualitatively with results from previous studies; quantitative comparisons are not possible due to divergent definitions for translational Motion. The relation between rotation and translation can be employed in individual cases to predict translational Motion, in dependence on the rotation actually performed. A comparison of the rotational Motion with the normal database and the difference between predicted and actual translational Motion allow Segmental hypo-, normal or hypermobility to be quantified. Conclusions. The new protocol measures Segmental Motion with high precision and corrects for radiographic distortion, variation in stature and alignment errors of patients. Thus, archive studies using existing radiographs are feasible. Relevance Flexion–extension radiographs of the cervical spine are performed to explore potential damage to the bony or ligamentous structure resulting in abnormal, Segmental Motion patterns. Determining rotational Motion gives only an incomplete picture. The new protocol allows for precise quantification of translational Motion and classification of segments as hypo- or hypermobile by comparison with normal Motion data.
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assessment of sagittal plane Segmental Motion in the lumbar spine a comparison between distortion compensated and stereophotogrammetric roentgen analysis
Spine, 1998Co-Authors: Gunnar Leivseth, Paul Brinckmann, Wolfgang Frobin, R Johnsson, B StromqvistAbstract:STUDY DESIGN Sagittal plane translatory and rotatory Motion was measured in 15 lumbar Motion segments of 8 patients by distortion-compensated and stereophotogrammetric Roentgen analysis. OBJECTIVE To compare measurement precision of the new distortion-compensated Roentgen analysis protocol with that of the established Roentgen stereophotogrammetric technique under realistic clinical conditions. SUMMARY OF BACKGROUND DATA Roentgen stereophotogrammetric analysis constitutes the most precise method available to assess Segmental Motion. Because of the invasive nature of the procedure, however, there is interest in alternative, noninvasive protocols suitable for studying larger patient cohorts. METHODS In 8 patients, Segmental Motion of 15 lumbar segments that had undergone previous spinal surgery was assessed from stereo views by using Roentgen stereophotogrammetric analysis. Sagittal plane Segmental Motion was assessed by distortion-compensated Roentgen analysis. Sagittal plane translatory and rotatory Motion data obtained by both methods were compared. RESULTS With respect to Roentgen stereophotogrammetric analysis, sagittal plane rotation was determined by distortion-compensated Roentgen analysis with an error (standard deviation) of 1.4 degrees and a mean difference of less than 0.05 degree. Sagittal plane translation was determined by distortion-compensated Roentgen analysis, with an error of 1.25 mm and a mean difference 0.5 mm. CONCLUSION Measurement precision of distortion-compensated Roentgen analysis is slightly inferior to that of Roentgen stereophotogrammetric analysis but substantially higher than that of conventional protocols assessing lumbar Segmental Motion. If measurement precision is considered adequate and if a noninvasive technique is indicated, distortion-compensated Roentgen analysis can be used to provide reliable Motion data required for epidemiologic and clinical studies.
