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Hans-joachim Wilke - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of personalized 3d printed versus standard expandable titanium vertebral body replacement implants in the mid Thoracic Spine using entire rib cage specimens
Clinical Biomechanics, 2020Co-Authors: Christian Liebsch, Viktor Aleinikov, Talgat Kerimbayev, Serik Akshulakov, Tugrul Kocak, Morten Vogt, Jan Ulrich Jansen, Hans-joachim WilkeAbstract:Abstract Background Expandable titanium implants have proven their suitability as vertebral body replacement device in several clinical and biomechanical studies. Potential stabilizing features of personalized 3D printed titanium devices, however, have never been explored. This in vitro study aimed to prove their equivalence regarding primary stability and three-dimensional motion behavior in the mid-Thoracic Spine including the entire rib cage. Methods Six fresh frozen human Thoracic Spine specimens with intact rib cages were loaded with pure moments of 5 Nm while performing optical motion tracking of all vertebrae. Following testing in intact condition (1), the specimens were tested after inserting personalized 3D printed titanium vertebral body replacement implants (2) and the two standard expandable titanium implants Obelisc™ (3) and Synex™ (4), each at T6 level combined with posterior pedicle screw-rod fixation from T4 to T8. Findings No significant differences (P Interpretation Personalized 3D printed vertebral body replacement implants provide a promising alternative to standard expandable devices regarding primary stability and three-dimensional motion behavior in the mid-Thoracic Spine due to the stabilizing effect of the rib cage.
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rib presence anterior rib cage integrity and segmental length affect the stability of the human Thoracic Spine an in vitro study
Frontiers in Bioengineering and Biotechnology, 2020Co-Authors: Christian Liebsch, Hans-joachim WilkeAbstract:The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on Thoracic spinal stability have not been extensively investigated, but are essential for the calibration and validation of numerical models of the Thoracic Spine and rib cage. The aim of the study was to quantify these effects by in vitro experiments. Eight human Thoracic Spine specimens (C7-L1) including the rib cage were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation while tracking the motions of all functional spinal units. Specimens were tested stepwise in four different conditions: (1) In the intact condition, (2) after cutting all anterior rib-to-rib connections, (3) after partitioning the polysegmental specimens into monosegmental specimens, and (4) after removing the ribs in the monosegmental condition. Significant increases of the range of motion (p < 0.05) were especially found at the segmental levels of the upper half of the Thoracic Spine in all motion planes and for all resection steps, particularly in axial rotation, while the stabilizing effects of the structures decreased in inferior direction. Partitioning of polysegmental specimens into monosegmental specimens primarily affected the stability in lateral bending, while the effects of resection were generally lowest in flexion/extension. Presence of the ribs, anterior rib cage integrity, and segmental length all affect the Thoracic spinal stability and have therefore to be considered in the calibration process of numerical models of the Thoracic Spine and rib cage.
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The rib cage stabilizes the human Thoracic Spine: An in vitro study using stepwise reduction of rib cage structures.
