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      Range of Motion of the Intact Lumbar Segment: A Multivariate Study of 42 Lumbar Spines

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          Abstract

          Background

          A thorough understanding of the biomechanical characteristics of the healthy human spine is critical in furthering the treatment of spinal pathology. The goal of this study was to investigate the motion of the intact lumbar spine segment as measured by range of motion (ROM), and to investigate the dependencies thereof on gender and intervertebral level.

          Materials and Methods

          Kinematic data was obtained for 42 human lumbar segments (L1-S1) in response to a pure-moment loading protocol in flexion extension (FE), lateral bending (LB) and axial torsion (AT). Data was obtained for 204 individual functional spinal units (91 female, 113 male). Multivariate analysis of variance was conducted to detect differences between genders and intervertebral levels in each mode of loading. Correlations between ROM and donor demographics, including height, weight, and age, were conducted.

          Results

          ROM was significantly greater for females than for males in FE, LB and AT (p<0.001). ROM tended to increase down the vertebral column in FE. L3-4 FE ROM was significantly greater than L1-2 (p=0.024), and L4-5 and L5-S1 FE ROM were significantly greater than for every other level (p<0.003). LB ROM tended to be greater toward the center of the segment with L2-3, L3-4 and L4-5 ROM being significantly greater than both L1-2 (p<0.001) and L5-S1 (p=0.006, p<0.001, p=0.043, respectively). A similar trend was found for AT, however only L1-2 was significantly less than all other levels (p=0.042, p<0.001, p<0.001, and p=0.034 for L2-3, L3-4, L4-5, and L5-S1 respectively).

          Conclusion

          The significant differences in lumbar ROM between male and female spine segments and between the intervertebral levels must be taken into account in study design in order to prevent biases in outcomes. The significant differences in ROM between levels may also have critical implications in the design of spinal implants, particularly those designed to maintain or restore healthy motion.

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          The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine.

          May Lim, A Fujiwara, N. Tanaka … (2000)
          A biomechanical and imaging study of human cadaveric spinal motion segments. To investigate the effect of both disc degeneration and facet joint osteoarthritis on lumbar segmental motion. Spinal degeneration includes the osteoarthritic changes of the facet joint as well as disc degeneration. Disc degeneration has been reported to be associated with spinal motion. The association of facet joint osteoarthritis with lumbar segmental motion characteristics and the combined influence of disc degeneration and facet osteoarthritis has not yet been investigated. A total of 110 lumbar motion segments (52 female, 58 male) from 44 human lumbar spines were studied (mean age = 69 years). Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the osteoarthritic changes in the facet joints in terms of cartilage degeneration, subchondral sclerosis, and osteophytes. Disc height, endplate size, and facet joint orientation and width also were measured from the computed tomographic images. Rotational movements of the motion segment in response to the flexion, extension, lateral bending, and axial rotational moments were measured using a three-dimensional motion analysis system. Female motion segments showed significantly greater motion (lateral bending: P < 0. 001, flexion: P < 0.01, extension: P < 0.05) and smaller endplate size (P < 0.001) than male ones. The segmental motion increased with increasing severity of disc degeneration up to Grade IV, but decreased in both genders when the disc degeneration advanced to Grade V. In male segments, the disc degeneration-related motion changes were significant in axial rotation (P < 0.001), lateral bending (P < 0.05), and flexion (P < 0.05), whereas female segments showed significant changes only in axial rotation (P < 0.001). With cartilage degeneration of the facet joints, the axial rotational motion increased, whereas the lateral bending and flexion motion decreased in female segments. In male segments, however, motion in all directions increased with Grade 3 cartilage degeneration and decreased with Grade 4 cartilage degeneration. Subchondral sclerosis significantly decreased the motion (female: axial rotation, P < 0. 05; extension, P < 0.05 vs.- male:flexion,P < 0.05). Severity of osteophytes had no significant association with the segmental motion. Axial rotational motion was most affected by disc degeneration, and the effects of disc degeneration on the motion were similar between genders. Facet joint osteoarthritis also affected segmental motion, and the influence differed for male and female spines. Further studies are needed to clarify whether the degenerative process of facet joint osteoarthritis differs between genders and how facet joint osteoarthritis affects the stability of the spinal motion segment.
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            A follower load increases the load-carrying capacity of the lumbar spine in compression.