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precision measurement of Segmental Motion from flexion extension radiographs of the lumbar spine
Clinical Biomechanics, 1996Co-Authors: Wolfgang Frobin, Gunnar Leivseth, Paul Brinckmann, M Biggemann, O ReikerasAbstract:OBJECTIVE: To measure sagittal plane Motion of lumbar vertebrae from lateral radiographic views. Previously identified factors of imprecision such as distortion in central projection, off-centre position, axial rotation, and lateral tilt of the spine were compensated. STUDY DESIGN: This study presents a new protocol to measure sagittal plane rotational and translational Motion from lateral flexion-extension radiographs of the lumbar spine. BACKGROUND: Conventional methods to determine sagittal plane rotation and translation are prone to error from the distortional effects of the divergence of the radiographic beam and the measurement error inherent in constructing tangents to the contours of the vertebral body. High precision is attained by roentgen-stereophotogrammetric methods, but because of their invasive nature they can be applied only in exceptional cases. Agreement has been reached only in that measurement of sagittal plane Motion from lumbar spine flexion-extension radiographs is inaccurate. Normal patterns of sagittal plane Motion and the definition of what is an abnormal flexion-extension radiograph have not been settled. METHOD: Starting from an analysis of vertebral contours in the lateral view, geometric measures are identified which are virtually independent of distortion, axial rotation or lateral tilt. Applying a new protocol based on those geometric measures, the pattern of translational and rotational Motion was determined from flexion-extension radiographs of 61 symptom-free, adult subjects. Measurement errors were quantified in a specimen experiment; a reproducibility study quantified inter- and intraobserver errors. RESULTS: Magnitude and sign of 'translation per degree of rotation' determined from a cohort of 61 adult subjects were very uniform for all levels of the lumbar spine. An auxiliary study evaluating a cohort of 10 healthy subjects where flexion-extension radiographs had been taken standing and side-lying showed no dependence of the rotation/translation pattern on posture. The error study demonstrated errors in angle ranging between 0.7 and 1.6 degrees and errors in displacement ranging between 1.2% and 2.4% of vertebral depth (the largest errors occurring at the L(5)/S(1) segment). Intra- and interobserver tests showed no or only negligibly small bias and an SD virtually equal to the measurement error multiplied by radical2. The relation of displacement to angle observed in the normal cohort can be used in individual cases to predict translational Motion depending on the rotation actually performed. A comparison of the predicted translation (determined from normal controls) and the value actually measured allows translational hypo-, normal, or hypermobility to be quantified. Examples illustrate application of the new method in cases of normal, hypo-, and hypermobility and in the case of an instrumented spine. CONCLUSIONS: The results of this study show that precision of the measurement of rotational and translational Motion can be considerably enhanced by making allowance for radiographic distortional effects and by minimizing subjective influence in the measurement procedure.
Wolfgang Frobin - One of the best experts on this subject based on the ideXlab platform.
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increased sagittal plane Segmental Motion in the lower cervical spine in women with chronic whiplash associated disorders grades i ii a case control study using a new measurement protocol
Spine, 2003Co-Authors: Eythor Kristjansson, Gunnar Leivseth, Paul Brinckmann, Wolfgang FrobinAbstract:STUDY DESIGN: Case-control study comparing sagittal plane Segmental Motion in women (n = 34) with chronic whiplash-associated disorders, Grades I-II, with women (n = 35) with chronic insidious onset neck pain and with a normal database of sagittal plane rotational and translational Motion. OBJECTIVE: To reveal whether women with chronic whiplash-associated disorders, Grades I-II, demonstrate evidence of abnormal Segmental Motions in the cervical spine. SUMMARY OF BACKGROUND DATA: It is hypothesized that unphysiological spinal Motion experienced during an automobile accident may result in a persistent disturbance of Segmental Motion. It is not known whether patients with chronic whiplash-associated disorders differ from patients with chronic insidious onset neck pain with respect to Segmental mobility. METHODS: Lateral radiographic views were taken in assisted maximal flexion and extension. A new measurement protocol determined rotational and translational Motions of segments C3-C4 and C5-C6 with high precision. Segmental Motion was compared with normal data as well as among groups. RESULTS: In the whiplash-associated disorders group, the C3-C4 and C4-C5 segments showed significantly increased rotational Motions. Translational Motions within each segment revealed a significant deviation from normal at the C3-C4 segment in the whiplash-associated disorders and insidious onset neck pain groups and at the C5-C6 segment in the whiplash-associated disorders group. Significantly more women in the whiplash-associated disorders group (35.3%) had abnormal increased Segmental Motions compared to the insidious onset neck pain group (8.6%) when both the rotational and the translational parameters were analyzed. When the translational parameter was analyzed separately, no significant difference was found between groups, or 17.6% (whiplash-associated disorders group) and 8.6% (insidious onset neck pain group), respectively. CONCLUSION: Hypermobility in the lower cervical spine segments in 12 out of 34 patients with chronic whiplash-associated disorders in this study point to injury caused by the accident. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.