PLOS ONE, 2017Co-Authors: Christian Liebsch, Konrad Appelt, Nicolas Graf, Hans-joachim WilkeAbstract:: The stabilizing effect of the rib cage on the human Thoracic Spine is still not sufficiently analyzed. For a better understanding of this effect as well as the calibration and validation of numerical models of the Thoracic Spine, experimental biomechanics data is required. This study aimed to determine (1) the stabilizing effect of the single rib cage structures on the human Thoracic Spine as well as the effect of the rib cage on (2) the flexibility of the single motion segments and (3) coupled motion behavior of the Thoracic Spine. Six human Thoracic Spine specimens including the entire rib cage were loaded quasi-statically with pure moments of ± 2 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) using a custom-built Spine tester. Motion analysis was performed using an optical motion tracking system during load application to determine range of motion (ROM) and neutral zone (NZ). Specimens were tested (1) in intact condition, (2) after removal of the intercostal muscles, (3) after median sternotomy, after removal of (4) the anterior rib cage up to the rib stumps, (5) the right sixth to eighth rib head, and (6) all rib heads. Significant (p < 0.05) increases of the ROM were found after dissecting the intercostal muscles (LB: + 22.4%, AR: + 22.6%), the anterior part of the rib cage (FE: + 21.1%, LB: + 10.9%, AR: + 72.5%), and all rib heads (AR: + 5.8%) relative to its previous condition. Compared to the intact condition, ROM and NZ increased significantly after removing the anterior part of the rib cage (FE: + 52.2%, + 45.6%; LB: + 42.0%, + 54.0%; AR: + 94.4%, + 187.8%). Median sternotomy (FE: + 11.9%, AR: + 21.9%) and partial costovertebral release (AR: + 11.7%) significantly increased the ROM relative to its previous condition. Removing the entire rib cage increased both monosegmental and coupled motion ROM, but did not alter the qualitative motion behavior. The rib cage has a strong effect on Thoracic Spine rigidity, especially in axial rotation by a factor of more than two, and should therefore be considered in clinical scenarios, in vitro, and in silico.
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EUROSpine 2016 FULL PAPER AWARD: Wire cerclage can restore the stability of the Thoracic Spine after median sternotomy: an in vitro study with entire rib cage specimens
European Spine Journal, 2016Co-Authors: Christian Liebsch, Nicolas Graf, Hans-joachim WilkeAbstract:The influence of the anterior rib cage on the stability of the human Thoracic Spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human Thoracic Spine after longitudinal median sternotomy. Six fresh frozen human Thoracic Spine specimens (C7–L1, 56 years in average, range 50–65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system. While applying 2 Nm pure moment in flexion/extension (FE), lateral bending (LB), and axial rotation (AR), the range of motion (ROM) and neutral zone (NZ) of the functional spinal units of the Thoracic Spine (T1–T12) were studied (1) in intact condition, (2) after longitudinal median sternotomy, and (3) after sternal closure using wire cerclage. The longitudinal median sternotomy caused a significant increase of the Thoracic Spine ROM relative to the intact condition (FE: 12° ± 5°, LB: 18° ± 5°, AR: 25° ± 10°) in FE (+12 %) and AR (+22 %). As a result, the sagittal cut faces of the sternum slipped apart visibly. Wire cerclage fixation resulted in a significant decrease of the ROM in AR (−12 %) relative to condition after sternotomy. ROM increased relative to the intact condition, in AR even significantly (+8 %). The NZ showed a proportional behavior compared to the ROM in all loading planes, but it was distinctly higher in FE (72 %) and in LB (82 %) compared to the ROM than in AR (12 %). In this in vitro study, the longitudinal median sternotomy resulted in a destabilization of the Thoracic Spine and relative motion of the sternal cut faces, which could be rectified by fixation with wire cerclage. However, the stability of the intact condition could not be reached. Nevertheless, a fixation of the sternum should be considered clinically to avoid instability of the Spine and sternal pseudarthrosis.
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In vitro analysis of the segmental flexibility of the Thoracic Spine.
