Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending

Abstract

Several attempts have been made to measure the segmental range of motion in the lumbar spine during flexion-extension with the purpose of gathering additional data for the diagnosis of instability. The previous studies were performed in vitro or in vivo during active motion. The aim of this study was to obtain normal values of passively performed segmental motions. Forty-one healthy adults were examined by means of functional radiographs during flexion-extension and lateral bending. A graphic construction method and a computer-assisted method were used to measure rotations. Comparing with recent in vivo studies, the values obtained for normal angles of rotation were predominately larger. This might be due to the passive examination used in the study. The graphic construction method and computer-assisted method techniques are equally reliable, but the computer-assisted method method yields other important kinematic data, such as translations. It is proposed that passive motion be applied during functional examination of patients with suspected instabilities. However, the large variation of rotational values between individuals in the normal population may limit the clinical usefulness of functional lumbar analysis using this parameter. Future studies should explore the clinical relevance of determining altered segmental mobility in low-back pain patients.

Fig 1.

A, Example of a passive flexion-extension examination. B, Typical flexion-extension radiographs of the lumbar region.

Fig 2.

A, Example of a passive lateral examination. B, Typical bending radiographs.

Fig 3.

A, The extension view is marked first. Each vertebra is enclosed by four lines, which are each tangential to a vertebral face. B, After superpositioning the radiographs, the markings on the extension view are copied directly onto the flexion view.

Fig 4.

Five motion parameters for flexion–extension movement.

Fig 5.

Intervertebral translations were determined at four points: A, B, C, and D.

Fig 6.

Detailed explanation of five motion parameters for flexion–extension movement.

Fig 7.

Detailed explanation of five motion parameters for lateral bending movement.

Fig 8.

A, Functional diagram for normal flexion–extension rotation and the two standard deviation confidence intervals. B, Functional diagram for normal flexion–extension translation of Point B in the z direction, also with two standard deviation confidence intervals.

Fig 9.

A, Functional diagram for normal lateral bending rotation and the two standard deviation confidence intervals. B, Functional diagram for normal lateral bending translation of Point D in the x direction, also with two standard deviation confidence intervals.