Motion Analysis of the Cervical Spine

2004 ◽  
Vol 9 (5) ◽  
pp. 1-11
Author(s):  
Patrick R. Luers
Keyword(s):  
Cervical Spine ◽  
Intervertebral Disk ◽  
Radiographic Evaluation ◽  
Ligamentous Injury ◽  
Pattern Of Injury ◽  
Motion Segment ◽  
Single Pattern ◽  
Compensatory Motion ◽  
Loss Of Motion ◽  
Flexion And Extension

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

Quick Reference: Rating Spine Impairment

1999 ◽  
Vol 4 (4) ◽  
pp. 5-6
Keyword(s):  
Cervical Spine ◽  
Structural Integrity ◽  
Angular Motion ◽  
X Rays ◽  
Fourth Edition ◽  
Motion Segment ◽  
Posterior Translation ◽  
Loss Of Motion ◽  
Flexion And Extension ◽  
Anterior Posterior

Abstract Spinal impairment evaluation includes determining the presence or absence of loss of motion segment (structural) integrity (LOMSI). The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, defines two ways of detecting LOMSI: anterior-posterior translation of one vertebra on another (more than 3.5 millimeters in the cervical spine or 5 millimeters in the thoracic or lumbar spine); or angular motion of one vertebra on another greater than 11 millimeters (15 millimeters at L5-S1). A finding of LOMSI results in at least a diagnosis-related estimate Category IV impairment rating in any of the three spinal regions. Measurements of vertebral translation and angular motion are made using standing lateral x-rays in maximal flexion and extension. The second method of detecting LOMSI is measurement of the angular motion between three adjacent vertebrae. Flexion and extension x-rays may not be necessary in every patient undergoing spinal impairment evaluation, particularly because patients rarely have LOMSI with normal supine spinal x-rays in the absence of translational or angular abnormality on routine films. Loss of structural integrity is rare in the workers’ compensation area and is seen most commonly in middle-aged women at L4-5 or following aggressive laminectomy. Attempted but unsuccessful fusion of a motion segment does not qualify as LOMSI.

Impairment Tutorial: Cervical Fusions: A Paradox in the Fifth Edition

2004 ◽  
Vol 9 (2) ◽  
pp. 4-4 ◽  
Author(s):  
Robert H. Haralson
Keyword(s):  
Cervical Spine ◽  
Surgical Procedure ◽  
Cervical Radiculopathy ◽  
Fourth Edition ◽  
Single Level ◽  
Motion Segment ◽  
Whole Person ◽  
Similar Patient ◽  
Definition Of ◽  
Loss Of Motion

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, presents an impairment paradox: Single-level fusions rating using the Diagnosis-related estimates (DRE) method often result in higher impairment values than do multilevel cervical spine fusions. In the AMA Guides, Chapter 15, The Spine, the definition of Cervical Category IV (alteration of motion segment integrity or bilateral or multilevel radiculopathy) changed from the definition in the fourth edition for Cervicothoracic Category IV (loss of motion segment integrity or multilevel neurological compromise) because of changes in the definition of “alteration of motion segment integrity,” which now also includes surgical arthrodesis. This applies only for single-level fusions because the AMA Guides, states the range-of-motion (ROM) method is used in situations when “there is alteration of motion segment integrity (eg, fusions).” The AMA Guides, Fourth Edition, rated impairment on the basis of the injury, not the surgical procedure, and the maximum whole person permanent impairment for a patient with a single-level, single-sided cervical radiculopathy who had a discectomy and fusion would be 15%, but the minimum award for a similar patient rated using the DRE method is 25%. The author reports that, for the reasons outlined, evaluators should rate all cervical fusions, including single-level fusions, using the ROM method.

A Comparison of Flexion and Extension Radiographs with Computed Tomography of the Cervical Spine in Blunt Trauma

2008 ◽  
Vol 74 (9) ◽  
pp. 855-857 ◽  
Author(s):  
Travis J. Goodnight ◽  
Stephen D. Helmer ◽  
Jonathan M. Dort ◽  
R. Joseph Nold ◽  
R. Stephen Smith
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Ligamentous Injury ◽  
American College Of Surgeons ◽  
Level I ◽  
Flexion And Extension

The purpose of this study was to compare flexion and extension (F/E) cervical radiographs with CT of the cervical spine in patients sustaining blunt trauma for the evaluation of ligamentous injury. A retrospective chart review of 2 years duration at an American College of Surgeons-verified Level I trauma center was performed. All patients sustaining blunt trauma who were evaluated with both a CT as well as F/E radiographs were identified. Exclusion criteria included penetrating injuries, neurologic symptoms, and age younger than 18 years. Follow-up MRI of each positive F/E radiograph after a negative CT scan was performed. Flexion and extension cervical radiographs were obtained in 379 patients after CT. Eight positive F/E radiographs were obtained after a negative CT scan. Follow-up MRI was negative for ligamentous injury in all cases. No cases of a clinically relevant positive F/E radiograph after a negative CT scan were identified. Follow-up F/E radiographs are not efficacious when a negative CT has been performed in blunt trauma without neurologic findings.