Public Library of Science (PLoS), 2024Co-Authors: Hans-joachim Wilke, Andrea Herkommer, Karin Werner, Christian LiebschAbstract:Basic knowledge about the Thoracic spinal flexibility is limited and to the authors' knowledge, no in vitro studies have examined the flexibility of every Thoracic spinal segment under standardized experimental conditions using pure moments. In our in vitro study, 68 human Thoracic functional spinal units including the costovertebral joints (at least n = 6 functional spinal units per segment from T1-T2 to T11-T12) were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation in a custom-built Spine tester to analyze range of motion (ROM) and neutral zone (NZ). ROM and NZ showed symmetric motion behavior in all loading planes. In each loading direction, the segment T1-T2 exhibited the highest ROM. In flexion/extension, the whole Thoracic region, with exception of T1-T2 (14°), had an average ROM between 6° and 8°. In lateral bending, the upper Thoracic region (T1-T7) was, with an average ROM between 10° and 12°, more flexible than the lower Thoracic region (T7-T12) with an average ROM between 8° and 9°. In axial rotation, the Thoracic region offered the highest overall flexibility with an average ROM between 10° and 12° in the upper and middle Thoracic Spine (T1-T10) and between 7° and 8° in the lower Thoracic Spine (T10-T12), while a trend of continuous decrease of ROM could be observed in the lower Thoracic region (T7-T12). Comparing these ROM values with those in literature, they agree that ROM is lowest in flexion/extension and highest in axial rotation, as well as decreasing in the lower segments in axial rotation. Differences were found in flexion/extension and lateral bending in the lower segments, where, in contrast to the literature, no increase of the ROM from superior to inferior segments was found. The data of this in vitro study could be used for the validation of numerical models and the design of further in vitro studies of the Thoracic Spine without the rib cage, the verification of animal models, as well as the interpretation of already published human in vitro data
Christian Liebsch - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of personalized 3d printed versus standard expandable titanium vertebral body replacement implants in the mid Thoracic Spine using entire rib cage specimens
Clinical Biomechanics, 2020Co-Authors: Christian Liebsch, Viktor Aleinikov, Talgat Kerimbayev, Serik Akshulakov, Tugrul Kocak, Morten Vogt, Jan Ulrich Jansen, Hans-joachim WilkeAbstract:Abstract Background Expandable titanium implants have proven their suitability as vertebral body replacement device in several clinical and biomechanical studies. Potential stabilizing features of personalized 3D printed titanium devices, however, have never been explored. This in vitro study aimed to prove their equivalence regarding primary stability and three-dimensional motion behavior in the mid-Thoracic Spine including the entire rib cage. Methods Six fresh frozen human Thoracic Spine specimens with intact rib cages were loaded with pure moments of 5 Nm while performing optical motion tracking of all vertebrae. Following testing in intact condition (1), the specimens were tested after inserting personalized 3D printed titanium vertebral body replacement implants (2) and the two standard expandable titanium implants Obelisc™ (3) and Synex™ (4), each at T6 level combined with posterior pedicle screw-rod fixation from T4 to T8. Findings No significant differences (P Interpretation Personalized 3D printed vertebral body replacement implants provide a promising alternative to standard expandable devices regarding primary stability and three-dimensional motion behavior in the mid-Thoracic Spine due to the stabilizing effect of the rib cage.
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rib presence anterior rib cage integrity and segmental length affect the stability of the human Thoracic Spine an in vitro study
Frontiers in Bioengineering and Biotechnology, 2020Co-Authors: Christian Liebsch, Hans-joachim WilkeAbstract:The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on Thoracic spinal stability have not been extensively investigated, but are essential for the calibration and validation of numerical models of the Thoracic Spine and rib cage. The aim of the study was to quantify these effects by in vitro experiments. Eight human Thoracic Spine specimens (C7-L1) including the rib cage were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation while tracking the motions of all functional spinal units. Specimens were tested stepwise in four different conditions: (1) In the intact condition, (2) after cutting all anterior rib-to-rib connections, (3) after partitioning the polysegmental specimens into monosegmental specimens, and (4) after removing the ribs in the monosegmental condition. Significant increases of the range of motion (p < 0.05) were especially found at the segmental levels of the upper half of the Thoracic Spine in all motion planes and for all resection steps, particularly in axial rotation, while the stabilizing effects of the structures decreased in inferior direction. Partitioning of polysegmental specimens into monosegmental specimens primarily affected the stability in lateral bending, while the effects of resection were generally lowest in flexion/extension. Presence of the ribs, anterior rib cage integrity, and segmental length all affect the Thoracic spinal stability and have therefore to be considered in the calibration process of numerical models of the Thoracic Spine and rib cage.
