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

Abstract

Background Context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in misdiagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities. Purpose: Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population. Study Design/Setting: Prospective analysis of images retrospectively collected from routine clinical practices. Methods: After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers. Results: At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions. Conclusions: Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion.

A Self-Polymerizing Mesh of Nano-Tethers for the Mechanical Constraint of Degraded Intervertebral Discs—A Review of 25 Years of Pre-Clinical and Early Clinical Research

“…Of high importance with regard to selecting appropriate candidates for this intervention, knowledge of the pathological processes of symptomatic internal disc disruption and the capability to identify patients with earlier-stage lumbar discogenic pain [ 64 ] have advanced considerably during the course of the investigations summarized here. These existing and emerging assessments, outside of the scope of this present review, involve functional MRI, MR spectroscopy and other advanced imaging techniques [ 64 , 65 , 66 ], the radiographic assessment of sagittal translation, rotations, and instability and associated clinical tests [ 67 , 68 , 69 ], and provocation or anesthetic discography combined with computed tomography (CT discogram) [ 64 , 66 ].…”

The challenge of diagnosing lumbar segmental instability

“…Many studies have investigated the potential of measuring intervertebral motion by comparing images of the patient supine with images of the patient standing or exed. (102,(121)(122)(123) Some of those studies found that the greatest intervertebral translation was between upright and supine positions, while in other patients, the greatest translation was between upright exion and extension. Again, it is unknown whether rigorous, quality-controlled protocols would have changed the results.…”