            B Dunlap, Gloria Meade, B. Lee … (1999)
            An experimental approach was used to test human cadaveric spine specimens. To assess the response of the whole lumbar spine to a compressive follower load whose path approximates the tangent to the curve of the lumbar spine. Compression on the lumbar spine is 1000 N for standing and walking and is higher during lifting. Ex vivo experiments show it buckles at 80-100 N. Differences between maximum ex vivo and in vivo loads have not been satisfactorily explained. A new experimental technique was developed for applying a compressive follower load of physiologic magnitudes up to 1200 N. The experimental technique applied loads that minimized the internal shear forces and bending moments, made the resultant internal force compressive, and caused the load path to approximate the tangent to the curve of the lumbar spine. A compressive vertical load applied in the neutral lordotic and forward-flexed postures caused large changes in lumbar lordosis at small load magnitudes. The specimen approached its extension or flexion limits at a vertical load of 100 N. In sharp contrast, the lumbar spine supported a load of up to 1200 N without damage or instability when the load path was tangent to the spinal curve. Until this study, an experimental technique for applying compressive loads of in vivo magnitudes to the whole lumbar spine was unavailable. The load-carrying capacity of the lumbar spine sharply increased under a compressive follower load, as long as the load path remained within a small range around the centers of rotation of the lumbar segments. The follower load path provides an explanation of how the whole lumbar spine can be lordotic and yet resist large compressive loads. This study may have implications for determining the role of trunk muscles in stabilizing the lumbar spine.
            Article 0 comments Cited 69 times – based on 0 reviews     Review now
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              Disc degeneration affects the multidirectional flexibility of the lumbar spine.

              Shail Vasavada, Manohar Panjabi, M Mimura … (1994)
              An in vitro biomechanical investigation using human lumbar cadaveric spine specimens was undertaken to determine any relationship between intervertebral disc degeneration and nonlinear multidirectional spinal flexibility. Previous clinical and biomechanical studies have not established conclusively such a relationship. Forty-seven discs from 12 whole lumbar spine specimens were studied under the application of flexion-extension, axial rotation, and lateral bending pure moments. Three flexibility parameters were defined (neutral zone (NZ), range of motion (ROM), and neutral zone ratio (NZR = NZ/ROM)) and correlated with the macroscopic and radiographic degeneration. In flexion-extension, the ROM decreased and NZR increased with degeneration. In axial rotation, NZ and NZR increased with degeneration. In lateral bending, the ROM significantly decreased and the NZR increased with degeneration. In all three loading directions, the NZR increased, indicating greater joint laxity with degeneration.
              Article 0 comments Cited 66 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Spine Surg
                Journal ID (iso-abbrev): Int J Spine Surg
                Journal ID (publisher-id): IJSS
                Title: International Journal of Spine Surgery
                Publisher: International Society for the Advancement of Spine Surgery
                ISSN (Electronic): 2211-4599
                Publication date (Electronic): 05 March 2015
                Publication date Collection: 2015
                Volume: 9
                Electronic Location Identifier: 5
                Affiliations
                Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA
                Author notes
                Corresponding Author Boyle C. Cheng, Allegheny Health Network, Department of Neurosurgery, 420 East North Ave, Suite 302, Pittsburgh, PA 15212. E-mail: boylecheng@ 123456yahoo.com
                Article
                Publisher ID: 14444-2005
                DOI: 10.14444/2005
                PMC ID: 4360610
                PubMed ID: 25785241
                SO-VID: ead71976-53b4-49bf-951a-bfa9709e0b81
                Copyright © Copyright © 2015 ISASS - International Society for the Advancement of Spine Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
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                Subject: Article

                Keywords: spine biomechanics,intact spine,range of motion,lumbar spine
                Data availability:
                Keywords: spine biomechanics, intact spine, range of motion, lumbar spine

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