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The rib cage stabilizes the human Thoracic Spine: An in vitro study using stepwise reduction of rib cage structures.
PLOS ONE, 2017Co-Authors: Christian Liebsch, Konrad Appelt, Nicolas Graf, Hans-joachim WilkeAbstract:: The stabilizing effect of the rib cage on the human Thoracic Spine is still not sufficiently analyzed. For a better understanding of this effect as well as the calibration and validation of numerical models of the Thoracic Spine, experimental biomechanics data is required. This study aimed to determine (1) the stabilizing effect of the single rib cage structures on the human Thoracic Spine as well as the effect of the rib cage on (2) the flexibility of the single motion segments and (3) coupled motion behavior of the Thoracic Spine. Six human Thoracic Spine specimens including the entire rib cage were loaded quasi-statically with pure moments of ± 2 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) using a custom-built Spine tester. Motion analysis was performed using an optical motion tracking system during load application to determine range of motion (ROM) and neutral zone (NZ). Specimens were tested (1) in intact condition, (2) after removal of the intercostal muscles, (3) after median sternotomy, after removal of (4) the anterior rib cage up to the rib stumps, (5) the right sixth to eighth rib head, and (6) all rib heads. Significant (p < 0.05) increases of the ROM were found after dissecting the intercostal muscles (LB: + 22.4%, AR: + 22.6%), the anterior part of the rib cage (FE: + 21.1%, LB: + 10.9%, AR: + 72.5%), and all rib heads (AR: + 5.8%) relative to its previous condition. Compared to the intact condition, ROM and NZ increased significantly after removing the anterior part of the rib cage (FE: + 52.2%, + 45.6%; LB: + 42.0%, + 54.0%; AR: + 94.4%, + 187.8%). Median sternotomy (FE: + 11.9%, AR: + 21.9%) and partial costovertebral release (AR: + 11.7%) significantly increased the ROM relative to its previous condition. Removing the entire rib cage increased both monosegmental and coupled motion ROM, but did not alter the qualitative motion behavior. The rib cage has a strong effect on Thoracic Spine rigidity, especially in axial rotation by a factor of more than two, and should therefore be considered in clinical scenarios, in vitro, and in silico.
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EUROSpine 2016 FULL PAPER AWARD: Wire cerclage can restore the stability of the Thoracic Spine after median sternotomy: an in vitro study with entire rib cage specimens
European Spine Journal, 2016Co-Authors: Christian Liebsch, Nicolas Graf, Hans-joachim WilkeAbstract:The influence of the anterior rib cage on the stability of the human Thoracic Spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human Thoracic Spine after longitudinal median sternotomy. Six fresh frozen human Thoracic Spine specimens (C7–L1, 56 years in average, range 50–65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system. While applying 2 Nm pure moment in flexion/extension (FE), lateral bending (LB), and axial rotation (AR), the range of motion (ROM) and neutral zone (NZ) of the functional spinal units of the Thoracic Spine (T1–T12) were studied (1) in intact condition, (2) after longitudinal median sternotomy, and (3) after sternal closure using wire cerclage. The longitudinal median sternotomy caused a significant increase of the Thoracic Spine ROM relative to the intact condition (FE: 12° ± 5°, LB: 18° ± 5°, AR: 25° ± 10°) in FE (+12 %) and AR (+22 %). As a result, the sagittal cut faces of the sternum slipped apart visibly. Wire cerclage fixation resulted in a significant decrease of the ROM in AR (−12 %) relative to condition after sternotomy. ROM increased relative to the intact condition, in AR even significantly (+8 %). The NZ showed a proportional behavior compared to the ROM in all loading planes, but it was distinctly higher in FE (72 %) and in LB (82 %) compared to the ROM than in AR (12 %). In this in vitro study, the longitudinal median sternotomy resulted in a destabilization of the Thoracic Spine and relative motion of the sternal cut faces, which could be rectified by fixation with wire cerclage. However, the stability of the intact condition could not be reached. Nevertheless, a fixation of the sternum should be considered clinically to avoid instability of the Spine and sternal pseudarthrosis.
