An in-vitro study of the kinematics of the normal, injured and stabilized cervical spine

Goel, Vijay K.; Clark, Charles R.; McGowan, Dennis; Goyal, Swati

doi:10.1016/0021-9290(84)90030-7

Cited by 101 publications

(57 citation statements)

References 22 publications

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“…Although standard clinical imaging techniques, especially nuclear magnetic resonance imaging (MRI), allow the detection of discoligamentous injuries [9,13,24,30,31], few biomechanical data exist concerning the significance of the different discoligamentous structures for the load-displacement properties of the cervical spine under physiological loads. Several studies have been carried out to evaluate the load-displacement properties of the normal lower cervical spine in vitro [6,15,17,19,25] and in vivo [2,3,12,20], as well as in different types of artificial defect situations [6,18,26,32]. Variations in the study designs with regard to testing protocol and type of artificial defect make comparison between the different studies difficult.…”

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confidence: 99%

Load-displacement properties of the normal and injured lower cervical spine in vitro

Richter¹,

Wilke

Kluger³

et al. 2000

European Spine Journal

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IntroductionThe discoligamentous structures of the cervical spine are often involved in cervical spine injuries, for example in whiplash injuries. Although standard clinical imaging techniques, especially nuclear magnetic resonance imaging (MRI), allow the detection of discoligamentous injuries [9,13,24,30,31], few biomechanical data exist concerning the significance of the different discoligamentous structures for the load-displacement properties of the cervical spine under physiological loads. Several studies have been carried out to evaluate the load-displacement properties of the normal lower cervical spine in vitro [6,15,17,19,25] and in vivo [2,3,12,20], as well as in different types of artificial defect situations [6,18,26,32]. Variations in the study designs with regard to testing protocol and type of artificial defect make comparison between the different studies difficult. Few studies have tested artificial discoligamentous defects in the lower cervical spine under near-physiological loads [25,26,32].The objective of this study was therefore to evaluate the type and amount of instability caused by injury of different discoligamentous structures of the cervical spine in comparison to the intact cervical spine.Abstract The objective of this study was to determine which discoligamentous structures of the lower cervical spine provide significant stability with regard to different loading conditions. Accordingly, the loaddisplacement properties of the normal and injured lower cervical spine were tested in vitro. Four artificially created stages of increasing discoligamentous instability of the segment C5/6 were compared to the normal C5/6 segment. Six fresh human cadaver spine segments C4-C7 were tested in flexion/extension, axial rotation, and lateral bending using pure moments of ± 2.5 Nm without axial preload. Five conditions were investigated consecutively: (1) the intact functional spinal unit (FSU) C5/6; (2) the FSU C5/6 with the anterior longitudinal ligament and the intertransverse ligaments sectioned; (3) the FSU C5/6 with an additional 10-mm-deep incision of the anterior half of the anulus fibrosus and the disc; (4) the FSU C5/6 with additionally sectioned ligamenta flava as well as interspinous and supraspinous ligaments; (5) the FSU C5/6 with additional capsulotomy of the facet joints. In flexion/extension, significant differences were observed concerning range of motion (ROM) and neutral zone (NZ) for all four stages of instability compared to the intact FSU. In axial rotation, only the stage 4 instability showed a significantly increased ROM and NZ compared to the intact FSU. For lateral bending, no significant differences were observed. Based on these data, we conclude that flexion/extension is the most sensitive load-direction for the tested discoligamentous instabilities.

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confidence: 99%

Load-displacement properties of the normal and injured lower cervical spine in vitro

Richter¹,

Wilke

Kluger³

et al. 2000

European Spine Journal

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“…Similarly, with the primary motion in right lateral bending, there is coupled motion in right rotation. This has been measured in healthy human subjects and cadaveric specimens [13,16,23,33,35,37,39,51,58].…”

Section: Discussionmentioning

confidence: 99%

“…processes [3,13,16,23,33,35,37,39,51,58]. Degenerative disc disease in the cervical spine can cause abnormal motions and altered load distribution within the disc, leading to discogenic pain and severely limiting the ability of individuals to perform ADL.…”

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Primary and coupled motions after cervical total disc replacement using a compressible six-degree-of-freedom prosthesis

et al. 2010

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This study tested the hypotheses that (1) cervical total disc replacement with a compressible, sixdegree-of-freedom prosthesis would allow restoration of physiologic range and quality of motion, and (2) the kinematic response would not be adversely affected by variability in prosthesis position in the sagittal plane. Twelve human cadaveric cervical spines were tested. Prostheses were implanted at C5-C6. Range of motion (ROM) was measured in flexion-extension, lateral bending, and axial rotation under ±1.5 Nm moments. Motion coupling between axial rotation and lateral bending was calculated. Stiffness in the high flexibility zone was evaluated in all three testing modes, while the center of rotation (COR) was calculated using digital video fluoroscopic images in flexion-extension. Implantation in the middle position increased ROM in flexion-extension from 13.5 ± 2.3 to 15.7 ± 3.0°(p \ 0.05), decreased axial rotation from 9.9 ± 1.7 to 8.3 ± 1.6°(p \ 0.05), and decreased lateral bending from 8.0 ± 2.1 to 4.5 ± 1.1°( p \ 0.05). Coupled lateral bending decreased from 0.62 ± 0.16 to 0.39 ± 0.15°for each degree of axial rotation (p \ 0.05). Flexion-extension stiffness of the reconstructed segment with the prosthesis in the middle position did not deviate significantly from intact controls, whereas the lateral bending and axial rotation stiffness values were significantly larger than intact. Implanting the prosthesis in the posterior position as compared to the middle position did not significantly affect the ROM, motion coupling, or stiffness of the reconstructed segment; however, the COR location better approximated intact controls with the prosthesis midline located within ±1 mm of the disc-space midline. Overall, the kinematic response after reconstruction with the compressible, six-degree-offreedom prosthesis within ±1 mm of the disc-space midline approximated the intact response in flexion-extension. Clinical studies are needed to understand and interpret the effects of limited restoration of lateral bending and axial rotation motions and motion coupling on clinical outcome.

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“…9,15,17,18,25,34,47,58 ROM is either reported as the rotation of the entire spinal section (cervical or lumbar), or the relative rotation of one vertebral body with respect to another (MSU rotation). It is common to report ROM data for harvested, non-altered specimen to be compared to ROM data for the same specimen instrumented or altered in some way.…”

Section: Range Of Motionmentioning

confidence: 99%

A Passive Pure Moment Protocol for Testing Spine Segments: Development and Application

Fraysur¹

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An in-vitro study of the kinematics of the normal, injured and stabilized cervical spine

Cited by 101 publications

References 22 publications

Load-displacement properties of the normal and injured lower cervical spine in vitro

Load-displacement properties of the normal and injured lower cervical spine in vitro

Primary and coupled motions after cervical total disc replacement using a compressible six-degree-of-freedom prosthesis

A Passive Pure Moment Protocol for Testing Spine Segments: Development and Application

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