Average rotation occurring at the five lumbar levels in the five control subjects as the gantry table is rotated left and right. Johansen et al (13) found an average rotation of 2.6° in normal disks and 3.8° in abnormal disks. Modified gravity goniometer being used to measure the angle of the sacrum with respect to the horizontal plane. Additional studies are warranted. rotation and, hence increasing lumbar contributions. Subject is sitting thereby stabilizing pelvis, feet on floor, 2. subject rotates till pelvis begins to rotate 3. In our cases, the diagnosis of instability was suggested by diskography, by the clinical evaluation, and by the satisfactory results from fusion. Rotations at each lumbar level in patients with back pain and abnormal intervertebral disks. The program specified a region of interest surrounding the pivot point (illustrated by the cursor in Fig 2A and B and by Fig 2C and D) in which the pixel shift analysis is applied. We tested the hypothesis that with MR imaging and a device to rotate the torso, axial rotations of lumbar vertebrae can be measured with sufficient accuracy and that significantly different rotations can be detected between lumbar segments with degenerated disks and those with normal disks. Such measurements hypothetically have greater value than measurements from flexion-extension radiographs for studying the motions of spinal vertebrae in vivo. The method illustrated here is a good compromise. To investigate the intratester reliability of a new measurement technique that evaluates lumbar range of motion in three planes using a pelvic restraint device, and to examine the reliability of lumbar lordosis measurement by inclinometer technique. CONCLUSION: Measurements of rotations of lumbar vertebrae with MR imaging may have value for determining levels that move abnormally in axial rotation. These were further subdivided into those that had evidence on the sagittal and axial images of a bulging disk or herniation based on American Society of Neuroradioloy criteria (18). This preliminary study shows that with MR imaging and a device to produce a clockwise and counterclockwise rotation of the torso, rotations of the lumbar vertebrae can be measured. The level of the concordant pain and the motions were compared. CONCLUSION: Measurements of rotations of lumbar vertebrae with MR imaging may have value for determining levels that move abnormally in axial rotation. Radiography of the spine in patients performing a flexion and extension maneuver is neither sensitive nor specific in the diagnosis of degenerative spinal instability (1–4). The average intrarater error was 1.025° in the Perdriolle measurement and 0.4° in the Raimondi measurement. Abstract Study Design. ROM, average velocity, maximum velocity and maximal acceleration of lumbar rotation in neutral standing and with full flexion were measured using an industrial lumbar motion monitor in 50 men (25 with NSCLBP and 25 controls). The magnitude and frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate for each mobilization grade. Each support could be rotated 8° in either direction. No herniations are evident. Objectives. Informed consent was obtained from each subject and approval for the study was obtained from our institutional review board. The milder degree of rotation has the advantage that it is well tolerated by patients who have back pain. All voxels outside the cursor are excluded from analysis of motion (C and D). A–G, Images illustrate the application of the pixel shift program to measure rotation. Average rotation for the normal disks in this group was 0.4° and for the abnormal disks was 2.2° (Table 3). To measure the loads acting at the lumbar spine and the resulting motions during rotational mobilization. The intrarater reliability was r =0.991 (Perdriolle) and r =0.997 (Raimondi). The difference was significant at P = .0005. In the series of images with clockwise rotation of the torso and the series with counterclockwise rotation, a section was chosen through the midportion of each vertebra to include the transverse process of the vertebra, or in the case of S1, the sacral alae (Fig 2A and B). Several investigators have attempted to measure axial rotations of the lumbar vertebrae. Read more information on low back pain. Future study with carefully controlled patient groups and comparison of imaging techniques is warranted. Parallelogram goniometer being used to measure the angle between the tangents to the spine at the sacrum and the thoracolumbar junction. The clinical measurements of global lumbar spine motion, such as fingertip-to-floor, inclinometers, and the modified Schober technique (tape measure on the skin overlying the . The five motion segments at L5-S1 in groups 2 and 3 with normal intervertebral disks rotated an average of 1.6°; the seven motion segments with abnormal disks in groups 2 and 3 rotated an average of 3.7°. The computations took about 5 minutes per subject. The rotations for each level in the control subjects were averaged. