Skip to main content
Top
Published in: European Spine Journal 9/2007

01-09-2007 | Original Article

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

Authors: Shyi-Kuen Wu, Li-Chieh Kuo, Haw-Chang H. Lan, Sen-Wei Tsai, Chiung-Ling Chen, Fong-Chin Su

Published in: European Spine Journal | Issue 9/2007

Login to get access

Abstract

The insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding of the cervical biomechanics and treating the cervical related dysfunction. The objective of this study was to quantitatively measure the continuous intervertebral translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. A total of 1,120 image sequences were analyzed for 56 healthy adult subjects by a precise image protocol during cervical flexion and extension. our results showed there were no statistical angular differences among five spinal levels in either flexion or extension, except for the comparison between C2/3 (13.5°) and C4/5 (22.6°) angles. During cervical flexion, the smallest anterior translations were 0.7 mm at C2/3 level, followed by 0.9 mm at C6/7, 1.0 mm at C3/4, 1.1 mm at C5/6, and the largest 1.2 mm at C4/5 levels. The significantly greater translations were measured in the posterior direction at C3/4 (1.1 mm, P = 0.037), C4/5 (1.3 mm, P = 0.039), and C5/6 (1.2 mm, P = 0.005) levels than in the anterior one. The relatively fluctuant and small average posterior translation fashion at C6/7 level (0.4 mm) possibly originated from the variations in the direction of translation during cervical extension among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.5, 13.7, 16.6, 15.0, and 8.6% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.
Literature
1.
go back to reference Axelsson P, Karlsson BS (2004) Intervertebral mobility in the progressive degenerative process. A radiostereometric analysis. Eur Spine J 13:567–572PubMedCrossRef Axelsson P, Karlsson BS (2004) Intervertebral mobility in the progressive degenerative process. A radiostereometric analysis. Eur Spine J 13:567–572PubMedCrossRef
2.
go back to reference Bell GD (1991) Skeletal applications of videofluoroscopy. J Manip Physiol Ther 14:390–392 Bell GD (1991) Skeletal applications of videofluoroscopy. J Manip Physiol Ther 14:390–392
3.
go back to reference Bhalla SK, Simmons EH (1969) Normal ranges of intervertebral joint motion of the cervical spine. Can J Surg 12:181–187PubMed Bhalla SK, Simmons EH (1969) Normal ranges of intervertebral joint motion of the cervical spine. Can J Surg 12:181–187PubMed
4.
go back to reference Bogduk N, Mercer M (2000) Biomechanics of the cervical spine I: normal kinematics. Clin Biomech 15:633–648CrossRef Bogduk N, Mercer M (2000) Biomechanics of the cervical spine I: normal kinematics. Clin Biomech 15:633–648CrossRef
5.
go back to reference Boyle JJW, Milne N, Singer KP (2002) Influence of age on cervicothoracic spinal curvature: An ex vivo radiographic survey. Clin Biomech 17:361–367CrossRef Boyle JJW, Milne N, Singer KP (2002) Influence of age on cervicothoracic spinal curvature: An ex vivo radiographic survey. Clin Biomech 17:361–367CrossRef
6.
go back to reference Descarreaux M, Blouin JS, Teasdale N (2003) A non-invasive technique for measurement of cervical vertebral angle: report of a preliminary study. Eur Spine J 12:314–319PubMed Descarreaux M, Blouin JS, Teasdale N (2003) A non-invasive technique for measurement of cervical vertebral angle: report of a preliminary study. Eur Spine J 12:314–319PubMed
7.
go back to reference Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM (1998) Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine 13:748–755CrossRef Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM (1998) Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine 13:748–755CrossRef
8.
go back to reference Frobin W, Leivseth G, Biggemann M, Brinckmann P (2002) Sagittal plane segmental motion of the cervical spine: a new precision measurement protocol and normal motion data of healthy adults. Clin Biomech 17:21–31CrossRef Frobin W, Leivseth G, Biggemann M, Brinckmann P (2002) Sagittal plane segmental motion of the cervical spine: a new precision measurement protocol and normal motion data of healthy adults. Clin Biomech 17:21–31CrossRef
9.