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sagittal plane Segmental Motion of the cervical spine a new precision measurement protocol and normal Motion data of healthy adults
Clinical Biomechanics, 2002Co-Authors: Wolfgang Frobin, Gunnar Leivseth, M Biggemann, Paul BrinckmannAbstract:Abstract Objective. (1) Precise documentation of sagittal plane Segmental rotational and posteroanterior translational Motion of segments C0/C1–C6/C7 of the human cervical spine from lateral radiographic views. (2) Compilation of a database describing normal Motion. (3) Comparison of individual Motion patterns with the normal database. Design. Descriptive study based on computer-aided measurements from lateral radiographic views taken in flexion and extension. Background. Previous studies concentrated on Segmental rotational Motion of the cervical spine. Normal data for translational Motion were not available. Description of cervical spine Motion patterns thus remained incomplete. Methods. Based on computer-aided measurements from lateral radiographic views taken in flexion and extension, a new protocol determines rotational and translational Motion for all segments (C0/C1–C6/C7) imaged on the radiographic views. Measured results are corrected for radiographic magnification and variation in stature; they are virtually uninfluenced by radiographic distortion and patient alignment errors. A database describing normal Motion was compiled from 137 sets of lateral views of healthy adults taken in active flexion and extension. A specimen study as well as inter- and intra-observer studies quantify measurement errors. Results. The error study demonstrated the error (SD) of a rotational Motion measurement to amount to slightly less than 2°. The error (SD) of a translational Motion measurement amounts to less than 5% of vertebral depth; for a vertebra of 15 mm depth this corresponds to 0.7 mm. A normal database for rotational and translational Motion was compiled. There was a linear relation between rotational and translational Motion. This finding agrees qualitatively with results from previous studies; quantitative comparisons are not possible due to divergent definitions for translational Motion. The relation between rotation and translation can be employed in individual cases to predict translational Motion, in dependence on the rotation actually performed. A comparison of the rotational Motion with the normal database and the difference between predicted and actual translational Motion allow Segmental hypo-, normal or hypermobility to be quantified. Conclusions. The new protocol measures Segmental Motion with high precision and corrects for radiographic distortion, variation in stature and alignment errors of patients. Thus, archive studies using existing radiographs are feasible. Relevance Flexion–extension radiographs of the cervical spine are performed to explore potential damage to the bony or ligamentous structure resulting in abnormal, Segmental Motion patterns. Determining rotational Motion gives only an incomplete picture. The new protocol allows for precise quantification of translational Motion and classification of segments as hypo- or hypermobile by comparison with normal Motion data.
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assessment of sagittal plane Segmental Motion in the lumbar spine a comparison between distortion compensated and stereophotogrammetric roentgen analysis
Spine, 1998Co-Authors: Gunnar Leivseth, Paul Brinckmann, Wolfgang Frobin, R Johnsson, B StromqvistAbstract:STUDY DESIGN Sagittal plane translatory and rotatory Motion was measured in 15 lumbar Motion segments of 8 patients by distortion-compensated and stereophotogrammetric Roentgen analysis. OBJECTIVE To compare measurement precision of the new distortion-compensated Roentgen analysis protocol with that of the established Roentgen stereophotogrammetric technique under realistic clinical conditions. SUMMARY OF BACKGROUND DATA Roentgen stereophotogrammetric analysis constitutes the most precise method available to assess Segmental Motion. Because of the invasive nature of the procedure, however, there is interest in alternative, noninvasive protocols suitable for studying larger patient cohorts. METHODS In 8 patients, Segmental Motion of 15 lumbar segments that had undergone previous spinal surgery was assessed from stereo views by using Roentgen stereophotogrammetric analysis. Sagittal plane Segmental Motion was assessed by distortion-compensated Roentgen analysis. Sagittal plane translatory and rotatory Motion data obtained by both methods were compared. RESULTS With respect to Roentgen stereophotogrammetric analysis, sagittal plane rotation was determined by distortion-compensated Roentgen analysis with an error (standard deviation) of 1.4 degrees and a mean difference of less than 0.05 degree. Sagittal plane translation was determined by distortion-compensated Roentgen analysis, with an error of 1.25 mm and a mean difference 0.5 mm. CONCLUSION Measurement precision of distortion-compensated Roentgen analysis is slightly inferior to that of Roentgen stereophotogrammetric analysis but substantially higher than that of conventional protocols assessing lumbar Segmental Motion. If measurement precision is considered adequate and if a noninvasive technique is indicated, distortion-compensated Roentgen analysis can be used to provide reliable Motion data required for epidemiologic and clinical studies.