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In vitro analysis of the segmental flexibility of the Thoracic Spine.
Public Library of Science (PLoS), 2024Co-Authors: Hans-joachim Wilke, Andrea Herkommer, Karin Werner, Christian LiebschAbstract:Basic knowledge about the Thoracic spinal flexibility is limited and to the authors' knowledge, no in vitro studies have examined the flexibility of every Thoracic spinal segment under standardized experimental conditions using pure moments. In our in vitro study, 68 human Thoracic functional spinal units including the costovertebral joints (at least n = 6 functional spinal units per segment from T1-T2 to T11-T12) were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation in a custom-built Spine tester to analyze range of motion (ROM) and neutral zone (NZ). ROM and NZ showed symmetric motion behavior in all loading planes. In each loading direction, the segment T1-T2 exhibited the highest ROM. In flexion/extension, the whole Thoracic region, with exception of T1-T2 (14°), had an average ROM between 6° and 8°. In lateral bending, the upper Thoracic region (T1-T7) was, with an average ROM between 10° and 12°, more flexible than the lower Thoracic region (T7-T12) with an average ROM between 8° and 9°. In axial rotation, the Thoracic region offered the highest overall flexibility with an average ROM between 10° and 12° in the upper and middle Thoracic Spine (T1-T10) and between 7° and 8° in the lower Thoracic Spine (T10-T12), while a trend of continuous decrease of ROM could be observed in the lower Thoracic region (T7-T12). Comparing these ROM values with those in literature, they agree that ROM is lowest in flexion/extension and highest in axial rotation, as well as decreasing in the lower segments in axial rotation. Differences were found in flexion/extension and lateral bending in the lower segments, where, in contrast to the literature, no increase of the ROM from superior to inferior segments was found. The data of this in vitro study could be used for the validation of numerical models and the design of further in vitro studies of the Thoracic Spine without the rib cage, the verification of animal models, as well as the interpretation of already published human in vitro data
Elizabeth A. Friis - One of the best experts on this subject based on the ideXlab platform.
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Effect of follower load on motion and stiffness of the human Thoracic Spine with intact rib cage.
Journal of Biomechanics, 2016Co-Authors: Hadley L. Sis, Erin M. Mannen, Dennis E. Anderson, Benjamin M. Wong, Eileen S. Cadel, Mary L. Bouxsein, Elizabeth A. FriisAbstract:Abstract Researchers have reported on the importance of the rib cage in maintaining mechanical stability in the Thoracic Spine and on the validity of a compressive follower preload. However, dynamic mechanical testing using both the rib cage and follower load has never been studied. An in vitro biomechanical study of human cadaveric Thoracic specimens with rib cage intact in lateral bending, flexion/extension, and axial rotation under varying compressive follower preloads was performed. The objective was to characterize the motion and stiffness of the Thoracic Spine with intact rib cage and follower preload. The hypotheses tested for all modes of bending were (i) range of motion, elastic zone, and neutral zone will be reduced with a follower load, and (ii) neutral and elastic zone stiffness will be increased with a follower load. Eight human cadaveric Thoracic Spine specimen (T1–T12) with intact rib cage were subjected to 5 Nm pure moments in lateral bending, flexion/extension, and axial rotation under follower loads of 0–400 N. Range of motion, elastic and neutral zones, and elastic and neutral zone stiffness values were calculated for functional spinal units and segments within the entire Thoracic section. Combined segmental range of motion decreased by an average of 34% with follower load for every mode. Application of a follower load with intact rib cage impacts the motion and stiffness of the human cadaveric Thoracic Spine. Researchers should consider including both aspects to better represent the physiologic implications of human motion and improve clinically relevant biomechanical Thoracic Spine testing.