go back to reference Frobin W, Leivseth G, Biggemann M, Brinckmann P (2002) Vertebral height, disc height, posteroanterior displacement and dens-atlas gap in the cervical spine: precision measurement protocol and normal data. Clin Biomech 17:423–431CrossRef Frobin W, Leivseth G, Biggemann M, Brinckmann P (2002) Vertebral height, disc height, posteroanterior displacement and dens-atlas gap in the cervical spine: precision measurement protocol and normal data. Clin Biomech 17:423–431CrossRef
10.
go back to reference Harada M, Abumi K, Ito M, Kaneda K (2000) Cineradiographic motion analysis of normal lumbar spine during forward and backward flexion. Spine 25:1932–1937PubMedCrossRef Harada M, Abumi K, Ito M, Kaneda K (2000) Cineradiographic motion analysis of normal lumbar spine during forward and backward flexion. Spine 25:1932–1937PubMedCrossRef
11.
go back to reference Harvey SB, Hukins DWL (1998) Measurement of lumbar spinal flexion–extension kinematics from lateral radiographs: simulation of the effects of out-of-plane movement and errors in reference point placement. Med Eng Phys 20:403–409PubMedCrossRef Harvey SB, Hukins DWL (1998) Measurement of lumbar spinal flexion–extension kinematics from lateral radiographs: simulation of the effects of out-of-plane movement and errors in reference point placement. Med Eng Phys 20:403–409PubMedCrossRef
12.
go back to reference Hino H, Abumi K, Kanayama M, Kaneda K (1999) Dynamic motion analysis of normal and unstable cervical spines using cineradiography: an in vivo study. Spine 24:163–168PubMedCrossRef Hino H, Abumi K, Kanayama M, Kaneda K (1999) Dynamic motion analysis of normal and unstable cervical spines using cineradiography: an in vivo study. Spine 24:163–168PubMedCrossRef
13.
go back to reference Houck J, Yack HJ, Mulhausen P (1997) Neck mobility: the influence of age and a history of neck pain. Gait Posture 5:184CrossRef Houck J, Yack HJ, Mulhausen P (1997) Neck mobility: the influence of age and a history of neck pain. Gait Posture 5:184CrossRef
14.
go back to reference Huang RC, Tropiano P, Marnay T, Girardi FP, Lim MR, Cammisa FP (2006) Range of motion and adjacent level degeneration after lumbar total disc replacement. Spine J 6:242–247PubMedCrossRef Huang RC, Tropiano P, Marnay T, Girardi FP, Lim MR, Cammisa FP (2006) Range of motion and adjacent level degeneration after lumbar total disc replacement. Spine J 6:242–247PubMedCrossRef
15.
go back to reference Koerhuis CL, Winters JC, van der Helm FCT, Hof AL (2003) Neck mobility measurement by means of the ‘Flock of Birds’ electromagnetic tracking system. Clin Biomech 18:14–18CrossRef Koerhuis CL, Winters JC, van der Helm FCT, Hof AL (2003) Neck mobility measurement by means of the ‘Flock of Birds’ electromagnetic tracking system. Clin Biomech 18:14–18CrossRef
16.
go back to reference Kolstad F, Myhr G, Kvistad KA, Nygaard OP, Leivseth G (2005) Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol 55:415–420PubMedCrossRef Kolstad F, Myhr G, Kvistad KA, Nygaard OP, Leivseth G (2005) Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol 55:415–420PubMedCrossRef
17.
go back to reference Kristjansson E, Jonsson H Jr (2002) Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. J Manip Physiol Ther 25:550–555CrossRef Kristjansson E, Jonsson H Jr (2002) Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. J Manip Physiol Ther 25:550–555CrossRef
18.
go back to reference Kuo LC, Su FC, Chiu HY, Yu CY (2002) Feasibility of using a video-based motion analysis system for measuring thumb kinematics. J Biomech 35:1499–1506PubMedCrossRef Kuo LC, Su FC, Chiu HY, Yu CY (2002) Feasibility of using a video-based motion analysis system for measuring thumb kinematics. J Biomech 35:1499–1506PubMedCrossRef
19.
go back to reference Lantz CA, Chen J, Buch D (1999) Clinical validity and stability of active and passive cervical range of motion with regard to total and unilateral uniplanar motion. Spine 24:1082–1089PubMedCrossRef Lantz CA, Chen J, Buch D (1999) Clinical validity and stability of active and passive cervical range of motion with regard to total and unilateral uniplanar motion. Spine 24:1082–1089PubMedCrossRef
20.
go back to reference Lee SW, Wong KWN, Chan MK, Yeung HM, Chiu JLF, Leong JCY (2002) Development and validation of a new technique for assessing lumbar spine motion. Spine 27:E215–E220PubMedCrossRef Lee SW, Wong KWN, Chan MK, Yeung HM, Chiu JLF, Leong JCY (2002) Development and validation of a new technique for assessing lumbar spine motion. Spine 27:E215–E220PubMedCrossRef