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precision measurement of Segmental Motion from flexion extension radiographs of the lumbar spine
Clinical Biomechanics, 1996Co-Authors: Wolfgang Frobin, Gunnar Leivseth, Paul Brinckmann, M Biggemann, O ReikerasAbstract:OBJECTIVE: To measure sagittal plane Motion of lumbar vertebrae from lateral radiographic views. Previously identified factors of imprecision such as distortion in central projection, off-centre position, axial rotation, and lateral tilt of the spine were compensated. STUDY DESIGN: This study presents a new protocol to measure sagittal plane rotational and translational Motion from lateral flexion-extension radiographs of the lumbar spine. BACKGROUND: Conventional methods to determine sagittal plane rotation and translation are prone to error from the distortional effects of the divergence of the radiographic beam and the measurement error inherent in constructing tangents to the contours of the vertebral body. High precision is attained by roentgen-stereophotogrammetric methods, but because of their invasive nature they can be applied only in exceptional cases. Agreement has been reached only in that measurement of sagittal plane Motion from lumbar spine flexion-extension radiographs is inaccurate. Normal patterns of sagittal plane Motion and the definition of what is an abnormal flexion-extension radiograph have not been settled. METHOD: Starting from an analysis of vertebral contours in the lateral view, geometric measures are identified which are virtually independent of distortion, axial rotation or lateral tilt. Applying a new protocol based on those geometric measures, the pattern of translational and rotational Motion was determined from flexion-extension radiographs of 61 symptom-free, adult subjects. Measurement errors were quantified in a specimen experiment; a reproducibility study quantified inter- and intraobserver errors. RESULTS: Magnitude and sign of 'translation per degree of rotation' determined from a cohort of 61 adult subjects were very uniform for all levels of the lumbar spine. An auxiliary study evaluating a cohort of 10 healthy subjects where flexion-extension radiographs had been taken standing and side-lying showed no dependence of the rotation/translation pattern on posture. The error study demonstrated errors in angle ranging between 0.7 and 1.6 degrees and errors in displacement ranging between 1.2% and 2.4% of vertebral depth (the largest errors occurring at the L(5)/S(1) segment). Intra- and interobserver tests showed no or only negligibly small bias and an SD virtually equal to the measurement error multiplied by radical2. The relation of displacement to angle observed in the normal cohort can be used in individual cases to predict translational Motion depending on the rotation actually performed. A comparison of the predicted translation (determined from normal controls) and the value actually measured allows translational hypo-, normal, or hypermobility to be quantified. Examples illustrate application of the new method in cases of normal, hypo-, and hypermobility and in the case of an instrumented spine. CONCLUSIONS: The results of this study show that precision of the measurement of rotational and translational Motion can be considerably enhanced by making allowance for radiographic distortional effects and by minimizing subjective influence in the measurement procedure.