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mechanical analysis of the human cadaveric Thoracic Spine with intact rib cage
Journal of Biomechanics, 2015Co-Authors: Erin M. Mannen, John T. Anderson, Paul M. Arnold, Elizabeth A. FriisAbstract:The goal of this study was to characterize the overall in-plane and basic coupled motion of a cadaveric human Thoracic Spine with intact true ribs. Researchers are becoming increasingly interested in the Thoracic Spine due to both the high prevalence of injury and pain in the region and also innovative surgical techniques that utilize the rib cage. Computational models can be useful tools to predict loading patterns and understand effects of surgical procedures or medical devices, but they are often limited by insufficient cadaveric input data. In this study, pure moments to ±5 Nm were applied in flexion-extension, lateral bending, and axial rotation to seven human cadaveric Thoracic Spine specimens (T1-T12) with intact true ribs to determine symmetry of in-plane motion, differences in neutral and elastic zone motion and stiffness, and significance of out-of-plane rotations and translations. Results showed that lateral bending and axial rotation exhibited symmetric motion, neutral and elastic zone motion and stiffness values were significantly different for all modes of bending (p<0.05), and out-of-plane rotations and translations were greater than zero for most rotations and translations. Overall in-plane rotations were 7.7±3.4° in flexion, 9.6±3.7° in extension, 23.3±8.4° in lateral bending, and 26.3±12.2° in axial rotation. Results of this study could provide inputs or validation comparisons for computational models. Future studies should characterize coupled motion patterns and local and regional level biomechanics of cadaveric human Thoracic Spines with intact true ribs.
Jay Hertel - One of the best experts on this subject based on the ideXlab platform.
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Thoracic Spine thrust manipulation improves pain range of motion and self reported function in patients with mechanical neck pain a systematic review
Journal of Orthopaedic & Sports Physical Therapy, 2011Co-Authors: Kevin M Cross, Terry L Grindstaff, Christopher Kuenze, Jay HertelAbstract:Study Design Systematic review. Background Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of Thoracic Spine thrust manipulation for the treatment of individuals with mechanical neck pain. Objective The purpose of this systematic review was to determine the effects of Thoracic Spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain. Methods Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included “Thoracic mobilization,” “Thoracic Spine mobilization,” “Thoracic manipulation,” and “Thoracic Spine manipulation.” Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range ...
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Thoracic Spine thrust manipulation improves pain range of motion and self reported function in patients with mechanical neck pain a systematic review
Journal of Orthopaedic & Sports Physical Therapy, 2011Co-Authors: Kevin M Cross, Terry L Grindstaff, Christopher Kuenze, Jay HertelAbstract:STUDY DESIGN: Systematic review. BACKGROUND: Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of Thoracic Spine thrust manipulation for the treatment of individuals with mechanical neck pain. OBJECTIVE: The purpose of this systematic review was to determine the effects of Thoracic Spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain. METHODS: Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "Thoracic mobilization," "Thoracic Spine mobilization," "Thoracic manipulation," and "Thoracic Spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals. RESULTS: Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect. CONCLUSIONS: Thoracic Spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable. LEVEL OF EVIDENCE: Therapy, level 1b-.
Joshua A Cleland - One of the best experts on this subject based on the ideXlab platform.
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short term combined effects of Thoracic Spine thrust manipulation and cervical Spine nonthrust manipulation in individuals with mechanical neck pain a randomized clinical trial
Journal of Orthopaedic & Sports Physical Therapy, 2013Co-Authors: Michael Masaracchio, Joshua A Cleland, Madeleine Hellman, Marshall HaginsAbstract:Study Design Randomized clinical trial. Objective To investigate the short-term effects of Thoracic Spine thrust manipulation combined with cervical Spine nonthrust manipulation (experimental group) versus cervical Spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain. Background Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical Spine and thrust manipulation directed at the Thoracic Spine in patients with neck pain. Previous studies have not determined if Thoracic Spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone. Methods Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical Spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional Thoracic ...