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Group 1 consisted of five volunteers (three women, two men; mean age, 37 years) without back pain and without a history of severe back pain; these were considered the control subjects. There is no criterion standard at the moment for confirming that instability is present or not. This rostrocaudal increase in rotation was significant in this small sample (P < .005). Rotations at each lumbar level in patients with concordant pain at diskography. The next step is to choose the pivot point and region of interest for the pixel shift analysis (crosshairs and circular cursor in A and B). Patients were selected to include some with intervertebral disk degeneration and nonspecific signs and symptoms (group 2) and some with probable degenerative instability (group 3). In this group, diminished signal intensity in a lumbar intervertebral disk on a T2-weighted image or diminished disk height were inclusion criteria. The magnitude and frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate for each mobilization grade. Enter multiple addresses on separate lines or separate them with commas. Each patient in group 3 was examined by the treating neurosurgeon 6 months after diskography. Before application of the program, the floating image, when subtracted from the reference image, showed poor registration (2E). For the characterization of spinal instability or hypermobility, a noninvasive functional method is still sought (25). Serious (such as fracture, cancer, infection and ankylosing spondylitis) and specific causes of back pain with neurological … The difference was significant at P = .03. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The largest rotations in the control subjects were measured in the subject with a degenerated disk at L5-S1. The insert is placed on the MR gantry. In group 3, the disks in which concordant pain was elicited rotated from 0.8° to 4.4°, with an average of 2.2°. Four of the abnormal disks were at L4-L5 and three at L5-S1. One of our control subjects had evidence of disk degeneration at one level and evidence of hypermobility at multiple levels. In rotational movements like throwing and hitting, people will compensate for poor T-spine mobility in the lumbar spine to achieve the necessary rotation required for sport. The abnormal disks were at L4-L5 and L5-S1. Johansen et al (13) used CT to measure the rotation of vertebrae in patients who were placed in positions of rotation by means of cushions. All these data suggest that the measurements of axial rotations in vivo with MR imaging provide accurate information about the motions of the lumbar motion segments. The rotation between two adjacent vertebrae was calculated as the difference between the rotations at contiguous levels. The primary purpose of this study was to assess the intrarater reliability of a new clinical examination procedure to measure combined thoracic and lumbar rotation range of motion using dual inclinometers. Conclusions regarding the mobility of the spine in cases of an abnormal diskogram cannot be drawn at this time. Alignment of the one image with the other before pixel shifting is illustrated by a subtraction image (E), which reveals a mismatch. This gave 14 results, from which we estimated the error. However, the magnitude of differences between the measurements in these two body positions (prone versus supine) is of doubtful clinical significance in patients with AIS … Table insert that provides clockwise and counterclockwise rotation at the lumbar spine. The rotations between vertebrae that have degenerated disks exceed those between vertebrae that have normal disks. 14, 16, 18 However, clinical assessment of lumbar spine motion often centers on assessing segmental motion so that interventions can be localized to a … Differences in mobility can be distinguished between disks that have a normal MR imaging appearance and those that have an abnormal appearance. In group 3 patients, 18 disks were classified as normal and seven as bulging anulus (Fig 3). For the disks in this group that had concordant pain, rotations were 0.8° to 4.4°. When the one image is rotated with respect to the other to maximize the correlation, the angle of rotation (illustrated by the reference lines in F) is recorded. Alignment of the images after rotation is illustrated by a subtraction image (G), which shows no mismatch for the vertebral bodies. Correlations have been found between signal intensity in the lumbar intervertebral disks or vertebral body marrow and the presence of instability (23, 24). The ROM value on the inclinometer is recorded for total flexion. The three motion segments at L4-L5 in which concordant pain was identified in group 3 rotated an average of 1.4°, and the two motion segments with normal disks in group 3 rotated an average of 0.6° (Fig 5). We found that the rotations calculated with this method varied with level in the control subjects, as they do in spines of cadavers (5) and live humans (13). Thank you for your interest in spreading the word on American Journal of Neuroradiology. The rotation for each level was tabulated and compared with the MR appearance of the disk at that level and the diskographic findings. Thus back pain can arise from any of the ligaments, muscles, fascia, joints or discs of the Lumbar Spine. The intervertebral disks in each participant were classified on the basis of the sagittal MR images. Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. 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