Using cineradiography for continuous dynamic-motion analysis of the lumbar spine.

STUDY DESIGN

Cineradiography was used to analyze continuous dynamic motion in the lumbar spine.

OBJECTIVES

To identify motion patterns of the lumbar spine in asymptomatic volunteers and symptomatic patients with L4 degenerative spondylolisthesis, and to use the findings to discuss segmental instability in this disorder.

SUMMARY OF BACKGROUND DATA

The use of radiographic findings to assess lumbar spine instability remains controversial. Although some studies have reported on lumbar kinematics during actual movement, the motion patterns in asymptomatic volunteers and symptomatic patients with L4 degenerative spondylolisthesis have not been fully clarified.

METHODS

While asymptomatic volunteers (n=20; mean age, 27; control group) and symptomatic patients with L4 degenerative spondylolisthesis (n=41; mean age, 63; degenerative spondylolisthesis [DS] group) flexed from a sitting neutral position and back to the neutral position (flexion course), cineradiography was used to record lateral segmental lumbar motions. Twelve frames were selected during the flexion course, and flexion-extension angle (f-e angle) and translation in the sagittal plane were measured at each motion segment (L2-L3, L3-L4, L4-L5, and L5-S1). The DS group was classified into 2 subgroups according to percentage of slip: DS group I, with a slip equal to or less than 15%; and DS group II, with a slip of more than 15%. The motion pattern was compared between the groups.

RESULTS

In the control group, f-e angle and translation at the L2-L3, L3-L4, and L4-L5 segments moved simultaneously, although the L5-S1 segment showed an initial delay. The amount of f-e angle and translation changed almost symmetrically. In both f-e angle and translation, the L4-L5 segment showed a large motion pattern. In DS group I (n=21), the L4-L5 segment showed a large motion pattern in f-e angle and an intermediate motion pattern in translation. In DS group II (n=20), the L4-L5 segment showed an intermediate motion pattern in f-e angle, and a small motion pattern in translation. The relative range of f-e angle at the L4-L5 segment had the largest range in DS group I, and the relative translation showed a serial decrease from the control group through DS group II. A significant correlation between f-e angle and translation (harmonious motion pattern) was noted at the L2-L3, L3-L4, and L4-L5 segments in the control group. The harmonious motion pattern at the L4-L5 segment was significantly less in the DS group than in the control group. The loss of harmonious motion pattern (disordered motion pattern) at L4-L5 was well-revealed in the DS group II.

CONCLUSIONS

Motion analyses using cineradiography helped to explain the phenomena of lumbar spine kinematics. Based on continuous dynamic-motion analysis with cineradiography, large f-e angle and disordered motion pattern during the flexion-backward course in the DS group I was considered to be caused by segmental instability. The decreased translation and disordered motion pattern throughout the flexion course in the DS group II was considered to be caused by restabilization.