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examination of motor and hypoalgesic effects of cervical vs Thoracic Spine manipulation in patients with lateral epicondylalgia a clinical trial
Journal of Manipulative and Physiological Therapeutics, 2011Co-Authors: Josue Fernandezcarnero, Joshua A Cleland, Roy La Touche ArbizuAbstract:Abstract Objectives The purpose of this study was to compare the effects of a cervical vs Thoracic Spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE). Methods A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended 1 experimental session. Participants were randomized to receive either a cervical or Thoracic Spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and 5 minutes postintervention by an examiner blind to group assignment. A 3-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip. Results The analysis of variance detected a significant interaction between group and time (F = 31.7, P P P = .42) existed. Conclusions Cervical Spine manipulation produced greater changes in PPT than Thoracic Spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions.
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Thoracic Spine thrust manipulation versus cervical Spine thrust manipulation in patients with acute neck pain a randomized clinical trial
Journal of Orthopaedic & Sports Physical Therapy, 2011Co-Authors: Emilio J Puentedura, Joshua A Cleland, Merrill R Landers, Paul E Mintken, Peter A Huijbregts, Cesar FernandezdelaspenasAbstract:Study Design Randomized clinical trial. Objective To determine if patients who met the clinical prediction rule (CPR) criteria for the success of Thoracic Spine thrust joint manipulation (TJM) for the treatment of neck pain would have a different outcome if they were treated with a cervical Spine TJM. Background A CPR had been proposed to identify patients with neck pain who would likely respond favorably to Thoracic Spine TJM. Research on validation of that CPR had not been completed when this trial was initiated. In our clinical experience, though many patients with neck pain responded favorably to Thoracic Spine TJM, they often reported that their symptomatic cervical Spine area had not been adequately addressed. Methods Twenty-four consecutive patients, who presented to physical therapy with a primary complaint of neck pain and met 4 out of 6 of the CPR criteria for Thoracic TJM, were randomly assigned to 1 of 2 treatment groups. The Thoracic group received Thoracic TJM and a cervical range-of-motion ...
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Thoracic Spine manipulation for the management of patients with neck pain a randomized clinical trial
Journal of Orthopaedic & Sports Physical Therapy, 2009Co-Authors: Javier Gonzaleziglesias, Joshua A Cleland, Cesar Fernandezdelaspenas, Maria Del Rosario GutierrezvegaAbstract:Design Randomized clinical trial. Objectives To investigate if patients with mechanical neck pain receiving Thoracic Spine thrust manipulation would experience superior outcomes compared to a group not receiving thrust manipulation. Background Evidence has begun to emerge in support of Thoracic thrust manipulation as an intervention in the management of mechanical neck pain. However, to make a strong recommendation for a clinical technique it is necessary to have multiple studies with convergent findings. Methods and Measures Forty five patients (21 females) were randomly assigned to 1 of 2 groups: a control group, which received electro/thermal therapy for 5 treatment sessions, and the experimental group, which received the same electro/thermal therapy program in addition to a Thoracic Spine thrust manipulation once a week for 3 consecutive weeks. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of treatment on pain (100-mm visual analogue scale), disability (100-point disabilit...
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development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain use of Thoracic Spine manipulation exercise and patient education
Physical Therapy, 2007Co-Authors: Joshua A Cleland, John D Childs, Julie M Fritz, Julie M Whitman, Sarah L EberhartAbstract:To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with neck pain who are likely to benefit from Thoracic Spine thrust manipulation. The purpose of this study was to develop a clinical prediction rule (CPR) to identify patients with neck pain who are likely to experience early success from Thoracic Spine thrust manipulation. Subjects This was a prospective, cohort study of patients with mechanical neck pain who were referred for physical therapy. Methods Subjects underwent a standardized examination and then a series of Thoracic Spine thrust manipulation techniques. They were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success.