21.
go back to reference McAviney J, Schulz D, Bock R, Harrison DE, Holland B (2005) Determining the relationship between cervical lordosis and neck complaints. J Manip Physiol Ther 28:187–193CrossRef McAviney J, Schulz D, Bock R, Harrison DE, Holland B (2005) Determining the relationship between cervical lordosis and neck complaints. J Manip Physiol Ther 28:187–193CrossRef
22.
go back to reference Muggleton JM, Allen R (1998) Insights into the measurement of vertebral translation in the sagittal plane. Med Eng Phys 20:21–32PubMedCrossRef Muggleton JM, Allen R (1998) Insights into the measurement of vertebral translation in the sagittal plane. Med Eng Phys 20:21–32PubMedCrossRef
23.
go back to reference Ng HW, Teo EC, Zhang QH (2004) Biomechanical effects of C2–C7 intersegmental stability due to laminectomy with unilateral and bilateral facetectomy. Spine 29:1737–1745CrossRef Ng HW, Teo EC, Zhang QH (2004) Biomechanical effects of C2–C7 intersegmental stability due to laminectomy with unilateral and bilateral facetectomy. Spine 29:1737–1745CrossRef
24.
go back to reference Nyland J, Johnson D (2004) Collegiate foot ball palters display more active servical spine mobility than high school football players. J Athl Training 39:146–150 Nyland J, Johnson D (2004) Collegiate foot ball palters display more active servical spine mobility than high school football players. J Athl Training 39:146–150
25.
go back to reference Okawa A, Shinomiya K, Komori H, Muneta T, Arai Y, Nakai O (1998) Dynamic motion study of the whole lumbar spine by videofluoroscopy. Spine 23:1743–1749PubMedCrossRef Okawa A, Shinomiya K, Komori H, Muneta T, Arai Y, Nakai O (1998) Dynamic motion study of the whole lumbar spine by videofluoroscopy. Spine 23:1743–1749PubMedCrossRef
26.
go back to reference Onan OA, Heggeness MH, Hipp JA (1998) A motion analysis of the cervical facet joint Spine 23:430–439PubMedCrossRef Onan OA, Heggeness MH, Hipp JA (1998) A motion analysis of the cervical facet joint Spine 23:430–439PubMedCrossRef
27.
go back to reference Panjabi MM, White AA, John RM (1975) Cervical spine mechanics as function of transaction of components. J Biomech 8:327–336PubMedCrossRef Panjabi MM, White AA, John RM (1975) Cervical spine mechanics as function of transaction of components. J Biomech 8:327–336PubMedCrossRef
28.
go back to reference Penning L (1978) Normal movements of the cervical spine. Am J Roentgenol 130:317–326 Penning L (1978) Normal movements of the cervical spine. Am J Roentgenol 130:317–326
29.
go back to reference Pfeiffer M, Geisel T (2003) Analysis of a computer-assisted technique for measuring the lumbar spine on radiographs: Correlation of two methods. Acad Radiol 10:275–282PubMedCrossRef Pfeiffer M, Geisel T (2003) Analysis of a computer-assisted technique for measuring the lumbar spine on radiographs: Correlation of two methods. Acad Radiol 10:275–282PubMedCrossRef
30.
go back to reference Pickett GE, Rouleau JP, Duggal N (2005) Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 30:1949–1954PubMedCrossRef Pickett GE, Rouleau JP, Duggal N (2005) Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 30:1949–1954PubMedCrossRef
31.
go back to reference Reitman CA, Hipp JA, Nguyen L, Esses SI (2004) Change in segmental intervertebral motion adjacent to cervical arthrodesis: A prospective study. Spine 29:E221–E226PubMedCrossRef Reitman CA, Hipp JA, Nguyen L, Esses SI (2004) Change in segmental intervertebral motion adjacent to cervical arthrodesis: A prospective study. Spine 29:E221–E226PubMedCrossRef
32.
go back to reference Reitman CA, Mauro KM, Nguyen L, Ziegler JM, Hipp JA (2004) Intervertebral motion between flexion and extension in asymptomatic individuals. Spine 29:2832–2843PubMedCrossRef Reitman CA, Mauro KM, Nguyen L, Ziegler JM, Hipp JA (2004) Intervertebral motion between flexion and extension in asymptomatic individuals. Spine 29:2832–2843PubMedCrossRef
33.
go back to reference Roche CJ, Eyes BE, Whitehouse GH (2002) The rheumatoid cervical spine: signs of instability on plain cervical radiographs. Clin Radiol 57:241–249PubMedCrossRef Roche CJ, Eyes BE, Whitehouse GH (2002) The rheumatoid cervical spine: signs of instability on plain cervical radiographs. Clin Radiol 57:241–249PubMedCrossRef
