Characteristics of Sagittal Vertebral Alignment in Flexion Determined by Dynamic Radiographs of the Cervical Spine

Abstract

Qualitative changes from extension to flexion and quantitative values of intervertebral differences in flexion radiographs help define the normal flexibility of the cervical spine more accurately.

Sagittal range of motion after extensive cervical fusion

“…In the sitting posture, the subjects were asked to perform movements to look at different targets : their feet (flexion) and the ceiling (extension) [13]. The median sagittal ROM of the cervical spine in the sitting posture was 11 (tenth to ninetieth percentile, [9][10][11][12][13][14][15][16][17][18] in the healthy control subjects and 11 (tenth to ninetieth percentile, [9][10][11][12][13] in patients [13]. There was no statistical difference between the two groups [13].…”

“…There was no statistical difference between the two groups [13]. The median sagittal ROM of cervical spine in the walking episodes was 13 (tenth to ninetieth percentile, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] in the healthy control subjects and 9 (tenth to ninetieth percentile, 7-11 ) in the patients [13]. There was statistical difference between the two groups [13].…”

“…Approximately half of all cervical flexion-extension motion comes from the occiput to C1 and half of all cervical rotation occurs at C1-C2 [11]. The sagittal ROMs of the cervical spine in the dynamic radiographs were 11.3 at C1-C2, 7.6 at C2-C3, 13.6 at C3-C4, 17.4 at C4-C5, 16.5 at C5-C6, and 15.0 at C6-C7 [12]. The ROM of the neck is important to the activities of daily living.…”

Radiographic Assessment and Quantitative Motion Analysis of the Cervical Spine After Serial Sectioning of the Anterior Ligamentous Structures

“…19 Other studies have also focused on intervertebral motion in asymptomatic individuals. [12][13][14][15][16][17][18] Dvorak et al examined flexion and extension lateral cervical spine films in 44 people. 12 They found a mean rotation of 21°and a mean translation of 3.6 mm at C4 -C5.…”

“…11 As a reference to help identify abnormal motion, many researchers have reported on motion in the asymptomatic, intact cervical spine in vivo, using a variety of measurement techniques. [12][13][14][15][16][17][18] More recently, Reitman et al documented cervical intervertebral motion in 140 asymptomatic subjects with a validated, computer-assisted measurement technology. 19 Using the same measurement technology, Brown et al compared intervertebral motion following posterior cervical ligamentous sectioning in intact cadavers to intervertebral motion reported in the asymptomatic population and found that intervertebral rotation or translation measurements from flexionextension radiographs were inadequate to consistently determine even extensive posterior injury.…”