scholarly journals Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients

2013 ◽  
Vol 22 (7) ◽  
pp. 1467-1473 ◽  
Author(s):  
Bonnie McCracken ◽  
Eric Klineberg ◽  
Brian Pickard ◽  
David H. Wisner
Keyword(s):  
Cervical Spine ◽  
Radiographic Evaluation ◽  
Trauma Patients ◽  
Flexion And Extension

Management of The Cervical Spine Tuberculosis

2018 ◽  
Vol 1 (2) ◽  
pp. 19
Author(s):  
Sabri Ibrahim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Spinal Tuberculosis ◽  
Intervertebral Disk ◽  
Posterior Fixation ◽  
Resonance Imaging ◽  
Vertebral Bodies ◽  
Intervertebral Disk Space ◽  
Developed Nations

Tuberculosis of the cervical spine is a rare clinical condition (10%), most commonly affected lower thoracic region (40-50% of the cases). Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Characteristically, there is a destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates an involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Anti-tuberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. With early diagnosis and early treatment, the prognosis is generally good.

The influence of fixed sagittal plane centers of rotation on motion segment mechanics and range of motion in the cervical spine

2013 ◽  
Vol 46 (7) ◽  
pp. 1369-1375 ◽  
Author(s):  
Brian P. Kelly ◽  
Nephi A. Zufelt ◽  
Elizabeth J. Sander ◽  
Denis J. DiAngelo
Keyword(s):  
Cervical Spine ◽  
Range Of Motion ◽  
Sagittal Plane ◽  
Motion Segment

A Computer Simulation Study of Fusion Surgery and Artificial Disc Replacement on the Human Cervical Spine

2006 ◽  
Vol 326-328 ◽  
pp. 903-906
Author(s):  
Hyung Soo Ahn ◽  
Il Hyung Park ◽  
Denis DiAngelo
Keyword(s):  
Cervical Spine ◽  
Adjacent Segment ◽  
Artificial Disc ◽  
Spherical Joint ◽  
Rotational Stiffness ◽  
Computer Simulation Study ◽  
Fusion Surgery ◽  
Biomechanical Changes ◽  
Disc Level ◽  
Flexion And Extension

The biomechanical changes brought on by spine fusion and the artificial disc designs to restore physiologic motion were studied by using a cervical spine computer model. Fusion increased the motion compensation at the adjacent segment during flexion and extension. The global rotational stiffness and segmental disc forces were also increased after fusion. Among the three prosthetic disc designs, the PDD-III (5-DOF spherical joint in plane parallel with the C5-C6 disc level) maintained the normal motion and minimized load build up of adjacent segment.

A novel method for measurement of occipital-cervical distance by occiput-C4 distance

2019 ◽  
Author(s):  
Chao Tang ◽  
Sheng Yang ◽  
Ye Hui Liao ◽  
Qiang Tang ◽  
Fei Ma ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Standardized Testing ◽  
Normal Population ◽  
Normal Subjects ◽  
Basilar Invagination ◽  
Shortest Distance ◽  
Novel Method ◽  
Asymptomatic Subjects ◽  
Spine Radiographs ◽  
Flexion And Extension

Abstract Background: To describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects that can be used to guide the restoration of vertical dislocation of the occipitocervical region in patients with basilar invagination and to perform standardized testing of occipitocervical constructs.Methods: Neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) judged to be normal were analyzed. The mean age was 48.0±8.4 years old (range 20–69 years; 48.4±10.2 years old for males and 47.6±6.4 years old for females). Analysis consisted of measurement of the OC4D. The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor’s line. Two spine surgeons measured the OC4D thrice in the normal population and obtained the average values. Height, weight, and body mass index (BMI) of each subject was recorded and analyze its correlation with OC4D.Results: The values of OC4D on neutral, flexion, and extension lateral cervical spine radiographs were 69.0±6.9 mm, 68.9±6.8 mm and 68.1±6.9 mm, respectively. There was no significantly different from the values measured in neutral、flexion and extension (P> 0.05). But the OC4D of males were higher than females in neutral, flexion, and extension (P < 0.001 for all). There was a positive correlation between OC4D and height and weight in neutral、flexion and extension (P <0.001 for all). The correlation between O-C4D and BMI was weak, and no significant in neutral, flexion, and extension (P > 0.05). The ICC values of inter- and intra-observer agreements for the radiographic parameter in all of the cervical positions were more than 0.93.Conclusions: OC4D, a new measurement method for occipital-cervical distance that is not affected by the change in neutral, flexion, and extension positions, should be a valuable parameter and intra-operative tool to guide the vertical restoration during OCF for patients with altered occiput-cervical anatomy.

Radiographic Evaluation of the Upper Cervical Spine

2022 ◽  
pp. 3-11
Author(s):  
Mark A. Pastore ◽  
Anthony Viola ◽  
Vadim Goz ◽  
Noor Tamimi ◽  
Alexander Vaccaro
Keyword(s):  
Cervical Spine ◽  
Radiographic Evaluation ◽  
Upper Cervical Spine ◽  
Upper Cervical
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