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kinetic magnetic resonance imaging analysis of lumbar Segmental Motion at levels adjacent to disc herniation
European Spine Journal, 2016Co-Authors: Lifeng Lao, Michael D Daubs, Shinji Takahashi, Elizabeth L Lord, Jeremiah R Cohen, Guibin Zhong, Jeffrey C WangAbstract:A retrospective radiographic study was carried out to analyze the effect of lumbar disc herniation on the kinetic Motion of adjacent segments. A total of 162 patients with low back pain or radicular pain in the lower limbs without a prior history of surgery were evaluated using kinetic magnetic resonance imaging. Translational Motion, angular variation, and disc height were measured at each segment from L1–L2 to L5–S1. Other factors including the degree of disc degeneration, age, gender, and vertebral segment location were analyzed to determine any predisposing risk factors for Segmental instability adjacent to disc herniations. Spinal levels above the disc herniation exhibited, on average, a 6.4 % increase in translational Motion per mm of disc herniation (P = 0.496) and a 21.4 % increase in angular Motion per mm herniation (P = 0.447). Levels below the herniation demonstrated a 5.2 % increase in translational Motion per mm of disc herniation (P = 0.428) and a decrease of 10.7 % in angular Motion per mm (P = 0.726). The degree of disc degeneration had no significant correlation with adjacent level Motion. Similarly, disc herniation was not significantly correlated with disc height at adjacent levels, although there was a significant relationship between gender and adjacent segment disc height. Although disc height, translational Motion, and angular variation are significantly affected at the level of a disc herniation, no significant changes are apparent in adjacent segments. Our results indicate that herniated discs have no effect on range of Motion at adjacent levels regardless of the degree of disc degeneration or the size of disc herniation, suggesting that the natural progression of disc degeneration and adjacent segment disease may be separate, unrelated processes within the lumbar spine.
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effect of modic changes on spinal canal stenosis and Segmental Motion in cervical spine
European Spine Journal, 2014Co-Authors: Tetsuo Hayashi, Michael D Daubs, Akinobu Suzuki, Kevin Phan, Keiichiro Shiba, Jeffrey C WangAbstract:Purpose Few studies have reported the characteristics of Modic changes (MCs) in the cervical spine in contrast to the lumbar spine. The purpose of this study was to identify the prevalence of MCs in the cervical spine and to elucidate the relationship of MCs with spinal canal stenosis and angular Motion.
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effect of modic changes on spinal canal stenosis and Segmental Motion in cervical spine
European Spine Journal, 2014Co-Authors: Tetsuo Hayashi, Michael D Daubs, Akinobu Suzuki, Kevin Phan, Keiichiro Shiba, Jeffrey C WangAbstract:Few studies have reported the characteristics of Modic changes (MCs) in the cervical spine in contrast to the lumbar spine. The purpose of this study was to identify the prevalence of MCs in the cervical spine and to elucidate the relationship of MCs with spinal canal stenosis and angular Motion. 437 consecutive, symptomatic patients with neck pain with or without neurogenic symptoms were included in this study. MRI in multiple positions was performed with dynamic Motion of the cervical spine in upright, weight-bearing neutral, flexion and extension positions. Type of MC, intervertebral disc degeneration grade, spinal cord compression grade and sagittal angular Motion between flexion and extension for each segment from C2–3 to C6–7 were evaluated. MCs were observed in 84 out of 437 patients (19.2 %) and in 109 out of 2,185 Motion segments (5.0 %) with type 2 changes predominating. Disc degeneration grades and spinal cord compression grades of segments with MCs were significantly higher than those without MCs. Sagittal angular Motion of segments with MCs were significantly lower than those without MCs. Multiple logistic regression analysis revealed that significantly elevated odds ratios for MCs were observed in segments with severe disc degeneration, severe spinal canal compression and less angular Motion. The cervical segments with MCs were significantly more likely to have disc degeneration and spinal canal stenosis. In addition, the segments with MCs had significantly less angular Motion, which suggests MCs may correlate with loss of mobility.