34.
go back to reference Sforza C, Grassi G, Fragnito N, Turci M, Ferrario VF (2002) Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects. Clin Biomech 17:611–614CrossRef Sforza C, Grassi G, Fragnito N, Turci M, Ferrario VF (2002) Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects. Clin Biomech 17:611–614CrossRef
35.
go back to reference Su FC, Kuo LC, Chiu HY, Hsu HY (2002) The validity of using a video-based motion analysis system measuring maximal area of fingertip motion and angular variation. Proc Instn Mech Eng [H] 216:257–263 Su FC, Kuo LC, Chiu HY, Hsu HY (2002) The validity of using a video-based motion analysis system measuring maximal area of fingertip motion and angular variation. Proc Instn Mech Eng [H] 216:257–263
36.
go back to reference Tousignant M, Boucher N, Bourbonnais J, Gravelle T, Quesnel M, Brosseau L (2001) Intratester and intertester reliability of the Cybex electronic digital inclinometer (EDI-320) for measurement of active neck flexion and extension in healthy subjects. Manual Ther 6:235–241CrossRef Tousignant M, Boucher N, Bourbonnais J, Gravelle T, Quesnel M, Brosseau L (2001) Intratester and intertester reliability of the Cybex electronic digital inclinometer (EDI-320) for measurement of active neck flexion and extension in healthy subjects. Manual Ther 6:235–241CrossRef
37.
go back to reference Trott PH, Pearcy MJ, Ruston SA, Fulton I, Brien C (1996) Three-dimensional analysis of active cervical motion: the effect of age and gender. Clin Biomech 11:201–206CrossRef Trott PH, Pearcy MJ, Ruston SA, Fulton I, Brien C (1996) Three-dimensional analysis of active cervical motion: the effect of age and gender. Clin Biomech 11:201–206CrossRef
38.
go back to reference Tsai KH, Chang GL, Lin HT, Kuo DC, Chang LT, Lin RM (2003) Differences of lumbosacral kinematics between degenerative and induced spondylolisthetic spine. Clin Biomech 18:S10–S16CrossRef Tsai KH, Chang GL, Lin HT, Kuo DC, Chang LT, Lin RM (2003) Differences of lumbosacral kinematics between degenerative and induced spondylolisthetic spine. Clin Biomech 18:S10–S16CrossRef
39.
go back to reference Wang SF, Teng CC, Lin KH (2005) Measurement of cervical range of motion pattern during cyclic neck movement by an ultrasound-based motion system. Manual Ther 10:68–72CrossRef Wang SF, Teng CC, Lin KH (2005) Measurement of cervical range of motion pattern during cyclic neck movement by an ultrasound-based motion system. Manual Ther 10:68–72CrossRef
40.
go back to reference Whit AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn Lippincott, Philadelphia Whit AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn Lippincott, Philadelphia
41.
go back to reference Wolfenberger VA, Batenchuk GB (2002) A comparison of methods of evaluating cervical range of motion. J Manip Physiol Ther 25:154–160CrossRef Wolfenberger VA, Batenchuk GB (2002) A comparison of methods of evaluating cervical range of motion. J Manip Physiol Ther 25:154–160CrossRef
42.
go back to reference Wong KWN, Leong JCY, Chan MK, Luk KDK, Lu WW (2004) The flexion–extension Profile of lumbar spine in 100 healthy volunteers. Spine 29:1636–1641PubMedCrossRef Wong KWN, Leong JCY, Chan MK, Luk KDK, Lu WW (2004) The flexion–extension Profile of lumbar spine in 100 healthy volunteers. Spine 29:1636–1641PubMedCrossRef
43.
go back to reference Wu SK, Lan HC, Kuo LC, Tsai SW, Chen CL, Su FC (2006) The feasibility of a video-based motion analysis system in measuring the segmental movements between upper and lower cervical spine. Gait Posture (in press) Wu SK, Lan HC, Kuo LC, Tsai SW, Chen CL, Su FC (2006) The feasibility of a video-based motion analysis system in measuring the segmental movements between upper and lower cervical spine. Gait Posture (in press)
Metadata
Title
The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension
Authors
Shyi-Kuen Wu
Li-Chieh Kuo
Haw-Chang H. Lan
Sen-Wei Tsai
Chiung-Ling Chen
Fong-Chin Su
Publication date
01-09-2007
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 9/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-007-0372-4

Other articles of this Issue 9/2007

European Spine Journal 9/2007 Go to the issue